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Epistaxis for the ENP

Epistaxis for the ENP. Dave Pothier ENT SpR RUH. Blood supply. Internal External. A B C. First aid. Definitely: Pinch over little’s area – at least 20 mins with zeroing with each release Sit forward Rest Possibly: Ice on neck Ice over nose/forehead Ice in mouth. AgNO3 Cautery.

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Epistaxis for the ENP

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  1. Epistaxis for the ENP Dave Pothier ENT SpR RUH

  2. Blood supply • Internal • External

  3. A B C

  4. First aid Definitely: • Pinch over little’s area – at least 20 mins with zeroing with each release • Sit forward • Rest Possibly: • Ice on neck • Ice over nose/forehead • Ice in mouth

  5. AgNO3 Cautery Top tips • Get comfortable • Get patient comfortable • Anaesthetise well • Have the right gear • Know how to use it

  6. Nasal packs First aid Merocel/RapidRhino Anterior packing with BIPP Posterior packing with BIPP + catheter Skill required + morbidity effectiveness

  7. Naseptin • Antibiotic • neomycin sulphate • Antiseptic • chlorhexidine hydrochloride

  8. Bilaterally, BD, 2/52

  9. Before discharge • Deal with usual social issues • No heavy activities • No hot meals or baths • No nose blowing – douche only • Do NOT stop asprin • Explain proper first aid

  10. What can we do? Posterior packing EUA Nose + cautery SPA Ligation Anterior ethmoid artery ligation External carotid artery ligation

  11. SPA Ligation

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