Nasal Emergencies Flashcards
If a patient presented with nasal trauma, what four questions would you want to ask
- When trauma occurred?
- Loss of consciousness?
- Epistaxis?
- Breathing?
What signs would you expect/ look for in a patient with nasal trauma
- Bruising/ swelling/ tenderness
- Deviation! => fracture
- Epistaxis
- Infraorbital sensation
- Cranial nerve examination
What would you want to exclude when looking in a patients nose with nasal trauma
Septal haematoma
What causes a septal haematoma
Bleeding under mucosa lining
Why is a septal haematoma a concern
Can get infected and infection can spread into cranial cavity
How & when would you manage a nasal fracture
Reduce fracture either straight away (before bruising & swelling) or in a follow up ENT clinic 5-7 days post-injury
Nasal trauma complications
Epistaxis
Septal haematoma
CSF leak
Meningitis
Anosmia
What is the main blood supply of the nasal cavity
Sphenopalatine artery of the external carotid artery
Epistaxis first aid
- Pinch the fleshy anterior part of the nose,
- Lean forward,
- Spitting out into a bowl,
- Ice pack compression
What is a common site for epistaxis
Kiesselbach’s plexus (littles area)
Epistaxis local aetiology
- Idiopathic
- Trauma
- Foreign bodies
- Inflammation
- Tumour
Epistaxis systemic aetiology
Anticoagulants & clotting abnormalities
Liver disease, haemophilia, thrombocytopenia
Leukaemia
Systemic inflammatory diseases & GPA
Epistaxis management in ENT
1st line - Anterior rhinoscopy & cauterisation
2nd line (if significant bleeding) - rapid rhino pack
3rd line (if bleeding not controlled) - sphenopalatine artery ligation
What pharmacological treatment would you give to a patient with epistaxis
- Tranexamic acid
- Correct anticoagulants
- Resuscitation/ platelet transfusion if necessary
- Treat hypertension!
Nasal CSF leak treatment
Usually settles spontaneous
DON’T give antibiotics (can mask meningitis symptoms)
What is the relevance of hypertension in epistaxis
It can prolong the bleeding
