Transcript Epistaxis
Epistaxis
BY LIZ CHUI
UCI T-RAP
SS1 STUDENT PRESENTATION
Background
Epistaxis is another name for what is commonly
known as nose-bleeds
It is an acute hemorrhage from the nostril, nasal
cavity, or nasopharynx
Common ED complaint, but 90% of patients can be
treated with
Occurs up to 60% of general population, but rarely
leads to massive bleeding and death
•
Two sources
•Anterior (more
common)
•Posterior
(typically
common among
old patients)
Where does it happen?
Causes
Many different causes – locally, systemically, and
environmentally
Environmental causes include allergens and
humidity
Can also be idiopathtic
Common local causes
Chronic sinusitis
Epistaxis digitorum (nose picking)
Foreign bodies
Intranasal neoplasm or polyps
Irritants
Medications
Rhinitis
Trauma
Common systemic factors
Hemophilia
Hypertension
Leukemia
Liver disease (e.g., cirrhosis)
Medications
Platelet dysfunction/Thrombocytopenia
Treatment
Flow of blood normally stops when the blood clots
To encourage blood clotting
- Pinch the upper fleshy part of nose
- Do so for 5-20 minutes
- Tilt head forward can decrease the chance of nausea
and airway obstruction from swallowing blood
- Vasoconstrictive agents can also be used
- Other products available to promote coagulation
•Anterior nasal
cavity is packed
from posterior to
anterior with
ribbon gauze that
has petroleum jelly
•Bayonet forceps
and a nasal
speculum can be
used to
approximate
accordion folding of
gauze
•Each layer should
be pressed down
firmly before next
layer is added
Bayonet forceps
Nasal speculum
Packing when simple treatment
fails for anterior bleeding
• Done by
Otolaryngologist
•A catheter is
passed through the
nostril and through
the nasopharynx
and out the mouth
•A gauze pack is at
the end of the
catheter
•The gauze pack is
guide through the
mouth and into the
posterior nasal
cavity
Packing for posterior epitasis
Other treatments
Balloon packing
Cauterization of blood vessel
Laser therapy
Embolization
Prevention
Cooler house
Vaporizer to return
humidity and
moisture to the air
Nasal saline spray
and water soluable
jelly (especially for
winter months)
Avoid picking the nose
or blowing the nose
too vigorously.
Do not strain to bend
down or lift anything
too heavy.
References
http://www.aafp.org/afp/2005/0115/p305.html
http://www.cgdms.org/emergmed/cases/entblock1/
entblockcase1.html
http://www.nlm.nih.gov/medlineplus/ency/article/
003106.htm
http://my.clevelandclinic.org/disorders/nosebleed/
hic_nosebleed_epistaxis.aspx
http://www.medterms.com/script/main/art.asp?arti
clekey=3290