Management of epistaxis

1. Dr. Vinay S Bhat

2.  At the end of the class audience should be able to
 Describe the blood supply lateral and medial wall
of nose
 Outline the various methods of treatment of
Epistaxis
 Describe the individual methods briefly
 List the newer methods in treatment of epistaxis
 Perform first aid for Epistaxis outside the
healthcare setting

3.  Why you should know about
management of epistaxis ?
 Very common
 Causes significant concern
 Most epistaxis can be
managed outside the hospital

5. ARTERY OF EPISTAXIS
Sphenopalatine artery

7.  Assessment of general condition
 Resuscitation if required
 Initial medical review
 Visualizing bleeding point

8. DEFINITIVE TREATMENT
Decongestant nasal
drops
Adrenaline soaked
cotton pledget
Chemical cauterization
–silver nitrate

9.  Using nasal endoscope and bipolar cautery
 Not always available in emergency settings
 Requires surgical expertise
 Expensive instruments required
 Excellent results

10. ANTERIOR POSTERIOR

12.  Sphenopalatine artery
 Anterior ethmoidal artery
 Posterior ethmoidal artery
 External carotid artery

13. ANTERIOR ETHMOID SPHENOPALATINE
ARTERY LIGATION ARTERY LIGATION

14. EXTERNAL CAROTID ARTERY
LIGATION
REMEMBER
External carotid
artery is ligated distal
to its first branch i.e.
SUPERIOR
THYROID ARTERY
WHY??

15.  Arterial embolization: selective, super selective
 Lasers
 Coblation
 Harmonic technology

17.  Commonly seen condition
 Most of the patients respond to conservative
theapy
 Follow the management protocol for best
results
 Endosopic methods are very accurate
 Arterial ligations are last options in cases of
intractable epistaxis
 Newer methods have excellent outcome but
expensive

18.  Method used to control epistaxis outside
healthcare settings is
1. Anterior nasal packing
2. Nose pinching
3. External carotid artery ligation
4. Arterial embolization

19.  Artery of epistaxis is
1. Anterior ethmoidal artery
2. External carotid artery
3. Sphenopalatine artery
4. Internal carotid artery

20.  Scott-browns otolaryngology 7th edition
 Cummings otolaryngology and head &neck
surgery 3rd edition

21. QUESTIONS?