This document discusses acute hemorrhage from the nasal cavity or nasopharynx. It begins by defining the condition and describing the arterial blood supply to an area called Little's area, which is the usual site of epistaxis in children and young adults. It then discusses the causes of epistaxis including local factors like nose picking, trauma, or tumors, as well as general factors like blood disorders, medications, or cardiovascular issues. It classifies epistaxis as anterior or posterior based on location and risk factors. The management section outlines assessing the patient's history, examining the nose, and providing first aid like pinching the nose. Treatment options are discussed like cauterization, anterior or posterior nasal packing, or arterial

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2. DEFINITION
ACUTE HAEMORRHAGE FROM THE NOSTRIL, NASAL CAVITY OR
NASOPHARYNX

3. ARTERIAL BLOOD SUPPLY
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Little’s area :
• Four arteries-anterior ethmoidal,
septal branch of superior labial, septal
branch of sphenopalatine and the
greater palatine, anastomose here to
form a vascular plexus called
“Kiesselbach’s plexus”.
This area is exposed to the drying
effect of inspiratory current and to
finger nail trauma, and is the usual
site for epistaxis in children and young
adults.

4. CAUSES
• LOCAL
• GENERAL
• IDIOPATHIC 4

5. LOCAL
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• Hereditary haemorrhagic telengectasiaCongenital
• Nose picking
• Fracture
• Foreign body
Traumatic
• Rhinitis
• SinusitisInflammatory
• Benign
• Malignant
Tumors
• Deviated nasal
septum
Septal

6. GENERAL
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Blood
Hepatic
Cardiovascula
Drugs
Temperature

7. CLASSIFICATION
Anterior
Posterior
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Anterior Posterior
Incidence More common Less common
Site Anterior inferior part of nasal cavity Posterior superior part of nasal cavity
Age Children or young adult After 40 years of age
Cause
Trauma
Idiopathic
Hypertension, atherosclerosis
Bleeding Mild Severe

10. MANAGEMENT
Primary Assessment
Treatment
Secondary Assessment 10

11. PRIMARY ASSESSMENT
• Onset,course, duration
• Amount
• Known medical disease
• Drug intake
History
• Side
• Site
• Local cause
Nasal Examination
• Vital signs
• General cause of
General
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12. TREATMENT
First aid
 Place the patient in sitting and leaning forward position
 Pinch the nose for 5 minutes
 Apply cold compressions if available
 Use topical vasoconstrictor
Cauterization
 Chemical cautery – silver nitrate
 Electrocautery
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13. Anterior nasal pack
Indication : profuse or unidentifiable site of
bleeding, failed cauterization
Method :
• Ribbon gauze impregnated with Vaseline
• 1m gauze is required for each nasal cavity. First
few cm of gauze are folded upon itself and
inserted along the floor and the whole cavity is
packed tightly by layering the gauze from floor
to roof
• One or both cavity may need to be packed
• Remove after 48 hours
• Antibiotics
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Posterior nasal pack
Inflatable Balloon
Foley’s catheter
Gauze

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Endoscopic cautery
 For posterior bleeding point
Arterial ligation
Indication: severe bleeding with failed nasal packing
 Superior bleeding – Ethmoidal artery (ethmoidectomy approach)
 Posterior bleeding – Maxillary artery (trans maxillary sinus approach)
External carotid (cervical approach)
General
 Rest
 Sedative
 Coagulants and vitamin K

16. SECONDARY ASSESSMENT
History
Nasal and general examination
Investigations
 Coagulation profile
 Blood picture
 CT scan and MRI
 Biopsy
Treatment of cause 16

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