bleeding from nose...ENT,,,,MBBS

1. EPISTAXIS

2. • EPISTAXIS IS BLEEDING FROM INSIDE THE NOSE
• OFTEN PRESENTS AS EMERGENCY
• THERE ARE MANY CAUSES FOR EPISTAXIS. SO THE
TREATMENT MUST BE FOCUSED ON THE CAUSE.

3. BLOOD SUPPLY OF NOSE
SEPTUM

4. LATERAL WALL

5. LITTLE’S AREA
• KIESSELBACH’S PLEXUS
• SITUATED IN THE ANTERIOR INFERIOR PART OF NASAL
SEPTUM, JUST ABOVE VESTIBULE
• ARTERIES ANASTOMOSING-
a) ANTERIOR ETHMOIDAL
b) SEPTAL BR. OF SUPERIOR LABIAL
c) SEPTAL BR. OF SPHENOPALATINE
d) GREATER PALATINE

6. • COMMON SITE OF BLEEDING DUE TO
a. DRYING EFFECT - EXPOSURE TO INSPIRATORY CURRENT
b. FINGER NAIL TRAUMA

7. WOODRUFF’S AREA
• SITUATED UNDER POSTERIOR END OF INFERIOR TURBINATE
• VASCULAR AREA – SPHENOPALATINE ARTERY
ANASTOMOSES WITH POSTERIOR PHARYNGEAL ARTERY
• POSTERIOR EPISTAXIS MAY OCCUR IN THIS AREA

8. CAUSES
LOCAL GENERAL IDIOPATHIC
• TRAUMA
• INFECTION
• FOREIGN BODIES
• NEOPLASM
• ATMOSPHERIC
CHANGES
• DEVIATED NASAL
SEPTUM
• CVS
• BLOOD DISORDERS
• LIVER DISEASE
• KIDNEY DISEASE
• DRUGS
• MEDIASTINAL
COMPRESSION
• VICARIOUS
MENSTRUATION

9. SITES OF EPISTAXIS
• LITTLE’S AREA – 90%
• ABOVE THE LEVEL OF MIDDLE TURBINATE
• BELOW THE LEVEL OF MIDDLW TURBINATE
• POSTERIOR PART OF NASAL CAVITY
• DIFFUSE
• NASOPHARYNX

10. CLASSIFICATION
ANTERIOR EPISTAXIS POSTERIOR
EPISTAXIS
INCIDENCE MORE COMMON LESS COMMON
SITE MOSTLY FROM LITTLES
AREA OR ANTERIOR PART
OF LATERAL WALL
MOSTLY FROM
POSTEROSUPERIOR PART OF
NASAL CAVITY TO LOCALISE
BLEEDING POINT
AGE CHILDREN OR YOUNG
ADULTS
AFTER 40 YEARS AGE
CAUSE MOSTLY TRAUMA SPONTANEOUS
BLEEDING USUALLY MILD BLEEDING IS SEVERE

12. MANAGEMENT
• MODE OF ONSET
• DURATION AND FREQUENCY OF BLEEDING
• AMOUNT OF BLOOD LOSS
• SIDE OF NOSE FROM WHERE BLEEDING IS OCCURING
• WHETHER BLEEDING IS ANTERIOR OR POSTERIOR TYPE
• ANY KNOWN BLEEDING TENDENCY IN THE PATIENT OR
FAMILY
• H/O KNOWN MEDICAL AILMENTS
• HISTORY OF DRUG INTAKE

13. FIRST AID
• PINCH NOSE WITH THUMB AND INDEX FINGER FOR ABOUT
5 MINUTES
• TROTTER’S METHOD – PATIENT IS MADE TO SIT LEANING A
LITTLE FORWARD OVER A BASIN TO SPIT ANY BLOOD AND
BREATHE QUIETLY FROM THE MOUTH
• COLD COMPRESSES – TO CAUSE VASOCONSTICTION

15. CAUTERISATION
• USEFUL IN ANTERIOR EPISTAXIS WHEN BLEEDING POINT IS
LOCATED
• AREA ANAESTHETISED AND BLEEDING POINT IS
CAUTERISED WITH BEAD OF SILVER NITRATE OR
COAGULATED WITH ELECTROCAUTERY

16. ANTERIOR NASAL PACKING
• NOSE CLEARED OF BLOOD CLOTS BY SUCTION
• SITE OF BLEED IS LOCALISED
• ABOUT ONE METRE RIBBON GAUZE SOAKED WITH LIQUID
PARAFFIN IS REQUIRED FOR EACH NASAL CAVITY

17. • FIRST, A FEW CENTIMETRES OF GAUZE ARE FOLDED UPON
ITSELF AND INSERTED ALONG THE FLOOR, AND THEN THE
WHOLE NASAL CAVITY IS PACKED BY LAYERING THE GAUZE
FROM THE FLOOR TO THE ROOF AND FROM BEFORE
BACKWARDS.
• IT CAN BE DONE IN VERTICAL LAYERS FROM BACK TO
FRONT

19. • PACK CAN BE REMOVED AFTER 24 HOURS IF BLEEDING HAS
STOPPED
• IF KEPT FOR LONGER TIME, SYSTEMIC ANTIBIOTICS SHOULD
BE GIVEN TO PREVENT SINUS INFECTION AND TOXIC SHOCK
SYNDROME

20. POSTERIOR NASAL PACKING
• POSTNASAL PACK IS FIRST PREPARED BY TYING THREE SILK
TIES TO A PIECE OF GAUZE ROLLED INTO THE SHAPE OF A
CONE
• RUBBER CATHETER IS PASSED THROUGH THE NOSE AND ITS
END BROUGHT OUT FROM THE MOUTH.
• ENDS OF THE SILK THREADS ARE TIED TO IT AND CATHETER
WITHDRAWN FROM THE NOSE.
• PACK, WHICH FOLLOWS THE SILK THREAD IS NOW GUIDED
INTO THE NASOPHARYNX WITH INDEX FINGER

21. • ANTERIOR NASAL CAVITY IS NOW PACKED AND SILK
THREADS TIED OVER THE DENTAL ROLL
• THE THIRD SILK THREAD IS CUT SHORT AND ALLOWED TO
HANG IN THE OROPHARYNX
• IT HELPS IN EASY REMOVAL OF THE PACK LATER

23. ENDOSCOPIC CAUTERY
• POSTERIOR BLEEDING POINTS CAN BE LOACTED WITH AN
ENDOSCOPE

24. ELEVATION OF
MUCOPERICHONDRIALAND SMR
OPERATION
• IN CASE OF PERSISTENT OR RECURRENT BLEEDS FROM
SEPTUM
• ELEVATION OF MUCOPERICHONDRIAL FLAP AND THEN
REPOSITIONING IT BACK HELPS TO CAUSE FIBROSIS AND
CONSTRICT BLOOD VESSELS

25. LIGATION OF VESSELS
• EXTERNAL CAROTID
• MAXILLARY ARTERY
• ETHMOIDAL ARTERIES

26. General Measures In EpIstaxIs
1. Make the patient sit up with a back rest and record any blood
loss taking place through spitting or vomiting.
2. Reassure the patient. Mild sedation should be given.
3. Keep check on pulse, BP and respiration.
4. Maintain haemodynamics . Blood transfusion may be
required.
5. Antibiotics may be given to prevent sinusitis, if pack is to be
kept beyond 24 hours.
6. Intermittent oxygen may be required in patients with
bilateral packs because of increased pulmonary resistance from
nasopulmonary reflex.
7. Investigate and treat the patient for any underlying local or
general cause

27. THANK
YOU