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Anatomy/Physiology of Epistaxis
Anatomy
Nasal cavity Vascular supply
Physiology
Vascular nature Mucosa
Woodruffs Plexus:
-Pharyngeal & Post. Nasal A of Sphenopalatine A (IMAX)
Etiology
Local factors
Vascular Infectious/Inflammatory Trauma (most common) Iatrogenic Neoplasm Desiccation Foreign Bodies/other
Hematologic malignancies
Initial Management
ABCs Medical history/Medications Vital signsneed IV? Physical exam
Anterior rhinoscopy Endoscopic rhinoscopy
bayonet forcepts
suction
bacitracin
gelfoam
good light
anesthetic Afrin epistat
endoscopes
silver nitrate
suction bovie/bipolar
merocels
surgicel
Non-surgical treatments
Control of hypertension Correction of coagulopathies/thrombocytopenia
FFP or whole blood/reversal of anticoagulant/platelets
Pressure/Expulsion of clots Topical decongestants/vasocontrictors Cautery (AgNo3 vs. Bipolar vs. Bovie) Nasal packing (effective 80-90% of time
Nasal packs
Anterior nasal packs
Traditional
Surgical treatment
Transmaxillary IMA ligation Intraoral IMA ligation Anterior/Posterior Ethmoidal ligation Transnasal Sphenopalatine ligation External carotid artery ligation