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ENT
18.Epistaxis
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
9 sections · 51 slides
Overview
- What this section teaches
- Why a nosebleed is never to be dismissed
- Epistaxis in three numbers
Where the blood comes from
The site of bleeding decides both the danger and the treatment
- The Kiesselbach plexus: the usual culprit
- Anterior versus posterior: the key divide
- A local red flag: the bleeding polyp
Why nosebleeds happen
Local problems in the nose versus whole-body disease showing through the nose
- Two families of cause
- Local causes of epistaxis (1 of 2)
- Local causes of epistaxis (2 of 2)
- Secondary causes (1 of 2)
- Secondary causes (2 of 2)
- Blood thinners: the modern common cause (DOACs)
- How kidney function stretches DOAC bleeding risk
Working out the cause
History, localizing the bleed, and checking the whole patient
- The diagnostic steps, in order
- Reading the site: what the location tells you
- Blood from the nose that did not start there
First response
Calm the patient, support the circulation, then stop the bleed locally
- Supportive measures for a severe nosebleed
- The simple first-aid manoeuvre
- The local toolkit for stopping a bleed
Local procedures
Cauterize the spot, or pack the nose to press it shut
- Cauterizing the Kiesselbach plexus
- Lasers: for recurrent, not acute, bleeding
- Anterior nasal packing and balloons
- The many packing materials available
- Anterior nasal packing and inflatable balloons
When bleeding will not stop
Endoscopic control, artery ligation, and embolization
- Endoscopic location and control
- Sphenopalatine artery (SPA) ligation
- Artery ligation and embolization sites in epistaxis
- Arteries and nerves around the sphenopalatine foramen
- Ethmoid arteries and the historical ligations
- Selective arterial embolization
- Posterior nasal packing (Bellocq)
- Dangers of packing — treat the pack with respect
Osler-Weber-Rendu disease
An inherited bleeding disease whose first sign is a nosebleed
- What hereditary hemorrhagic telangiectasia is
- Telangiectasias of the lips and nasal mucosa in HHT
- Curacao criteria: diagnosing HHT
- Interpreting the criteria and screening the patient
- Managing HHT nosebleeds
- HHT: bigger operations and drugs on the horizon
Bringing it together
The reasoning to carry into the emergency room
- Three principles to remember
- One-page summary of epistaxis
- A middle-aged patient on a DOAC has a heavy posterior nosebleed. Why does their kidney function matter?
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery