Block 1- nasal topics Flashcards
Epistaxis Prognosis
- Most are a nuisance only
- Mortality rare
- With proper treatment: excellent Prognosis
- Greater morbidity with nasal packing: risk of infection, TSS, respiratory depression
Epistaxis Treatment Patient Education
- Avoid straining, vigorous exercise, increased head pressure
- Keep nasal packing moist with nasal saline
- Avoid vasodilators: hot spicy foods, tobacco
- Avoid nasal trauma
- Increase home humidity
- Use lube in nares-petrolatum jelly/bacitracin (at night especially)
- IF nasal packing: abx cephalexin/clindamycin
- Refer for recurrency, large bleeding volume
- ED if not controlled with proper technique for 15 minutes
if giving a pt a nasal packing for epistaxis, what antibiotics should you prescribe?
cephalexin/clindamycin
epistaxis treatment
- Nasal saline spray
- Avoid increased pressure (sneeze with mouth open)
- No digital manipulation
- Avoid hot spicy foods, Smoking
- Avoid ASA/IBU
epistaxis labs
- Mostly not helpful!!
- CBC (PLT, H&H)
- INR (PT/PTT)
- LFT
- Bleeding time, vWF
- Scope: fibreoptic endoscopy with flex/rigid
- CT/MR?
epistaxis primary intervention failure
If anterior bleed not controlled and/or source not visualised, what should you do?
- Anterior- hemostatic sealant, pneumatic nasal tamponade, anterior packing
- Epistat (balloon pads)
- Life threatening bleed: endovascular embolisation interior maxillary artery or facial artery/Ligation external carotid (very rare)
epistaxis intervention
- Most controlled with direct pressure within 15 minutes
- Sitting down vs lying down: less venous pressure
- Lean forward to decrease ingestion
- Short acting phenylephrine/vasoconstrictors
- Ice packs
- Topical 4% cocaine spray on cottons swab
- Topical decongestant oxymetazoline Afrin
- Cautery/silver nitrate/electrocautery
- Relaxation
during epistaxis physical exam, what should you as patient about?
- Ask patient about: History, Onset/activities, Timing , Duration, A&A, Risk factors, Associated sxs, Severity
if you see clot in epistaxis pt, what do you do?
If clot: have them blow it out
in physical exam of epistaxis patient, what do you use to inspect?
Inspection w/nasal speculum
what to look out for in physical exam of epistaxis pt
¥ Source? Bilateral?
¥ Masses? Persistent bleeding? Septal hematoma?
¥ Blood in oropharynx?
etiology of epistaxis
- 10% no identifiable cause
- Nasal trauma/surgery
- Mucosal irritation: topical antihistamines/steroids
- Foreign body
- Forceful blowing
- Rhinitis/URI
- Nasal cannula supplemental oxygen
- Decreased humidity (winter/seasonal)
- Septal deviation
- Septal perforations
- Tumour
- Dyscrasias
- Liver disease
- Cocaine/ETOH
- HTN?
- Anticoagulant/Antiplatelet Therapy?
- Childhood migraines
epistaxis epidemiology
- Bimodal: young 2-10yo, older 50-80yo
- Life long incidence: 60%
- Male 58%, Female 42%
most common bleed in epistaxis pt
Unilateral anterior bleeds
90% of bleeding in epistaxis patients occur from what area in nose?
occur in Kiesselbach’s Triangle (Little’s Area)
