Ent Topics- Epistaxis Slides PDF

12/12/2022 ENT TOPICS- EPISTAXIS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with epistaxis Understand the pathophysiology associat...

12/12/2022 ENT TOPICS- EPISTAXIS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with epistaxis Understand the pathophysiology associated with epistaxis Describe the clinical presentation and work up of a person with epistaxis Develop a medical plan for a person with epistaxis 1  12/12/2022 INTRODUCTION Epistaxis, or bleeding from the nose, is a common complaint.It is rarely life threatening. Most nosebleeds are benign, self-limiting, and spontaneous, but some can be recurrent. Many uncommon causes are also noted. Epistaxis can be divided into 2 categories, anterior bleeds and posterior bleeds, on the basis of the site where the bleeding originates. The true prevalence of epistaxis is not known, because most episodes are self-limited and thus are not reported. When medical attention is needed, it is usually because of either the recurrent or severe nature of the problem. PATHOPHYSIOLOGY Bleeding typically occurs when the mucosa is eroded Posterior bleeds arise further back in and vessels become exposed and subsequently break. the nasal cavity, are usually more More than 90% of bleeds occur anteriorly and arise profuse, and are often of arterial origin from Little’s area, where the Kiesselbach plexus forms on the septum. The Kiesselbach plexus is where (eg, from branches of the vessels from both the ICA (anterior and posterior sphenopalatine artery in the posterior ethmoidal arteries) and the ECA (sphenopalatine and nasal cavity or nasopharynx). A branches of the internal maxillary arteries) converge. posterior source presents a greater These capillary or venous bleeds provide a constant ooze, rather than the profuse pumping of blood risk of airway compromise, aspiration observed from an arterial origin. Anterior bleeding of blood, and greater difficulty may also originate anterior to the inferior turbinate. controlling bleeding. 2  12/12/2022 CONTRIBUTING FACTORS 90% of the time bleeding is the result of a Systemic causes include arteriolosclerosis, spontaneous rupture of a blood vessel in the hematological disorders or hereditary anterior septum in Kisselbach’s plexus. hemorrhagic telangiectasias. Local causes include: trauma, irritants Around 10% of nose bleeds are idiopathic. (smoking), inflammation of the nasal mucosa, a Epistaxis occurs more frequently in young septal defect or paranasal tumors, intranasal children and in elderly persons. steroids, medications such as NSAIDS, Occurs more frequently in males than in anticoagulants and antiplatelets. females. 3  12/12/2022 SIGNS AND SYMPTOMS DIAGNOSTIC TESTING SIGNS AND SYMPTOMS DIAGNOSTIC TESTING Usually, no signs or symptoms are associated No laboratory studies are indicated for with epistaxis other than external bleeding or an minor and nonrecurring nose bleeds. awareness of blood dripping down the posterior For more substantial or recurring nosebleeds nasopharynx. a CBC, including platelet count, bleeding time, prothrombin time and partial thromboplastin time may be useful. INR if a patient is on Coumadin Type and Cross if a patient is anticipated to need a blood transfusion due to blood loss. DIFFERENTIAL DIAGNOSIS Trauma Inflammation due to rhinitis or infection Vascular disorders Clotting disorders and blood dyscrasias Intranasal foreign bodies Hereditary telangiectasia Tumors 4  12/12/2022 TREATMENT Most episodes of epistaxis are mild and Anterior bleeding that does not stop self-limited and resolve spontaneously with manual pressure alone may be without treatment. controlled with two sprays of Epistaxis may be controlled by pinching Oxymetazolone 0.05% applied directly the nostrils together for 5 to 10 minutes, to the bleeding site followed by 10-15 keeping the patient in erect position with minutes of manual pressure. head tilted forward to prevent bleeding The nares can also be packed, if from going down the posterior necessary. nasopharynx. Have suction available. WHEN TO REFER TO ENT Bleeding that is not controlled after 15 minutes of compression. Evidence of massive bleeding. Recurrent bleeding within the first hour. Second episode of epistaxis within 1 week. Uncontrolled bleeding from the posterior nasopharynx. 5  12/12/2022 PATIENT TEACHING Avoid NSAID use Sneeze with the mouth open Avoid hot and spicy foods Do not pick at nose Avoid hot showers CONSIDERATIONS FOR THE GERIATRIC POPULATION Typically, people older than age 50 have more serious bleeding that requires medical attention. Anemia can be a complication of excessive or frequent bouts of epistaxis. Severe blood loss can exacerbate existing diseases. Older patients should be assessed for dyspnea, chest pain/pressure and syncope. Epistaxis in older adults could be a sign of arterial hypertension, cardiovascular disease or coagulation disorder. 6  12/12/2022 REFERENCES Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandburg-Cook, J. (2017). Primary care a collaborative practice. (5 ed.). St. Louis, Missouri: Mosby Elsevier. Nguyen, Q., & Meyers, A. (2022, April 13). Epistaxis. Retrieved June 17, 2022, from https://emedicine.medscape.com/article/863220-overview 7