3 epistaxis transborneo

7/23/2019 3 Epistaxis Transborneo

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EPISTAXIS


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Common

Afects all age group

Nose supplied by internal andexternal carotid arteries


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AETIOLO!


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LOCAL CA"SES

T#A"$A

%ractures Sel%&

induced

NASAL'#!NESS

Lo()umidity

Cold

IN*LA$$ATION

#)initis in%ection

IAT#OENIC

Nasal+ sinus+orbit surgery

Nasal spray

T"$O#

,enign - polyps

$alignant - NPC

,arometric c)anges

Suddenmo.ement to)ig) altitude


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#)inosinusitis/polyp pictures


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NPC pictures


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S!STE$IC CA"SES

'rugs 0aemop)ilia+ .on

(illebrand disease 0aematological

malignancy Li.er %ailure+ uraemia

COA"LOPAT0!

0ypertension/at)eroscl

erosis 00T1ASC"LA#


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$ANAE$ENT

23 *irst aids

43 Cauteri5ation

63 Nasal pac7ing83 Emboli5ation

93 External carotid ligation

:proceed to t)e next step i% t)e earlierone %ails;


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Epistaxis- $anagement

STEP 1: First aids

23 #elax< Stay calm

43 6=s > lo.es+ o(n ? oggles

63 #esuscitate i% necessary :A,C;83 Patient s)ould be sitting up ? bending %or(ard

93 Apply direct pressure %or 2@mins& pinc)cartilaginous part o% nose+ not t)e incompressible

nasal bones3 ,reat) t)roug) mout)+ spit blood/sali.a into bo(l3

Ensure blood not s(allo(ed

B3 Ice pac7 o.er t)e dorsum o% nose may )elp


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Applying directpressure to t)enose

A > Incorrect

, > Correct


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In t)e mean time- get 0ISTO#! uanti%y+ c)aracteristic+ duration

Any signs/symptoms o% anemia

TraumaD Nasal symptomsD

$edication

Social- cocaine/ alco)ol abuse

Lab test- *,C+ coag+ L*T+ S0/X$

Large bore branula/I1 lines


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Examine using good LI0TIN

S"CTION APPA#AT"S

SPEC"L"$

Loo7 %or source o% bleeding : anterior+

posterior or bot);

,LEE'IN SO"#CE I'ENTI*IE'DD


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Epistaxis- $anagementSTEP 2: Cauterization23 C)emical cautery- sil.er nitrate/tric)loroacetic acid O#

electrocautery units

43 Explain t)e procedure to t)e patient

63 Inspect nasal ca.ity+ clear out blood/clots

83 Spray nasal ca.ity (it) lidocaine :anaest)esia; ?p)enylep)rine :.asoconstrictor; > to s)rin7 nasal mucosa+remain in place %or 29mins

93 Ensure adeuate illumination

3 Identi%y bleeding points

B3 Apply t)e cautery %or F 2@ seconds

-. Tip o% sil.er nitrate stic7 is rolled o.er mucosa until a grayesc)ar %orms

-. Electrocautery de.ice reser.ed %or aggressi.e bleeding+done under LA or A


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I% t)e source is not identiGedDD

,leeding too pro%useH


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STEP 3A: Anteriorpacking

&using

23 #ibbon gau5e

impregnated (it)bismut) iodo%ormparan paste :,IPP;

or antibiotic oitment+

C$C 43 nasal tampon

:eg-rapid r)ino+ merocel;

Adrenaline not ad.isable


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,IPP picture


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0OJ TO PACK

Ribbon gauzepacking

Pic7 t)e gau5e (it)%orceps F 2@&29 cm %rom

t)e tip Pac7 t)e nasal ca.ity

starting %rom t)e oorup(ards+ layering it untilt)e ca.ity roo% is reac)ed

,ot) ends o% t)e ribbongau5e s)ould protrude%rom t)e nostril

Secure t)e gau5e


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Merocel packing Lubricate t)e $erocel

pac7 (it) K! Melly orNaseptin cream

Insert t)e pac7 alongt)e oor o% nasal ca.ity

Pac7 t)e ot)er side as(ell i% in.ol.e bot)

Secure t)e string to t)ec)ee7 (it) tape

Once (et (it) blood+ itexpands to Gll t)e nasalca.ity


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Nasal tampon picture

Merocel Rapid Rino


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Still bleeding despite adeuateanterior pac7ingDD J)ats nextDD


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STEP 3!: postnasalpacking

,rig)tonballoon

Simpsonballoon

*oleycat)eter


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PICT"#ES

STEP 3!: postnasal packing

#emo.e t)e anterior pac7 and re&examine t)e nasal ca.ity3 'o suction()en reuired3Jit) t)e patient breat)ing t)roug) mout)+ insert t)e cat)eter )ori5ontallyalong t)e nasal oorOnce t)e tip passes beyond t)e palate into t)e OP+ inate t)e balloon toGt in t)e posterior c)oanaently pull t)e cat)eter %or(ard until resistance %elt


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*urt)er management33

Nasal pac7- 7ept 8 )rs

Antibiotics

C#I, Correct t)e underlying pat)ology

Control ,P

Correct coagulopat)y


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#emo.al o% nasal pac733

A%ter remo.al+ obser.e in (ard t)enarrange %or diagnostic endoscopy

I% re&bleed+ repac7 and arrange %orangiograp)y /& emboli5ation :i%a.ailable;


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E"bolisation 'one by I#

endo.ascular treatment o% epistaxis

t)roug) selecti.e embolisation )asemerged as t)e treatment

o% c)oice %or persistent+ intractable

epistaxis3


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EPISTAXIS- Surgical management

Options

a; Endoscopically

E"A endoscopic SPA ligation E"A I$AX ligation

b; Open

External caratid artery ligation


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I% t)e bleeding is %rom a tumour+t)ere s al(ays an option o%)emostatic #T


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Pope, L E R et al. Postgrad Med J 2005;81:309-314


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T0ANK !O"

3 epistaxis transborneo

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