Upload
oliver-flower
View
3.641
Download
3
Embed Size (px)
Citation preview
Stopping the bleeding….from the ENT point of view
Georgie Harris
ENT Registrar
Why is it such a problem?
High output vessels
Anastomoses under
friable mucosa
Limited compression
from surrounding
structures
Limited access
High vascularity
Kesselbach’s plexus Woodruff’s plexus
Choose your tools….
Get a good view….
Know where to look…..
Identify bleeding point….
Remove clot
Decongest/anaesthetise
Cophenylcaine forte
Drixine/otrivin
Most can be controlled with simple
measures
Topical measures
Direct pressure
Cotton ball soaked with cophenylcaineforte
Cautery
Silver nitrate
Adjuvant measures
Surgicel
Nasalate cream
Vaseline
Post cautery care important
Packing
Nose – Rapid rhino
Oral cavity – throat
pack with adrenaline
Trache site – Surgicel
Other options –
vasgauze, merecel
Rapid Rhino
If all else fails…..
Surgical intervention
EUA
SPA ligation
Maxillary artery ligation
Anterior ethmoidal artery ligation
Angiography/embolisation
Don’t forget the basics…
Choose your instruments
Get a good view
Know where to look
Topical measures first
Ask the obvious but often forgotten question
Questions?