5Common causes of epistaxis Child: nose picking, foreign body,exanthematous feverAdolescent: nasopharyngeal angiofibroma,trauma, sinusitisAdults: sinusitis, traumaElderly: hypertension, malignancy
6Common sites of epistaxis Little’s area (80-90 %): Kiesselbach’s arterial plexus at antero-inferior part of septal cartilage. Common in children.Woodruff’s venous (?) plexus: near posterior end of middle turbinate. Common in elderly, hypertensives.Retro-columellar vein: common in adults.
10Evaluation of pt. with epistaxis mode of onset, duration, frequency, amount, side, site, previous bleedingnasal trauma, purulent nasal dischargehypertension, hepatic diseases, family history of bleeding, bleeding from other sites, use of anticoagulants, aspirinmeasurement of pulse & blood pressure
12General treatment Record pulse & blood pressure Reassurance + bed rest in sitting posture with back restAdequate sedation (Diazepam)Inj. Ethamsylate 500 mg IV Q8HAmlodipine / Nifedipine for hypertensionIV fluids / blood transfusion for shock
13Anterior epistaxis Pinch nostrils + ice pack Bleeding continues Insert cotton pledgets soaked in 1: 1000 adrenaline in nasal cavityChemical cautery with AgNO3 or electrical cautery (if bleeder is localized) or anterior nasal packing
14Trotter’s method Elderly pt in sitting position, leaning forward, mouth open allowingbleeding to continue tillhypotension develops.May lead to coronarythrombosis + death.
32Posterior nasal packing Post nasal pack prepared by tying 3 ribbon gauze strips to piece of gauze roll2 Foley’s catheters passed through each nostril & their ends brought out via mouth2 ends of gauze strips attached to nasal pack tied to catheter tips & withdrawn from nose
33Posterior nasal packing Pack that follows ribbon gauze strips, is guided into nasopharynx with index finger.Anterior nasal packing done. 2 ribbon gauze strips tied over a gauze piece on columella.3rd gauze strip brought out from mouth & taped to cheek. Pack removed after hr.
34Antero-Posterior Nasal Packing with Foley’s catheter
441. Arterial ligation by external approach external carotid artery: ligated in neck, distal to superior thyroid arteryinternal maxillary artery: ligated in pterygo- palatine fossa (Caldwell-Luc opn)anterior or posterior ethmoidal artery: ligated in orbit (Lynch-Howarth incision)