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| Line 47: |
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| Statement Action Strength | | Statement Action Strength |
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| 1:The patients needs prompt action
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| 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.
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| Recommendation
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| 2:
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| Nasal compression The clinician should treatactivebleedingforpatientsinneedofpromptmanagementwithfirmsustainedcompressionto thelowerthirdofthenose,withorwithouttheassistanceofthepatientorcaregiver,for5minutesorlonger.
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| Recommendation
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| 3a:NasalpackingForpatientsinwhombleedingprecludesidentificationofableedingsitedespitenasalcompression,theclinicianshould treatongoingactivebleedingwithnasalpacking.
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| Recommendation
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| 3b:Nasalpackinginpatientswith suspectedincreasedbleedingrisk
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| Theclinicianshoulduseresorbablepackingforpatientswithasuspectedbleedingdisorderorforpatientswhoareusing anticoagulationorantiplateletmedications.
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| Recommendation
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| 4:NasalpackingeducationTheclinicianshouldeducatethepatientwhoundergoesnasalpackingaboutthetypeofpackingplaced,timingofandplan forremovalofpacking(ifnotresorbable),postprocedurecare,andanysignsorsymptomsthatwouldwarrantprompt reassessment.
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| Recommendation
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| 5:RiskfactorsTheclinicianshoulddocumentfactorsthatincreasethefrequencyorseverityofbleedingforanypatientwithanosebleed, includingpersonalorfamilyhistoryofbleedingdisorders,useofanticoagulantorantiplateletmedications,orintranasal druguse.
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| Recommendation
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| 6:Anteriorrhinoscopytoidentify locationofbleeding
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| Theclinicianshouldperformanteriorrhinoscopytoidentifyasourceofbleedingafterremovalofanybloodclot(if present)forpatientswithnosebleeds.
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| Recommendation
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| 7a:Examinationusingnasal endoscopy
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| Theclinicianshouldperform,orshouldrefertoaclinicianwhocanperform,nasalendoscopytoidentifythesiteof bleedingandguidefurthermanagementinpatientswithrecurrentnasalbleeding,despitepriortreatmentwithpackingor cautery,orwithrecurrentunilateralnasalbleeding.
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| Recommendation
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| 7b:Examinationofnasalcavityand nasopharynxusingnasal endoscopy
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| Theclinicianmayperform,ormayrefertoaclinicianwhocanperform,nasalendoscopytoexaminethenasalcavityand nasopharynxinpatientswithepistaxisthatisdifficulttocontrolorwhenthereisconcernforunrecognizedpathology contributingtoepistaxis.
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| Option
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| 8:Appropriateinterventionsfor identifiedbleedingsite
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| Theclinicianshouldtreatpatientswithanidentifiedsiteofbleedingwithanappropriateintervention,whichmayinclude oneormoreofthefollowing:topicalvasoconstrictors,nasalcautery,andmoisturizingorlubricatingagents.
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| Recommendation
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| 9:NasalcauteryWhennasalcauteryischosenfortreatment,theclinicianshouldanesthetizethebleedingsiteandrestrictapplicationof cauteryonlytotheactiveorsuspectedsite(s)ofbleeding.
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| Recommendation
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| 10:Ligationand/orembolizationfor persistentnosebleeds
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| Theclinicianshouldevaluate,orrefertoaclinicianwhocanevaluate,candidacyforsurgicalarterialligationorendovascular embolizationforpatientswithpersistentorrecurrentbleedingnotcontrolledbypackingornasalcauterization.
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| Recommendation
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| 11:Managementofpatientsusing anticoagulationandantiplatelet medications
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| Intheabsenceoflife-threateningbleeding,theclinicianshouldinitiatefirst-linetreatmentspriortotransfusion,reversalof anticoagulation,orwithdrawalofanticoagulation/antiplateletmedicationsforpatientsusingthesemedications.
