Nose Problems Flashcards
what is epistaxis?
nose bleeding
causes of epistaxis
idiopathic trauma inflammation tumour drugs (warfarin, aspirin) clotting abnormalities (haemophilia, leukaemia) liver disease Osler-Weber-Rendu hypertension
when may you have to resuscitate a patient with epistaxis?
hypovolaemic shock due to amount lost
where should external pressure be applied in epistaxis?
cartilaginous portion of the nose for 15-20 minutes
when to go to hospital with epistaxis?
if bleeding has not stopped in 15-20 minutes
options for epistaxis management
external pressure
ice
cautery
nasal packing
hospital management of epistaxis
topical vasoconstrictor +/- LA (lignocaine and adrenaline +/- co-phenylcaine) remove clot (suction or blowing nose) cauterise vessel (silver nitrate and diathermy)
which vessel is usually responsible for epistaxis?
sphenopalatine artery
anterior ethmoidal artery
systemic management of epistaxis
reversal of anticoagulants (takes longer if antiplatelets)
platelet transfusion
manage hypertension
two types of rhinitis
- non-infective
2. infective (rhinosinusitis)
two types of non-infective rhinitis
allergic
non-allergic
two types of allergic rhinitis
intermittent rhinitis
persistent rhinitis
two types of non-allergic rhinitis
vasomotor rhinitis
polyps
presentation of rhinitis
4S’s= stuffy, smell, snot and sore
sneezing in allergic
crusting and epistaxis
secondary symptoms= dry mouth, sore throat, snoring, halitosis, loss of taste
criteria for intermittent rhinitis
symptoms for <4 days/7 or symptoms for <4 weeks
criteria for persistent rhinitis
symptoms for more than 4/7 days or more than 4 weeks duration
complications of rhinitis
orbital cellulitis
brain abscess from frontal sinus
diagnosis of rhinitis
skin prick RAST levels (IgE)= allergy test to cats, dogs, dust mites and grass pollen
management of rhinitis
allergen avoidance
- Symptomatic therapy e.g. antihistamines (cetirizine), topical steroids (beclomethasone), decongestants (pseudoephedrine), anticholinergics (ipratropium) and LTR blockers (montelukast) and analgesics (antibiotics if infective
what are nasal polyps associated with?
non-allergic asthma
management of nasal polyps
topical steroids
surgery
causes of a blocked nose
cold adenoid swelling foreign body mucopiosed (frontal sinus swelling) maxillary sinus tumour (space to grow so late presentation)
risks in a broken nose?
septal haematoma (blood fills under perichondrium)
if occurs on both sides it causes cartilage death of the nose
there is loss of nose shape and on palpation is boggy
check nasal airflow
management of broken nose
review 5-7 days post-injury due to swelling and consider digital manipulation if <3 weeks old, otherwise rhinoplasty
complications of a broken nose
epistaxis
CSF leak/ meningitis (CSF can get out so bugs can get in)
anosmia (cribriform plate fracture)
cartilage death in haematoma
who needs to be told about obstructive sleep apnoea?
DVLA
management of obstructive sleep apnoea
weight loss if BMI >28
CPAP
