Epistaxis resident survival guide: Difference between revisions

Jump to navigation Jump to search
Line 136: Line 136:
{{familytree | | | | | | | | | | A01 | | | | |A01=Patient with epistaxis}}
{{familytree | | | | | | | | | | A01 | | | | |A01=Patient with epistaxis}}
{{familytree | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | A02 | | | | | |A02=patient needs prompt management?}}
{{familytree | | | | | | | | | | A02 | | | | | |A02=Does the patient need immediate action?}}
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }}
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }}
{{familytree | | | B01 | | | | | | | | | | | | | B02 | | |B01=Yes|B02=No}}
{{familytree | | | B01 | | | | | | | | | | | | | B02 | | |B01=Yes→Volume replacement,airway check, Needs for emergency departement|B02=No}}
{{familytree | | | |!| | | | | | | | | | | | | | |!| | | | }}
{{familytree | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|'| | | | }}
{{familytree | | | C01 | | | | | | | | | | | | | C02 | | |C01= Volume replacement,airway check, Needs for emergency departement|C02=C02}}
{{familytree | | | | | | | | | | | | C01 | | | | | | | |C01=Active Bleeding?}}
{{familytree | |,|-|^|-|.| | | | | | | | | | |,|-|^|-|.| | }}
{{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | }}
{{familytree | D01 | | D02 | | | | | | | | | D03 | | D04 |D01=D01|D02=D02|D03=D03|D04=D04}}
{{familytree | | | | | D01 | | | | | | | | | | | | D03 |D01=Yes→Nasal compression for≥5 min|D03=NO→Rhinoscopy to identify location of bleeding}}
{{familytree | |!| | | |!| | | | | | | | | | |!| | | |!| | }}
{{familytree | |!| | | |!| | | | | | | | | | | | |!| | | | }}
{{familytree | E01 | | E02 | | | | | | | | | E03 | | |!| |E01=E01|E02=E02|E03=E03}}
{{familytree | E01 | | E02 | | | | | | | | | | | E03 | | | | |E01=E01|E02=E02|E03=E03}}
{{familytree | | | | | |!| | | | | | | | | | |!| | | |!| | | | }}
{{familytree | | | | | |!| | | | | | | | | | | | |!| |!| | | | }}
{{familytree | | | | | F01 | | | | | | | | | F02 | | |!| |F01=F01|F02=F02}}
{{familytree | | | | | F01 | | | | | | | | | F02 | | |!| |F01=F01|F02=F02}}
{{familytree | | | |,|-|^|-|.| | | | | | |,|-|^|-|.| |!| | }}
{{familytree | | | |,|-|^|-|.| | | | | | |,|-|^|-|.| |!| | }}

Revision as of 17:32, 13 August 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Overview

Epistaxis also known as noes bleeding, is a terminology name for bleeding of nose vessels that drains out from nostril (most often) and/or nasopharynx. Epistaxis is often stop easily but sometimes it's an ENT emergency which can be critical if appropriate action does not occur. Kiesselbach's plexus is the source of most epistaxis.

Causes

Base on the cause and severity of Epistaxis it can be life threatening.

Life Threatening Causes

Life-threatening causes of epistaxis include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Epistaxis according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Statement Action Strength

1:The patients needs prompt action

Prompt management At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not.

Recommendation

2:

Nasal compression The clinician should treatactivebleedingforpatientsinneedofpromptmanagementwithfirmsustainedcompressionto thelowerthirdofthenose,withorwithouttheassistanceofthepatientorcaregiver,for5minutesorlonger.

Recommendation

3a:NasalpackingForpatientsinwhombleedingprecludesidentificationofableedingsitedespitenasalcompression,theclinicianshould treatongoingactivebleedingwithnasalpacking.

Recommendation

3b:Nasalpackinginpatientswith suspectedincreasedbleedingrisk

Theclinicianshoulduseresorbablepackingforpatientswithasuspectedbleedingdisorderorforpatientswhoareusing anticoagulationorantiplateletmedications.

Recommendation

4:NasalpackingeducationTheclinicianshouldeducatethepatientwhoundergoesnasalpackingaboutthetypeofpackingplaced,timingofandplan forremovalofpacking(ifnotresorbable),postprocedurecare,andanysignsorsymptomsthatwouldwarrantprompt reassessment.

