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EPISTAXIS

EPISTAXIS. Dr Gary Kroukamp. Sites of bleeding. Nasal Septum - Little’s Area ~90% of epistaxis seen in hospitals ~vessel often visible - Rest of septum ~spurs, convexities (turbulent flow). Sites of bleeding. Nasal cavities - blood supply.

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EPISTAXIS

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  1. EPISTAXIS Dr Gary Kroukamp

  2. Sites of bleeding • Nasal Septum - Little’s Area ~90% of epistaxis seen in hospitals ~vessel often visible - Rest of septum ~spurs, convexities (turbulent flow)

  3. Sites of bleeding

  4. Nasal cavities - blood supply Rich supply from 2 branches of Common Carotid: • Ext. Carotid - maxillary a. - most • Int. Carotid - ethmoidal aa.- roof

  5. Osler-Weber-Rendu

  6. HYPERTENSION • Is NOT a cause but contributes • Once epistaxis has occurred, it is more difficult to control in the presence of: - hypertension - tachycardia - raised venous pressure

  7. Management – immediate • Position • Pressure • Pulse / BP • Cautery • Packing

  8. 5 minute pressure

  9. Incorrect

  10. Management - immediate • Cautery - clear nose - suction -“hawk” - inspect - bleeding vessel - local / vasoconstrictor (cocaine) - cauterise - AgNO3 - electro-

  11. Packing - anterior • local anaesthetic • BIPP impregnated gauze in layers

  12. Packing - posterior • Inflatable balloons • Saline better than air

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