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| Recommendation
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| 12:Hereditaryhemorrhagic telangiectasia(HHT)identification
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| Theclinicianshouldassess,orrefertoaspecialistwhocanassess,thepresenceofnasaltelangiectasiasand/ororalmucosal telangiectasiasinpatientswhohaveahistoryofrecurrentbilateralnosebleedsorafamilyhistoryofrecurrentnosebleeds todiagnosehereditaryhemorrhagictelangiectasiasyndrome.
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| Recommendation
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| 13:Patienteducationand prevention
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| Theclinicianshouldeducatepatientswithnosebleedsandtheircaregiversaboutpreventivemeasuresfornosebleeds,home treatmentfornosebleeds,andindicationstoseekadditionalmedicalcare.
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| Recommendation
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| 14:NosebleedoutcomesTheclinicianordesigneeshoulddocumenttheoutcomeofinterventionwithin30daysordocumenttransitionofcarein patientswhohadanosebleedtreatedwithnonresorbablepacking,surgery,orarterialligation/embolization.
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| Recommendation
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| {{familytree/start |summary=PE diagnosis Algorithm.}} | | {{familytree/start |summary=PE diagnosis Algorithm.}} |
| Line 144: |
Line 60: |
| {{familytree | | | | | D01 | | | | | | | | | | | |!|D01=Yes→Nasal compression for≥5 min}} | | {{familytree | | | | | D01 | | | | | | | | | | | |!|D01=Yes→Nasal compression for≥5 min}} |
| {{familytree | |,|-|-|-|^|-|.| | | | | | | | | | |!| | | | }} | | {{familytree | |,|-|-|-|^|-|.| | | | | | | | | | |!| | | | }} |
| {{familytree | | E01 | | E02 |-|-|-|-|-|-|-|-|-|-| E03 | | | | |E01=E01|E02=E02|E03=NO→Rhinoscopy to identify location of bleeding}} | | {{familytree | | E01 | | E02 |-|-|-|-|-|-|-|-|-|-| E03 | | | | |E01=Bleeding resume|E02=Bleeding stoped|E03=NO→Rhinoscopy to identify location of bleeding}} |
| {{familytree | | | | | |!| | | | | | | | | | | | |!| |!| | | | }} | | {{familytree | | |!| | | | | | | | | | | | | | | |!| |!| | | | }} |
| {{familytree | | | | | F01 | | | | | | | | | F02 | | |!| |F01=F01|F02=F02}} | | {{familytree | | | F01 | | | | | | | | | | | | F02 | | |!| |F01=Risk assesment (Assess for Hereditary Hemoragic Telangiectasia|F02=F02}} |
| {{familytree | | | |,|-|^|-|.| | | | | | |,|-|^|-|.| |!| | }} | | {{familytree | | | |,|-|^|-|.| | | | | | |,|-|^|-|.| |!| | }} |
| {{familytree | | | G01 | | G02 | | | | | G03 | | G04 |!| | |G01=G01|G02=G02|G03=G03|G04=G04}} | | {{familytree | | | G01 | | G02 | | | | | G03 | | G04 |!| | |G01=G01|G02=G02|G03=G03|G04=G04}} |
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
| | | | | | | | | Patient with epistaxis | | | | |
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| | | | | | | | | Does the patient need immediate action? | | | | | |
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| | Yes→Volume replacement,airway check, Needs for emergency departement | | | | | | | | | | | | | No | | |
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| | | | | | | | | | | Active Bleeding? | | | | | | | |
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| | | | Yes→Nasal compression for≥5 min | | | | | | | | | | | | | |
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| Bleeding resume | | Bleeding stoped | | | | | | | | | | | NO→Rhinoscopy to identify location of bleeding | | | | |
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| | Risk assesment (Assess for Hereditary Hemoragic Telangiectasia | | | | | | | | | | | | F02 | | | | | |
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| K01 | | | | | | | | | | | | | | | | | | | K02 | |
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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