Download Posterior Pack

Epistaxis
(nosebleed)
Classification
I. According to site
• Anterior
• Superior; Anterior ethmoid ( bleeding is
from above ant. half of middle turbinate)
• Inferior; Greater palatine,
• Posterior; Sphenopalatine (Bleeding is
from below anterior half of middle
turbinate
II. Primary & secondary
Ⅲ. According to Age
• Children:
– Foreign body, nose picking ,nasal diphtheria.
• Adults:
– Trauma, idiopathic.
• Middle age:
– tumors.
• Old age:
– hypertension.
etiological factor of
nose bleed
1 local cause:
• trauma
• inflammation
• tumor
• deviated nasal septum
2 systom reason
Aetiology
Local Causes
Trauma
– Nose picking,
– Fractures (nasal bone, sinuses and/or skull base)
– Nasal intubation
– Surgery
Infections
Fungal infection
● Suppurative sinusitis
● Influenza, Measles,Diphtheria,Tuberculosis
● Atrophic rhinitis
●
Local Causes
• Septum disorder (deviated nasal septum )spur,perforation.
•
.
Foreign body.
Angiofibroma
Local Causes
• Neoplasms
of
the nose, nasopharynx
and sinuses
Hemangioma
Carcinom of the Nasopharynx
General Causes
• Acute infectious disease
- Influenza,measles,diphtheria,malaria,
typhoid,et al.
• Cardiovascular disease
- Hypertension,
- Atherosclerosis,
- Osler-Weber-Rendu disease
• Blood clotting problem
- Haemophilia, purpura, leukemias, aregenerative
anemia,et al.
General Causes
Osler-Weber-Rendau‘s syndrome
General Causes
• Vitamin C ,P & K deficiencies.
• Severe liver & kidney disease.
• Drugs – prescribed
- Anticoagulants - Warfarin / Heparin.
- Aspirin- platelet function inhibitor.
• Toxicosis
• Vicarious menstruation -during the period.
Environmental reason
• High altitudes
(drier and lower atm. pressure)
• Air-conditioning
• Extreme changes in temperature
Idiopathic
• “Spontaneous” is a better description.
• Usually initiated by minor ‘digital’ trauma.
• Often associated with atmospheric drying.
Anatomy
ICA (branches of ophthalmic)
Anterior ethmoid – supplies lateral wall of nose, nasal
septum, nasal tip
Posterior ethmoid – posterior lateral wall of nose,
superior turbinate and sup septum
ECA (branches of internal maxillary)
sphenopalatine – supplies the posterior septum,
poste-rior middle and superior turbinates
Descending palatine – lower midseptum
Superior labial (facial artery) anterior septum
Blood supply of nasal cavity
Internal maxillary a.
Anterior & posterior
ethmoidal a.
sphenopalatine a.
External
carotid
Great palatine a.
Vessels Involved
• Anterior ethmoid a.
• Posterior ethmoid a.
Internal carotid
• Greater palatine a.
• Sphenopalatine a.
• Superior labial a.
External carotid
Sites of bleeding
• Nasal Septum
- Little’s Area
90% of epistaxis from this site.
- Rest of septum
spurs,perforation ,etc
Little’s area
Confluence of :
–
–
–
–
Anterior Ethmoidal a.
Greater Palatine a.
Sphenopalatine a.
Sup. Labial a.
Sites of bleeding
• Posterior nasal cavity
- Woodruff’s plexus
- artery
often due to hypertension
severe
Management
FIRST AID
– Make the patient sit up, pinch or
press nose, open mouth and
breath.
– Ice on forehead.
5 minute pressure
correct
Incorrect
CAUTERIZATION
1) Chemicals
• Silver Nitrate stick,
• Chromic acid bead.
2) Electrical
• Apply ointment and advise against
blowing and nose picking.
Anterior Pack
• For active anterior epistaxis.
• Keep for 24-48 hours.
• Antibiotics if for more than 24 hrs.
SEDATION
Anterior pack
Anterior Pack
PVA foam packs are usually packaged sterile.
The foam is compressed to provide smaller packs
for easier insertion into tiny areas without pain.
The expansion of the compressed foam produces
gentle pressure on the mucosa
and provides both active and
passive absorption.
Posterior Pack
Posterior packing if
bleed is posterior.
③
②
④
posterior pack
①
packing
OTHER TREATMENTS
• Ligation of vessels
– Maxillary artery
– Ethmoid arteries
– External Carotid artery
• Embolization-DSA
• Blood transfusion
• Treatment of primary affection
Management protocol