Epistaxis
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Epistaxis, or nosebleed, can be classified by location in the nose and cause. The most common location is an area called Little's area, where blood vessels from different areas of the nose come together near the septum. Causes include local trauma, infections, tumors, and general medical conditions like hypertension. Treatment depends on severity but generally involves first aid measures, cauterization or packing to stop bleeding, and treating any underlying medical issues. Recurrent or severe epistaxis may require surgical interventions like ligation of arteries or resection procedures.
![III. According to Etiology
Local
Causes:
[1] Trauma
– Nose picking,
– fractures.
6](https://image.slidesharecdn.com/epistaxis-131223002336-phpapp02/85/Epistaxis-6-320.jpg)
![LOCAL CAUSES
[2] Infections:
Viral:Influenza,
measles
Diphtheria,
lupus
vulgaris, leprosy,
Parasites, maggots,
fungal
9](https://image.slidesharecdn.com/epistaxis-131223002336-phpapp02/85/Epistaxis-9-320.jpg)
![LOCAL CAUSES
[3] Idiopathic:
Wegner's granulomatosis,
Osler-Weber-Rendau's syn.,
atrophic rhinitis
10](https://image.slidesharecdn.com/epistaxis-131223002336-phpapp02/85/Epistaxis-10-320.jpg)
![LOCAL CAUSES
[4] Neoplasms:
Of the
Carcinom of the Nasopharynx
– nose,
– nasopharynx and
– sinuses.
Angiofibroma
11](https://image.slidesharecdn.com/epistaxis-131223002336-phpapp02/85/Epistaxis-11-320.jpg)
![Local Causes
[4] Miscellaneous:
Septal spur,
foreign bodies
13](https://image.slidesharecdn.com/epistaxis-131223002336-phpapp02/85/Epistaxis-13-320.jpg)
Epistaxis
- 1. EPISTAXIS 1
- 2. Definition Epistaxis is bleeding from the nose 2
- 4. I. According to site Anterior Superior; Anterior ethmoid ( bleeding is from above ant. half of middle turbinate) Inferior; Greater palatine, Posterior; Sphenopalatine (Bleeding is from below anterior half of middle turbinate 4
- 6. III. According to Etiology Local Causes: [1] Trauma – Nose picking, – fractures. 6
- 7. LITTLE'S ( KIESSELBACH'S) AREA 1/2 inch from the caudal border of the septum antero-inferiorly. Vessels anastomosing are; Anterior ethmoid, greater palatine, and sphenopalatine, and septal branch of superior labial. 7
- 8. Little’s area Confluence of : – Anterior Ethmoidal a. – Greater Palatine a. – Sphenopalatine a. – Sup. Labial a. 8
- 9. LOCAL CAUSES [2] Infections: Viral:Influenza, measles Diphtheria, lupus vulgaris, leprosy, Parasites, maggots, fungal 9
- 10. LOCAL CAUSES [3] Idiopathic: Wegner's granulomatosis, Osler-Weber-Rendau's syn., atrophic rhinitis 10
- 11. LOCAL CAUSES [4] Neoplasms: Of the Carcinom of the Nasopharynx – nose, – nasopharynx and – sinuses. Angiofibroma 11
- 12. Local Causes Congenital Multiple telangiectases (Osler’s disease) are characterised by multiple capillary hemangioma’s in the nose and tongue. 12
- 13. Local Causes [4] Miscellaneous: Septal spur, foreign bodies 13
- 14. General Causes Hypertension, CCF, mitral stenosis, Cirrhosis, coagulopathies, anemias, purpura, leukemias, 14
- 15. General Causes Malignancies, Caissons' disease, Endometriosis, Nephritis, Typhoid 15
- 16. Clinical features Bleeding from the nose Anterior and posterior bleeding Continuous or intermittent bleeding Hemoptysis or Heametemesis Anxiety Shock in case of severe epistaxis 16
- 17. Investigations BP Monitoring Radiography Endoscopy of nose and paranasal sinus Biopsy CBC, Bleeding profile, BT, CT, PT, APTT, Platelets Hb. 17
- 18. II. TREATMENT First aid Definitive treatment Prevention of recurrences 18
- 19. FIRST AID – Trotter’s procedure Make the patient sit up, pinch nose, open mouth and breath. – Ice or cold application on the bridges of the nose. – Pinching the nose for a minute. 19
- 20. DEFINITIVE TREATMENT Look into the nose. Assess blood loss. – Crystalloids or colloids – Transfusion Locate the point after packing the nose with 4% xylocaine and 1:1000 adrenaline mixture 20
- 21. CAUTERIZATION 1) Chemicals; Silver Nitrate stick, chromic acid bead. 2) Electrical Apply ointment and advise against blowing and nose picking. 21
- 22. ANTERIOR PACKING Unable to control bleeding. Ribbon, tampon, splints.
- 23. 23
- 24. 24
- 25. POSTERIOR PACKING Posterior packing if bleed is posterior. GA. Foley's or other inflatable devices Removed as soon as possible. Antibiotics. Transfuse. Blood gases in children. 25
- 26. Lubricants Ointment, vaseline, ghee, oil or butter prevents crust formation 26
- 27. Systemic management Antihypertensives Replace blood Fresh blood transfusion Antibiotics Sedatives 27
- 28. Surgical Management Ligation of external carotid artery, maxillary (Caldwell-Luc operation) or anterior ethmoidal artery. Sub-mucous resection (SMR) or septoplasty. 28
- 30. SPECIAL CASES Haemophilia; – Replace factor VIII, or fresh blood. Other clotting deficiency; – FFP. Purpura; – Platelets 30
- 31. SPECIAL CASES Anticoagulants; – Stop drug, or titrate. – Heparin is reversed with protamine sulphate, – warfarin with vitamin K Unconscious head injury; – Dangerous to pack in suspected skull #. Telengiectasia; – Septodermoplasty. 31
- 32. OTHER TREATMENTS Embolization Catheters with iced water lavage 2% lignocaine and adrenaline injection in greater palatine foramen 32
- 33. Thank you. 33