Epistaxis

Question 1

AR the blood supply to the nose

Answer 1

also descending palatine down back of palate

Question 2

What are the causes of epistaxis?

Answer 2

Idiopathic
Iatrogenic (surgery, topical spray, cocaine)
Traumatic (fracture, FB, picking)
Infection, inflammatory (rhinitis)
Malignancy (angiofibroma, carcinoma)
Anticoagulants
Coagulopathies
Hereditary haemorrhagic Telangiectasia
Granulomatosis with polyangitis
HTN

Question 3

What are some examples of bleeding disorders that could lead to epistaxis?

Answer 3

Immune thrombocytopenia
Waldenstrom’s macroglobulinaemia

Question 4

What is angiofibroma?

Answer 4

Often juvenile angiofibroma

benign tumor of blood vessels and fibrous tissues that is highly vascularised - often on nose and cheeks (small red bumps)

see in adolescent males

Question 5

What is management of epistaxis? (BB lec think broad headings for now)

Answer 5

Initial assessment :
Acitively bleeding ?
Signs of shock (pale, pulse, BP)?

Cannulate (bloods for Hb, G&S, clotting)

Examine - identify location of bleed
Nasal cautery
Nasal packing (merocil, catheter, BIPP)
Surgery

Question 6

If a pt with epistaxis is haemodynamically stable, first aid measures are all that is needed. Outline what these are…

Answer 6

1. Sit pt forward with mouth open
   (so they can spit out blood/ reduce risk of aspirating and decrease blood flow to nasopharynx)
2. Pinch the cartilaginous soft are of nose for at least 20 mins
   (ask pt to breathe through mouth)
3. consider topical antiseptic to reduce risk of crusting / vestibulitis e.g. Mupirocin

Question 7

Which pts with epistaxis should you have a low threshold for admission?

Answer 7

Comorbidity
e.g. coronary artery disease / severe HTN/ underlying cause is suspected

Children under 2 yrs
haemophilia / leukaemia (underlying) cause more likely

Question 8

If bleeding from nose does not stop after 10-15 minites of continuous pressure what should you consider ?

Answer 8

Cautery initially if source of bleed is visible

Packing - if cautery not tolerated / cannot visualise bleed point

Question 9

What might need to be done for pts who have not repsonded to all emergency management of epistaxis?

Answer 9

Sphenopalatine ligation in theatre

Question 10

AR the management of epistaxis flow diagram

Answer 10

Question 11

How would you classify epistaxis?

Answer 11

Anterior bleeds

Posterior bleeds

Question 12

Where is an anterior bleed located in epsitaxis?

Answer 12

Originate from “Little’s” area a high vascularised region formed by anastomosis of 5 arteries

Question 13

Which are more a common cause of epistaxis: anterior or posterior bleeds?

Answer 13

Anterior - Little’s area = 90% cases

Question 14

Where is a posterior bleed located in espistaxis?

Answer 14

Posterior nasal cavity, often from branches of sphenopalatine arteries of nose
more common in older pts

Question 15

Complication of nasal cautery?

Answer 15

Septal perforation