| ID | 292 |
|---|---|
| Name | EPISTAXIS |
| Cause | According to age - 1. Children- injury to the nose, nose picking, exan-thematous fevers, foreign body, diphtheric rhinitis, enlarged adenoids. 2. Adolescents & young adult- trauma. 3. Adult- acute & chronic sinusitis, injury nose (playing, boxing etc.), head injury etc. 4. Elderly- hypertension & malignant growth. |
| Signs Symptoms | Bleeding from one or both nostrils and bleeding down the back of the throat with spitting, coughing, or vomiting of blood. Prolonged or recurrent nosebleeds may cause anemia. After a big nosebleed, dark or tarry bowel movements mean that a large amount of blood was swallowed |
| Diagnosis | Routine laboratory testing is not required. If patients have symptoms or signs of a bleeding disorder and severe or recurrent epistaxis, a complete blood count (CBC), prothrombin time (PT), and partial thromboplastin time (PTT) should be done |
| Investigations | CBC. coagulation studies (prothrombin time, activated partial thromboplastin time, platelet function tests) BUN, serum creatinine. LFTs. autoimmune screen/autoantibodies. CT scan of paranasal sinuses. MRI of head. internal and external carotid angiography |
| Management | Management: 1. If the bleeding is mild particularly in young children, pressure on the nostrils from outside, stops the bleeding. 2. Traumatic bleeding is controlled by application of ice on bridge of the nose. 3. In cases of hypertensive patient- the mouth kept opened & patient sitting upright and inclined slightly forward, is instructed to breath quietly spitting out any blood in the pharynx. In majority of cases, rest, sedative and antihypertensive treatment control the bleeding. 4. In cases of persisting bleeding, the blood is sucked out including clots, after spraying nose with 4% xylocaine. The bleeding point is cauterised by silver nitrate or trichlor acetic acid or electric cautery. If bleeding point is not seen, then cotton wool pledget soaked in adrenaline hydrochlor, 1:1000 is inserted & after several minutes the cotton is removed. 5. If above methods failed then internal pressure methods is used as follows- a. inflatable bag, b. nasal packing etc. plus- c. antibiotic d. vit-K + vit-C e. sedative + f. Adrenochrome Monosemicarbazone. Or Tranxaminic Acid ( As advised by Physician) 6. If the patient is shocked, then complete bed rest, foot end raised. + Inj. pethedine lOOmg or Inj. morphine 15mg i.m given. + Saline may be given if required. 7. If above methods fail then please consult with a specialist (ligation of the vessels may be needed). |
| Introduction | Any bleeding per nose is called epistaxis. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Epistaxis is usually of sudden onset. There may be past history of hypertension or injury. 2. The bleeding may be mild, moderate or severe, & may come through the ant. nares or vomited out. 3. Patient may be in a state of shock if there is severe bleeding. |
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| Treatment | |
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| Prognosis | |
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| Observation | |
| Pathology | Most nasal bleeding is anterior, originating from a plexus of vessels in the anteroinferior septum (Kiesselbach area). Less common but more serious are posterior nosebleeds, which originate in the posterior septum overlying the vomer bone or laterally on the inferior or middle turbinate |
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