Recommendation

5:RiskfactorsTheclinicianshoulddocumentfactorsthatincreasethefrequencyorseverityofbleedingforanypatientwithanosebleed, includingpersonalorfamilyhistoryofbleedingdisorders,useofanticoagulantorantiplateletmedications,orintranasal druguse.

Recommendation

6:Anteriorrhinoscopytoidentify locationofbleeding

Theclinicianshouldperformanteriorrhinoscopytoidentifyasourceofbleedingafterremovalofanybloodclot(if present)forpatientswithnosebleeds.

Recommendation

7a:Examinationusingnasal endoscopy

Theclinicianshouldperform,orshouldrefertoaclinicianwhocanperform,nasalendoscopytoidentifythesiteof bleedingandguidefurthermanagementinpatientswithrecurrentnasalbleeding,despitepriortreatmentwithpackingor cautery,orwithrecurrentunilateralnasalbleeding.

Recommendation

7b:Examinationofnasalcavityand nasopharynxusingnasal endoscopy

Theclinicianmayperform,ormayrefertoaclinicianwhocanperform,nasalendoscopytoexaminethenasalcavityand nasopharynxinpatientswithepistaxisthatisdifficulttocontrolorwhenthereisconcernforunrecognizedpathology contributingtoepistaxis.

Option

8:Appropriateinterventionsfor identifiedbleedingsite

Theclinicianshouldtreatpatientswithanidentifiedsiteofbleedingwithanappropriateintervention,whichmayinclude oneormoreofthefollowing:topicalvasoconstrictors,nasalcautery,andmoisturizingorlubricatingagents.

Recommendation

9:NasalcauteryWhennasalcauteryischosenfortreatment,theclinicianshouldanesthetizethebleedingsiteandrestrictapplicationof cauteryonlytotheactiveorsuspectedsite(s)ofbleeding.

Recommendation

10:Ligationand/orembolizationfor persistentnosebleeds

Theclinicianshouldevaluate,orrefertoaclinicianwhocanevaluate,candidacyforsurgicalarterialligationorendovascular embolizationforpatientswithpersistentorrecurrentbleedingnotcontrolledbypackingornasalcauterization.

Recommendation

11:Managementofpatientsusing anticoagulationandantiplatelet medications

Intheabsenceoflife-threateningbleeding,theclinicianshouldinitiatefirst-linetreatmentspriortotransfusion,reversalof anticoagulation,orwithdrawalofanticoagulation/antiplateletmedicationsforpatientsusingthesemedications.

Recommendation

12:Hereditaryhemorrhagic telangiectasia(HHT)identification

Theclinicianshouldassess,orrefertoaspecialistwhocanassess,thepresenceofnasaltelangiectasiasand/ororalmucosal telangiectasiasinpatientswhohaveahistoryofrecurrentbilateralnosebleedsorafamilyhistoryofrecurrentnosebleeds todiagnosehereditaryhemorrhagictelangiectasiasyndrome.

Recommendation

13:Patienteducationand prevention

Theclinicianshouldeducatepatientswithnosebleedsandtheircaregiversaboutpreventivemeasuresfornosebleeds,home treatmentfornosebleeds,andindicationstoseekadditionalmedicalcare.

Recommendation

14:NosebleedoutcomesTheclinicianordesigneeshoulddocumenttheoutcomeofinterventionwithin30daysordocumenttransitionofcarein patientswhohadanosebleedtreatedwithnonresorbablepacking,surgery,orarterialligation/embolization.

Recommendation

 
 
 
 
 
 
 
 
 
Patient with epistaxis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient need immediate action?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes→Volume replacement,airway check, Needs for emergency departement
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Active Bleeding?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes→Nasal compression for≥5 min
 
 
 
 
 
 
 
 
 
 
 
NO→Rhinoscopy to identify location of bleeding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E01
 
E02
 
 
 
 
 
 
 
 
 
 
E03
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
F01
 
 
 
 
 
 
 
 
F02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
G01
 
G02
 
 
 
 
G03
 
G04
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
H01
 
H02
 
 
 
 
 
 
 
 
 
H03
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I01
 
 
 
 
 
 
 
 
 
 
 
 
 
I02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
J01
 
J02
 
 
 
 
 
 
 
 
 
J03
 
J04
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
K01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
K02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References


Template:WikiDoc Sources