C2 - epistaxis

Question 1

What are the two main division contributing to the blood supply of the nasal cavity?

Answer 1

Internal carotid 20%-> opthalmic artery
External carotid - 80%-> facial artery and the maxillary artery.

Question 2

How does the internal carotid artery help supply the nasal cavity with blood?

Answer 2

Via the opthalmic artery
Has the anterior ethmoid branch -> external nasal branch
Has the posterior ethmoid branch

Question 3

How does the external carotid artery contribute to the nasal cavity blood supply?

Answer 3

The facial artery has the superior labial branch
The maxillary artery has the greater palatin and the sphenopalatine branch

Question 4

What are the nose has a high risk of epistaxis?

Answer 4

Littles area

Question 5

Compare anterior and posterior epistaxis

Answer 5

Posterior -< more dangerous -> blood into pharnyx, oesophagus risk of aspiration into lungs
Anterior -> more benign

Question 6

What are the common causes of epistaxis?

Answer 6

Idiopathic
Trauma
Allergies
HTN
Coagulopathies
Post operative

Question 7

What is the key management of epistaxis?

Answer 7

Compression - 15 mins
Ice packs
Topical antiseptic - naseptin to reduce crusting
Cauterisation (one side only)
Nasal packing - 24/48hrs - posterior foley catheter

Question 8

What treatment should be given for epistaxis if the patient is hemodynamically unstable?

Answer 8

Tranexamic acid
Plasminogen inhibitor - prevents conversion to plasmin, this reduces the bleeding risk.