Epistaxis and Tumor
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Transcript of Epistaxis and Tumor
Epistaxis(nosebleed)Epistaxis(nosebleed)
EpistaxisEpistaxis
Synonyms:Synonyms: nasal hemorrhage, nose bleed, bosebleed, bloody nasal hemorrhage, nose bleed, bosebleed, bloody nose.nose.
Background:Background: nosebleed is defined as acute hemorrhage from nosebleed is defined as acute hemorrhage from the nostril, nasal cavity, nasopharynx. In the majority of the the nostril, nasal cavity, nasopharynx. In the majority of the cases, bleeding is in small quantities and self-limited, cases, bleeding is in small quantities and self-limited, sometimes it can be very intense and life-threateningsometimes it can be very intense and life-threatening..
Incidence:Incidence: with peak in those aged 2-10 years and 50-80 years. No sex predilection.
Climates factor:Climates factor: nose bleed most common occurs nose bleed most common occurs
during colder month and in dry colder climatesduring colder month and in dry colder climates
EpistaxisEpistaxis
Pathophysiology:● Primary bleeding site: anterior is common. Posterior is rare● Little’s area is most commonly bleeding site
(Kieselbach’ plexus)● Posterior bleeding usually originate below the posterior half of the inferior turbinate or roof of the nasal cavity.
EpistaxisEpistaxis
Cause:Cause:Local causesLocal causes
◆ Trauma: fracture of nasal boneTrauma: fracture of nasal bone ◆ ◆ Infection: viral rhinitis, acute rhinitis.Infection: viral rhinitis, acute rhinitis. ◆ ◆ Foreign bodies:Foreign bodies:
◆◆ Deviation of the nasal septumDeviation of the nasal septum ◆ ◆ Atmospheric change, dry climatesAtmospheric change, dry climates ◆ ◆ Tumors in nasal cavity and sinusesTumors in nasal cavity and sinuses
EpistaxisEpistaxis
General CausesGeneral Causes ◆ hypertension and heart diseaseshypertension and heart diseases
◆ ◆ pregnancypregnancy
◆◆ Acute general infection Acute general infection
◆ ◆ Drugs abuseDrugs abuse
◆ ◆ Diseases of blood systemDiseases of blood system
EpistaxisEpistaxis
Diagnostic step:Diagnostic step:
1.history: 1.history:
2.localize bleeding site2.localize bleeding site
3.determine causes3.determine causes
4.measurement of blood 4.measurement of blood pressurepressure
5.analysis of blood coagulation5.analysis of blood coagulation
6.radiograph or CT image6.radiograph or CT image
EpistaxisEpistaxis
Treatment:Treatment:Digital press:Digital press: 10 minutes 10 minutes
Cautery:Cautery: AgNO AgNO3 3 ,, laser, laser,
microwavemicrowave
Hardener injection:Hardener injection: 40% urea 40% urea
Nasal packing: Nasal packing:
vaseline gauze, vaseline gauze,
balloonballoon
glutinglutin spongesponge
compressed spongecompressed sponge
EpistaxisEpistaxis
Traditional packing:Traditional packing:
Vaseline gauze ribbonVaseline gauze ribbon
for 24~48 hoursfor 24~48 hours
Prevent infection of Prevent infection of sinus with antibioticsinus with antibiotic
EpistaxisEpistaxis
The step of posterior The step of posterior
nasal packingnasal packing
EpistaxisEpistaxis
Vascular ligationVascular ligation this procedure is used for uncontrolled life-this procedure is used for uncontrolled life-
threatening epistaxis threatening epistaxis external carotid artery(ECA) often be ligated external carotid artery(ECA) often be ligated
because most nosebleed site is the area because most nosebleed site is the area supplied with the branch of ECA .supplied with the branch of ECA .
Calming the patientCalming the patientLowering of blood pressureLowering of blood pressureDiscontinuation of anticoagulationDiscontinuation of anticoagulationAdministration of fluid expandersAdministration of fluid expanders
EpistaxisEpistaxis
How to prevent rebleeding after initial bleeding has stopped
Do not pick or blow nose. Do not pick or blow nose. Do not strain or bend down to lift Do not strain or bend down to lift
anything heavy. anything heavy. Keep head higher than the heart. Keep head higher than the heart. Use a humidifier during dry Use a humidifier during dry
winter monthswinter months A saline nasal spray will also A saline nasal spray will also
moisten dry nasal membranesmoisten dry nasal membranes.