2. Epistaxis

3. Epistaxis
Interact!
A mother walks in with a 2year old child whose nose is bleeding profusely
What questions will you ask?
How will you manage?
Here the speaker must interact with observers to see how practicioners are currently handling this situation

4. What to ask ? First time/ recurrent Bleeding tendency in the family
Foreign body insertion
Infectious (RTI )
H/o trauma /nasal picking
Use of drugs*
# ibuprofen ,aspirin, warfarin, clopidogrel, steroid sprays, anticoagulants

5. Classification of Epistaxis
Primary –no obvious cause
Mild – no hemodynamic alteration
Anterior : Kiesselbach’s plexus/Littles area
Seasonal : cold dry months
Unilateral : one nostril bleed
Secondary-cause present
Moderate to severe- hemodynamically unstable
Posterior : Woodruff's plexus
Perennial: throughout year
Bilateral : bleeds into throat or from both nostrils
This classification is just to help observers ask direct questions from patients for better triage

6. Evaluate History Airway , Breathing , Circulation
Hemodynamics – BP, O2, CRT,
Skin and retina – erythema, rash, petechial
The speaker must sensitize observers about the importance of vitals monitoring

7. Management

8. *ABC- Assess for hypovolemic shock (start IV fluids)
History of Active bleeding
ABC *
Pinch nostrils 5-20min child will be breathing through mouth
Ice pack
Apply Vasoconstrictors
Oxymethazoline one to two squirts into the bleeding side of the nose with 0.05 percent 
Refer
Steps in
Managing
epistaxis

9. When not to ignore ??

10. When to refer ? Recurrent epistaxis Uncontrollable epistaxis
Posterior epistaxis
Haemotympanum
Facial trauma
Polyps / tumors.

11. Some don’t’s
Don’t sneeze. If unavoidable, try to sneeze with the mouth open.
Don’t drink or eat anything hot for 24 hours after a nosebleed, hot drinks can expand the blood vessel in the lining of your nose and cause fresh Bleeding.
Don’t attempt to remove any packing applied by a doctor
Don’t lift heavy objects or attempt strenuous exercise for one week.
Don’t bathe with hot water for 24 hours
Don't underestimate the amount of blood that can be lost from epistaxis.