What is Epistaxis?
Bleeding from inside the nose is also known as Epistaxis.
Why does it occur?
There are many different reasons.
Most important ones are- Among children due to trauma due to nasal picking.
Another important cause in children is foreign body in nose.
- Infections of nose, - Deviated Nasal Septum, - Raised blood pressure, - Kidney disease and liver disease.
What are the sites of Epistaxis?
1.Most important site of epistaxis in nose is Little's area. In 90% of cases, Epistaxis occurs from here.
It is situated in antero-inferior part of Nasal Septum.
Four Arteries: anterior ethmoidal, septal branch of superior labial, septal branch of sphenopalatine and the greater palatine arteryanastamose here.
2.Posterior part of nasal cavity. After bleeding from here blood flows directly into pharynx.
Diffuse: It is bleeding from septum and lateral wall. This is often seen in general systemic disorders and blood dyscrasias.
How will you manage a case of Epistaxis?
In any case of epistaxis, it is important to ask the patients: 1) Mode of onset. Was it spontaneousor was there finger nail trauma?
2) Duration and frequency of bleeding. 3) Amount of blood loss.
4) Side of nose from where bleeding is occurring or is it occuring from both sides of nose?
5) Any known bleeding tendency in patient or family?
6) Any history of drug intake? Analgesics? Anticoagulants etc.
How will you treat epistaxis?
1.First Aid. Most of time, bleeding occurs from Little's areaand can be controlled by pinching nose with thumb and index for 5 minutes. This compresses blood vessels of Little's area.
2.Cauterisation. Useful in patients where bleeding point has been located.
3.Anterior Nasal Packing.
4.Posterior Nasal Packing
1.Make the patient sit up.
2.Reassure the patient.
3.Keep check on pulse and BP.