Management of epistaxis

Management of epistaxis

1. MANAGEMENT OF ePISTAXIS Dr. V inay S Bhat

2. OBJECTIVES At the end of the class audience should be able to Describe the blood supply lateral and medial wall of nose Outline the various methods of treatment of Epistaxis Describe the individual methods briefly List the newer methods in treatment of epistaxis Perform first aid for Epistaxis outside the healthcare setting

3. Why you should know about management of epistaxis ? Very common Causes significant concern Most epistaxis can be managed outside the hospital

4. BLOOD SUPPLY OF NOSE

5. REMEMBER ARTERY OF EPISTAXIS Sphenopalatine artery

6. FIRST AID

7. INITIAL STEPS Assessment of general condition Resuscitation if required Initial medical review Visualizing bleeding point

8. DEFINITIVE TREATMENT Decongestant nasal drops Adrenaline soaked cotton pledget Chemical cauterization – silver nitrate

9. ENDOSCOPIC CAUTERIZATION Using nasal endoscope and bipolar cautery Not always available in emergency settings Requires surgical expertise Expensive instruments required Excellent results

10. NASAL PACKING ANTERIOR POSTERIOR

11. BALLOON CATHETERS FOR PACKING

12. ARTERIAL LIGATION Sphenopalatine artery Anterior ethmoidal artery Posterior ethmoidal artery External carotid artery

13. ARTERIAL LIGATION ANTERIOR ETHMOID ARTERY LIGATION SPHENOPALATINE ARTERY LIGATION

14. EXTERNAL CAROTID ARTERY LIGATION REMEMBER External carotid artery is ligated distal to its first branch i.e. SUPERIOR THYROID ARTERY WHY??

15. NEWER METHODS IN MANAGEMENT OF EPISTAXIS Arterial embolization : selective, super selective Lasers Coblation Harmonic technology

16. MANAGEMENT PROTOCOL

17. SUMMERY Commonly seen condition Most of the patients respond to conservative theapy Follow the management protocol for best results Endosopic methods are very accurate Arterial ligations are last options in cases of intractable epistaxis Newer methods have excellent outcome but expensive

18. ASSESSEMENT Method used to control epistaxis outside healthcare settings is Anterior nasal packing Nose pinching External carotid artery ligation Arterial embolization

19. ASSESSEMENT Artery of epistaxis is Anterior ethmoidal artery External carotid artery Sphenopalatine artery Internal carotid artery

20. FURTHER REDING Scott-browns otolaryngology 7 th edition Cummings otolaryngology and head &neck surgery 3 rd edition

21. QUESTIONS?

22. THANK YOU