This document provides an evaluation and management guide for epistaxis (nosebleeds) by Patrick Carter of the University of Michigan. It begins with an overview of the epidemiology, anatomy, pathology, etiology, and clinical evaluation of epistaxis. It then discusses management strategies for anterior and posterior epistaxis, as well as alternative therapies and complications of nasal packing. The goal is to inform healthcare workers on properly treating epistaxis.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
This presentation gives a lucid idea of causes of epistaxis, emergency treatment options and operative treatment of epistaxis, too.
Bleeding from inside the nose is called epistaxis
Fairly common and is seen in all age groups.
“Epistaxis refers to nose bleed or hemorrhage from the nose”.
It‘s mostly commonly originates in the anterior portion of the nasal cavity.
A hemorrhage from the nose, referred to as epistaxis, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
Most commonly, the site is the anterior septum, where three major blood vessels enter the nasal cavity:
(1) the anterior ethmoidal artery on the forward part of the roof (Kesselbach’s plexus)
(2) the sphenopalatine artery in the posterosuperior region, and
(3) the internal maxillary branches (the plexus of veins located at the back of the lateral wall under the inferior turbinate).
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students.
Epistaxis is one of the commonly encountered problem in day to day life by the otolaryngologists. Most of the times, it is mild , but sometimes, it is very difficult to manage and there may be mortality, too.
This presentation gives a lucid idea of causes of epistaxis, emergency treatment options and operative treatment of epistaxis, too.
Bleeding from inside the nose is called epistaxis
Fairly common and is seen in all age groups.
“Epistaxis refers to nose bleed or hemorrhage from the nose”.
It‘s mostly commonly originates in the anterior portion of the nasal cavity.
A hemorrhage from the nose, referred to as epistaxis, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
Most commonly, the site is the anterior septum, where three major blood vessels enter the nasal cavity:
(1) the anterior ethmoidal artery on the forward part of the roof (Kesselbach’s plexus)
(2) the sphenopalatine artery in the posterosuperior region, and
(3) the internal maxillary branches (the plexus of veins located at the back of the lateral wall under the inferior turbinate).
Coagulation: In medicine, the clotting of blood. The process by which the blood clots to form solid masses, or clots.
More than 30 types of cells and substances in blood affect clotting. The process is initiated by blood platelets. Platelets produce a substance that combines with calcium ions in the blood to form thromboplastin, which in turn converts the protein prothrombin into thrombin in a complex series of reactions. Thrombin, a proteolytic enzyme, converts fibrinogen, a protein substance, into fibrin, an insoluble protein that forms an intricate network of minute threadlike structures called fibrils and causes the blood plasma to gel. The blood cells and plasma are enmeshed in the network of fibrils to form the clot.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Emergency Management of Ano-Rectal Disorders - Resident Training Open.Michigan
This is a lecture by Dr. Joseph Hartmann from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Emergency Management of Ano-Rectal Disorders: Resident TrainingOpen.Michigan
This is a lecture by Dr. Joseph Hartmann from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- A Pain in the Neck- Resident TrainingOpen.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
05.26.09(b): Development of the Respiratory System and DiaphragmOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M1 Embryology sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1Embryology
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Central Nervous System InfectionsOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Slideshow is from the University of Michigan Medical School's M2 Respiratory sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Resp
This is a lecture by Dr. Joseph Hartmann from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Oral and Facial Infections- Resident TrainingOpen.Michigan
This is a lecture by Dr. Shannon Langston from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: ENT Case Files: Resident Training Open.Michigan
This is a lecture by Dr. Matt Dawson and Dr. Zach Sturges from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- COPD in the Emergency Department- Resident TrainingOpen.Michigan
This is a lecture by Dr. Frank Madore from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Measles, Mumps, Rubella - for NursesOpen.Michigan
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Slideshow is from the University of Michigan Medical
School's M1 Embryology sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1Embryology
This is a lecture by Dr. Stuart Bradin from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Selected E.N.T. Emergencies Related to SepsisOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc.
This is a lecture by Ryan LaFollette, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Pneumonia in the ED: Resident TrainingOpen.Michigan
This is a lecture by Dr. Phil Bossart from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Similar to GEMC: Evaluation and Management of Epistaxis: Resident Training (20)
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
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Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
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Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
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• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
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GEMC: Evaluation and Management of Epistaxis: Resident Training
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Evaluation and Management of Epistaxis
Author(s): Patrick Carter (University of Michigan), 2008
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2
3. Patrick
Carter
University
of
Michigan
Department
of
Emergency
Medicine
July
8,
2008
Dan
Keezer
2002
(Flickr)
3
4. ObjecKves
ž
Epidemiology
ž
Review
of
Anatomy
ž
Pathology/EKology
ž
EvaluaKon
of
the
paKent
with
Epistaxis
ž
Management
ž Anterior
Epistaxis
ž Posterior
Epistaxis
ž AlternaKve
Therapies
ž ComplicaKons
of
Packing
4
5. Hippocrates
–
4th
Century
B.C.
