Epistaxis

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Epistaxis

• nasal bleeding

Anatomy

• usually arises from nasal septum
• Littles area

Types

• spontaneous
  • common in children / young adults
  • precipitated by infection / minor trauma
  • easy to stop
  • tends to recur
• hypertensive
  • older age group
  • arises far back and high up
  • difficult to stop
  • may recur

Aetiology

• Local causes
  • spontaneous
  • trauma
  • post-operative
  • tumours
  • hereditary telangiectasia
  • hay fever
• General causes
  • cardiovascular
    • hypertension
    • raised venous (mitral stenosis)
  • coagulation / vessel defects
    • haemophilia
    • leukaemia
    • anticoagulant
    • thrombocytopenia
  • fevers
    • typhoid fever
    • influenza

Treatment

Little's area

• direct pressure
• medical
  • cocaine paste
  • lidocaine / phenylephrine soaked cotton wool 5-10 mins
• cautery
  • silver nitrate
  • electric

Unidentified Site

• need for rescucitation
• direct digital pressure
  • sitting forward
  • breathe through mouth
  • no swallowing
• examine with good light
• spray with lidocaine / phenylephrine
• cautery
• nasal packing
• post-nasal packing (experts only)
• surgery (rarely neccesary)
  • submucous resection if bleeding behind septal spur
  • ligation of ethmoid arteries
  • ligation of external carotid artery / sphenopalatine artery
• angiography / vessel embolisation

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