Scribd
Upload
9 views

12 Epistaxis - Copy

Uploaded by

acerbook177
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
9 views

12 Epistaxis - Copy

Uploaded by

acerbook177
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 14

EPISTAXIS

BY:
PROD. DR. SHAHEEN IQBAL
MALLICK
EPISTAXIS

EPISTAXIS (BLEEDING FROM NOSE)

 Is the most common form of bleeding encountered in


the field of medicine.
 It is most commonly seen in children and the elderly.
 Most episodes are minor, with no more than a few
milliliters of blood loss, but occasionally life
threatening haemorrhage may occur.
VASCULAR ANATOMY:

• The arterial supply of nose is derived from both the


internal carotid (anterior & posterior ethmoidals)
• The external carotid (sphenopalatine, greater palatine
& superior labial) systems.
• The terminal baranches of vessels form a plexus
(kisselbach) on the antero-inferior part of septum
known as little’s area.
AETIOLOGY:
There are a number of local and general causes:
• In children and young adults, spontaneous bleeding
from little’s area is quite common and may be
precipitated by infection or minor trauma and is usually
easily treated although it tends to recur.
• In elderly people hypertension is often associated with
epistaxis, although there is usually a local cause as well.
It is more difficult to control as it is quite often from a
posteriorly placed or a high up located bleeding area
and also atherosclerosis may impair the
vasoconstriction.
CLINICAL FEATURES:
• Bleeding usually occurs suddenly without warning, but
may be preceded by a headache or pressure sensation.
• The bleeding point in majority of cases is in the little’s
area, though in elderly it may be more posteriorly
placed.
• The blood may trickle into the throat, be swallowed and
subsequently vomited either as fresh blood or large
clots.
• Anxiety is a natural consequence.
• Rapid pulse and raised blood pressure may aggravate
the problem.
• Hypovolumic shock may rapidly develop.
MANAGEMENT:
MILD TO MODERATE BLEEDING:
• The first aim is to stop the bleeding. This may be
achieved by a combination of local pressure,
vasoconstriction and cautery.
• Sit the patient upright in a chair and get him to pinch his
nose for 3-4 minutes. This is a standard first aid
procedure.
• Suck the blood or clots out or get the patient to blow
them out.
• In some cases this simple procedure may be sufficient
or at-least obvious bleeding point may become visible.
• Anaesthetize and constrict the nasal mucosa by placing
½” ribbon gauze soaked in solution of equal parts of
lignocain 4% and adrenaline 1:1000 for 3-4 minutes.
This alone may be sufficient to control the bleeding.
• If possible, the bleeding point should be sealed off with
electrocautery or chemical cautery (50% silver nitrate).
• Not all epistaxes can be controlled by this means and
precious time may be lost trying for this method. In such
situation anterior nasal packing is required.
• Once the bleeding has been controlled, we must proceed
with history taking, physical examination and some base
line investigations (hb% haematocrat, grouping & cross
matching).
• Rest in bed and a minor tranquilizer to sooth the nerves
are needed.
• Broad spectrum antibiotics is started as antibiotic
umbrella.
• The pack is removed after 2-3 days. By then the bleeding
blood usual gets thrombosed.
SEVERE NOSE BLEEDING:

• The patient first must be resuscitated and an


attempt is made to control the bleeding as soon as
possible.
• The most effective way is to pass a lubricated
foley’s catheter along the floor of nasal cavity,
inflate it and draw it into the choana and hold tight
with an artery forceps. Then the usual anterior
packing is done. By this way most of the
troublesome bleedings can be controlled.
• But if it fails to stop the bleeding, then we have to do the
post-nasal packing.
• Failure to control bleeding by either of these methods,
may necessitate external carotid artery tie or clamping
the internal maxillary artery in the pterygomaxillary
fossa.
• After the bleeding has stopped and the patient has been
resuscitated, an endeavour is made to find out the
cause of bleeding and dealt with accordingly.
• The role of plasma expenders and blood replacement, if
needed, is to be well understood.

You might also like