Epistaxis ( nose bleed)

Nosebleeds are very common in young children, affecting most at some time or another. From the outset, it is important to be aware that nosebleeds will often settle down on their own, sometimes requiring medical treatment, but that major underlying causes (blood clotting problems or abnormalities in the nose) are very rare.

1. Epistaxis PRESENTED BY PANKAJ SINGH RANA NURSE PRACTITIONER IN CRITICAL CARE

2. Introduction Epistaxis is common in children. In infant almost 30% of children. From 0 to 5 year old have epistaxis of nose bleed 56% for 6to10yr old children and 64% of 11to15yr old child.

3. definition When one or two small veins in the nose erupt the resulting condition is nosebleed or epistaxis Bleeding occur usually from anterior- inferior portion of the cartilaginous nasal septum due to run capillary vasculature in this zone know as little area or kiesselbach’s plexus.

4. Types of epistaxis: Recurrent Epistaxis: - in recurrent nose bleeds the episode of bloods happens only at certain periods of time. Recurrent nosebleed can be occur in seasonal patter. Its most happen when the weather get hot and dry . Constant Epistaxis:- this is type of nosebleed that happens for a longer period of time. The bleeding is continuously occur.( 45min )

5. Sudden epistaxis:- These are nosebleeds which could happen anytime of the day, regardless of the activity of the child. Whether the child resting or playing . Chronic epistaxis:- condition that are continuously experienced for more then 6month. Chronic bleeding happen as result of a chronic disease this include. Chronic liver or kidney disease, vascular malformation, long term use medication.

6. Heavy nosebleed:- heavy nosebleeds pertain to episodes where there is a significant amount of blood coming out of the nose. Only this type is seen immediate first aid treatment must be employed.

7. Causes The common causes of children are Major trauma Nose picking Foreign body in the nose Nasal injury Nasal polyp Rhinitis Nasal diphtheria Nasopharyngeal tumors Nasal spry abuse Hot summer month

8. Other systemic causes :- Leukemia Hemophilia Ingestion of aspirin Vitamin K deficiency Ca deficiency Nephritis Solar radiation Acute infections Thrombocytopenia

9. classification Anterior epistaxis More common Mostly from Little’s area or anterior part of lateral wall Mostly occurs in children or young adults Mostly trauma Usually mild, can be easily controlled by local pressure or anterior pack  Posterior epistaxis Less common Mostly from posterosuperior part of nasal cavity After 40 years of age Spontaneous ; often due to hypertension or arteriosclerosis Bleeding is severe, requires hospitalization; postnasal pack often required 

10. Sign & symptoms Signs of excessive blood loss include : dizziness weakness confusion fainting

11. Complication Hypotension Shock Anemia Secondary infection

12. Diagnostic evaluation Blood pressure Complete blood count Coagulation studies Angiography Endoscopy MRI X ray

13. Management First aid measures:- Keep the patient quiet Place the patient in a sitting position, leaning forward, semifowler position. Apply direct pressure by pinching the entire soft lower portion of the nose for 10 tom15min. Apply icepack to the nose and check area. Loosing clothes and giving reassurance. Partially insert a small gauze pad into the nose.

14. Bleeding nostril and apply digital pressure if bleeding continues. Take medical treatment if bleeding dose not stop.

15. Medical management:- Identification of bleeding sit by a nasal speculum or headlight. Little’s area- pinching the nose with thumb and index finger for about 5 minutes- compression of vessels

16. Trotter’s method

17. Nasal packing

18. Application of a vasoconstrictive agent . Cauterization Nasal packing

19. Electrocauterization

20. Anterior nasal bleeding:- Silver nitrate application gelform Electrocauterization Topical vasoconstrictor adrenaline(1:100) creaine (0.5%) phenylephrine Posterior nasal bleeding:- Posterior nasal packing imprognate with a vasoconstricting soluation .

21. Cotton tempon Suction to remove the blood clots Radiologic embolization of the artery Ligation of the internal maxillary artery.

22. Nursing management Monitor vital signs. Assisting in the control of bleeding . Provide tissue paper and cotton. To instructed child to avoid aspiration of blood. Nasal packing may alter respiration status so closely monitor respiratory rate, heart rate, rhythm, LOC Instruct the child to avoid vigorous nasal blowing, strenuous activity, or lifting straining for4-6 weak.

23. Also instructed to avoid nasal blowing or picking nose after nosebleed, Instructions to be given to the parents to apply lubricant to nasal septum twice daily to reduce dryness. Advice to were loose garments

24. CONCLUSION

25. Thanks to sayani mam for her guidance