Epistaxis Flashcards
common name for epistaxis
nose bleed
where can be the site of bleed in epistaxis
nasal cavity or nostrils or nasopharynx
can be classified as anterior or posterior
aetiology
vessels may bleed due to mucosal compromise or there is an imbalance between vasoconstriction and the clotting cascade
what may you see in adults with a nose bleed in the basic observations
elevated BP; this may be causative or may be secondary to anxiety
effect of alcohol on epistaxis
alcohol increases the risk of epistaxis due to increased bleeding time
what plexus does anterior epistaxis originate from
Kiesselbach plexus
risk factors of epistaxis
age (children and older)
climates (cold dry climates)
local nasal (rubbing, trauma, sneezing, drug misuse (cocaine) or foreign bodies in the nose (kids)
what investigations will be done for diagnosis
NONE
if there is a nose bleed a clinical diagnosis of epistaxis can be made
what investigations to consider
FBC (if bleeding for a long time, Hb may be low)
group and save
clotting studies
U&E’s
LFTs
CT of paranasal sinuses
how to manage it (adults) if no major haemorrhage
Ask the patient to lean forward but remain upright and firmly pinch the soft part of the nose compressing both nostrils (and possible anterior bleeding sites) for at least 10 minutes.
Encourage the patient to spit out, rather than swallow, any blood passing into the throat (blood is irritating to the stomach and may make the patient nauseous).
Provide an oral ice pack.
Alternative, practical options include an ice cube for the patient to suck, or applying an ice pack directly to the nose to reduce nasal blood flow.
managing a minor haemorrhage in children
child sits on parents lap and the parent can compress both nostrils for 10 mins
treatment
electrocautery or chemical cautery
anterior nasal packing]
referral to ENT specialist for posterior packing
