Epistaxis
* Plethora of anastamoses between branches of internal and external carotid arteries at Little's area
* 95% of bleeds are anterior
* 5% posterior - more common in elderly.
Risk factors
* hypertension
* bleeding disorders
* anticoagulant use
* previous epoistaxis and cautery,
* trauma
* cocaine use,
* recent URTI
* foreign body
Investigations
* FBC and clotting
* group and save
Management
* ABC approach, may need fluid resus and epistaxis control simultaneously,
* step-wise approach to epistaxis management
* consider prothrombin complex if INR increased and bleed is torrential (vit k too slow)
STEP-WISE Approah:
1. pinch nose for 15 minutes,
2. remove clot, adrenaline (1:1000) and lidocaine pledget,
3. cautery with silver nitrate
4. anetrior nasal pack
5. bilateral anterior nasal pack,
6. posterior nasal pack.
ALL packed patients need referral to ENT.
Nasal Fracture
- remember that a nasal injury is potentially a head injury and c-spine injury also; so assess as for these.
Examination
- clinical diagnosis,
- nasal swelling and tenderness post-trauma,
- look for deviation,
- check patency of both nostrils,
- look for a septal haematoma (pedisposes to septal necrosis and infection),
Investigation
- do not x-ray,
- obtain appropriate x-rays of other injuries as required,
Tretament
- resuscitate, treat for asscoaited injuries,
- if there is continuing epistaxis (uncommon), insert nasal tamponand refer ENT to consider urgent MUA,
- refer urgently to ENT if there is septal haematoma. Requires I&D.
- provide oral analgesia,
- if the nose is deviated, or too swollen to judge, arrange f/up in 5-7 days, so the MUA may be performed within 10 days.
- discharge with HI instructions in the care of an adult.