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Y3 - ENT > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

What is epistaxis?

A

Epistaxis is bleeding from the nose

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2
Q

How common is epistaxis?

A

Epistaxis is a commonly-found complaint, especially in fields of emergency medicine related to the treatment of ear, nose, and throat (ENT) conditions.

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3
Q

What is epistaxis caused by?

A

caused by damage to the blood vessels of the nasal mucosa.

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4
Q

Who is epistaxis most commonly found in?

A

Epistaxis more commonly occurs in children (ages 2–10) and older adults (ages 50–80)

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5
Q

How many types of epistaxis are there?

A

There are two types of epistaxis depending on their origin: anterior and posterior epistaxis.

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6
Q

What is anterior epistaxis?

A

Anterior epistaxis refers to a nosebleed that originates from the anterior (frontal) part of the nose.

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7
Q

Where does most of anterior epistaxis originate from?

A

. Most of the time, cases of anterior epistaxis originate from the Kiesselbach plexus, which is a vascular network found on the nasal septum, as these arteries can be easily traumatized.

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8
Q

Is anterior or posterior epistaxis more common?

A

Anterior

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9
Q

What is posterior epistaxis?

A

Posterior epistaxis refers to bleeding from the posterior or superior nasal cavity.

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10
Q

Where does posterior epistaxis usually originate from?

A

Most often, it originates from the Woodruff plexus, which is a vascular network found in the lateral wall of the nasal cavity.

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11
Q

Does posterior epistaxis usually involve one or both nostrils?

A

Posterior epistaxis usually involves both nostrils.

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12
Q

What is a complication with posterior epistaxis?

A

For these types of nosebleeds, the blood may also flow backwards and uncomfortably get swallowed or coughed up (hemoptysis).

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13
Q

What are the 4 categories of causes for epistaxis?

A
  1. Local
  2. Systemic
  3. Environmental
  4. Medication
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14
Q

What are some examples of local causes of epistaxis?

A
  1. Local trauma (Nose-picking)
  2. A foreign body in the nose
  3. Anatomic irregularities ( Deviated septum)
  4. Facial trauma
  5. incorrect or excessive use of topical nasal sprays
  6. Inflammatory reactions
  7. Rarely intranasal tumours
  8. Smoking and snorting illicit drugs
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15
Q

What are some examples of systemic causes of epistaxis?

A
  1. High BP
  2. Vascular malformations
  3. cardiovascular diseases
  4. Bleeding disorders such as von Willebrand disease and hemophilia A and B
  5. Heavy alcohol consumption (Disrupts normal blood clotting activity and dilates superficial blood vessels)
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16
Q

What are some examples of environmental factors that cause epistaxis?

A
  1. Change in temperature or humidity (More prone to rupturing in cold and dry environments)
  2. Allergies (Excessive blowing of nose)
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17
Q

What are some examples of medications that cause epistaxis?

A
  1. Blood thinners
  2. Anticoagulants
  3. Homeopathic medications (Ginseng and vitamin E)
18
Q

What does management of Epistaxis depend on?

A

the severity of the bleeding and the individual’s accompanying medical conditions.

19
Q

IS anterior or posterior epistaxis more easy to manage?

A

Anterior

20
Q

How would Epistaxis be treated at home?

A

The first step to stop a nosebleed is to apply direct pressure by pinching the tip of the nose using two fingers for 15 to 20 minutes. You can help prevent blood from reaching the throat by sitting up straight, slightly leaning forward and tilting your head a little forward.

21
Q

What if bleeding persists after pinching nose at home?

A

if bleeding persists, topical sprays containing vasoconstrictive medications or local anesthetics can help too.

22
Q

When should a patient attend the hospital presenting with epistaxis?

A

the nosebleed is severe, extended, causes difficulty breathing, makes you vomit due to swallowing a large amount of blood, was caused by a serious traumatic injury, or if a child under two years of age has a nosebleed

23
Q

How is anterior epistaxis usually managed in the hospital setting?

A

Simple medications used for treatment include topical vasoconstrictive nasal sprays (such as epinephrine, oxymetazoline, local anesthetics)

24
Q

How is posterior epistaxis usually managed in the hospital

A

posterior or anterior nasal packing is used

25
Q

What is nasalpacking?

A

Nasal packing involves inserting a gauze-like material or nasal tampon into the nasal cavity to absorb blood and provide pressure to the affected area.

26
Q

What complications can be found with nasal packing?

A

Infectious complications arising from nasal packing are uncommon and usually local. Rhinosinusitis can develop, but usually spontaneously heals after packing removal or a short course of antibiotics. Other bacterial systemic infections like toxic shock syndrome can occur.

27
Q

What is toxic shock syndrome via epistaxis treated by?

A

Toxic shock syndrome is treated by immediate removal of the nasal packing and any infected or necrotic tissue, as well as antibiotic therapy following a nasal culture

28
Q

How could you treat recurrent or persistent anterior epistaxis?

A

Cauterization

29
Q

What is cauterization?

A

burn the skin or flesh of (a wound) with a heated instrument or caustic substance in order to stop bleeding or to prevent infection however a silver nitrate swab should be tried before more advanced electrocautery is used.

30
Q

How do you prevent epistaxis?

A
  1. avoid nose-picking as much as possible, and try to keep your fingernails short.
    2.Try to not blow your nose too often, and only gently when you do, especially in winter time and during allergy seasons.
  2. If you’re taking cold or allergy medications, make sure you follow the instructions that come with the package.
    4.if you are taking part in any activities that can endanger the nose and head, make sure to wear proper protective headgear
  3. avoid excessive alcohol drinking and smoking
31
Q

What is a primary nose bleed?

A

Majority of bleeds, no clear and obvious cause

32
Q

What is a secondary nosebleed?

A

When there is a clearly identifiable factor

33
Q

Management of a serious nosebleed?

A

ABCDE resuscitation approach
Identify site of bleed.
1) Direct compression of nasal alae (cartilaginous part)
Most anterior bleeds resolve after 10-15 minutes of compression
Sit patient up and lean them forwards – minimise blood entering oral cavity and pharynx
2) Nasal cautery
Chemical (silver nitrate) or electrical (thermal)
3) Nasal packing (if cautery fails or severe bleeding)
Nasal tampons, inflatable packs, ribbon gauze impregnated with Vaseline)

34
Q

What is next management step if direct compression of nasal alae in a nosebleed does not work?

A

Nasal cautery

35
Q

What is next management step if direct compression of nasal cautery in a nosebleed does not work?

A

Nasal packing

36
Q

Complications of severe epistaxis?

A

Hypovolaemic shock
Aspiration
Intranasal adhesions
Mucosal damage from excessive cautery
Infected nasal packing

37
Q

Nasal trauma can result in a septal haematoma. What is this?

A

Bleeding under the perichondrium lining the septal cartilage

38
Q

What is the danger of a septal haematoma?

A

As the septal cartilage receives blood supply from the overlying mucosa, the haematoma can disrupt blood flow
Damage to septal cartilage can occur within 24 hours and if untreated → irreversible septal perforation and necrosis, saddle nose deformity

39
Q

A septal haematoma can lead to which nose deformity?

A

Saddle nose deformity

40
Q

3 major complications of nasal trauma?

A

Septal haematoma
Nasal obstruction e.g. due to septal deviation
Epistaxis

41
Q
A

Y3 - ENT (9 decks)

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