MDT Nose Epistaxis

Question 1

What is the convergence of small fragile arteries and veins, located on the anterior-superior portion of the septum?

Answer 1

Kiesselbach plexus

Question 2

What are the parallel, curved bony structures covered by vascular mucous membrane?

Answer 2

Turbinates

Question 3

What is the main source of anterior nosebleeds

Answer 3

Kiesselbach’s plexus

Question 4

What is the main source of posterior nosebleeds?

Answer 4

Sphenopalantine artery

Question 5

What is bleeding from the nasal cavity?

Answer 5

Epistaxis

Question 6

What is the most common source of epistaxis?

Answer 6

unilateral, anterior nasal cavity (Kiesselbach’s plexus)

Question 7

What are some predisposing factors for Epistaxis

Answer 7

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

Question 8

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)

Answer 8

Epistaxis

Question 9

What causes posterior nasal cavity bleeds?

Answer 9

High blood pressures

Question 10

What are some DDx for Epistaxis?

Answer 10

(1) Nasal foreign body

(2) Nasal Fracture.

Question 11

What type of labs would you run for an Epistaxis patient?

Answer 11

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)

Question 12

What is the best treatment for most cases of Anterior epistaxis?

Answer 12

• 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.

Question 13

What med would you give for most cases of

anterior epistaxis, and why?

Answer 13

Short-acting topical nasal decongestants
-Phenylephrine, 0.125–1% solution, one or two sprays
(acts as vasoconstrictor)

Question 14

IF the nose bleed does not easily subside what you do first?

Answer 14

Nose exam

-Illumination and suction to locate the bleeding site

Question 15

Treatment
“Epistaxis Does not readily subside”
What meds/ procedures would you perform

Answer 15

-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

Question 16

Treatment
Anterior cavity Epistaxis
“If inaccessible”

Answer 16

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

Question 17

Treatment
Posterior cavity Epistaxis
“If inaccessible”

Answer 17

• 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

Question 18

True/False

In Posterior cavity Epistaxis “If inaccessible” Vasovagal syncope is quite possible.

Answer 18

True

Question 19

True/False

In Posterior cavity Epistaxis “If inaccessible”, Hospitalization for monitoring and stabilization is NOT indicated

Answer 19

FALSE

IS indicated they may need surgery

Question 20

True/False

In Posterior cavity Epistaxis “If inaccessible”, Hospitalization for monitoring and stabilization is NOT indicated

Answer 20

FALSE

IS indicated they may need surgery

Question 21

When nose packing is in place for at lease 5 days what should you administer and why?

Answer 21

Anti-staphylococcal antibiotics, to reduce the risk of toxic shock syndrome developing.

Question 22

What antibiotic is indicated when nasal packing is in place for at least 5 days?

Answer 22

Cephalexin (Keflex)
Dose: 500mg PO QID for 7 days

-OR-

Clindamycin
Dose: 150mg PO QID for 7 days

Question 23

True/False

Nasal saline should be applied to the packing frequently to keep the packing moist.

Answer 23

True

Question 24

True/False

Your pt can continue vigorous exercise immediately after having a nosebleed

Answer 24

FALSE

They should avoid straining and vigorous exercise for several days.

Question 25

Avoidance of hot or spicy foods and tobacco is also advisable, since these may cause what?

Answer 25

nasal vasodilation

Question 26

True/False

Pt’s should be avoiding nasal trauma, including nose picking

Answer 26

True

Question 27

What are some complications for Epistaxis?

Answer 27

(1) Vasovagal syncope

(2) Extreme hemorrhage

Question 28

What can your pt do at home to help reduce risk of reoccurrence of epistaxis?

Answer 28

• Increased home humidity

- Lubrication with petroleum jelly or bacitracin ointment