Epistaxis

ORL Complete Epistaxis Management (nosebleeding)

Order: Reorder
Duration: 9:30
Updated: 22 Oct 2013

Epistaxis is a common condition, experienced by approximately 60% of people at some point during their lifetime. Though often alarming to patients, only 6% of epistaxis cases require medical attention. Epistaxis accounts for 1 in 200 emergency department visits annually and occurs in a bimodal distribution, with the majority of patients less than 10 years of age or greater than 50 years of age. Most nosebleeds can be treated successfully in the emergency department. Though occasionally indicative of underlying pathology, nosebleeds are usually idiopathic and self-limited. Despite advances in technology, management of epistaxis has changed little from the days of Hippocrates, who treated nosebleeds by packing the nasal cavity with sheep's wool soaked in the oil of figs. The indication for medical management of epistaxis is persistent nose bleeding. Since most epistaxis originates in the anterior septal area, control can generally be achieved simply by squeezing the soft fleshy part of the nose immediately distal to the cartilaginous bridge, firmly and continuously for 10 to 20 minutes, Cases where this is not effective require further evaluation. The location and severity of the bleeding dictate the appropriate management. ANATOMY The nasal septum is supplied by the ethmoid branches of the internal carotid artery and facial and internal maxillary branches of the external carotid artery. Broadly, epistaxis is categorized as either anterior or posterior bleeding, with anterior bleeding accounting for 80% to 90% of nosebleeds. Anterior nosebleeds usually arise from Kiesselbach's plexus, a rich vascular anastomosis along the nasal septum. This is also referred to as Little's area. Posterior bleeding, alternatively, arises from branches of the sphenopalatine artery at Woodruff's plexus. This bleeding usually occurs behind the posterior aspect of the middle nasal turbinate or at the roof of the nasal cavity and is more difficult to visualize. Notably, crossover between the right and left carotid systems can result in persistent bleeding despite unilateral arterial ligation. The trajectory of the nasal canal is almost perpendicular to the plane of the face. INDICATIONS Nose bleeding persists despite direct pressure for 10-20 minutes. Chemical cautery or electrocautery is done if a source is identified. Anterior nasal packing is indicated when no source can be identified or cautery has failed. Posterior nasal packing is indicated when epistaxis cannot be localized anteriorly or controlled with anterior packing. CONTRAINDICATIONS Disrupted anatomy, facial fracture, or nasal hematoma (relative contraindications) Hemodynamic status, airway management, and appropriate resuscitation should be addressed before epistaxis management. PROCEDURE Position the patient upright, leaning forward in chair with a headrest. Identify the source of bleeding. Try direct application of oxymetazoline. If bleeding is brisk, apply a gauze soaked in a vasoconstrictor solution. If bleeding continues, proceed to silver nitrate cautery or electrocautery. If you cannot identify a source or attempts at vasoconstriction or cautery have failed, you should perform anterior packing of the nose. Traditional nasal packing Using a bayonet forceps, grasp the gauze about 10 cm from the end and enter the naris, advancing the gauze along the floor of the nasal cavity to the posterior wall of the nasopharynx. Leave about 5 cm outside the nose. Insert the gauze in layers, starting at floor of the nose. Alternatively, use a nasal sponge, such as Merocel. Apply 5% viscous lidocaine to the interior of the nose. Enter the nasal canal at a 45-degree angle, and insert the sponge into the nasal cavity approximately 1-2 cm. Bring the sponge perpendicular to the face and gently advance then rehydrate the sponge. Posterior or uncontrolled bleeding requires posterior packing. Apply 5% viscous lidocaine topically within the nose for patient comfort and lubrication. Insert a 12F to 16F Foley catheter along the floor of the nasopharynx until the tip of the catheter is visible in the mouth. Inflate the Foley balloon and slowly pull the catheter anteriorly until the balloon meets resistance. Secure the tube in place with an umbilical clamp wrapped with gauze to protect the tip of the nose.

