FESSDRRAJINI

EPISTAXIS(BLEEDING FROM THE NOSE)






BLEEDING FROM INSIDE THE NOSE IS CALLED EPISTAXIS,COMMON IN ALL AGE GROUPS.IT IS A SIGN,NOT A DISEASE ,CAUSE TO BE FOUND OUT AND TREAT THE PATIENT. USUALLY IT IS AN EMERGENCY.
CAUSES:
1 LOCAL
2 GENERAL
3 IDIO PATHIC
LOCAL
NOSE

TRAUMAFROM FINGER NAILS ,FRACTURES OF MID THIRD OF FACE,SKULL BASE ,VIOLENT
SNEEZE /HARD BLOWING OF NOSE, NASOPHARY NX
ADENOIDITIS
JUVENILE ANGIO FIBROMA
MALIGNANT TUMORS
BOTH
INFECTION
ACUTE SINUSITIS
VIRAL RHINITS
TUBERCULOSIS
LIVING MAGGOTS OR LEECHES
NEOPLASM OF NOSE AND PARANASAL SINUSES
HAEMANGIOMA
CARCINOMA
ATMOSPHERIC CHANGES LIKE HIGH ALTITUDE
ATROPHIC RHINITS
FOREIGN BODIES IN THE NOSE

OR DECOMPRESSION DISEASE(DIVING)
DEVIATED NASAL SEPTUM WITH SPUR
B)GENERAL CAUSES
1 HYPER TENSION
2 A THEROSLEROSIS,MITRAL STENOSIS,PREGNANCY
3 DISORDERS OF BLOOD AND BLOOD VESSELS LIKE ANAEMIA,
HAEMOPHILIA,ALTERED CLOTTING FACTOR MECHANISM.
4 LIVER DISEASE LIKE CIRRHOSIS
5 CHRONIC NEPHRITIS
6 EXCESS USE OF ANALGESIC AND ANTICOAGULANTS.
7 TUMORS IN MEDIASTINUM
8 VICARIOUS MENSTRUATION
C) IDIOPATHIC

MANY TIMES CAUSE OF EPISTAXIS IS NOT CLEAR
1 LITTLE AREA
ANTERIOR OR INFERIOR PART OF NASAL SEPTUM,IT IS RICH IN BLOOD SUPPLY ,EXPOSED TO DRYING EFFECT OF INSPIRATORY CURRENT ,COMMON SITE FOR FINGER NAIL TRAUMA.90% OF EPISTAXIS OCCUR IN THIS REGION ESPECIALLY YOUNG ADULT& CHILDREN.
2 ABOVE AND BELOW THE LEVEL OF MIDDLE TURBINATES.
3 POSTERIOR PART OF NASAL CAVITY
4 DIFFUSE FROM BOTH THE SEPTUM AND LATERAL NASAL WALL USUALLY IN SYSTEMIC DISEASE
5 NASOPHARYNX
CLASSIFICATION OF EPISTAXIS
1 ANTERIOR EPISTAXIS ,
WHEN BLOOD FLOWS FROM BACK OF THE NOSE.
2 POSTERIOR EPISTAXIS
WHEN BLOOD FLOWS BACK IN TO THE THROAT, PATIENT SWALLOWS AND BRING IT IN VOMIT FORM.
ANTERIOR EPISTAXIS
MORE COMMON,FROM LITTLE AREA,IN CHILDREN AND YOUNG ADULT,CAUSE IS TRAUMA.
BLEEDING IS MILD & CONTROLLED BY ANTERIOR NASAL PACK
POSTERIOR EPISTAXIS
LESS COMMON,FROM POSTERIOR PART OF THE NOSE,AFTER 40 YEARS,HYPERTENSION,OR ATHEROSCLEROSIS.
BLEEDING IS SEVERE &REQUIRES HOSPITALISATION AND POST NASAL PACK.

MANAGEMENT
IT IS IMPORATANT TO KNOW MODE OF ONSET OF BLEEDING, SPONATNEOUS /TRAUMA.
FREQUENCY OF BLEEDING
AMOUNT OF BLOOD LOSS
SITE OF THE NOSE BLEEDING
TYPE ANTERIOR OR POSTERIOR
KNOWN BLEEDING TENDENCY
MEDICAL ILLNESS (HYPERTENSION,NEPHRITIS,LEUKEMIAS ETC)
FIRST AID
PINCH THE NOSE WITH INDEX &THUMB FINGER FOR 5 MINUTES .BREATH THROUGH THE MOUTH,LEAN FORWARD TO SPIT OUT BLOOD .LATER COLD COMPRESSION TO THE NOSE.
CAUTERISATION OF THE BLEEDING AREA.
MAINLY FOR ANTERIOR EPISTAXIS WITH SILVER NITRATE OR ELCTRO CAUTERY.
ANTERIOR NASAL PACKING
USUALLY PROFUSE BLEEDING ESPECIALLY ANTERIOR EPISTAXIS,IF IT IS NOT CONTROLLED WITH CAUTERISATION, A LONG RIBBON GAUZE WITH LIQUID PARAFIN IS INSERTED ALONG THE FLOOR OF NASAL CAVITY, IN LAYERS ,TIGHTLY FROM BEFORE BACKWARDS.IT IS
KEPT FOR ATLEAST 24 HOURS.
POSTERIOR NASLA PACKING
A POST NASAL PACK IS USED OR A FOLEY’S CATHETOR CAN BE USED FOR POSTERIOR EPISTAXIS.THESE DAYS NASAL BALLOONS ARE ALSO USED .IT HAS 2 BULBS ONE FOR POST NASAL SPACE ONE FOR NASAL CAVITY.
ENDOSCOPIC CAUTERY.
USUALLY POSTERIOR BLEEDING POINTS CAN BE LOCATED AND CAUTERISED.
SEPTOPLASTY PLUS SPUR CORRECTION
IT WILL CURE EPISTAXIS PERMANENTLY
LIGATION OF VESSELS
LIGATION OF MAXILLARY ARTERY IS DONE IN UNCONTROLLABLE POSTERIOR EPISTAXIS.
GENERAL MEASURES OF EPISTAXIS.
1 REASURRE THE PATIENT NOT TO PICK NOSE,MILD SEDATION SHOULD BE GIVEN
2 CHECK BP,PULSE RESPIRATION HOURLY ,MAINTAIN HAEMODYNAMICS,BLOOD TRANFUSION MAY BE REQUIRED.
ANTIBIOTICS TO BE GIVEN TO PREVENT SINUSITIS BEYOND 24 HOURS OF NASAL PACK.
INVESTIGATE AND TREAT THE CAUSE.
OXYGEN MAY BE REQUIRED WITH BILATERAL NASAL PACK.
HEAD END TO BE IN ELEVATED POSTION.
RECORD THE AMOUNT OF BLOOD LOSS.

Labels: BLEEDING FROM THE NOSE