Epistaxis and nasal cautery A.HABIB

Msc(Edin),MRCS(London)SpecialtyRegistrarENT

Agenda

•  Introduction• Anatomyofnasalcavityandbloodsupply•  Treatmentofepistaxis• Nasalcautery• Nasalpacking•  Furthermanagement

Epistaxis

• Commoncomplaint• Rarelyfatal• Majoritydonotrequirehospitaladmission•  10%ofallepistaxisserious•  60%ofallpeoplehaveatleastoneepistaxisduringalifetime• Bimodaldistribution-<10,>50

Basic anatomy

• Nasalcavity•  https://www.youtube.com/watch?v=d8eS9eSoVrI• Nasalbloodsupply

Blood supply

Blood supply

•  Sources:internalcarotidandexternalcarotid•  Little’sarea/Kiesselbachplexus

Treatment

•  Firstaid• Nasalpackingwithvasoconstrictor/localanaesthetic• Nasalcautery(silvernitrate)• Nasalpacking• Posteriorpacking•  Surgery

What you’ll need

• Headlamp•  Tilleyforceps•  Thudicumspeculum•  Silvernitratesticks• Cottonwool/ribbongauze•  Suction• Protection-gloves,apron,mask• Adrenaline,saline• Xylocaine10%spray

Packing with topical vasoconstrictor and LA

• Adrenalinevials:1:1000• Dilutewith10mlofsaline•  Soakcottonwoolballsinsolution• Packthesideofbleedingandapplyfirmpressureovernosefor10-15minutes• Arrestofbleedinganddecongestthenose• Canberepeatedupto3times.

Nasal cautery

•  Silvernitratesticks• Contactwithmucosalsurfacegeneratesnitricoxidecreatingachemicalburn• https://www.youtube.com/watch?v=B3cd1sKKBOs• Gentlydabtheseptalmucosa/holdfor5-10seconds• Caretoprotecttheupperlip–burns•  InstillationofNaseptincream• Observefor30minutespostarrestofbleeding

Nasal packing

• Rapidrhino• Merocel• Nasopore•  Foleycatheter• BIPPpacking

Rapid rhino pack

Rapid rhino

•  Forbriskbleedingnotcontrolledbycautery•  Immerseinsterilewaterfor30seconds• Aimtoinsertatthebaseofthenasalcavity•  Iffailedattempt,chancesarethepatienthasadeviatednasalseptumornasalspur• Donotattemptanyfurtherasriskoftrauma• CallENTSHO/SPRforadvice

Further treatment

•  Foleycatheter• BIPPpacking• Considerationofsurgery–SPAligation•  Embolization