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EPISTAXIS Dr Gary Kroukamp
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Sites of bleeding Nasal Septum
- Little’s Area ~90% of epistaxis seen in hospitals ~vessel often visible - Rest of septum ~spurs, convexities (turbulent flow)
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Sites of bleeding
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Nasal cavities - blood supply
Rich supply from 2 branches of Common Carotid: Ext. Carotid - maxillary a. - most Int. Carotid - ethmoidal aa.- roof
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Osler-Weber-Rendu
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HYPERTENSION Is NOT a cause but contributes
Once epistaxis has occurred, it is more difficult to control in the presence of: - hypertension - tachycardia - raised venous pressure
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Management – immediate
Position Pressure Pulse / BP Cautery Packing
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5 minute pressure
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Incorrect
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Management - immediate
Cautery - clear nose - suction -“hawk” - inspect - bleeding vessel - local / vasoconstrictor (cocaine) - cauterise - AgNO3 - electro-
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Packing - anterior local anaesthetic BIPP impregnated gauze in layers
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Packing - posterior Inflatable balloons Saline better than air
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