Stopping the bleeding….from the ENT point of view

Georgie Harris

ENT Registrar

Why is it such a problem?

High output vessels

Anastomoses under

friable mucosa

Limited compression

from surrounding

structures

Limited access

High vascularity

Kesselbach’s plexus Woodruff’s plexus

Choose your tools….

Get a good view….

Know where to look…..

Identify bleeding point….

Remove clot

Decongest/anaesthetise

Cophenylcaine forte

Drixine/otrivin

Most can be controlled with simple

measures

Topical measures

Direct pressure

Cotton ball soaked with cophenylcaineforte

Cautery

Silver nitrate

Adjuvant measures

Surgicel

Nasalate cream

Vaseline

Post cautery care important

Packing

Nose – Rapid rhino

Oral cavity – throat

pack with adrenaline

Trache site – Surgicel

Other options –

vasgauze, merecel

Rapid Rhino

If all else fails…..

Surgical intervention

EUA

SPA ligation

Maxillary artery ligation

Anterior ethmoidal artery ligation

Angiography/embolisation

Don’t forget the basics…

Choose your instruments

Get a good view

Know where to look

Topical measures first

Ask the obvious but often forgotten question

Questions?