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Epistaxis

Epistaxis. By Stacey Singer-Leshinsky R-PAC. Function of the Nose. Vasculature just under the mucosa. Vasculature supply originates from the ethmoid branches of the internal carotid arteries and the facial and internal maxillary divisions of the external carotid arteries.

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Epistaxis

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  1. Epistaxis By Stacey Singer-Leshinsky R-PAC

  2. Function of the Nose • Vasculature just under the mucosa. • Vasculature supply originates from the ethmoid branches of the internal carotid arteries and the facial and internal maxillary divisions of the external carotid arteries. • Nose bleeds are very common

  3. Epistaxis • Acute hemorrhage from the nostril, nasal cavity, or nasopharynx. • Etiology includes: infection, trauma, allergic rhinitis, renal failure, nasal defects, hypertension, tumors, use of blood thinners, aspirin. • History:

  4. Epistaxis • Classified by the location • Can be either anterior or posterior.

  5. Anterior Epistaxis • Kiesselbach’s plexus most common. • Clinical Manifestations: • History • Unilateral bleeding • No sensation of post nasal drip • Blood is bright red

  6. Anterior Epistaxis • Diagnostics • Hemoglobin/Hematocrit • CBC • Bleeding time

  7. Anterior Epistaxis • Management: • ABC • Direct pressure. Pinch nostrils sit forward. • Cautery- chemical, electric, thermal. Silver nitrate sticks • Use of vasoconstrictors sprays. / anesthetic agents. • Anterior packing Merocel: compressed sponge. • Remove any clots visualized • Anterior epistaxis balloons.

  8. Anterior Epistaxis • Complications of nasal packing: • Septal hematomas/abscess • Sinusitis • Pressure necrosis

  9. Posterior Epistaxis • Usual source is the branches of the sphenopalatine artery. Bleeding occurs behind the posterior portion of the middle turbinate or posterior superior roof of the nasal cavity.

  10. Posterior Epistaxis • Clinical Manifestations: • Nausea, hematemesis, anemia, hemoptysis or melena. • No visualized anterior source of bleeding • Post nasal drip of blood • Blood is dark red • Brisk arterial bleed

  11. Posterior Epistaxis • Diagnostics: • Hemoglobin/ Hematocrit • History of bleeding disorder

  12. Posterior Epistaxis • Management: • Attempt to locate the source • Vasoconstrictive/ anesthetic agents • Posterior nasal packing • Immediate otolaryngologist referral • Prophylactic antibiotics • Hospitalization and monitoring

  13. Posterior Epistaxis Packing

  14. Posterior Epistaxis • Indications for surgery/ embolization • Continued bleeding with packing • Required transfusion • Nasal anomaly precluding packing • Patient intolerance to packing

  15. EpistaxisDifferential Diagnosis • Local irritation • Occupational exposure • Allergies • Malignancy due to systemic disease such as granulomatous disease(Wegener’s sarcoidosis) • Hereditary hemorrhagic telangiectasia(Osler-Weber-Rendu syndrome) • Bleeding disorders • hypertension

  16. EpistaxisComplications • Sinusitis • Possibility of airway obstruction • Toxic shock syndrome • Septal hematoma or abscess • Septal perforation

  17. Osler-Weber-Rendu syndrome • Disorder of blood vessels • Etiology: Genetic: • Clinical manifestations: telangiectases on the lips, tongue and nasal mucosa • Complications include hemorrhage

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