http://wn.com/ORL_Complete_Epistaxis_Management_nosebleeding

ENT Basics: Epistaxis

Order: Reorder
Duration: 13:14
Updated: 26 Jul 2013

We hope you enjoy our humorous guide to understanding and managing Epistaxis! The video covers the basic anatomy, aetiology and management of acute epistaxis...

http://wn.com/ENT_Basics_Epistaxis

Management of epistaxis

Order: Reorder
Duration: 4:04
Updated: 19 Jun 2013

Basic guide on how to manage epistaxis. Actors: Karan Kapoor and Tom Ashfield, Filming: Anil Joshi, Editing: Tom Ashfield.

http://wn.com/Management_of_epistaxis

Epistaxis - Nosebleeds

Order: Reorder
Duration: 3:47
Updated: 17 Aug 2013

Dr. Carlo Oller, emergency physician, talks about nosebleeds.

http://wn.com/Epistaxis_Nosebleeds

Epistaxis

Order: Reorder
Duration: 5:01
Updated: 31 May 2013

A scene from the classic Tv show cardiac arrest showing how serious expistaxis (nosebleeds) can be.

http://wn.com/Epistaxis

VIDEO TAPONAMIENTO DE EPISTAXIS

Order: Reorder
Duration: 5:49
Updated: 20 Jul 2013

CAUTERIZACION Y TAPONAMIENTO.

http://wn.com/VIDEO_TAPONAMIENTO_DE_EPISTAXIS

Sphenopalatine artery cauterization - Epistaxis

Order: Reorder
Duration: 3:16
Updated: 02 Jun 2013

www.sinuscentro.com.br - Edited video showing the surgical technique for sphenopalatine artery cauterization. Patient with recurrent epistaxis. The important...

http://wn.com/Sphenopalatine_artery_cauterization_Epistaxis

Endoscopic Control of Epistaxis Youtube.wmv

Order: Reorder
Duration: 4:49
Updated: 17 Jun 2013

Demonstrates cauterization of bleeding mucosa and sphenopalatine artery ligation for epistaxis (nosebleeds).

http://wn.com/Endoscopic_Control_of_Epistaxis_Youtubewmv

¿Porque sangra la nariz? - Hemorragia nasal remedios caseros - Epistaxis - Causas

Order: Reorder
Duration: 8:39
Updated: 24 Jul 2013

Qué es la epistaxis? ¿Por qué sangra la nariz? Hemorragia nasal remedios caseros - Epistaxis - Causas. La epistaxis es el sangrado de la nariz. Al menos el ...

http://wn.com/¿Porque_sangra_la_nariz?_Hemorragia_nasal_remedios_caseros_Epistaxis_Causas

Large Epistaxis YouTube

Order: Reorder
Duration: 1:53
Updated: 05 Jul 2013

http://wn.com/Large_Epistaxis_YouTube

Sphenopalatine Artey Cauterization for Refractory Epistaxis

Order: Reorder
Duration: 7:31
Updated: 29 Jun 2013

Endoscopic Sphenopalatine Artey Cauterization for Refractory Posterior Epistaxis.

http://wn.com/Sphenopalatine_Artey_Cauterization_for_Refractory_Epistaxis

epistaxis - emergentologia pfo unc

Order: Reorder
Duration: 4:53
Updated: 29 Apr 2013

Video educativo orientado a la comunidad.

http://wn.com/epistaxis_emergentologia_pfo_unc

Epistaxis

Order: Reorder
Duration: 29:16
Updated: 17 Mar 2013

Realizado para beneficio del aprendizaje.

http://wn.com/Epistaxis

Epistaxis Emergentologia

Order: Reorder
Duration: 3:43
Updated: 09 Apr 2013

Epistaxis Catedra de Emergentologia - Facultad de Ciencias Medicas - Universidad Nacional de Cordoba.

http://wn.com/Epistaxis_Emergentologia

Epistaxis First Aid

Order: Reorder
Duration: 5:41
Updated: 22 Jul 2013

A simple trick to help you manage your epistaxis patients in the ED. For an alternative device check out Cliff Reid's article from 2001 here: http://t.co/ADk...

http://wn.com/Epistaxis_First_Aid