Nosebleed, medicine, medstudent

1. Montes Vanoye Christian Vianey
Longoria Camargo Itzel

2. Is define as bleeding from the nose or
nasal hemorrhage and is classified as
either anterior or posterior.
Also known as nosebleed

3. Accounts for one of
every 200
emergency
department visits in
the US actually
It increases in
frequency after age
20 yr and eachs the
highest levels among
the elderly population
More than 80% of
cases of epistaxis
are anterior and
occur from
Kiesselbach’s plexus
Only 5% of patients
with epistaxis have
posterior bleeds

4. Nosebleed
Hypotension
Hemodynamic instability
Acute, severe epistaxis

5. 90 % are idiopathic
Common identifiable causes are:
Irritants
Tumors
Foreing bodies in the nasal cavity
Allergies
Inflammatory (rhinosinusitis, nasal polyposis)
Structural deformities (septal deviations or spurs, chronic perforations)
Trauma (nose picking, accidents and physical altercations)
Cold, dry enviroment

6. Pseudoaneurysm and aneurysm of the internal carotis artery might
present as epistaxis
Bloos vessel disorders
Drugs: aspirin, NSAIDs, warfarin, alcohol, sildenafil and tadalafil
Renal failure
Osler-Weber-Rendu disaese
Coagulopathy
Hypertension

7. A good attempt should be made to directly
visualize the source of bleeding to confirm
the diagnosis and determinate the best
treatment

8. Pseudoepistaxis must be ruled out.
Common extranasal sites of bleeding that
can stimulate epistaxis include:
• Pulmonary hemoptysis
• Bleeding esophageal varices
• Tumor bleeding from the pharynx, larynx, or
trachea

9. Include laboratory blood testing to exclude
obvious causes. Type and cross in
anticipation of transfusion if the bleeding is
severe

10. Hemoglobin and
hematocrit
Platelet count
Blood urea nitrogen and
creatinine
Coagulation studies
Type and crossmatching of
blood products

11. Radiographic studies are usually not
helpful

12. -Classification
• According to site of bleeding source
Anterior epistaxis:
Accounts for approximately 90% of nosebleeds
Usually originates from the Kiesselbach plexus, a rich
vascular anastomosis located at the anterior nasal septum;
this region is called Little's area.

13. Posterior epistaxis:
Originates from the posterior nasal cavity or nasopharynx
Posterior nasal and nasopharyngeal vessels often have a
larger caliber and may produce more active bleeding.

14. • TREATMENT
-Nonpharmacologic terapy
Digital compression or
pinching of the lower soft
cartilaginous part of the
nose for 10 min is the
method of choice
Application of cold
compresses to the bridge
of the nose to cause a
vasoconstrictive effect; the
patient may also suck on
ice to achieve this effect

15. Acute general treatment
 Anterior nasal epistaxis
-Local vasoconstriction is performed by moistening a cotton
pledget with either:
4% lidocaine with epinephrine
4% lidocaine with 1%
phenylephrine
4% lidocaine with 0.05%
oxymetazoline

16. Cauterization with silver
nitrate or trichloroacetic
acid is performed once
hemostasis is achieved

17. Anterior nasal packing is
needed when local
measures are unsuccessful.
Nasal packing is performed
under local anesthesia and
is done by inserting vaseline
gauze strips in layers from
the floor of the nasal cavity
to the front entrance of the
nasal orifice.

18. Posterior nasal epistaxis
Nasal sponge
packing
Foley catheter
balloon insertion
into the
nasopharynx

19. -Chronic treatment
Electrocautery or
endoscopic
cauterization
Arterial ligation or
embolization has
been used in
refractory posterior
epistaxis