Epistaxis

ANATOMY

Epistaxis

• Self-limited, but can be life threatening

• 90-95% anterior epistaxis

Etiology

Types of Nosebleeds

• Anterior– Younger population– Little’s area– Mucosal dryness– Precipitated by infection or minor trauma– Less severe– Tend to reccur– Usually controlled with conservative

measures

Types of Nosebleeds

• Posterior– Older population– Hypertention– Significant bleeding in posterior pharynx– Difficult to stop

Philosophy

• Establish the site of bleeding• Stop the bleeding• Treat the cause

First aid

• Pinched the nostril tightly for 10-20 mins

• Sit up right & lean forward

• Do not swallow the blood

• Prepared with – Gown– Mask– Suction– Speculum– Packing

• Evacuate clots• Topical vasoconstrictor and anesthetic• Identify source

Bleeding from Little’s area

• Cautery (Silver nitrate stick)

• Anterior nasal packing for refractory epistaxis

Other Anterior Nasal Packs• Formed

expandable sponges are very effective

• Available in many shapes, sizes and some are impregnated with antibacterial properties

Bleeding from an unidentified site

• Anterior nasal packingOr

• Posterior nasal packing

Posterior packing

Other posterior nasal Packing

Other Treatments for Refractory Epistaxis

• Greater palatine foramen block• Septoplasty• Endoscopic cauterization• Selective embolization by interventional

radiologist• Internal maxillary artery ligation• Transantral sphenopalatine artery ligation• Intraoral ligation of the maxillary artery• Anterior and posterior ethmoid artery ligation• External carotid artery ligation

Complications Epistaxis Management