Nosebleeds, Fractures, Sinusitis ☺️

Question 1

Nose bleed

• blood supply of nose
• source of bleed
• characteristics of bleed

Answer 1

Very common - most idiopathic

Nose supplied by ICA, ECA

• Ant bleed - Little’s area => blood out nose
• Post bleed - Woodruff plexus => blood down throat

Ant - MOST COMMON
-younger, less severe
Post - less common
-older, more serious

Question 2

Nose bleed causes

• local
• systemic

Answer 2

Local - TRAUMA MOST COMMON

• idiopathic
• foreign bodies
• vascular
• cancer

Systemic

• AC, AP
• Garlic
• HTN
• liver/renal/alcohol impairment

Question 3

Initial management of nosebleeds

• key points to cover in a history
• investigations

Answer 3

A-E major hemorrhage protocol if severe
Pressure and ice

Cause of bleed
Other locations of bleeding/bruising
Factors that affect coagulability

Ant rhinoscopy, endoscopy to locate source

Question 4

Non surgical management of nosebleeds

Answer 4

Correction

• HTN
• Coagulation - FFP/whole blood/platelets/reverse AC

Remove clots

Reduce blood loss

• decongestants/VCs
• cautery (AgNO)
• nasal packing

Question 5

Surgical management of nosebleeds

Answer 5

Artery ligation
Embolisation

Target sphenopalatine, ant ethmoid

Question 6

Nasal fracture

• presentation
• causes
• investigations
• management
• when to refer

Answer 6

Nose pain, swelling, bleeding
Difficulty breathing through nose

Trauma

Clinical diagnosis - looks physically broken, hard to breathe through

If in position - supportive
If repositioning needed - manipulation (1-2wks) or surgical repair

LOC
Visual, sensory loss
CSF rhinorrhea
Septal hematoma
Significant soft tissue injury

Question 7

Sinusitis

• presentation
• causative organism
• risk factors

Answer 7

Often after URTI - S pneum, H inf, rhinovirus

Face pain in sinus distribution
-pain worse on bending forward
Thick purulent snot
Nasal obstruction

Nasal obstruction
Recent local infection, dental extraction
Swimming/diving
Smoking

Question 8

Sinusitis

• management
• complications and management

Answer 8

Simple analgesia
Steam, decongestants

If symptomatic for 10+ days => CS
Abx for high risk/systemically unwell

Orbital cellulitis
Frontal osteomyelitis
Meningitis, abscess
Cavernous sinus thrombosis
-drain abscesses
-ABx, wash out sinuses