1. EPISTAXIS
Dr Gary Kroukamp

2. Sites of bleeding Nasal Septum
- Little’s Area ~90% of epistaxis seen in hospitals
~vessel often visible
- Rest of septum
~spurs, convexities (turbulent flow)

3. Sites of bleeding

4. Nasal cavities - blood supply
Rich supply from 2 branches of Common Carotid:
Ext. Carotid - maxillary a. - most
Int. Carotid - ethmoidal aa.- roof

5. Osler-Weber-Rendu

6. 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

7. Management – immediate
Position
Pressure
Pulse / BP
Cautery
Packing

8. 5 minute pressure

9. Incorrect

10. Management - immediate
Cautery - clear nose - suction
-“hawk”
- inspect - bleeding vessel
- local / vasoconstrictor (cocaine)
- cauterise - AgNO3
- electro-

11. Packing - anterior
local anaesthetic
BIPP impregnated gauze in layers

12. Packing - posterior
Inflatable balloons
Saline better than air