Epistaxis

Epistaxis Interact! A mother walks in with a 2year old child whose nose is bleeding profusely What questions will you ask? How will you manage? Here the speaker must interact with observers to see how practicioners are currently handling this situation

What to ask ? First time/ recurrent Bleeding tendency in the family Foreign body insertion Infectious (RTI ) H/o trauma /nasal picking Use of drugs* # ibuprofen ,aspirin, warfarin, clopidogrel, steroid sprays, anticoagulants

Classification of Epistaxis Primary –no obvious cause Mild – no hemodynamic alteration Anterior : Kiesselbach’s plexus/Littles area Seasonal : cold dry months Unilateral : one nostril bleed Secondary-cause present Moderate to severe- hemodynamically unstable Posterior : Woodruff's plexus Perennial: throughout year Bilateral : bleeds into throat or from both nostrils This classification is just to help observers ask direct questions from patients for better triage

Evaluate History Airway , Breathing , Circulation Hemodynamics – BP, O2, CRT, Skin and retina – erythema, rash, petechial The speaker must sensitize observers about the importance of vitals monitoring

Management

*ABC- Assess for hypovolemic shock (start IV fluids) History of Active bleeding ABC * Pinch nostrils 5-20min child will be breathing through mouth Ice pack Apply Vasoconstrictors Oxymethazoline one to two squirts into the bleeding side of the nose with 0.05 percent  Refer Steps in Managing epistaxis

When not to ignore ??

When to refer ? Recurrent epistaxis Uncontrollable epistaxis Posterior epistaxis Haemotympanum Facial trauma Polyps / tumors.

Some don’t’s Don’t sneeze. If unavoidable, try to sneeze with the mouth open. Don’t drink or eat anything hot for 24 hours after a nosebleed, hot drinks can expand the blood vessel in the lining of your nose and cause fresh Bleeding. Don’t attempt to remove any packing applied by a doctor Don’t lift heavy objects or attempt strenuous exercise for one week. Don’t bathe with hot water for 24 hours Don't underestimate the amount of blood that can be lost from epistaxis.