Epistaxis
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- 2. DEFINITION ACUTE HAEMORRHAGE FROM THE NOSTRIL, NASAL CAVITY OR NASOPHARYNX
- 3. ARTERIAL BLOOD SUPPLY 3 Little’s area : • Four arteries-anterior ethmoidal, septal branch of superior labial, septal branch of sphenopalatine and the greater palatine, anastomose here to form a vascular plexus called “Kiesselbach’s plexus”. This area is exposed to the drying effect of inspiratory current and to finger nail trauma, and is the usual site for epistaxis in children and young adults.
- 4. CAUSES • LOCAL • GENERAL • IDIOPATHIC 4
- 5. LOCAL 5 • Hereditary haemorrhagic telengectasiaCongenital • Nose picking • Fracture • Foreign body Traumatic • Rhinitis • SinusitisInflammatory • Benign • Malignant Tumors • Deviated nasal septum Septal
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- 9. 9 Anterior Posterior Incidence More common Less common Site Anterior inferior part of nasal cavity Posterior superior part of nasal cavity Age Children or young adult After 40 years of age Cause Trauma Idiopathic Hypertension, atherosclerosis Bleeding Mild Severe
- 11. PRIMARY ASSESSMENT • Onset,course, duration • Amount • Known medical disease • Drug intake History • Side • Site • Local cause Nasal Examination • Vital signs • General cause of General 11
- 12. TREATMENT First aid Place the patient in sitting and leaning forward position Pinch the nose for 5 minutes Apply cold compressions if available Use topical vasoconstrictor Cauterization Chemical cautery – silver nitrate Electrocautery 12
- 13. Anterior nasal pack Indication : profuse or unidentifiable site of bleeding, failed cauterization Method : • Ribbon gauze impregnated with Vaseline • 1m gauze is required for each nasal cavity. First few cm of gauze are folded upon itself and inserted along the floor and the whole cavity is packed tightly by layering the gauze from floor to roof • One or both cavity may need to be packed • Remove after 48 hours • Antibiotics 13
- 14. 14 Posterior nasal pack Inflatable Balloon Foley’s catheter Gauze
- 15. 15 Endoscopic cautery For posterior bleeding point Arterial ligation Indication: severe bleeding with failed nasal packing Superior bleeding – Ethmoidal artery (ethmoidectomy approach) Posterior bleeding – Maxillary artery (trans maxillary sinus approach) External carotid (cervical approach) General Rest Sedative Coagulants and vitamin K
- 16. SECONDARY ASSESSMENT History Nasal and general examination Investigations Coagulation profile Blood picture CT scan and MRI Biopsy Treatment of cause 16
- 17. Thank Youuuuu Made and presented by Basyar Nazri
Editor's Notes
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