This document provides an overview of a lecture on post-basic ENT nursing regarding epistaxis (nosebleeds). It defines epistaxis and discusses the blood supply and common sites in the nose where bleeding occurs. Epistaxis is classified as anterior or posterior based on its location. Causes are categorized as local, general/systemic, or idiopathic. Initial management involves techniques to arrest bleeding like nasal packing. Definitive treatment depends on severity but may include cauterization, medications, surgery, or embolization.

1. POST-BASIC ENT NURSING LECTURE
BY
DR. BASHIR MUHAMMAD(FWACS ORL)

2. Outline
 Intoduction
 Blood supply of the nose
 Common sites
 Classification
 Causes
 Management

3. Introduction
Definition
 Bleeding from inside the nose
 Nasal cavity/ Paranasal sinuses
 Nasopharynx
 5-10% of the population experience an episode of epistaxis
each year.
 10% of those will see a physician.
 1% of those seeking medical care will need a specialist.
 It can be seen in all age groups

4. Blood supply
Both internal and external carotid systems contribute
Medial wall:
 Anterior and posterior ethmoidal
 Sphenopalatine
 Greater palatine
 Superior labial
Lateral wall:
 Antrior and posterior ethmoidal
 Sphenopalatine
 Greater palatine
 Anterior superior alveolar
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External carotid system
External carotid system
Internal carotid system
Internal carotid system

5. Blood supply
Medial wall Lateral wall
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Ant & Post ethmoidal
Br SPA
Gr P Art
Septal br SLA
Br SPA
Gr P & Ls P art
Little’s A

6. Common sites of Epistaxis
Little’s area(90%)
 Situated in the antero-
inferior part of the nasal
septum
 Four arteries are involved
(Kiesselbach’s plexus)
 Anterior ethmoidal
 Sphenopalatine
 Superior labial
 Greater palatine

7. …sites of epistaxis
Woodruff’s plexus
 Plexus of arteries(?
Veins)
 Situated inferior to
posterior end of inferior
turbinate
 Site of posterior epistaxis
in adults

8. …sites of epistaxis
Others
 Retrocolumellar vein
 Runs vertically downwards behind the columella
 Common site of epistaxis in children
 Above/ below the middle turbinate
 Nasopharynx
 Diffuse bleeding

9. Classification
Demarcated by the opening of the maxillary sinus(ostium)
into
 Anterior: From the anterior part of the nose
 Mostly drains through the nares in sitting position
 Less severe
 Commoner in younger age group
 Posterior:
 From the posterior part of the nose
 Mostly drain into throat through the nasopharynx

10. Posterior:
 May induce vomiting blood
 More severe
 Commoner in older age group(>40years)
 Less common

11. Causes of Epistaxis
 Local
 General/ Systemic
 Idiopathic (85%)

12. Local causes
Nose/ Nasopharynx
 Trauma: Finger nail trauma(nose picking), fractures
etc
 Infections/ Inflammations: Viral, Bacterial, Fungal
 Foreign bodies: Living & Non-living
 Tumours: Benign and malignant
 Iatrogenic: Surgery, steroid spray

13. General/ systemic
 Blood disorders: Leukaemia, Haemophilia,
Thrombocytopenia, Vitamin K deficiency
 Cardiovascular diseases: Arteriosclerosis, ?Hypertension
 Liver diseases: Liver cirrhosis
 Kidney diseases: CRF
 Drugs: eg NSAIDs, anticoagulant therapy

14. Management
It depends on how the patient presents
 Volume of blood loss
 Duration and frequency
 Anterior or posterior bleed
 Consciousness level
 Associated risk factors

15. Initial care
In emergency situations,
 Resuscitation
 Hospital admission
 History and Examination
 Investigations eg FBC, GXM, U&E, LFT, clotting
profile etc
 IVF N/saline, blood transfusion
 Arrest/control further bleed

16. Initial care
 Pinching the nose between thumb and index finger +/-
cold packs
 Trotter’s / Modified Trotter’s method
 Cauterisation
 Chemical eg silver nitrate
 Electrocautery
 Anterior nasal packing: especially in profuse anterior bleed

17. ..treatment
 Posterior nasal packing: in posterior bleed, using
gauze/ Foley’s catheter
 Nasal balloon
 Endoscopic cauterisation
 Antibiotics
 Treat underlying cause if any!

18. On discharge…
 Humidity
 Discontinue offending medications
 Nasal saline sprays
 Avoidance of nose picking
 Sneeze with mouth open
 Avoid straining/ bed rest

19. Treatment
Anterior packing Posterior packing

20. …treatment
Nasal balloon Nasal balloon

21. Surgical management
Ligation of vessels
 Sphenopalatine artery
 Ethmoidal arteries
 Internal maxillary artery
 External carotid artery
Embolization by radiologists

22. Conclusion
 Epistaxis is a fairly common presentation in ENT
practice
 It can be distressing to the patient
 Reassurance and prompt institution of care is
important