Hospital threatment of epistaxis

1. HOSPITALNI TRETMAN
EPISTAKSE

2. ANGIOGRAPHIC EMBOLISATION
FOR THE TREATMENT OF
EPISTAXIS: A REVIEW OF 108
CASES, Elden, Montanera, Terbrugge,
Willinsky, Lasjaunias, Charles
Otolaryngol head neck surg 1994,
Toronto/Le Kremlin Bicetre, France

3. • MENAGMENT OF
EPISTAXIS IN THE
ORAL AND
MAXILLOFACIAL
SURGERY SETTING:
AN UPDATE ON
CURRENT PRACTICE
Mahmood, Lowe
Oral Surg Oral Med
Oral Pathol Oral Endod
2003
Glasgow Scotland

4. UVOD
• PREDNJA EPISTAKSA
• STRAŽNJA EPISTAKSA:
stražnja tamponada
• 26 – 52% neuspjeha
• Komplikacije: alarna i
septalna nekroza,
tamponadom inducirana
hipoksija, aspiracija, otitis,
sinuitis, diskomfort
• Infarkt miokarda, moždani
udar, iznenadna smrt, toxic
shock sy, sleep apnea

5. ANGIOGRAFSKA
EMBOLIZACIJA
• Embolizirati što
distalnije
• Pitanje anastomoze
između arterije karotis
eksterne i arterije
karotis interne
• Slijepoća i moždani
udar

6. METODE
• 1984-1992
• 97 hosp. Pacijenata
• 108 embolizacija
• 2:1 muški/žene
• 53 godine
• 12 do 91
• Većina pacijenata
po prednjoj/stražnjoj
tamponadi
• Po uklanjanju ili
nezaustavljivo
unatoč
• 3 pacijenta samo s
prednjom; stari i
nemoćni

7. • 1 podvezivanje a. ethmoidalis ant
• 1 septoplastika
• Nekoliko pacijenata s Osler Weber Rendu
imalo je u neimedijatnoj anamnezi
podvezivanje maksilarne ili karotis externe
• 16 pacijenata elektivno, zbog rekurirajućih
epistaksi

8. • 5,8 : bolnički dani pred embolizaciju
• Mutiple transfuzije krvi
• 20% pacijenata s hemoglobinom ispod
10 gm/ml
• 50% potencirana anestezija
• 50% opća

9. • 2,7 f: superselektivna
• A. Maxillaris int. bilaterlano,
transfemoralni pristup
• 1/3 pac. a. facialis, kolaterale
• A. pharyngica asc. u jednom slučaju
• U angiografskoj sali odstranjena
tamponada

13. NIJE BILO LOŠIJE

19. ZAKLJUČAK
• Osler Rendu Weber- samo u hitnosti
• Embolizacija je visokoučinkovita metoda
po neuspjeloj tamponadi
• može zamijeniti kirurgiju
• elektivno u selektiranim slučajevima
____________________________________

20. Rodos: tamponadu izbaciti kod iole ozbiljnijeg
krvarenja:
kirugija/endoskopija ( a sphenopalatina, a.
ethmoidalis ant, a. maxillaris)

21. Arch Otolaryngol Head Neck Surg.
1999 Jun;125(6):686-90. New modification of hot-water
irrigation in the treatment of posterior
epistaxis. Stangerup SE, Dommerby H, Siim C, Kemp L,
Stage J.

22. Kooperabilnost
Aspiracija
2 minute
55/44 %
2,9/4 dana

23. 1. Ann Otol Rhinol Laryngol. 2003 May;112(5):410-4.
Effect of modern fibrin glue on bleeding after tonsillectomy and
adenoidectomy.Vaiman M, Eviatar E, Shlamkovich N, Segal S.
2.Oral Surg Oral Med Oral Pathol. 1993 Mar;75(3):280-2.
Dental extractions in patients with bleeding disorders. The use of fibrin
glue.
Rakocz M, Mazar A, Varon D, Spierer S, Blinder D, Martinowitz U.
3.Otolaryngol Head Neck Surg. 2002 Apr;126(4):388-91.
Effectiveness of second-generation fibrin glue in endonasal operations.
Vaiman M, Eviatar E, Segal S.
4.Rhinology. 2002 Dec;40(4):185-8.
The use of fibrin glue as hemostatic in endonasal operations: a prospective,
randomized study.
Vaiman M, Eviatar E, Segal S.
5.Clin Otolaryngol. 2001 Aug;26(4):284-5.
The use of fibrin glue in refractory coagulopathic epistaxis.
Walshe P, Harkin C, Murphy S, Shah C, Curran A, McShane D.
Tallaght Hospital, Dublin, Ireland.
6. Rhinology. 2002 Jun;40(2):88-91.
Fibrin glue treatment for epistaxis.
Vaiman M, Segal S, Eviatar E.

24. • 1912 Dr. W.G.Jefferson, Portland Me. wrote the
"Declaration at Principles"
• A 81 EPISTAXIS.Catarrhal patients are subject to
postnasal ulceration which results in local hyperemia and
hemorrhage, and thefollowing has never failed to control
it: Ammonium Carbonate one dram, Sp. Bella. Gtt 5.
Water 4 ounces, Giveone dram every 2 or 3 hours
• B 24 VICARIOUS MENSTRUATION.For epistaxis as
vicarious menstruation, if not caused from catching cold
during menses, give Tr. Bryonia tenminims in four ounces
of water, teaspoonful every hour

25. • Sigmund Freud's relationship with Wilhelm Fliess,
the nose and throat physician who was his closest
friend during the years Freud was formulating his
new theories.
• Fliess sent Freud a paper entitled "Die nasale
Reflexneurose" ("The Nasal Reflex Neurosis"),
which he intended to deliver at the 12th Congress
for Internal Medicine, in Wiesbaden, in June of
1893
• Fliess went on to say that masturbation altered
the left middle turbinate bone in its frontal
third, and that therefore he had decided to call this
spot the "stomach-ache spot." He added that
hemorrhages from the nose were well known
among women who masturbated (die Epistaxis
der Onanisten ist ganz bekannt).

26. TORQUEMADA
• “ ISTODOBNO ČIŠĆENJE SPOLNE I
TJELESNE NEČISTI KROZ NOS MOŽE
BITI SAMO DIJELO NEČASTIVOG”

27. TOMAS TORQUEMADA
INKVIZITOR

28. Dr. MIRKO IVKIĆ
MENTOR
Mr. Dražen Shejbal
SPECIJALIZANT