EPISTAXIS Bleeding from inside the nose

• Seen in all age groups• Presents as an emergency• Sign of an underlying disease

Kanika GuptaIII Year MBBSKasturba Medical College

Blood Supply of Nose

Causes of Epistaxis

LocalGener

alIdiopathic

Local• Trauma• Infections• Foreign Bodies

• Neoplasms• Atmospheric Changes

• Deviated Nasal Septum

• Adenoiditis

• Juvenile Angiofibroma

• Malignant Tumours

General

• CVS• Disorders of blood and blood vessels

• Liver disease

• Kidney disease

• Drugs• Mediastinal Compression

• Acute general infection

• Vicarious Menstruation

Idiopathic

• The cause of epistaxis is unknown

Classification Anterior Epistaxis More common Mostly from little’s

area or anterior part of lateral wall

Mostly occurs in children or young adults

The cause is mostly Trauma

Bleeding is usually mild and easily controlled

Posterior Epistaxis Less common Mostly from

posterosuperior part of nasal cavity (bleeding point difficult to localize)

Mostly >40 years of age

The cause is mainly due to hypertension or arteriosclerosis

Severe bleeding, hospitalization, postnasal pack

Sites of Epistaxiso Little’s area – site for 90% of the bleeding caseso Above middle turbinate – due to anterior and posterior ethmoidal arterieso Below middle turbinate – due to sphenopalatine arteryo Posterior nasal cavity – blood directly flows into the pharynxo Diffuse – bleeding occurs both from the septum and lateral wall and is usually seen in blood dyscrasiaso Nasopharynx

MANAGEMENT

Mode of onset Spontaneous/Trauma

Duration and Frequency of bleeding

Amount of blood loss

Site of bleedingBleeding tendencies in

familyKnown medical illness

History of drug intake

Patient made to

sit, record blood loss

during vomiiting or spitting

Reassure, mild sedatio

n

Check pulse, BP

and Respirati

on

Give blood

transfusion if

necesary

Antibiotics to

prevent Sinusitis

Intermittent

Oxygen +/-

Treat any underlying local/general cause

FIRST AID

Pinch the nose with thumb and index finger for about 5 minutes (Compresses vessels in little’s area)Trotter’s Method : Patient in sitting position, made to lean over a sink, spit blood and breathe quietly from mouthCold Compresses : Vasoconstriction

CAUTERIZATION

Chemical Cautery

ANTERIOR NASAL PACKING

•Clear the nose by suction

•Localise the bleeding site

•Profuse – Anterior nasal packing

POSTERIOR NASAL PACKING

ENDOSCOPIC CAUTERIZATION

ELEVATION OF MUCOPERICHONDRIAL

FLAP AND SMR

LIGATION OF VESSELS

External Carotid•Above the level of

superior thyroid

Maxillary Artery•Uncontrollable

bleeding•Caldwell-Luc

approach

Ethmoidal Arteries•Anterosuperior

bleeding, not controlled by packing

•Lynch Incision

TRANSNASAL ENDOSCOPIC

SPHENOPALATINE ARTERY LIGATION

(TESPAL)

EMBOLIZATION • Done by interventional radiologist• Femoral artery catheterization• Internal Maxillary Artery is embolized with gelfoam, polyvinyl alcohol or coils• Usually a safe procedure with some risks :• Cerebal Thromboembolism• Local haematoma

Ethmoidal arteries cannot be embolized

THANK YOU