Epistaxis is the medical term for "nasal bleeding".
This ppt is more of use for medical students ....a compilation of all the required knowledge about epistaxis.
6. Why nose?
⢠Situated in a vulnerable position as it protrudes
on the face
⢠Has a very rich blood supply
⢠Vasculature runs just under the mucosa
⢠Exposed to the drying effect of inspiratory
current
7. Epidemiology
⢠Lifelong incidence of epistaxis in general
population is about 60%
⢠Fewer than 60% seek medical attention
⢠Peaks in young children (2 â 10 y) and older
individuals (50 â 80 y)
⢠Males 58%, females 42%
8. Blood Supply
⢠Superior part of the nose (Internal carotid artery)
⍠Ophthalmic artery
ď Anterior ethmoidal artery
ď Posterior ethmoidal artery
⢠Inferior part of the nose (External carotid artery)
⍠Maxillary artery
ď Greater palatine artery
ď Sphenopalatine artery
⍠Facial artery
ď Superior labial artery ď vestibule of the nose
9.
10. Kiesselbachâs Plexus
⢠Littleâs area
⢠Anteroinferior part of the nasal septum
⢠Anastomosis between upper and lower arteries
⍠Anterior ethmoidal artery
⍠Posterior ethmoidal artery
⍠Sphenopalatine artery
⍠Greater palatine artery
⍠Septal branch of superior labial artery
11. Woodruffâs Plexus
⢠Lateral wall of inferior meatus
⢠Blood vessels have very little muscle tissue
within their walls, therefore hemostasis is poor
⢠Anastomosis between:
⍠Pharyngeal artery
⍠Posterior nasal artery
⍠Sphenopalatine artery
⍠Posterior septal artery
14. Classification
⢠Anterior
⍠90% of all cases of epistaxis
⍠Kiesselbachâs plexus
⍠Younger population
⍠Typically less severe
⍠A constant ooze, rather than profuse pumping of
blood
15. ⢠Posterior
⍠Woodruffâs plexus
⍠Older population
⍠Profuse, prolonged and more difficult to control
⍠Associated with bleeding from both nostrils
⍠Greater flow of blood into the mouth
⍠Greater risk of airway compromise and aspiration
of blood
19. History
⢠Age
⢠Onset, duration, severity, frequency
⢠Bilateral or unilateral
⢠Preceding factors: exercise, sleep, migraine, trauma
⢠Bleeding from other sites
⢠Aggravating and relieving factors
⢠Nasal discharge
⢠Medical conditions
⢠Current medications
⢠Smoking and drinking habits
⢠Previous epistaxis, recurrent bleeding, easy bruising
⢠Family history of bleeding disorders
21. Management
⢠Control significant bleeding or hemodynamic
instability before obtaining a lengthy history
⢠Steps:
⍠First aid and resuscitation
⍠Assess blood loss
⍠Localize bleeding
⍠Control bleeding
⍠Prevention
22. First Aid & Resuscitation
⢠Address ABC
⢠Neck should not be hyperextended to prevent
blood flow into the stomach or possible
aspiration
⢠Trotterâs triad
@ Blood in mouth should not be swallowed
@ Mouth breathing
@ Direct pressure over the cartilaginous part of
the nose
@ 5 â 10 minutes is usually sufficient
⢠Gauze moistened with epinephrine may be
placed to promote vasoconstriction
23. ⢠Vital signs and signs of shock
⢠Patient with significant hemorrhage should
receive an IV line and crystalloid infusion and
reptilase/ethamsylate in bolus or infusion
⢠Cross match for 2 units packed RBC
⢠Continuous cardiac monitoring and pulse
oximetry
24. Localization of Bleeding
⢠Pledgets soaked with anesthetic-vasoconstrictor
solution are inserted into the nasal cavity to
anesthetize and shrink nasal mucosa
⢠Allow them to remain for 10 â 15 minutes
⢠Visualize cavity with speculum + good light
source
⢠Aspirate excess blood and clots
⢠If the bleeding originated from Littleâs area, it is
clearly visible
25.
26. ⢠Rigid endoscope is used to localize posterior
bleeding
⍠Superior optics
⍠Allow endoscopic suction and cauterization
⢠Points suggesting posterior source:
⍠Anterior surface cannot be visualized
⍠Bilateral bleeding
⍠Constant dripping of blood in the posterior
pharynx
⍠Bleeding in the pharynx with the anterior nasal
packing in place
27.
28. Control of Bleeding
⢠Topical vasoconstrictors
⍠Otrivin (xylomethazoline)
⍠Cocaine
⢠Chemical cauterization with silver nitrate stick
⍠Rolled over mucosa until a grey eschar forms
⍠Only one side should be cauterized to prevent
septal necrosis or perforation
⢠Thermal cauterization with an electrocautery
device for more aggressive bleeding under LA or
GA
29.
30. Anterior Nasal Packing
⢠Roller gauze soaked with petroleum jelly and
an antibiotic ointment
⢠Success rate 85%
31.
32.
33. Posterior Nasal Packing
⢠Indications:
⍠Failure of anterior packing
⍠High suspicion of posterior bleeding
⍠Older patient with atherosclerosis
⍠Patient with bleeding diathesis
⢠Contraindications
⍠Facial trauma
⍠Shock
⍠Altered mental status
34. ⢠Uncomfortable and difficulty in breathing
⢠Risk of hypoventilation and hypoxia
⢠Admission, bed rest, sedation
⢠Supplemental oxygen:
⍠Elderly patients
⍠Cardiac disorders
⍠COPD
⢠Monitor blood pressure and hemoglobin level
⢠Control coexistent hypertension
38. Surgical Intervention
⢠Indications:
⍠Bleeding continues despite adequate packing and
resuscitation
⍠Nasal anomaly (septal deviation)
⍠Patientâs refusal or intolerance to packing
39. ⢠Arterial ligation
⍠External carotid artery
⍠Internal maxillary artery transorally or
transnasally
⍠Ethmoidal arteries
⍠Most commonly ligated vessel is
SPHENOPALATINE ARTERY
⢠Angiography and vessel embolization
40. Prevention
ďControl of hypertension
ďCorrection of bleeding disorders
ďHumidifier or vaporizers
ďNasal saline sprays, ointment, vaseline
⢠Avoid hard nose blowing or sneezing
⢠Sneeze with mouth open
⢠Avoid nose picking
⢠Control the use of medications