Epistaxis resident survival guide: Difference between revisions

Jump to navigation Jump to search
Line 58: Line 58:
{{familytree | | | | | | | | | | | | C01 | | | | | | | |C01=Active Bleeding?}}
{{familytree | | | | | | | | | | | | C01 | | | | | | | |C01=Active Bleeding?}}
{{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | }}
{{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | }}
{{familytree | | | | | D01 | | | | | | | | | | | |!|D01=Yes→Nasal compression for≥5 min}}
{{familytree | | | | | D01 | | | | | | | | | | | D02 | |D01=Yes→Nasal compression for≥5 min| D02=No}}
{{familytree | | |,|-|-|^|-|.| | | | | | | | | | |!| | | | }}
{{familytree | | |,|-|-|^|-|.| | | | | | | | | | |!| | | | }}
{{familytree | | E01 | | E02 |-|-|-|-|-|-|-|-|-|-| E03 | | | | |E01=Bleeding resume|E02=Bleeding stopped|E03=NO→Rhinoscopy to identify location of bleeding}}
{{familytree | | E01 | | E02 |-|-|-|-|-|-|-|-|-|-| E03 | | | | |E01=Bleeding resume|E02=Bleeding stopped|E03=Rhinoscopy to identify location of bleeding}}
{{familytree | | |!| | | | | | | | | | | | | | | |!| |!| | | | }}
{{familytree | | |!| | | | | | | | | | | | | | | |!| |!| | | | }}
{{familytree | | | F01 | | | | | | | | | | | | F02 | | |!| |F01=Risk assesment (Assess for Hereditary Hemoragic Telangiectasia|F02=F02}}
{{familytree | | | F01 | | | | | | | | | | | | F02 | | |!| |F01=Risk assesment (Assess for Hereditary Hemoragic Telangiectasia|F02=F02}}
Line 80: Line 80:
{{Familytree | | | | | G01 | | G02 | | |!| | |!| |G01=Bleeding controlled| G02=Bleeding resume}}
{{Familytree | | | | | G01 | | G02 | | |!| | |!| |G01=Bleeding controlled| G02=Bleeding resume}}
{{Familytree | | | | |!| | |,|-|^|-|.| |!| | |!| | }}
{{Familytree | | | | |!| | |,|-|^|-|.| |!| | |!| | }}
{{Familytree | | | |H01| | H02 | |H03 | | |!| | |!| |H01=H01| H02=Patient '''doesn't use''' anticoagulant or antiplatelet medications | H03=Patient use anti coagulant or antiplatelet medications }}
{{Familytree | | | | H01 | | H02 | |H03 | | | | | |!| |H01=H01| H02=Patient '''doesn't use''' anticoagulant or antiplatelet medications | H03=Patient use anti coagulant or antiplatelet medications }}
{{Familytree | | | |,|-|^|-|.| | | |!| |!| | |!| | }}
{{Familytree | | | |,| | | | | | | |!| | | | | | | }}
{{Familytree | | | I01 | | I02 | | I03 | |!| | |!| |I01=I01| I02=I02| I03=Life treatening nose bleeding?}}
{{Familytree | | | I01 | | | | | | I03 | | | | |!| |I01=I01| I02=I02| I03=Life treatening nose bleeding?}}
{{Familytree | | | |!| | | |!| |,|-|^|-|.| | |!| | }}
{{Familytree | | | |!| | | | | |,|-|^|-|.| | |!| | }}
{{Familytree | | | J01 | | |!| J02 | | |!| | |!| |J01=| J02=Yes→ Evaluate need for or risk of discontinuation Anti-Coag/Anti-Platelet medications | J03= }}
{{Familytree | | | J01 | | | | J02 | | J03 | |!| |J01=| J02=Yes→ Evaluate need for or risk of discontinuation Anti-Coag/Anti-Platelet medications | J03=No }}
{{Familytree | |,|-|^|-|.| |,|-|^|.| | |!| | | | | }}
{{Familytree | K01 | | | | K02 | | K03 |!| | | | | |K01=K01| K02=Bleeding controled| K03=Bleeding resume }}
{{Familytree | |!| | | |!| |!| | |!| | |!| | | | | }}
{{Familytree | L01 | | L02 | | | |`|-| L03 | | | |L01=L01| L02=L02| L03=Evaluate candidency for Embolization or Surgical arterial ligation| L04=}}
{{familytree | |!| | | | | | | | | | | |!| | |!| | | | | | |}}
{{Familytree | | | | | | | E01 | | | | E02 | |!| |E01=E01| E02=Appropriate intervention which may include Embolization, Surgety, Additional packing or cautery}}
{{Familytree | | | | | | | |!| | | | | |!| | |!| | }}
{{Familytree | | | | | | | F01 | | | | |!| | |!| |F01=F01}}
{{Familytree | | | | | |,|-|^|-|.| | | |!| | |!| | }}
{{Familytree | | | | | G01 | | G02 | | |!| | |!| |G01=G01| G02=G02}}
{{Familytree | | | | | |!| | | |!| | | |!| | |!| | }}
{{Familytree | | | | | H01 | | |!| | | |!| | |!| |H01=H01}}
{{Familytree | | | |,|-|^|-|.| |!| | | |!| | |!| | }}
{{Familytree | | | I01 | | I02 |!| | | |!| | |!| |I01=I01| I02=I02}}
{{Familytree | | | |!| | | |!| |!| | | |!| | |!| | }}
{{Familytree | | | J01 | | |!| |!| | | |!| | |!| |J01=J01}}
{{Familytree | |,|-|^|-|.| |!| |!| | | |!| | |!| | }}
{{Familytree | |,|-|^|-|.| |!| |!| | | |!| | |!| | }}
{{Familytree | K01 | | K02 |!| |!| | | |!| | |!| |K01=K01| K02=K02}}
{{Familytree | K01 | | K02 |!| |!| | | |!| | |!| |K01=K01| K02=K02}}
{{Familytree | |!| | | |!| |!| |!| | | |!| | |!| | }}
{{Familytree | L01 | | L02 |`| L03 |-|-|^|-|-|'| |L01=L01| L02=L02| L03=L03}}
{{familytree | |!| | | | | | | | | | | | | | |!| | | | | | |}}
{{Family tree | | | | | | | E01 | | | | E02 | |!| |E01=E01| E02=E02}}
{{Family tree | | | | | | | |!| | | | | |!| | |!| | }}
{{Family tree | | | | | | | F01 | | | | |!| | |!| |F01=F01}}
{{Family tree | | | | | |,|-|^|-|.| | | |!| | |!| | }}
{{Family tree | | | | | G01 | | G02 | | |!| | |!| |G01=G01| G02=G02}}
{{Family tree | | | | | |!| | | |!| | | |!| | |!| | }}
{{Family tree | | | | | H01 | | |!| | | |!| | |!| |H01=H01}}
{{Family tree | | | |,|-|^|-|.| |!| | | |!| | |!| | }}
{{Family tree | | | I01 | | I02 |!| | | |!| | |!| |I01=I01| I02=I02}}
{{Family tree | | | |!| | | |!| |!| | | |!| | |!| | }}
{{Family tree | | | J01 | | |!| |!| | | |!| | |!| |J01=J01}}
{{Family tree | |,|-|^|-|.| |!| |!| | | |!| | |!| | }}
{{Family tree | K01 | | K02 |!| |!| | | |!| | |!| |K01=K01| K02=K02}}
{{Family tree | |!| | | |!| |!| |!| | | |!| | |!| | }}
{{Family tree | |!| | | |!| |!| |!| | | |!| | |!| | }}
{{familytree/end}}
{{familytree/end}}

