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Published byRandall Short Modified over 9 years ago
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Epistaxis
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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
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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
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Investigations: Radiological Lab Tests PT/PTT, bleeding time, liver function tests, creatinine, CBC, type and cross
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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
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Surgical Management Cauterization Anterior Nasal Packing Posterior Nasal Packing Embolization Vascular Ligation Septoplasty/Submucous resection
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