Epistaxis and nasal cautery A.HABIB
Msc(Edin),MRCS(London)SpecialtyRegistrarENT
Agenda
• Introduction• Anatomyofnasalcavityandbloodsupply• Treatmentofepistaxis• Nasalcautery• Nasalpacking• Furthermanagement
Epistaxis
• Commoncomplaint• Rarelyfatal• Majoritydonotrequirehospitaladmission• 10%ofallepistaxisserious• 60%ofallpeoplehaveatleastoneepistaxisduringalifetime• Bimodaldistribution-<10,>50
Basic anatomy
• Nasalcavity• https://www.youtube.com/watch?v=d8eS9eSoVrI• Nasalbloodsupply
Blood supply
Blood supply
• Sources:internalcarotidandexternalcarotid• Little’sarea/Kiesselbachplexus
Treatment
• Firstaid• Nasalpackingwithvasoconstrictor/localanaesthetic• Nasalcautery(silvernitrate)• Nasalpacking• Posteriorpacking• Surgery
What you’ll need
• Headlamp• Tilleyforceps• Thudicumspeculum• Silvernitratesticks• Cottonwool/ribbongauze• Suction• Protection-gloves,apron,mask• Adrenaline,saline• Xylocaine10%spray
Packing with topical vasoconstrictor and LA
• Adrenalinevials:1:1000• Dilutewith10mlofsaline• Soakcottonwoolballsinsolution• Packthesideofbleedingandapplyfirmpressureovernosefor10-15minutes• Arrestofbleedinganddecongestthenose• Canberepeatedupto3times.
Nasal cautery
• Silvernitratesticks• Contactwithmucosalsurfacegeneratesnitricoxidecreatingachemicalburn• https://www.youtube.com/watch?v=B3cd1sKKBOs• Gentlydabtheseptalmucosa/holdfor5-10seconds• Caretoprotecttheupperlip–burns• InstillationofNaseptincream• Observefor30minutespostarrestofbleeding
Nasal packing
• Rapidrhino• Merocel• Nasopore• Foleycatheter• BIPPpacking
Rapid rhino pack
Rapid rhino
• Forbriskbleedingnotcontrolledbycautery• Immerseinsterilewaterfor30seconds• Aimtoinsertatthebaseofthenasalcavity• Iffailedattempt,chancesarethepatienthasadeviatednasalseptumornasalspur• Donotattemptanyfurtherasriskoftrauma• CallENTSHO/SPRforadvice
Further treatment
• Foleycatheter• BIPPpacking• Considerationofsurgery–SPAligation• Embolization