MDT Nose Epistaxis Flashcards
What is the convergence of small fragile arteries and veins, located on the anterior-superior portion of the septum?
Kiesselbach plexus
What are the parallel, curved bony structures covered by vascular mucous membrane?
Turbinates
What is the main source of anterior nosebleeds
Kiesselbach’s plexus
What is the main source of posterior nosebleeds?
Sphenopalantine artery
What is bleeding from the nasal cavity?
Epistaxis
What is the most common source of epistaxis?
unilateral, anterior nasal cavity (Kiesselbach’s plexus)
What are some predisposing factors for Epistaxis
a) Trauma (nose picking, foreign bodies, forceful nose blowing)
(b) Rhinitis
(c) Dry nasal mucosal
(d) Septum deviation
(e) Inhaled nasal cocaine or other drug use
(f) Alcohol use
(g) Hypertension and atherosclerotic disease (rare)
(h) Anticoagulation or antiplatelet medications
Patient has these issues what would you suspect?
(1) Acute, unilateral bleeding from the anterior nasal cavity (most common)
(2) High blood pressures (normally controlled after treatment of acute bleeding)
Epistaxis
What causes posterior nasal cavity bleeds?
High blood pressures
What are some DDx for Epistaxis?
(1) Nasal foreign body
(2) Nasal Fracture.
What type of labs would you run for an Epistaxis patient?
Labs that provide assessment of bleeding parameters
- Coagulation tests such as
1) Prothrombin time (PT)
2) Activated partial thromboplastin time (aPTT)
3) Thrombin time (TT)
What is the best treatment for most cases of Anterior epistaxis?
- Direct pressure by compression of the nares continuously for 15 minutes
- Venous pressure is reduced in the sitting position, and slight leaning forward lessens the swallowing of blood.
What med would you give for most cases of
anterior epistaxis, and why?
Short-acting topical nasal decongestants
-Phenylephrine, 0.125–1% solution, one or two sprays
(acts as vasoconstrictor)
IF the nose bleed does not easily subside what you do first?
Nose exam
-Illumination and suction to locate the bleeding site
Treatment
“Epistaxis Does not readily subside”
What meds/ procedures would you perform
-Oxymetazoline (Afrin)
12 Hour Nasal Relief Spray: 0.05% (15 mL, 30 mL), Instill 2 to 3 sprays into each nostril twice daily for 3 days.
-topical Lidocaine (vasoconstrictor)
Dose: 2-5 ml placed on cotton or soaked into a nasal tampon
- Cauterize with silver nitrate, diathermy, or electrocautery
- Apply a Petroleum-based ointment as a moisture barrier
Treatment
Anterior cavity Epistaxis
“If inaccessible”
Hemostatic sealant, pneumatic nasal tamponade, or anterior PACKING may suffice
a) With several feet of lubricated iodoform
b) Packing systematically placed in the floor of the nose
Treatment
Posterior cavity Epistaxis
“If inaccessible”
- Hospitalization for monitoring and stabilization is indicated
- Surgical ligation of the nasal arterial supply
- Endovascular embolization of the internal maxillary artery or facial artery
- Posterior pack
True/False
In Posterior cavity Epistaxis “If inaccessible” Vasovagal syncope is quite possible.
True
True/False
In Posterior cavity Epistaxis “If inaccessible”, Hospitalization for monitoring and stabilization is NOT indicated
FALSE
IS indicated they may need surgery
True/False
In Posterior cavity Epistaxis “If inaccessible”, Hospitalization for monitoring and stabilization is NOT indicated
FALSE
IS indicated they may need surgery
When nose packing is in place for at lease 5 days what should you administer and why?
Anti-staphylococcal antibiotics, to reduce the risk of toxic shock syndrome developing.
What antibiotic is indicated when nasal packing is in place for at least 5 days?
Cephalexin (Keflex)
Dose: 500mg PO QID for 7 days
-OR-
Clindamycin
Dose: 150mg PO QID for 7 days
True/False
Nasal saline should be applied to the packing frequently to keep the packing moist.
True
True/False
Your pt can continue vigorous exercise immediately after having a nosebleed
FALSE
They should avoid straining and vigorous exercise for several days.
Avoidance of hot or spicy foods and tobacco is also advisable, since these may cause what?
nasal vasodilation
True/False
Pt’s should be avoiding nasal trauma, including nose picking
True
What are some complications for Epistaxis?
(1) Vasovagal syncope
(2) Extreme hemorrhage
What can your pt do at home to help reduce risk of reoccurrence of epistaxis?
- Increased home humidity
- Lubrication with petroleum jelly or bacitracin ointment
