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1. • Seen in all age groups
• Presents as an emergency
• Sign of an underlying disease
Kanika Gupta
III Year MBBS
Kasturba Medical College

5. Local
General
Idiopathic

6. Local
•Trauma
•Infections
•Foreign Bodies
•Neoplasms
•Atmospheric Changes
•Deviated Nasal Septum
•Adenoiditis
•Juvenile Angiofibroma
•Malignant Tumours
General
•CVS
•Disorders of blood and
blood vessels
•Liver disease
•Kidney disease
•Drugs
•Mediastinal
Compression
•Acute general infection
•Vicarious Menstruation
Idiopathic
•The cause of
epistaxis is
unknown

7.  Anterior Epistaxis
 More common
 Mostly from little’s area or
anterior part of lateral wall
 Mostly occurs in children or
young adults
 The cause is mostly Trauma
 Bleeding is usually mild and
easily controlled
 Posterior Epistaxis
 Less common
 Mostly from posterosuperior
part of nasal cavity (bleeding
point difficult to localize)
 Mostly >40 years of age
 The cause is mainly due to
hypertension or arteriosclerosis
 Severe bleeding, hospitalization,
postnasal pack

8. o Little’s area – site for 90% of the bleeding cases
o Above middle turbinate – due to anterior and posterior ethmoidal
arteries
o Below middle turbinate – due to sphenopalatine artery
o Posterior nasal cavity – blood directly flows into the pharynx
o Diffuse – bleeding occurs both from the septum and lateral wall
and is usually seen in blood dyscrasias
o Nasopharynx

11. Mode of onset Spontaneous/Trauma
Duration and Frequency of bleeding
Amount of blood loss
Site of bleeding
Bleeding tendencies in family
Known medical illness
History of drug intake

12. Patient made to
sit, record blood
loss during
vomiiting or
spitting
Reassure, mild
sedation
Check pulse,
BP and
Respiration
Give blood
transfusion if
necesary
Antibiotics to
prevent Sinusitis
Intermittent
Oxygen +/-
Treat any
underlying
local/general cause

13. Pinch the nose with thumb and index finger for about 5
minutes (Compresses vessels in little’s area)
Trotter’s Method : Patient in sitting position, made to lean
over a sink, spit blood and breathe quietly from mouth
Cold Compresses : Vasoconstriction

14. Chemical Cautery

16. •Clear the nose by suction
•Localise the bleeding site
•Profuse – Anterior nasal packing

21. External
Carotid
•Above the level
of superior
thyroid
Maxillary
Artery
•Uncontrollable
bleeding
•Caldwell-Luc
approach
Ethmoidal
Arteries
•Anterosuperior
bleeding, not
controlled by
packing
•Lynch Incision

23. • Done by interventional
radiologist
• Femoral artery catheterization
• Internal Maxillary Artery is
embolized with gelfoam, polyvinyl
alcohol or coils
• Usually a safe procedure with
some risks :
• Cerebal Thromboembolism
• Local haematoma
Ethmoidal arteries cannot be
embolized

25. THANK YOU