This document discusses epistaxis (nosebleeds), including its definition, causes, pathophysiology, and management. It notes that nosebleeds can be anterior or posterior based on the source of bleeding within the nasal cavities and outlines the various blood vessels involved. Common causes include trauma, inflammation/infection, tumors, hypertension, and medications. Management involves first aid, cauterization, nasal packing, and potentially surgical intervention. Prevention focuses on controlling risk factors and avoiding behaviors that could cause trauma to nasal tissues.

2.  Definition of epistaxis
 Vasculatures of the nose
 Pathophysiology
 Etiology
 management

3.  Bleeding from
nostril, nasal cavity
or nasopharynx

4.  Fairly common and is
seen in all age Groups
 Epistaxis is a sign ,
NOT a disease
 It should never be
treated as a harmless
event.

5.  Superior part of the nose(Internal carotid artery)
› Ophthalmic artery
 Anterior ethmoidal artery
 Posterior ethmoidal artery
 Inferior part of the nose (External carotid artery)
› Maxillary artery
 Greater palatine artery
 Sphenopalatine artery
› Facial artery
 Superior labial artery vestibule of the nose

8.  Little’s area
 Anteroinferior part of the nasal septum
 Anastomosis between upper and lower
arteries
› Anterior ethmoidal artery
› Sphenopalatine artery
› Greater palatine artery
› Septal branch of superior labial artery

9.  Lateral wall of inferior meatus
 Blood vessels have very little muscle tissue
 within their walls, therefore hemostasis is poor
 Anastomosis between:
› Posterior pharnygeal artery
› Sphenopalatine artery

11.  Nosebleeds are caused by the rupture of
a blood vessel within the nasal mucosa.
 Rupture may be spontaneous or initiated
by trauma

12.  Epistaxis can be divided into 2 categories, anterior
bleeds and posterior bleeds

13.  There are multiple causes of epistaxis
which can be divided into local, systemic,
environmental, and medication induced

14.  Trauma
› Nose picking
› Facial and skull bone fractures
› Foreign body
› Iatrogenic trauma( e.g. nasal cannula)
› Hard blowing or violent sneeze

15.  deviated septum

16.  Inflammation/infection
› Bacterial, viral, and allergic rhinosinusitis.
 Tumors
› Benign- e.g. Nasopharyngeal Angiofibroma
Malignant –e.g. Squamous Cell Carcinoma

17.  Hypertension
› Hypertension is rarely a direct cause of
epistaxis.
› Stress and anxiety
can cause an acute
elevation of blood
pressure. Thus
nosebleeding

18.  Vascular abnormalities
E.g.Arteriosclerotic vascular disease
 coagulopathies
› Congenital- eg.Hemophilia
› Acquired-
 Hepatic cirrhosis
 Thrombocytopenia
 Vitamin K deficiency
 Anticoagulant therapy

19.  Dry air
 Cold weather
 allergies
Winter is
coming!!

20.  Anticoagulant(blood-thinning) medications
 Nonsteroidal anti-inflammatory drugs
 nasal drugs such as antihistamines and
corticosteroids

21.  The cause of epistaxis is not always readily
identifiable.

22.  In any case of epistaxis , it is important to know :
› Mode of onset
› Duration and frequency of bleeding
› Amount of blood loss
› Side of nose from where bleeding is occurring
› Type of bleeding
› History of medical aliment ( hypertension , leukemia ..)
› Any history of drug intake ( analgesic , anticoagulants and aspirin )

23. ❖ First aid and resuscitation
❖ Cauterization
❖ Nasal packing
❖ Surgical intervention
❖ Prevention

24.  Address ABC
 Little’s area- pinching the nose with thumb and
index ginger for about 5 minutes- compression
of vessels.
 Trotter’s method : patient is made to sit, leaning
a little forward over a basin to spit any blood,
and breathe quietly from mouth- cold
compresses should be applied to nose to
cause reflex vasoconstriction.

26.  Useful in anterior epistaxis.
 The area is first anaesthetized and the
bleeding point cauterized with a bead of silver
nitrate or coagulated with electrocautery.

27.  If bleeding is profuse and/or the site of
bleeding is difficult to localize, anterior
packing is done.
 For this, a ribbon gauze soaked with liquid
paraffin is used.
 About 1 meter gauze (2.5 cm wide in adults
and 12 mm in children) is required for each
nasal cavity.
 Pack can be removed after 24 hours if
bleeding has stopped.

29.  It is required for patients bleeding posteriorly into
the throat.
 This procedure is used if bleeding doesn't stop
after anterior packing
 Can be carried through different instrument
Gauze
Foley catheter
Double-balloon catheter

33.  • Indications:
› Bleeding continues despite adequate
packing and resuscitation
› Nasal anomaly (septal deviation)
› Patient’s refusal or intolerance to
packing

34.  a) External carotid artery
 b) Maxillary artery
 c) Ethmoidal arteries

35.  Bleeding from the ECA system may be
controlled with embolization.

36. Control of hypertension
Correction of bleeding disorders
Nasal saline sprays, ointment, vaseline
Avoid hard nose blowing or sneezing
 Sneeze with mouth open
Humidifier or vaporizers
Avoid nose picking
Control the use of medications