Epitaxis.pptx

Epitaxis

1. EPISTAXIS

2. DEFINITION Epistaxis refers to nose bleed or hemorrhage from the nose. It most commonly originates in the anterior portion of the nasal cavity.

3. ETIOLOGY 1. Local causes: a) Dryness leading to crust formation—bleeding occurs with removal of crusts by nose picking,rubbing,or blowing . b) Trauma—direct blows. 2. Systemic causes: Hypertension,arterio sclerosis, renal disease, bleeding disorders.  Hereditary hemorrhagia telangiectasia,hemophilia,liver disease are examples of bleeding disorders that can predispose patients to frequent episodes of epitaxis.

4. CLINICAL MANIFESTATIONS 1 .Dark or bright red bleeding from one or both nostrils is the most common sign of epitaxis. 2. Patient may also have trouble in breathing, swallowing and talking if blood clots block the nostrils. If patient swallow blood, stool may look black. Other symptoms: 1. Head ache. 2. Confusion. 3 . Fainting. 4. Dizziness. 5. Weakness.

5. DIAGNOSTIC EVALUATION 1.Inspection with nasal speculum to determine site of bleeding or nasal endoscopy by otolaryngologist. Important to determine which side bled first. 2.Laboratory evaluation to exclude blood dyscrasias and coagulopathy.

6. MANAGEMENT 1 .Make the patient sit quietly with the head up and inclined slightly forward to prevent blood from entering the pharynx and causing gagging or swallowing of blood. 2. The patient is instructed not to blow the nose for several hours after a nose bleed. 3 .Firm pressure should be maintained for at least 5 to 10 minutes and it may be necessary as long as 30 minutes. 4. Ice compression may be applied over the nose. 5. Bleeding may be controlled by placing a cotton ball soaked in topical vasoconstrictor such as phenylephrine into the nose and applying pressure. 6. If these measures do not control bleeding, then seek for medical advice. 7 .Locate the site of bleeding. 8 .Watch the sign and symptoms of shock.

7. 9 .Nose should be packed and left in place for 2 to 5 days, then remove gently. 10 .Severe bleeding results in a drops of blood pressure, so check the vital signs carefully. 11 .Instruct a patient not to swallow blood because it may cause nausea and vomiting. 12 .Give adequate oxygenation with humidifier. 13. Administer analgesic to the patient. 14 . Administer antibiotics and sedatives to the patient. 15. Nasal packs make eating and swallowing difficult, so give liquid diet to patient. 16 .Persistent or recurrent profuse epitaxis may require surgical ligation of the external carotid artery, the ethmoid artery or the internal maxillary artery.