Management of epistaxis
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MANAGEMENT OF EPISTAXIS
Dr. Vinay S Bhat
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OBJECTIVES
At the end of the class audience should be able to
Describe the blood supply lateral and medial wall of nose
Outline the various methods of treatment of Epistaxis
Describe the individual methods briefly List the newer methods in treatment of
epistaxis Perform first aid for Epistaxis outside the
healthcare setting
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Why you should know about management of epistaxis ?
Very common Causes significant concern Most epistaxis can be
managed outside the hospital
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BLOOD SUPPLY OF NOSE
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REMEMBER
ARTERY OF EPISTAXIS
Sphenopalatine artery
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FIRST AID
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INITIAL STEPS
Assessment of general condition
Resuscitation if required
Initial medical review
Visualizing bleeding point
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DEFINITIVE TREATMENT
Decongestant nasal drops
Adrenaline soaked cotton pledget
Chemical cauterization –silver nitrate
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ENDOSCOPIC CAUTERIZATION
Using nasal endoscope and bipolar cautery
Not always available in emergency settings
Requires surgical expertise
Expensive instruments required
Excellent results
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NASAL PACKING
ANTERIOR POSTERIOR
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BALLOON CATHETERS FOR PACKING
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ARTERIAL LIGATION
Sphenopalatine artery
Anterior ethmoidal artery
Posterior ethmoidal artery
External carotid artery
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ARTERIAL LIGATIONANTERIOR ETHMOID ARTERY LIGATION
SPHENOPALATINE ARTERY LIGATION
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EXTERNAL CAROTID ARTERY LIGATION
REMEMBERExternal carotid artery is ligated distal to its first branch i.e. SUPERIOR THYROID ARTERY WHY??
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NEWER METHODS IN MANAGEMENT OF EPISTAXIS
Arterial embolization: selective, super selective
Lasers
Coblation
Harmonic technology
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MANAGEMENT PROTOCOL
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SUMMERY
Commonly seen condition Most of the patients respond to
conservative theapy Follow the management protocol for best
results Endosopic methods are very accurate Arterial ligations are last options in cases
of intractable epistaxis Newer methods have excellent outcome
but expensive
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ASSESSEMENT
Method used to control epistaxis outside healthcare settings is
1. Anterior nasal packing2. Nose pinching3. External carotid artery ligation4. Arterial embolization
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ASSESSEMENT
Artery of epistaxis is
1. Anterior ethmoidal artery2. External carotid artery3. Sphenopalatine artery4. Internal carotid artery
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FURTHER REDING
Scott-browns otolaryngology 7th edition
Cummings otolaryngology and head &neck surgery 3rd edition
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QUESTIONS?
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THANK YOU