1. By Stacey Singer-Leshinsky R-PAC
Epistaxis By
Stacey Singer-Leshinsky R-PAC

2. Function of the Nose Vasculature just under the mucosa.
Vasculature supply originates from the ethmoid branches of the internal carotid arteries and the facial and internal maxillary divisions of the external carotid arteries.
Nose bleeds are very common

3. Epistaxis
Acute hemorrhage from the nostril, nasal cavity, or nasopharynx.
Etiology includes: infection, trauma, allergic rhinitis, renal failure, nasal defects, hypertension, tumors, use of blood thinners, aspirin.
History:

4. Epistaxis Classified by the location
Can be either anterior or posterior.

5. Anterior Epistaxis Kiesselbach’s plexus most common.
Clinical Manifestations:
History
Unilateral bleeding
No sensation of post nasal drip
Blood is bright red

6. Anterior Epistaxis
Diagnostics
Hemoglobin/Hematocrit
CBC
Bleeding time

7. Anterior Epistaxis Management: ABC
Direct pressure. Pinch nostrils sit forward.
Cautery- chemical, electric, thermal. Silver nitrate sticks
Use of vasoconstrictors sprays. / anesthetic agents.
Anterior packing Merocel: compressed sponge.
Remove any clots visualized
Anterior epistaxis balloons.

8. Anterior Epistaxis Complications of nasal packing:
Septal hematomas/abscess
Sinusitis
Pressure necrosis

9. Posterior Epistaxis
Usual source is the branches of the sphenopalatine artery. Bleeding occurs behind the posterior portion of the middle turbinate or posterior superior roof of the nasal cavity.

10. Posterior Epistaxis Clinical Manifestations:
Nausea, hematemesis, anemia, hemoptysis or melena.
No visualized anterior source of bleeding
Post nasal drip of blood
Blood is dark red
Brisk arterial bleed

11. Posterior Epistaxis Diagnostics: Hemoglobin/ Hematocrit
History of bleeding disorder

12. Posterior Epistaxis Management: Attempt to locate the source
Vasoconstrictive/ anesthetic agents
Posterior nasal packing
Immediate otolaryngologist referral
Prophylactic antibiotics
Hospitalization and monitoring

13. Posterior Epistaxis Packing

14. Posterior Epistaxis Indications for surgery/ embolization
Continued bleeding with packing
Required transfusion
Nasal anomaly precluding packing
Patient intolerance to packing

15. Epistaxis Differential Diagnosis
Local irritation
Occupational exposure
Allergies
Malignancy due to systemic disease such as granulomatous disease(Wegener’s sarcoidosis)
Hereditary hemorrhagic telangiectasia(Osler-Weber-Rendu syndrome)
Bleeding disorders
hypertension

16. Epistaxis Complications
Sinusitis
Possibility of airway obstruction
Toxic shock syndrome
Septal hematoma or abscess
Septal perforation

17. Osler-Weber-Rendu syndrome
Disorder of blood vessels
Etiology: Genetic:
Clinical manifestations: telangiectases on the lips, tongue and nasal mucosa
Complications include hemorrhage