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Epistaxis (Aetiology (Trauma Local (picking, FBs) Facial (nasal #,…

- - - - Anterior
        
        MOA
        Lubricate and insert horizontal (parallel to hard palate)
        Inflate and tape to face
        Check oropharynx for bleeding from back of nose
        If still bleeding, pack other nostril to inc pressure
        Remove at 24h
        
        Complications
        Septal haematoma/abscess
        Pressure necrosis
        Toxic shock syndrome
        Apnoeic episodes
        Sinusitus
        
        E.g.
        Nasal tampons (Merocel)
        Inflatable packs (Rapid Rhino)
        
        Indication
        Anterior bleed and cautery ineffective/
        can't locate bleeding point
      - Posterior
        
        MOA
        Pass foley catheter via nostrol into nasopharynx
        Inflate balloon, pull anterior to occlude
        Clamp in place with padding over skin
        
        Complications
        Septal haematomy/abscess
        Pressure necrosis
        Toxic shock syndrome
        Apnoeic episodes
        Sinusitis
        
        Indication
        Cautery ineffective/bleeding can't be
        seen and suspected posterior bleed
        
        E.g.
        Foley catheter
    - - MOA
        Patient blows out clots
        Cotton ball soaked in Adr for 2 min, or LA spray (vasoconstriction)
        Locate bleeding points in nose, must NOT be actively bleeding
        Cautery with silver nitrate (NOT both sides of septum, risk perf)
        Topical antiseptic e.g. naseptin
      - CIs
        Active bleeding (will wash chemical away
        and burn lips/throat)
      - Indication
        Bleeding not stopped with first aid, but bleeding point
        visible and can be tolerated by patient (i.e. not children)
      - Complications
        Septal perforation
    - - Ice pack
        MOA: dorsum of nose, causes
        vasoconstriction of vessels reducing bleeding
      - Topical antiseptic
        Indication: if bleeding stops
        E.g. naaseptin (chlorhexidine and neomycin)
        MOA: reduces crusting and vestibulitis
      - Patient applies pressure
        MOA: pinch lower soft nose) for 20m,
        breathe via mouth, sit forward
        and spit blood into bowl
    - - Arterial ligation
        Indication: severe bleeds (specialist units)
        MOA: endoscopic ligation of sphenopalatine artery
      - Embolisation
        Indication: severe bleed
        MOA: embolization of internal maxillary/facial artery
        Complications: stroke
      - Examination under anesthesia
        Indication: discrete posterior bleeding point
        MOA: examination and diathermy