3 epistaxis transborneo
TRANSCRIPT
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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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Epistaxis- $anagement
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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Epistaxis- $anagement
STEP 3A: Anteriorpacking
&using
23 #ibbon gau5e
impregnated (it)bismut) iodo%ormparan paste :,IPP;
or antibiotic oitment+
C$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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Epistaxis- $anagement
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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Epistaxis- $anagement
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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Epistaxis- $anagement
E"bolisation 'one by I#
endo.ascular treatment o% epistaxis
t)roug) selecti.e embolisation )asemerged as t)e treatment
o% c)oice %or persistent+ intractable
epistaxis3
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EPISTAXIS- Surgical management
Options
a; Endoscopically
E"A endoscopic SPA ligation E"A I$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"