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ENT > Epitaxis > Flashcards

Epitaxis Flashcards

1
Q

What are the two forms of epitaxis?

A
  1. Anterior bleeds
  2. Posterior bleeds
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2
Q

Where is the source of anterior bleeds?

A
  • a visible source of bleeding
  • occurs due to an insult to the network of capillaries that form Kiesselbach’s plexus
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3
Q

What is the source of posterior bleeds?

A
  • Tend to be more profuse
  • originate from deeper structures
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4
Q

What are the risk factors for posterior bleeds?

A
  • older patients
  • Higher risk of aspiration
  • Higher risk of airway compromise.
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5
Q

What are the benign causes of epitaxis?

A
  • nose picking
  • nose blowing
  • trauma to the nose
  • insertion of foreign bodies
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6
Q

What are more serious causes of epitaxis? (4)

A
  1. bleeding disorders
    immune thrombocytopenia
  2. Juvenile angiofibroma
    benign tumour that is highly vascularised
  3. Granulomatosis with polyangiitis
  4. Cocaine use
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7
Q

What is juvenile angiofibroma and who is it normally seen in?

A
  • benign tumour that is highly vascularised
  • adolescent males
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8
Q
A
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9
Q

What is the pathophysiology of cocaine use on the nose?

A
  1. Atrophy of the nasal neptum due to inhalaed cocaine
  2. cocaine is a powerful vasoconstrictor and repeated use may result in obliteration of the septum.
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10
Q

What is the management of epitaxis in a haemodynamically stable patient?

A
  1. Asking the patient to sit with their torso forward and their mouth open
  2. Pinch the cartilaginous (soft) area of the nose firmly
    * Done for min 20 minutes
    * Breathe through the mouth
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11
Q

Why is it suggested to sit with torso forward and nose open?

A
  • Decreases blood flow to the nasopharynx and allows the patient to spit out any blood in their mouth
  • it also reduces the risk of aspirating blood
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12
Q

What is the management following first aid measures? (2)

A
  • opical antiseptic such as Naseptin (chlorhexidine and neomycin)
  • reduce crusting and the risk of vestibulitis
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13
Q

When should Naseptin be used in caution and what is an alternative? (2)

A
  1. cautions to this include patients that have peanut, soy or neomycin allergies
  2. Mupirocin is a viable alternative
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14
Q

What self care advice should be given to prevent rebleeding? (4)

A

Avoid;

  • blowing or picking the nose
  • heavy lifting, exercise
  • lying flat
  • drinking alcohol or hot drinks should be avoided
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15
Q

When is cautery / packing indicated?

A
  • If bleeding does not stop after 10-15 min of continous pressure on the nose
    1. * Cautery is used if
  • Source of bleeding is visible
  • Well tolerated
    • Packing is used
      - Bleeding point cant be visualised
      - Cautery is not viable
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16
Q

Explain the method of cautery for epitaxis (4)

A
  1. ask the patient to blow their nose in order to remove any clots
  2. Use topical local anaesthetic
  3. Apply silver nitrate stick for 3-10 seconds until area becomes grey white
    * Only cauterise one side due to risk of perforation
  4. Apply naseptin
17
Q

Explain the method of packing for epitaxis (4)

A
  1. Anaesthetise with topical local anaesthetic spray
  2. Pack the patient’s nose while they are sitting with their head forward
  3. Examine the patient’s mouth and throat for any continuing bleeding, and 4. Consider packing the other nostril as this increases pressure on the septum and offending vessel.
  4. Admit to hospital for observation and review, and to ENT if available
18
Q

What is the management of haemodynamically unstable patients?

A

1.Control bleeding with first aid measures in the interim
2.If unknown source or posterior bleed } admit
If all failed;
3. Sphenopalatine ligation in theatre

19
Q

What is sphenopalatine ligation?

A

Ligation of the sphenopalatine artery which supplies the blood to the nasal cavity
- Frequent cause of nose bleeds

20
Q

Nasal septal haematoma : Definition

A

complication of nasal trauma
development of a haematoma between the septal cartilage and the overlying perichondrium.

21
Q

Nasal septal haematoma : Clinical features

A

may be precipitated by relatively minor trauma
1. Sensation of nasal obstruction
2. Pain and rhinorrhea

Examination : bilateral red swelling arising from the nasal septum

22
Q

Nasal septal haematoma :Mx

A

If untreated irreversible septal necrosis may develop within 3-4 days - causing ‘saddle-nose’ deformity.
* surgical drainage
* intravenous antibiotics

ENT (9 decks)

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