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    Epistaxis is acute haemorrhage from the nostril, nasal cavity or nasopharynx.

CAUSES:

  1. LOCAL CAUSE:

NOSE: 1. Trauma- Fingernail trauma, violent sneeze, hard blowing.

  1. Infections- a. Acute viral rhinitis, acute sinusitis. b. Chronic- Atrophic rhinitis, rhinitis sicca.
  2. Foreign Body- Non-living- Rhinolith, Living- Maggots, Leeches.
  3. Neoplasms of nose & paranasal sinuses- a. Benign- hemangioma, papilloma. b. Malignant- Carcinoma or sarcoma.
  4. Atmospheric changes- High altitude.
  5. DNS.

NASOPHARYNX: 1. Adenoiditis.

  1. Juvenile Angiofibroma.
  2. Malignant tumors.

  2. GENERAL CAUSES: 1. CVS- Hypertension, Mitral stenosis.

  1. Disorders of blood & blood vessels- Aplastic anemia, Leukaemia.
  2. Liver Diseases- Hepatic cirrhosis.
  3. Kidney Diseases- Chronic Nephritis.
  4. Drugs- Salicylate, Analgesic.
  5. Mediastinal Compression- Tumors of mediastinum.
  6. Acute general Infection- Influenza, Measles, Chicken Pox.

   3. IDIOPATHIC. 

INVESTIGATION:

VITAL SIGNS: 1. Vomiting status. 2. Blood pressure, 3. Adequacy of airway, 4. Oral & nasal examination. [Detailed medical & treatment history is taken]

  1. ANTERIOR RHINOSCOPY.
  2. POSTERIOR RHINOSCOPY.
  3. NASAL ENDOSCOPY.
  4. RADIOLOGICAL: a. X-Ray PNS- Infective, traumatic & neoplastic, b. CT SCAN, c. Digital subtraction angiography- identification of blood vessels.
  5. HAEMATOLOGICAL: Complete blood picture- 1. Clotting & bleeding profiles. b. Blood grouping & cross matching. c. Blood counts including total platelet count.

MANAGEMENT:

FIRST AID: Pinching the nose with thumb & index finger for 5 minutes.

Trotter’s method: Patient is made to sit, leaning a little forward over a basin to spit any blood & breath quietly from mouth.

Cold compression.

CAUTERISATION: Anaesthetised= Bleeding point cauterized with a bead of silver nitrate or coagulated with electro cautery.

ANTERIOR NASAL PACKING: A ribbon gauge soaked with liquid paraffin inserted the floor, from floor to the roof & from before backward. Remove after 24 hr, if bleeding stopped.

POSTERIOR NASAL PACKING:

      A post nasal pack is prepared by trying three silk ties to a piece of gauze rolled into the shape of cone.

                                                                         ↓

          A rubber catheter is passed through the nose & end is brought out from mouth.

SURGICAL INTERVENTION:

  1. Nasal endoscopy assisted bipolar cauterisation under GA.
  2. Ligation of artery when bleeding fails to atop after packing-    a) ECA is ligated distal to lingual branch, b) Trans-antral clipping or ligation of the internal maxillary artery, c) Ligation or clipping of Anterior Ethmoidal Artery.
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