Epistaxis

1. EPISTAXIS
1

2. Definition
 Epistaxis
is bleeding from the nose
2

3. CLASSIFICATION
3

4. I. According to site
 Anterior
 Superior;
Anterior ethmoid ( bleeding is
from above ant. half of middle turbinate)
 Inferior; Greater palatine,
 Posterior; Sphenopalatine (Bleeding is
from below anterior half of middle
turbinate
4

5. II. PRIMARY
&
SECONDARY
5

6. III. According to Etiology
 Local
Causes:
[1] Trauma
– Nose picking,
– fractures.
6

7. LITTLE'S ( KIESSELBACH'S)
AREA
1/2
inch from the caudal border
of the septum antero-inferiorly.
Vessels anastomosing are;
Anterior ethmoid, greater
palatine, and sphenopalatine,
and septal branch of superior
labial.
7

8. Little’s area
 Confluence
of :
– Anterior Ethmoidal
a.
– Greater Palatine
a.
– Sphenopalatine a.
– Sup. Labial a.
8

9. LOCAL CAUSES
[2] Infections:
 Viral:Influenza,
measles
 Diphtheria,
 lupus
vulgaris, leprosy,
 Parasites, maggots,
 fungal
9

10. LOCAL CAUSES
[3] Idiopathic:
Wegner's granulomatosis,
 Osler-Weber-Rendau's syn.,
 atrophic rhinitis

10

11. LOCAL CAUSES
[4] Neoplasms:
Of the
Carcinom of the Nasopharynx
– nose,
– nasopharynx and
– sinuses.
Angiofibroma
11

12. Local Causes
Congenital
 Multiple telangiectases (Osler’s disease)
are characterised by multiple capillary
hemangioma’s in the nose and tongue.
12

13. Local Causes
[4] Miscellaneous:

Septal spur,

foreign bodies
13

14. General Causes
 Hypertension,
 CCF,
mitral stenosis,
 Cirrhosis,
 coagulopathies,
 anemias, purpura, leukemias,
14

15. General Causes
 Malignancies,
 Caissons'
disease,
 Endometriosis,
 Nephritis,
 Typhoid
15

16. Clinical features
 Bleeding
from the nose
 Anterior and posterior bleeding
 Continuous or intermittent bleeding
 Hemoptysis or Heametemesis
 Anxiety
 Shock in case of severe epistaxis
16

17. Investigations
 BP
Monitoring
 Radiography
 Endoscopy of nose
and paranasal sinus
 Biopsy
 CBC,
Bleeding profile, BT,
CT, PT, APTT,
Platelets
 Hb.

17

18. II. TREATMENT
 First
aid
 Definitive treatment
 Prevention of recurrences
18

19. FIRST AID
– Trotter’s procedure
Make the patient sit up,
pinch nose, open mouth
and breath.
– Ice or cold application
on the bridges of the
nose.
– Pinching the nose for a
minute.
19

20. DEFINITIVE TREATMENT
Look into the nose.
 Assess blood loss.
– Crystalloids or colloids
– Transfusion
 Locate the point after packing the nose with 4% xylocaine
and 1:1000 adrenaline mixture

20

21. CAUTERIZATION
1) Chemicals;
 Silver
Nitrate stick, chromic acid
bead.
2) Electrical

Apply ointment and advise against
blowing and nose picking.
21

22. ANTERIOR PACKING
Unable to control
bleeding.
 Ribbon, tampon,
splints.


23. 23

24. 24

25. POSTERIOR PACKING
Posterior packing if bleed is posterior.
 GA.
 Foley's or other inflatable devices
 Removed as soon as possible.
 Antibiotics.
 Transfuse.
 Blood gases in children.

25

26. Lubricants
 Ointment,
vaseline, ghee, oil or
butter prevents crust formation
26

27. Systemic management
 Antihypertensives
 Replace
blood
 Fresh blood transfusion
 Antibiotics
 Sedatives
27

28. Surgical Management
 Ligation
of external carotid artery,
maxillary (Caldwell-Luc operation)
or anterior ethmoidal artery.
 Sub-mucous resection (SMR) or
septoplasty.
28

29. Complications
Infection,
loose
pack obstructing airway.
29

30. SPECIAL CASES
 Haemophilia;
– Replace factor VIII, or fresh blood.
 Other
clotting deficiency;
– FFP.
 Purpura;
– Platelets
30

31. SPECIAL CASES
 Anticoagulants;
– Stop drug, or titrate.
– Heparin is reversed with protamine
sulphate,
– warfarin with vitamin K
 Unconscious
head injury;
– Dangerous to pack in suspected skull
#.
 Telengiectasia;
– Septodermoplasty.
31

32. OTHER TREATMENTS
 Embolization
 Catheters
with iced water lavage
 2% lignocaine and adrenaline
injection in greater palatine foramen
32

33. Thank you.
33