Epistaxis management
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EPISTAXIS Sreedevi k p
52nd batch
BLOOD SUPPLYNASAL SEPTUM
LITTLE’S AREA
EPISTAXIS - DEFINITION
Bleeding from inside the nose
Seen in all age groups as emergency
Sign of local or constitutional cause
Sites of epistaxis Little’s area Above the level of middle turbinate Below the level of middle turbinate Posterior part of nasal cavity Diffuse Nasopharynx
Classification
Anterior
Posterior
ANTERIOR EPISTAXIS
POSTERIOR EPISTAXIS
ANTERIOR More common
Little’s area,ant. Part of lat. Nasal wall
Children /young adult
Trauma
Mild Local
pressure/ant. pack
Less common
Post. Superior part-nasal cavity
>40yrs
Spontaneous; often d/t HTN or arteriosclerosis
Hospitalization Post nasal pack
POSTERIORIncidence
Site
Age
Cause
Bleeding
CAUSES
Local
General
Idiopathic
A.LOCAL
1.Congenital
Unilateral choanal atresia
Meningocoele
Encephalocoele
Glioma
Glioma
2.TRAUMA
Injuries of nose
Intra nasal surgery
Violent sneeze
Fracture of middle one third of face & base of skull
4.Infection
Acute Viral rhinitis
Nasal diphtheria
A/c sinusitis
Chronic Atrophic rhinitis
Rhinitis sicca
Tuberculosis
Syphilis
Rhinosporidiosis
4.Foreign bodies
Non-living Rhinolith
Foreign body
Living
Maggots,leech
6.Atmospheric changes
High altitude
Caissons disease
7.DNS
NASOPHARYNX
Adenoiditis
Juvenile angiofibroma
Malignant tumors
GENERAL
CVS Hypertension Arteriosclerosis Mitral stenosis
Blood disorder Aplastic anemia
Leukemia Hemophilia
Liver disease Hepatic cirrhosis
Kidney disease C/c nephritis
Drugs Salicylates Anti coagulant therapy
Mediastinal compression Tumors
A/c general infection Influenza
Chicken pox Malaria
Vicarious menstruation
MANAGEMENT
Enquire…..
Mode of onset Duration & fequency Site Side Type Any medical ailment Drug intake
FIRST AID
Littles area compression
Trotters method
CAUTERIZATION
IN ANT. EPISTAXIS Anaesthetize bleeding point
Cauterise with bead of silver nitrate/coagulate with electro cautery
Anterior nasal packing
Posterior nasal packing
Or….
Foley’s catheter
Nasal baloon
Endoscopic cautery
Better location of posterior bleed Local anaesthasia with sedation It is coagulated with suction cautery
Elevation of mucoperiosteal flap& SMR operation
Ligation of vessels
External carotid – above origin of sup. Thyroid A.
Maxillary artery Approach via Caldwell-Luc operation
Ethmoidal arteries
General Measures
Sit up with back rest Record blood loss in spitting & vomiting Reassure Mild sedation Check vital signs Maintain haemodynamics-blood transfusion if
required Intermittent oxygenation Investigate & treat
Hereditary hemorrhagic telangiectasia
Osler-Weber-Rendu disease is a genetic disorder that leads to abnormal
blood vessel formation in the skin, mucous membranes
It may lead to nosebleeds, acute and chronic digestive tract bleeding, and various problems due to the involvement of other organs.
Can occur on anterior part of nasal septum
Argon,KTP(Potassium titanyl phosphate) or Nd;YAG laser (neodymium-doped yttrium
aluminum garnet)
Septodermoploasty
THANK YOU