鼻出血(英文)

– Dangerous to pack in suspected skull #.
Telengiectasia;
– Septodermoplasty.
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OTHER TREATMENTS
Ligation
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II. PRIMARY & SECONDARY
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III. According to Etiology
of vessels
– Maxillary artery – Ethmoid arteries – External Carotid artery
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OTHER TREATMENTS
Embolization Catheters

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CAUTERIZATION
1) Chemicals;
Silver
Nitrate stick, chromic acid bead. Apply ointment and advise against blowing and nose picking.
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CLASSIFICATION
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I. According to site
Anterior Superior;
Children; – Foreign body, nose picking, nasal diphtheria. Adults: – Trauma, idiopathic. Middle age: – tumors. Old age: – hypertension.

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2) Electrical

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ANTERIOR PACKING
Unable to control bleeding. Ribbon, tampon, splints. BIPP, Polyfax
EPISTAXIS
Raza M. Jafri, FRCS Asst. Prof. Of Otolaryngology Hamdard University
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REASONS FOR EXCESSIVE BLEEDING


Vascularity of nose Both external and internal carotids. Anastomsis between arteries and veins. Blood vessels run just under the mucosaunprotected. Larger vessels on the turbinate run in bony canals- cannot contract.

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POSTERIOR PACKING
Posterior packing if bleed is posterior. GA. Foley's or other inflatable devices Removed as soon as possible. Antibiotics. Transfuse. Blood gases in children.
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SPECIAL CASES
Anticoagulants;
– Stop drug, or titrate. – Heparin is reversed with protamine sulphate, – warfarin with vitamin K
Unconscious
head injury;
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General Causes
Malignancies, Caissons'
disease, Endometriosis, Nephritis, Typhoid
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IV. According to Age
Anterior ethmoid ( bleeding is from above ant. half of middle turbinate) Inferior; Greater palatine, Posterior; Sphenopalatine (Bleeding is from below anterior half of middle turbinate
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LITTLE'S ( KIESSELBACH'S) AREA
1/2
inch from the caudal border of the septum antero-inferiorly. Vessels anastomosing are; Anterior ethmoid, greater palatine, and sphenopalatine, and septal branch of superior labial. Bleeding may be arterial or venous.

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LOCAL CAUSES
[4] Neoplasms:
Of the
– nose, – nasopharynx and – sinuses.
Carcinom of the Nasopharynx
Angiofibroma
First
aid Definitive treatment Prevention of recurrences
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FIRST AID
– Make the patient sit up, pinch nose, open mouth and breath. – Ice on fore head.
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SPECIAL CASES
Haemophilia;
– Replace factor VIII, or fresh blood.
Other
clotting deficiency;
– FFP.
Purpura;
– Platelets
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Complications
Infection,
loose
pack obstructing airway.
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General Causes
Hyperl stenosis, Cirrhosis, coagulopathies, anemias, purpura, leukemias,
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Frank Netter. Ciba
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Little’s area
Confluence
of :
– Anterior Ethmoidal a. – Greater Palatine a. – Sphenopalatine a. – Sup. Labial a.
measles
vulgaris, leprosy, Parasites, maggots, fungal
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LOCAL CAUSES
[3] Idiopathic:
Wegner's granulomatosis, Osler-Weber-Rendau's syn., atrophic rhinitis
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DEFINITIVE TREATMENT
Look into the nose. Assess blood loss. – Crystalloids or colloids – Transfusion Locate the point after packing the nose with 4% xylocaine and 1:1000 adrenaline mixture
MANAGEMENT
I] Investigations:
CBC,
Bleeding