refleksi epistaxis
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Epistaxis
Ng Xiang Wei08/273673/KU/12915
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Identitas Pasien
Nama : S
Jenis kelamin : Perempuan
Umur : 24 tahunAlamat : Purworejo
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Keluhan Utama
Hidung kiri keluar darah
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Riwayat Penyakit Sekarang
Pagi tadi pasien mengeluh hidung kirikeluar darah setelah pasien bersin. Darahkurang dari satu sendok teh dan bercampurdengan lendir. Sekarang pendarahan sudahberhenti.
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Riwayat Penyakit Dahulu
Sering batuk pilek, alergi debu dan dingin(+), trauma (-), penyakit darah (-)
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Epistaxis
Bleeding inside the nose
Sign of local or constitutional cause
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Blood supply of the nose
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Littles Area
Anterior inferior part of nasal septum
4 arteries: anterior ethmoidal, septalbranch of superior labial, septal branchof
sphenopalatine and greater palatineanastomoseKiesselbachs plexus
Subject to drying effect of inspiratory
current and finger nail trauma Usual site for epistaxis in children and
yound adults
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Retrocolumellar vein
Common site of venous bleeding in youngpeople
Vein runs vertically downwards justbehind columella, cross the floor of noseand join venous plexus on lateral nasalwall
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Woodruffs Area
Under posterior end of turbinate wheresphenopalatine artery anastomoses withposterior pharyngeal artery
Site of posterior epistaxis
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Causes
Local
General
Idiopathic
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Local
Nose1. Trauma2. Infections3. Foreign bodies
4. Neoplasms of nose and paranasal sinuses5. Atmospheric changes6. Deviated nasal septumNasopharynx
1. Adenoiditis2. Juveinile angiofibroma3. Malignant tumors
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General
1. Cardiovascular
2. Disease of blood
3. Liver disease
4. Kidney disease
5. Drugs
6. Mediastinal compression
7. Acute general infection
8. Vicarious menstruation
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Sites of Epistaxis
1. Littles area: 90%
2. Above level of middle turbinate on septum
3. Below the level of middle turbinate onseptum
4. Posterior part of nasal cavity
5. Diffuse (both septum and lateral nasal wall)
6. Nasopharynx
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Classification
Anterior epistaxis
Blood flows out from front of nose in sittingposition
Posterior epistaxis
Blood flows back into throat, coffee coloredvomitus
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1. Mode of onset
2. Duration and frequency of bleeding3. Amount of blood loss
4. Side of nose where bleeding occurs
5. Bleeding is anterior or posterior type6. Bleeding tendency in patient
7. Medical history (HT, leukaemia, mitralvalve disease, cirrhosis, nephritis)
8. Drug intake (analgesics, anticoagulants,etc)
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First Aid
Pinching nose with thumb and indexfinger for 5 mins
Trotters method
Cold compress
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Management
1. In active bleeding, clear blood clot in nose bysuction and localise bleeding site.
2. In minor bleeds from accessible sites, mayuse cauterisation.
3. If bleeding is profuse and/or site of bleedingdifficult to localise anterior nose packing.
4. Pack can be removed after 24 hours. If it has
to be kept for 2-3 days, give systemicantibiotics.5. Posterior nasal packing for posterior
bleeding.
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Cauterisation
Silver nitrate
Electrocautery
Endoscopic cautery (posterior bleeding)
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Anterior Nasal Packing
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Posterior Nasal Packing
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Epistaxis balloon
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