[PPT]NOSE: ANATOMY & PHYSIOLOGY - 锦州医科大学-研...
Transcript of [PPT]NOSE: ANATOMY & PHYSIOLOGY - 锦州医科大学-研...
Epistaxis(nosebleed)
Classification I. According to site
• Anterior• Superior; Anterior ethmoid ( bleeding is
from above ant. half of middle turbinate)• Inferior; Greater palatine,• Posterior; Sphenopalatine (Bleeding is
from below anterior half of middle turbinate
II. Primary & secondary
Ⅲ. According to Age• Children:
– Foreign body, nose picking ,nasal diphtheria.
• Adults: – Trauma, idiopathic.
• Middle age:– tumors.
• Old age: – hypertension.
etiological factor of nose bleed
1 local cause:• trauma• inflammation• tumor• deviated nasal septum 2 systom reason
Aetiology Local Causes Trauma
– Nose picking, – Fractures (nasal bone, sinuses and/or skull base)– Nasal intubation– SurgeryInfections
● Fungal infection ● Suppurative sinusitis ● Influenza, Measles,Diphtheria,Tuberculosis ● Atrophic rhinitis
Local Causes• Septum disorder (deviated nasal septum )-
spur,perforation.
• Foreign body.
.
Local Causes• Neoplasms of
the nose, nasopharynx and sinuses
Carcinom of the Nasopharynx
Angiofibroma
Hemangioma
General Causes• Acute infectious disease - Influenza,measles,diphtheria,malaria, typhoid,et al.• Cardiovascular disease - Hypertension, - Atherosclerosis, - Osler-Weber-Rendu disease• Blood clotting problem - Haemophilia, purpura, leukemias, aregenerative anemia,et al.
General General CausesCauses
Osler-Weber-Rendau‘s syndrome
General Causes• Vitamin C ,P & K deficiencies.• Severe liver & kidney disease.• Drugs – prescribed - Anticoagulants - Warfarin / Heparin.
- Aspirin- platelet function inhibitor.
• Toxicosis • Vicarious menstruation -during the period.
Environmental reason
• High altitudes
(drier and lower atm. pressure)
• Air-conditioning
• Extreme changes in temperature
Idiopathic
• “Spontaneous” is a better description.
• Usually initiated by minor ‘digital’ trauma.
• Often associated with atmospheric drying.
AnatomyAnatomy
ICA (branches of ophthalmic)Anterior ethmoid – supplies lateral wall of nose, nasal septum, nasal tipPosterior ethmoid – posterior lateral wall of nose, superior turbinate and sup septum
ECA (branches of internal maxillary)sphenopalatine – supplies the posterior septum, poste-rior middle and superior turbinatesDescending palatine – lower midseptumSuperior labial (facial artery) anterior septum
Blood supply of nasal cavity
External carotid
Internal maxillary a.
Anterior & posterior ethmoidal a.
sphenopalatine a.
Great palatine a.
Vessels Involved
• Anterior ethmoid a.
• Posterior ethmoid a.
• Greater palatine a.
• Sphenopalatine a.
• Superior labial a.
Internal carotid
External carotid
Sites of bleeding
• Nasal Septum - Little’s Area 90% of epistaxis from this site.- Rest of septum
spurs,perforation ,etc
Little’s area
Confluence of :– Anterior Ethmoidal a.– Greater Palatine a.– Sphenopalatine a.– Sup. Labial a.
Sites of bleeding
• Posterior nasal cavity - Woodruff’s plexus - artery often due to hypertensionoften due to hypertension
severe
FIRST AID–Make the patient sit up, pinch or
press nose, open mouth and breath.
– Ice on forehead.
Management
5 minute pressure
correctIncorrect
CAUTERIZATION1) Chemicals• Silver Nitrate stick, • Chromic acid bead.2) Electrical• Apply ointment and advise against
blowing and nose picking.
Anterior Pack• For active anterior epistaxis.• Keep for 24-48 hours.• Antibiotics if for more than 24 hrs.
SEDATION
Anterior pack
Anterior Pack
PVA foam packs are usually packaged sterile. The foam is compressed to provide smaller packs for easier insertion into tiny areas without pain. The expansion of the compressed foam produces gentle pressure on the mucosa
and provides both active and passive absorption.
Posterior Pack
Posterior packing if bleed is posterior.
posterior pack
① ③② ④
packingpacking
OTHER TREATMENTS
• Ligation of vessels – Maxillary artery– Ethmoid arteries– External Carotid artery
• Embolization-DSA• Blood transfusion• Treatment of primary affection
Management protocolManagement protocol