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Epistaxis

Greek term “ epistazo” means to bleed from nose


Epistaxis

Blood supply of the nasal septum

Epistaxis

Woodruff`s plexus // posterior part of inf. Meatus

Kiesselbach`s plexus // ant. Part of the septum (Little`s area) 90%

Epidemiology

Lifelong incidence of epistaxis in general populations is about 60%
Fewer seek medical attendance
Peak incidence in children(2-5 yrs) & adult ( 50 -80 yrs).


AETIOLOGY
Aetiological factors
1.Idiopathic : 80%
2.Trauma : Digital, external nasal trauma or iatrogenic.
3.Coagulopathy : Idiopathic thrombocytopenia (ITP) Disseminated
intravascular coagulopathy (DIC) .
4.Drugs : Warfarin, aspirin, clopidogrel, (NSAIDs)
5.Chronic granulomatous disease : Wegener’s granuloma, sarcoidosis
6.Neoplastic: Angiofibroma, inverted papilloma, squamous cell cancer
7.Hereditary : Hereditary haemorrhagic telangiectasia (HHT), haemophilia,
Von Willebrand’s factor deficiency.

Aetiological associations

1.Septal abnormalities : Spurs, perforations
2.Alcohol
3.Hypertension


Epistaxis


Epistaxis


Evaluation and Management

History and Physical Exam
1. Age,
2. Amount of bl. loss ,onset duration,
intermittent or continuous , spontaneous or
induced, unilat or bilat. Bleeding from other site,
fainting , type of packs was previously used
indicate of severity .
3. Medical History and Blood disease ,blood
transfusion
4. Medications: antiplatelet , anticoagulants.
5. Social History: cocaine abuse, alcoholism, smoking
6. Family history , pregnancy
7. Toxin Exposure: ammonia, gasoline, phosphorus.
8. Other :trauma ,high altitude living ,allergy, sinusitis
rhinitis, URI

Physical Examination

• patient should sit up with body tilted forward
• initial attempt to stop bleeding by applying pressure to nasal alae for several minutes
• decongestant/anesthetic agents .
• adequate lighting, nasal speculum, suctions machine ,attempt to
localize active bleeding (examine for abrasions, foreign bodies,
masses, sign of infection …etc.).
general ex. : vital signs ,pallor ,jaundice, ecchymosis, malena, haematuria, haemoptysis
• for chronic or recurrent epistaxis without an obvious bleeding source
patient should undergo an endoscopic exam


Investigations:
C.B.F. , E.S.R. , B/ FILM
Proth. time, partial thromboplastin time ,bleeding time and clotting time.
Liver enzymes( Liver function tests).
S. Fibrinogen ,ferritin .
Blood group
Clotting factors.
Renal function tests

Management

Control significant bleeding before lengthily history
Steps:
1- first aids and resuscitations
2- localization of bleeding
3- control bleeding
4- assess blood loss.
5- prevention

First aids & resuscitation

ABC
Neck should not be hyperextend to prevent blood flow into the stomach or possible aspiration.
Trotter`s method:
-- blood in mouth should not be swallowed.
-- mouth breathing.
-- direct pressure over the cartilaginous part of the nose for 5minutes is
usually sufficient
-- gauze moisten with epinephrine may be placed to promote
vasoconstriction



applying of pledge socked with anesthetic-vasoconstrictor solution into nasal cavity to anesthetize and shrink the mucosa.
Localization the site of bleeding ..
Cauterize the bleeding point with silver nitrate stick under L/A or electrocautery under local or general anesthesia.
If bleeding stops , blood sample should be sent for investigation and cross matching especially in sever cases.
Intravenous infusion to replace hypovolaemia
Antibiotics ,analgesia and sometime sedation may be essential.


Epistaxis




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رفعت المحاضرة من قبل: Mubark Wilkins
المشاهدات: لقد قام عضوان و 105 زائراً بقراءة هذه المحاضرة








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