Management of epistaxis

MANAGEMENT OF EPISTAXIS

Dr. Vinay S Bhat

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

Why you should know about management of epistaxis ?

Very common Causes significant concern Most epistaxis can be

managed outside the hospital

BLOOD SUPPLY OF NOSE

REMEMBER

ARTERY OF EPISTAXIS

Sphenopalatine artery

FIRST AID

INITIAL STEPS

Assessment of general condition

Resuscitation if required

Initial medical review

Visualizing bleeding point

DEFINITIVE TREATMENT

Decongestant nasal drops

Adrenaline soaked cotton pledget

Chemical cauterization –silver nitrate

ENDOSCOPIC CAUTERIZATION

Using nasal endoscope and bipolar cautery

Not always available in emergency settings

Requires surgical expertise

Expensive instruments required

Excellent results

NASAL PACKING

ANTERIOR POSTERIOR

BALLOON CATHETERS FOR PACKING

ARTERIAL LIGATION

Sphenopalatine artery

Anterior ethmoidal artery

Posterior ethmoidal artery

External carotid artery

ARTERIAL LIGATIONANTERIOR ETHMOID ARTERY LIGATION

SPHENOPALATINE ARTERY LIGATION

EXTERNAL CAROTID ARTERY LIGATION

REMEMBERExternal carotid artery is ligated distal to its first branch i.e. SUPERIOR THYROID ARTERY WHY??

NEWER METHODS IN MANAGEMENT OF EPISTAXIS

Arterial embolization: selective, super selective

Lasers

Coblation

Harmonic technology

MANAGEMENT PROTOCOL

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

ASSESSEMENT

Method used to control epistaxis outside healthcare settings is

1. Anterior nasal packing2. Nose pinching3. External carotid artery ligation4. Arterial embolization

ASSESSEMENT

Artery of epistaxis is

1. Anterior ethmoidal artery2. External carotid artery3. Sphenopalatine artery4. Internal carotid artery

FURTHER REDING

Scott-browns otolaryngology 7th edition

Cummings otolaryngology and head &neck surgery 3rd edition

QUESTIONS?

THANK YOU