Nose Flashcards
(29 cards)
What are the sources of bleeding in epistaxis?
Branches of:
Internal Carotid: Ant & post ethmoid artery
External carotid: Sphenopalatine & branches of internal maxillary artery
What are the sources of bleeding in an anterior haemorrhage?
Source of bleeding visible in 95% cases- Usually nasal septum (Little’s area- Kiesselbach’s plexus forms)
What are the sources of bleeding in a posterior haemorrhage?
Deeper structures of nose- large volume and ↑risk of airway compromise
What are the risk factors for epistaxis?
Trauma Insertion of foreign bodies Thrombocytopenia Splenomegaly Drugs (Aspirin, Anti-coag, Cocaine) Malignancy Granulomatosis w/polyangitis
Who is most likely to have a posterior haemorrhage?
Commonly in elderly
How can an anterior or posterior haemorrhage be deduced from the patients history?
Blood running out of NOSE + ONE nostril = Anterior
Blood running into THROAT + BOTH nostrils = Posterior
What are key things to ask about in a epistaxis history?
Trauma: Nose picking PMH: Drugs, HTN, Clotting disorders Prev nasal surgery Facial pain or otalgia Nasal obstruction, headache, anosmia, rhinorrhoea
What are the signs of juvenile angiofibroma?
Nasal obstruction
Headache
Rhinorrhoea
Anosmia
What are the red flags for nasopharyngeal cancer?
Facial pain
Otalgia
What bloods might need doing in a severe nosebleed?
FBC (↓Hb)
Group & Save
Cross match
How is a nosebleed managed?
MILD: Sit patient up + forward Squeeze bottom of nose for 10-20mins Breathe through mouth Encourage spitting out blood & clots Monitor BP & HR Inspect: Once bleeding stops (w/nasal speculum)
Consider: Cautery (Silver nitrate)
SEVERE: Resus Anterior pack THEN Postnasal pack after 24hours Inject Tranexamic acid
What should be done if a nosebleed starts to rebleed?
Apply ice & pinch
What should be avoided post-epistaxis?
Bending
Sneezing
Lifting
Pick or blowing nose
How is a nasal # treated?
UNDISPLACED: No Tx
DISPLACED: Reduction, septoplasty if traumatic
How is a nasal # reduced?
1) Reduction under LA/GA w/splint- best within 2weeks
2) Ice = 12hrs post-op
3) Sleep w/head elevated
What are the risk factors for septal perforation?
Surgery Nose picking Piercings Cocaine Malignancy (rodent ulcer) Nasal sprays Chronic granulomatous disease (TB, Sarcoid)
What are the Sx of a septal perforation?
Whistle noise!!
Crust
Epistaxis
How is a septal perforation treated?
1) Rhinoplasty
2) Saline douche (for crusts)
3) Silastic buttons (occlude hole)
How does CSF rhinorrhoea occur?
Ethmoid/basal skull fracture!!!
Disruption of dura & arachnoid = CSF leak
How is rhinorrhoea tested to check if it is CSF?
Send CSF to lab for B2 transferrin = GOLD STANDARD
Dipstick: +ve for glucose
How is CSF rhinorrhoea treated?
Conservative:
Bed rest- resolves 7-10days
Abx cover
Pneumococcal vaccine
How are foreign bodies removed from noses?
1) Forceps
2) 2.5% Cocaine spray: AVOID IN CHILDREN- can shrink mucosa to allow suction
What object needs URGENT removal in any part of the ENT tract?
Batteries
Where are nasal polyps typically found?
Clefts of middle meatus
Arising from nasal mucosa
