#epistaxis 🔺More than 90% of episodes of epistaxis occur along the anterior nasal septum at a site called Kiesselbach's area. 🔺Approximately 10% of nosebleeds occur posteriorly, along the nasal septum or lateral nasal wall . Posterior nosebleeds are more common in older patients .
🔵 Causes and Associated Conditions : 🅰️local causes: 1️⃣ Self-induced digital trauma (nose picking) is common, particularly among children. 2️⃣ Mucosal trauma from topical nasal drugs, such as corticosteroids or antihistamines, may result in minor epistaxis . 3️⃣ Profound epistaxis may result from trauma to the nasal bones or septum. 4️⃣ Dehumidification of the nasal mucosa probably underlies the increased incidence of nosebleeds noted during the winter months. 5️⃣ Idiopathic 🅱️ Systemic causes : 1️⃣ Coagulopathies : including genetic disorders such as hemophilia and acquired coagulopathies due to liver or renal disease, use of anticoagulant medication, or hematologic cancers. 2️⃣ Hypertension may contribute to epistaxis 3️⃣ Excitement
🔶 EVALUATIONS : 🔸 it must begin by ensuring a secure airway and hemodynamic stability . 🔸 history should be taken, with attention to duration, frequency, and severity of epistaxis; to any contributing or inciting factors, as outlined above; and to a family history of bleeding disorders. ✳️ Treatment options : ✅ It can be controlled by pinching the anterior aspect of the nose for 15 minutes, which provides tamponade for the anterior septal vessels. The patient should relax, if possible. The head position can be either forward or backward, whichever is more comfortable, but it is important for the patient to avoid swallowing or aspirating any blood that may be draining posteriorly into the pharynx . ✅Topical sprays of anesthetics and vasoconstrictors, such as combinations of lidocaine or ponticaine with phenylephrine or oxymetazoline, may be needed to control the bleeding . ✅Epistaxis that is refractory to pressure and topical vasoconstrictors may require cautery , either chemical cautery with silver nitrate OR electric cautery . ✅Anterior nasal packing is used for epistaxis that originates in Kiesselbach's area and is refractory to the above treatments. These packs are left in place for 1 to 3 days before removal. ✅Posterior nasal packing may be required for bleeding attributable to the sphenopalatine artery. ✅When nasal packs are in place, topical antibiotic ointments that coat the nasal packing or oral antibiotics are often used because of concern about the toxic shock syndrome. ✅ When conservative measures fail to stop the bleeding, embolization or surgical ligation of the offending vessels is needed.