Nosebleeds
occur
in
those
who
are
beginning
to
have
feelings
of
lust
or
who
are
geXng
the
signs
of
manliness
El
Bibliomata
2010
(Flickr)
5
6. Epidemiology
ž
60%
of
populaKon
with
at
least
one
nosebleed
ž
6-‐10%
will
require
medical
treatment
ž
1.6/10,000
will
require
admission
ž
Bimodal
age
distribuKon
ž
High
Incidence
<
10
y/o
ž 30%
of
all
children
0-‐5
y/o
ž 56%
of
all
children
6-‐10
y/o
ž
Second
peak:
45-‐65
y/o
ž
Bleeding
categories
ž Anterior
(90-‐95%)
ž Posterior
(5-‐10%)
Cult
Gigolo
2008
(Flickr)
6
11. Hereditary
Hemorrhagic
Telangiectasia
ž
Osler-‐Weber-‐Rendu
Disease
ž
First
described
in
1864
ž
Mucocutaneous
telangiectasias
+
AV
MalformaKon
ž
U.S.
Incidence
=
1/16,500
ž
Curacao
Criteria
ž
Recurrent
Epistaxis
(90%)
ž
Treatment
ž
Standard
therapies
ž
Surgical
intervenKon
Herbert
L.
Fred,
MD
and
Hendrik
A.
van
Dijk
(Wikimedia
Commons)
11
16. Digital
Pressure
(Trofer’s
Method)
ž
ApplicaKon
of
digital
pressure
over
Kiesselbach’s
plexus
for
at
least
15-‐20
minutes
Pinch
here
SuperFantasKc
16
17.
Merocel
Packing
ž
Nasal
Tampon
inserted
horizontally
aoer
lubricaKon
of
pack
with
bacitracin
or
KY-‐
Jelly
and
then
allowed
to
expand
aoer
saturaKon
with
normal
saline.
17
18. Rapid
Rhino
ž
Balloon
Catheter
coated
in
carbocymethylcellulose
mesh
which
acts
as
a
lubricant
and
platelet
aggregator.
ž
The
catheter
is
soaked
in
water
for
30
seconds
and
then
inserted
into
the
nose
along
the
base
of
the
nasopharynx.
ž The
cuff
is
then
inflated
with
air/water
unKl
it
provides
adequate
tamponade.
18
19. Formal
Anterior
Packing
ž
Pack
the
nasal
cavity
with
xeroform
ribbon
gauze
from
the
floor
upwards
in
an
accordion
fashion
using
a
bayonet
forceps
leaving
a
four
inch
tail
on
each
end
out
of
nares
19
21. TradiKonal
Posterior
Packing
1. Catheter
through
affected
nostril
and
through
the
nasopharynx
is
drawn
out
the
mouth
by
ring
forceps.
2. A
gauze
pack
is
secured
to
the
end
of
the
catheter
with
umbilical
tape
or
suture
material,
and
long
tails
protrude
from
the
mouth.
3.
The
gauze
pack
is
guided
through
the
mouth
and
around
the
soo
palate
4. The
gauze
pack
in
the
posterior
nasal
cavity
maintaining
tension
on
the
catheter
with
a
padded
clamp
or
firm
gauze
roll
placed
anterior
to
the
nostril.
21
23. ComplicaKons
of
Packing
ž
Failure
to
control
bleeding
ž
Toxic
Shock
Syndrome
ž
Blockage
of
Duct
drainage
ž
Nasovagal
Reflex
(Controversial)
ž
ObstrucKve
Sleep
Apnea
ž
Airway
obstrucKon
ž
Removal
can
cause
re-‐bleeding
ž
Pressure
necrosis
23
24. Summary
ž
Epistaxis
is
common
complaint
affecKng
60%
of
populaKon
at
some
point
in
lifeKme
ž Key
to
evaluaKon
is
differenKaKon
between
anterior
and
posterior
bleeding
source
ž Anterior
=
90-‐95
%
(from
Kiesselbach’s
plexus)
ž Posterior
=
5-‐10%
(from
sphenopalanKne
artery)
ž Consider
possible
causes
for
epistaxis
with
recurrent
or
difficult
to
control
nosebleeds
ž
Non-‐invasive
techniques
will
stop
the
majority
of
epistaxis
(Trofer’s
method,
cautery,
vasoconstricKve
compounds)
ž Difficulty
to
control
epistaxis
may
require
nasal
packing
ž Consider
anKbioKcs
while
packing
in
place
ž Posterior
nasal
bleeds
should
all
be
hospitalized
24
26. References
ž Alter,
Harrison.
Approach
to
the
adult
with
epistaxis.
www.uptodate.com.
Accessed
6/29/08.
ž Corry,
J.
Kucik
et
al.
Management
of
Epistaxis.
Am
Fam
Physician.
2005
Jan
15;
71
(2):305-‐311.
ž Leong,
SC
et
al.
No
Frills
Management
of
Epistaxis.
Emerg
Med
J.
2005;22:470-‐472.
ž Messner,
A.
EvaluaKon
of
epistaxis
in
Children.
www.uptodate.com.
Accessed
6/29/08.
ž Middleton,
P.
Epistaxis.
Emergency
Medicine
Australasia.
2004;
16:
428-‐440.
ž Pope,
LE
et
al.
Epistaxis:
An
update
on
Current
Management.
Postgraduate
Med
J.
2005;81:309-‐314.
ž TinKnelli,
J.
Emergency
Medicine:
Nasal
Emergencies.
McGraw-‐Hill.
2004.
1476-‐1479.
ž Viehweg
et
al.
Epistaxis:
Diagnosis
and
Treatment.
Journal
of
Oral
Maxillofacial
Surgery
2006;64:511-‐518.
26