Epistaxis resident survival guide: Difference between revisions
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Statement Action Strength | Statement Action Strength | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | | | A01 | | | | |A01=Patient with [[Epistaxis]]}} | {{familytree | | | | | | | | | | A01 | | | | |A01=Patient with [[Epistaxis]] }} | ||
{{familytree | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | | | | | A02 | | | | | |A02=Does the patient need [[Immediate Action]]?}} | {{familytree | | | | | | | | | | A02 | | | | | |A02=Does the patient need [[Immediate Action]]? }} | ||
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }} | {{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }} | ||
{{familytree | | | B01 | | | | | | | | | | | | | B02 | | |B01= | {{familytree | | | B01 | | | | | | | | | | | | | B02 | | |B01=<div style="float: left; text-align: left; height: 7em; width: 14em; padding:1em;"> '''Yes→ :'''<br> | ||
---- | |||
❑ Assess [[Airway]] <br> ❑ [[Hemodynamic]] stability <br> ❑ Needs for [[emergency setting]] </div> |B02=No }} | |||
{{Familytree | | | |!| | | | | | | | | | | | | | |!| }} | |||
{{familytree | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|'| | | | }} | {{familytree | | | |`|-|-|-|-|-|-|-|-|v|-|-|-|-|-|'| | | | }} | ||
{{familytree | | | | | | | | | | | | C01 | | | | | | | |C01=[[Active Bleeding]]?}} | {{familytree | | | | | | | | | | | | C01 | | | | | | | |C01= [[Active Bleeding]]? }} | ||
{{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | }} | {{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | }} | ||
{{Familytree | | | | | |!| | | | | | | | | | | | |!| }} | |||
{{familytree | | | | | D01 | | | | | | | | | | | D02 | |D01=Yes→[[Nasal compression]] for≥5 min| D02=No}} | {{familytree | | | | | D01 | | | | | | | | | | | D02 | |D01=Yes→[[Nasal compression]] for≥5 min| D02=No}} | ||
{{familytree | | | |,|-|^|.| | | | | | | | | | | |!| | | | }} | {{familytree | | | |,|-|^|.| | | | | | | | | | | |!| | | | }} | ||
{{familytree | | E01 | | E02 | | | | | | | | | | |!| | | | | |E01=Bleeding resume|E02=Bleeding | {{familytree | | E01 | | E02 | | | | | | | | | | |!| | | | | |E01=Bleeding resume|E02=Bleeding Controlled }} | ||
{{familytree | | | |!| | |`|-|-|-|-|-|-|-|-|-|-| E03 | | | | | |E03=[[Rhinoscopy]] to identify location of bleeding}} | {{familytree | | | |!| | |`|-|-|-|-|-|-|-|-|-|-| E03 | | | | | |E03=[[Rhinoscopy]] to identify location of bleeding}} | ||
{{familytree | | | |!| | | | | | | | | | | | | | |!| | | | | | }} | {{familytree | | | |!| | | | | | | | | | | | | | |!| | | | | | }} | ||
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{{familytree | | | | G01 | | | | | | | | G03 | | | | | G04 | | | | |G01=[[Rhinoscopy]] to identify location of [[bleeding]]| G03=<div style="float: left; text-align: left; height: 7em; width: 14em; padding:1em;"> '''Yes→ Three options:'''<br> | {{familytree | | | | G01 | | | | | | | | G03 | | | | | G04 | | | | |G01=[[Rhinoscopy]] to identify location of [[bleeding]]| G03=<div style="float: left; text-align: left; height: 7em; width: 14em; padding:1em;"> '''Yes→ Three options:'''<br> | ||
---- | ---- | ||
❑ 1=Lubricants <br> ❑ 2=Topical vasoconstrictors <br> ❑ 3=Nasal cautery </div>| G04=No}} | ❑ 1=[[Lubricants]] <br> ❑ 2=[[Topical vasoconstrictors]] <br> ❑ 3=[[Nasal cautery]] </div>| G04=No}} | ||
{{familytree | | | |,|^|-|-|-|.| | | | | |!| | | | | | |!| | | }} | {{familytree | | | |,|^|-|-|-|.| | | | | |!| | | | | | |!| | | }} | ||
{{familytree | | | H01 | | | H02 | | | | H03 | | | | | |!| | | |H01=Bleeding site Identified|H02=Bleeding site not identified| H03=Decision for [[Nausal Cautery]]? | H04= }} | {{familytree | | | H01 | | | H02 | | | | H03 | | | | | |!| | | |H01=Bleeding site Identified|H02=Bleeding site not identified| H03=Decision for [[Nausal Cautery]]? | H04= }} | ||
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{{Familytree | | | | | | | | |!| | | | | |!| | | | | | | }} | {{Familytree | | | | | | | | |!| | | | | |!| | | | | | | }} | ||
{{Familytree | | | | | | | | |`|-|-|-|-| F01 |-|-| F02 |-|-| F03 | | | |F01=Patient Education and Prevention| F02=Outcome Assesment| F03=Discharge}} | {{Familytree | | | | | | | | |`|-|-|-|-| F01 |-|-| F02 |-|-| F03 | | | |F01=Patient Education and Prevention| F02=Outcome Assesment| F03=Discharge}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 11:36, 14 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
- Local trauma
- Acute sinusitis
- Allergic rhinitis
- Anticoagulation
- Aspirin
- Chronic rhinitis
- Chronic sinusitis
- Cocaine
- Common cold
- Foreign bodies
- Nose-picking
- Neoplasia
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 to the [...] guidelines.
Statement Action Strength
| Patient with Epistaxis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient need Immediate Action? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Active Bleeding? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes→Nasal compression for≥5 min | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding resume | Bleeding Controlled | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhinoscopy to identify location of bleeding | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Risk assesment (Assess for Hereditary Hemoragic Telangiectasia | Bleeding site identified? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhinoscopy to identify location of bleeding | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding site Identified | Bleeding site not identified | Decision for Nausal Cautery? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Anestesia bleeding site and limit Nasal cautery to site | Yes→ Anestesia bleeding site and limit Nasal Cautery to site | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding controlled | Bleeding resume | Rist factor assessment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suspected Bleeding site HHT* or Anticoagulants? | Patient education and prevention | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| NO→Non absorbable or Absorbable packing(Preferred in children) | Yes→Absorbable packing | Outcome Assesment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Nasal packing education | Discharge | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding controlled | Bleeding resume | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Patient use Anticoagulant or Antiplatelet medications | Patient doesn't use Anticoagulant or Antiplatelet medications | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Patient Education and prevention | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Life treatening Nose bleeding? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Outcome Assement | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes→ Evaluate need for or risk of discontinuation Anti-Coag/Anti-Platelet medications | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Discharge | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding controled | Bleeding resume | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Evaluate candidency for Embolization or Surgical arterial ligation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Appropriate intervention which may include Embolization, Surgery, Additional Nasal packing or Cautery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Patient Education and Prevention | Outcome Assesment | Discharge | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.