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Common
Affects all age group
Nose supplied by internal and
external carotid arteries
AETIOLOGY
LOCAL CAUSES
TRAUMA
NASAL
DRYNESS
fractures
Selfinduced
Low
humidity
Cold
Rhinitis
INFLAMMATIO
infection
N
Nasal, sinus,
IATROGEN orbit surgery
Nasal spray
IC
Benign : polyps
TUMOR
Malignant : NPC
Sudden
Barometri movement to
c changes high altitude
Rhinosinusitis/polyp pictures
NPC pictures
SYSTEMIC CAUSES
COAGULOPAT
HY
VASCULAR
Drugs
Haemophilia, von
willebrand disease
Haematological
malignancy
Liver failure, uraemia
Hypertension/atheroscl
erosis
HHT
MANAGEMENT
1.
2.
3.
4.
5.
First aids
Cauterization
Nasal packing
Embolization
External carotid ligation
Epistaxis: Management
STEP 1: First aids
1.
2.
3.
4.
5.
Epistaxis: Management
Applying direct
pressure to the
nose
A Incorrect
B Correct
Epistaxis: Management
STEP 2: Cauterization
1. Chemical cautery: silver nitrate/trichloroacetic acid OR
electrocautery units
2. Explain the procedure to the patient
3. Inspect nasal cavity, clear out blood/clots
4. Spray nasal cavity with lidocaine (anaesthesia) &
phenylephrine (vasoconstrictor) to shrink nasal mucosa,
remain in place for 15mins
5. Ensure adequate illumination
6. Identify bleeding points
7. Apply the cautery for ~ 10 seconds
-. Tip of silver nitrate stick is rolled over mucosa until a gray
eschar forms
-. Electrocautery device reserved for aggressive bleeding,
done under LA or GA
Epistaxis: Management
STEP 3A: Anterior
packing
-using
1. Ribbon gauze
impregnated with
bismuth iodoform
paraffin paste (BIPP)
or antibiotic oitment,
CMC
2. nasal tampon
(eg:rapid rhino, merocel)
Adrenaline not advisable
BIPP picture
HOW TO PACK
Ribbon gauze
packing
Pick the gauze with
forceps ~ 10-15 cm from
the tip
Pack the nasal cavity
starting from the floor
upwards, layering it until
the cavity roof is reached
Both ends of the ribbon
gauze should protrude
from the nostril
Secure the gauze
Epistaxis: Management
Merocel packing
Lubricate the Merocel
pack with KY jelly or
Naseptin cream
Insert the pack along
the floor of nasal cavity
Pack the other side as
well if involve both
Secure the string to the
cheek with tape
Once wet with blood, it
expands to fill the nasal
cavity
Rapid Rhino
Epistaxis: Management
STEP 3B: postnasal
packing
Brighton
balloon
Simpson
balloon
Foley
catheter
PICTURES
Further management..
Epistaxis: Management
Embolisation
Done by IR
endovascular treatment of epistaxis
through selective embolisation has
emerged as the treatment
of choice for persistent, intractable
epistaxis.
THANK YOU