Refleksi Epistaxis

7/29/2019 Refleksi Epistaxis

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Epistaxis

Ng Xiang Wei08/273673/KU/12915


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Identitas Pasien

Nama : S

Jenis kelamin : Perempuan

Umur : 24 tahunAlamat : Purworejo


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Keluhan Utama

Hidung kiri keluar darah


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Riwayat Penyakit Sekarang

Pagi tadi pasien mengeluh hidung kirikeluar darah setelah pasien bersin. Darahkurang dari satu sendok teh dan bercampurdengan lendir. Sekarang pendarahan sudahberhenti.


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Riwayat Penyakit Dahulu

Sering batuk pilek, alergi debu dan dingin(+), trauma (-), penyakit darah (-)


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Epistaxis

Bleeding inside the nose

Sign of local or constitutional cause


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Blood supply of the nose


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Littles Area

Anterior inferior part of nasal septum

4 arteries: anterior ethmoidal, septalbranch of superior labial, septal branchof

sphenopalatine and greater palatineanastomoseKiesselbachs plexus

Subject to drying effect of inspiratory

current and finger nail trauma Usual site for epistaxis in children and

yound adults


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Retrocolumellar vein

Common site of venous bleeding in youngpeople

Vein runs vertically downwards justbehind columella, cross the floor of noseand join venous plexus on lateral nasalwall


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Woodruffs Area

Under posterior end of turbinate wheresphenopalatine artery anastomoses withposterior pharyngeal artery

Site of posterior epistaxis


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Causes

Local

General

Idiopathic


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Local

Nose1. Trauma2. Infections3. Foreign bodies

4. Neoplasms of nose and paranasal sinuses5. Atmospheric changes6. Deviated nasal septumNasopharynx

1. Adenoiditis2. Juveinile angiofibroma3. Malignant tumors


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General

1. Cardiovascular

2. Disease of blood

3. Liver disease

4. Kidney disease

5. Drugs

6. Mediastinal compression

7. Acute general infection

8. Vicarious menstruation


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Sites of Epistaxis

1. Littles area: 90%

2. Above level of middle turbinate on septum

3. Below the level of middle turbinate onseptum

4. Posterior part of nasal cavity

5. Diffuse (both septum and lateral nasal wall)

6. Nasopharynx


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Classification

Anterior epistaxis

Blood flows out from front of nose in sittingposition

Posterior epistaxis

Blood flows back into throat, coffee coloredvomitus


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1. Mode of onset

2. Duration and frequency of bleeding3. Amount of blood loss

4. Side of nose where bleeding occurs

5. Bleeding is anterior or posterior type6. Bleeding tendency in patient

7. Medical history (HT, leukaemia, mitralvalve disease, cirrhosis, nephritis)

8. Drug intake (analgesics, anticoagulants,etc)


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First Aid

Pinching nose with thumb and indexfinger for 5 mins

Trotters method

Cold compress


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Management

1. In active bleeding, clear blood clot in nose bysuction and localise bleeding site.

2. In minor bleeds from accessible sites, mayuse cauterisation.

3. If bleeding is profuse and/or site of bleedingdifficult to localise anterior nose packing.

4. Pack can be removed after 24 hours. If it has

to be kept for 2-3 days, give systemicantibiotics.5. Posterior nasal packing for posterior

bleeding.


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Cauterisation

Silver nitrate

Electrocautery

Endoscopic cautery (posterior bleeding)


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Anterior Nasal Packing


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Posterior Nasal Packing


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Epistaxis balloon

Documents

Refleksi Epistaxis