Epistaxis management discussion summary
Hippocratic technique: is pinching of nose to stop Epistaxis
Trotters method :is allowing the patient to bleed till he becomes hypotensive-Now it is not followed
Hippo tech, maintain hydration, limit trauma if any
Specific active - Chemical cautery (silver nitrate), electrocautery
Surgical - posterior packing, ligation tech, septal surgery, embolization
Botroclot a Topical haemostatic is used
Usually pack nose and give it time to stop.
Then once patient stable take him up for cautery
Ligation is used in Intractable Epistaxis not responding to treatment
Woodruffs plexus bleed will not stop with anterior packing.
Most commonly seen in hypertensive patients
For them posterior packing.
Posterior pack with control of htn usually suffices
Ligation is really a radical approach and should not be thought of till u out of options
Always remember transient things like drops, adr packs etc should be used for immediate control.. But not for permanent solution
Post pack best with foleys
Nasal endoscopy should be done in all epistaxis cases...
It suggests direct visualisation with endoscopy n bipolar cautery ideal for epistaxis... now if bleeding is heavy and cautery not possible then 6hrs packing of nose and repeat endoscopic cauterization..
Sublingual depin
Best
But always remember.. Sudden drop is never good
Foleys is lot better than conventional post nasal packs...
make pt to blow nose before packing
For good visibility
Or fiction
Suction
use tranexamic acid 10 mg per kg body weight
Even ethamsylate tablets prove helpful
And safe among three drugs
Botropage tranexa and ethamsylate
Tranexa packs also help control local bleeds
H2o2 otherwise called as holy water
Treatment for septal turbinates is
Piriform turbinoplasty described by simon jones
“Clot Buster” - Additionally, some Otolaryngologists advocate a
“hard nose blow” to clear clots from the nose. This provides
visualization of the bleeding site while also allowing better
penetration of oxymetazoline or other vasoconstricting
medications. This may in itself stop the bleeding.
A stepwise approach should be followed in the treatment of epistaxis.
Non-surgical treatments should initially be pursued including topical
treatment, cauterization, nasal packs, and blocks. These treatments
will generally stop the bleed 90% of the time.
If the bleed is refractory to these treatments, surgical intervention
should then be pursued.
An alternative to this is to insert a foley catheter through
the nare and advance until the tip of the catheter can be
visualized in the back of the pharynx.
The balloon is then filled with 10 cc of sterile water and pulled back into the
nasopharynx.
saline may cause theoretically aspiration, if the bulb accidentally ruptures
The greater palatine injection offer yet another non surgical intervention for epistaxis.
This method Is often used to reduce
bleeding in endoscopic sinus surgery for both analgesia and control
of bleeding.
The injection involves accessing the pterygopalatine fossa through
the greater palatine canal. Either 1% lidocaine with epi or sterile
water can be used.
Woodruff’s plexus : Collection of blood vessels in inferior meatus posteriorly. Appear to originate from posterior pharyngeal wall.
Branches from :
Ascending pharyngeal artery (smallest b/o external carotid)
Posterior nasal b/o Sphenopalatine
Sphenopalatine
Hippocratic technique: is pinching of nose to stop Epistaxis
Trotters method :is allowing the patient to bleed till he becomes hypotensive-Now it is not followed
Hippo tech, maintain hydration, limit trauma if any
Specific active - Chemical cautery (silver nitrate), electrocautery
Surgical - posterior packing, ligation tech, septal surgery, embolization
Botroclot a Topical haemostatic is used
Usually pack nose and give it time to stop.
Then once patient stable take him up for cautery
Ligation is used in Intractable Epistaxis not responding to treatment
Woodruffs plexus bleed will not stop with anterior packing.
Most commonly seen in hypertensive patients
For them posterior packing.
Posterior pack with control of htn usually suffices
Ligation is really a radical approach and should not be thought of till u out of options
Always remember transient things like drops, adr packs etc should be used for immediate control.. But not for permanent solution
Post pack best with foleys
Nasal endoscopy should be done in all epistaxis cases...
It suggests direct visualisation with endoscopy n bipolar cautery ideal for epistaxis... now if bleeding is heavy and cautery not possible then 6hrs packing of nose and repeat endoscopic cauterization..
Sublingual depin
Best
But always remember.. Sudden drop is never good
Foleys is lot better than conventional post nasal packs...
make pt to blow nose before packing
For good visibility
Or fiction
Suction
use tranexamic acid 10 mg per kg body weight
Even ethamsylate tablets prove helpful
And safe among three drugs
Botropage tranexa and ethamsylate
Tranexa packs also help control local bleeds
H2o2 otherwise called as holy water
Treatment for septal turbinates is
Piriform turbinoplasty described by simon jones
“Clot Buster” - Additionally, some Otolaryngologists advocate a
“hard nose blow” to clear clots from the nose. This provides
visualization of the bleeding site while also allowing better
penetration of oxymetazoline or other vasoconstricting
medications. This may in itself stop the bleeding.
A stepwise approach should be followed in the treatment of epistaxis.
Non-surgical treatments should initially be pursued including topical
treatment, cauterization, nasal packs, and blocks. These treatments
will generally stop the bleed 90% of the time.
If the bleed is refractory to these treatments, surgical intervention
should then be pursued.
An alternative to this is to insert a foley catheter through
the nare and advance until the tip of the catheter can be
visualized in the back of the pharynx.
The balloon is then filled with 10 cc of sterile water and pulled back into the
nasopharynx.
saline may cause theoretically aspiration, if the bulb accidentally ruptures
The greater palatine injection offer yet another non surgical intervention for epistaxis.
This method Is often used to reduce
bleeding in endoscopic sinus surgery for both analgesia and control
of bleeding.
The injection involves accessing the pterygopalatine fossa through
the greater palatine canal. Either 1% lidocaine with epi or sterile
water can be used.
Woodruff’s plexus : Collection of blood vessels in inferior meatus posteriorly. Appear to originate from posterior pharyngeal wall.
Branches from :
Ascending pharyngeal artery (smallest b/o external carotid)
Posterior nasal b/o Sphenopalatine
Sphenopalatine
