Podcast
Questions and Answers
Which methods can be used to treat nasal bleeding?
Which methods can be used to treat nasal bleeding?
- Nasal surgery and radiation therapy
- Nasal irrigation and topical steroids
- Nasal cautery and chemical cauterization (correct)
- Endovascular embolization and antibiotic therapy
What is the purpose of using absorbable and non-absorbable nasal packing?
What is the purpose of using absorbable and non-absorbable nasal packing?
- To reduce inflammation and pain
- To provide a stable platform for fibrin and platelet aggregation (correct)
- To prevent infection
- To remove excess mucus
What is chitosan and how can it assist in stopping bleeding?
What is chitosan and how can it assist in stopping bleeding?
- A biocompatible polymer that promotes platelet aggregation (correct)
- A surgical tool used to cauterize blood vessels
- A type of bacteria that produces a clotting factor
- A type of medication that reduces blood pressure
What are the risks associated with posterior packing for nasal bleeding?
What are the risks associated with posterior packing for nasal bleeding?
Why might comorbid systemic factors need to be addressed in cases of nasal bleeding?
Why might comorbid systemic factors need to be addressed in cases of nasal bleeding?
What are some surgical management options for nasal bleeding?
What are some surgical management options for nasal bleeding?
What are some other sources of intranasal bleeding besides HHT?
What are some other sources of intranasal bleeding besides HHT?
What is septodermoplasty and when might it be necessary in cases of HHT?
What is septodermoplasty and when might it be necessary in cases of HHT?
What complications should be avoided when treating nasal bleeding?
What complications should be avoided when treating nasal bleeding?
What is the controversy surrounding the use of antibiotics for nasal packing?
What is the controversy surrounding the use of antibiotics for nasal packing?
What is endovascular embolization and when might it be used for nasal bleeding?
What is endovascular embolization and when might it be used for nasal bleeding?
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Study Notes
- Various methods can be used to treat nasal bleeding, including nasal cautery, endoscopic-assisted nasal cautery, and chemical cauterization.
- Absorbable and non-absorbable nasal packing can also be used to provide a stable platform for fibrin and platelet aggregation.
- Chitosan is a biocompatible polymer that can assist in stopping bleeding.
- Posterior packing may be necessary, but it carries risks such as ulceration, perforation, and toxic shock syndrome.
- Comorbid systemic factors such as excessive bleeding or abnormal clotting may need to be addressed.
- Surgical management options include sphenopalatine artery ligation and ethmoidal artery ligation.
- Other sources of intranasal bleeding include sinonasal tumors, high volume venous plexus bleeding, and proximal internal carotid artery aneurysm/pseudoaneurysm.
- Septodermoplasty may be necessary in stubborn cases of HHT.
- Care must be taken to avoid complications such as neuropraxia and septal perforation.
- Antibiotic use for nasal packing is controversial but may be recommended.
- Endovascular embolization is an alternative option for patients who are not suitable for SPA ligation.
- It requires collaboration with a radiologist and has a higher complication rate.
- The control rate is around 60-90% and there may be re-bleeding due to collateral arterial input.
- Complications include facial pain, trismus, amaurosis, ophthalmoplegia, embolic stroke, and death.
- Arteriography can help identify active bleeding for embolization.
- Embolization is used for maxillary artery posterior epistaxis.
- SPA ligation is the primary option for posterior epistaxis.
- Embolization is a secondary option if SPA ligation fails or is not suitable.
- Embolization involves blocking the blood vessels to stop bleeding.
- The procedure is performed by a radiologist.
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