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