Transcript Epistaxis
Epistaxis Evaluation and Management History and Physical Exam 1. Evaluating the ABC. 2. Characterize Epistaxis ; amount,length of time , intermittent vs continuous ,side,previous episodes,hospitalizations, packing. 3. Medical History and Blood Dyscrasias . 4. Medications: antiplatelet , anticoagulants. 5. Social History: cocaine abuse, alcoholism, smoking . 6. Toxin Exposure: ammonia, gasoline, phosphorus. 7. Other :trauma,high altitude living,allergy, sinusitis, rhinitis, URI Physical Exam • patient should sit up with body tilted forward • initial attempt to stop bleeding by applying pressure to nasal alae for several minutes • decongestant/anesthetic agents . • adequate lighting, nasal speculum, forceps, suctions machine ,attempt to localize active bleeding (examine for abrasions, foreign bodies, masses, nasoseptal deformities, etc.). •general ex. :pale,jaundice, echymosis,melaena, haematurea,haemoptysis • for chronic or recurrent epistaxis without an obvious bleeding source patient should undergo an endoscopic exam Investigations: Radiological Lab Tests PT/PTT, bleeding time, liver function tests, creatinine, CBC, type and cross Medical Management • Acute Management: * correct hypovolemia (3:1 Rule) * hypertension (antihypertensive agents) * coagulopathy(fresh frozen plasma, platelets, cryoprecipitate) • Chronic Management: * hypertonic nasal spray and humidification * long-term medical management of hypertension * antimicrobial ointment to excoriated lesions Surgical Management Cauterization Anterior Nasal Packing Posterior Nasal Packing Embolization Vascular Ligation Septoplasty/Submucous resection