Revision as of 09:15, 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

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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bleeding resume
 
Bleeding stopped
 
 
 
 
 
 
 
 
 
 
Rhinoscopy to identify location of bleeding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risk assesment (Assess for Hereditary Hemoragic Telangiectasia
 
 
 
 
 
 
 
 
 
 
 
F02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rhinoscopy to identify location of bleeding
 
 
 
G02
 
 
 
 
G03
 
G04
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bleeding site Identified
 
Bleeding site not identified
 
 
 
 
 
 
 
 
 
H03
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anestesia bleeding site and limit nasal cautery to site
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bleeding stopped
 
Bleeding resume
 
 
 
 
 
 
 
 
 
 
J03
 
J04
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
K01
 
 
Suspected Bleeding site HHT* or Anticoagulants?
 
 
 
 
 
 
 
 
 
 
 
 
 
Suspected Bleeding site HHT* or Anticoagulants?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NO→Non absorbable or absorbable packing(Preferred in children)
 
 
 
Yes→Absorbable packing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nasal packing education
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bleeding controlled
 
Bleeding resume
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
H01
 
Patient doesn't use anticoagulant or antiplatelet medications
 
Patient use anti coagulant or antiplatelet medications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I01
 
 
 
 
 
Life treatening nose bleeding?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes→ Evaluate need for or risk of discontinuation Anti-Coag/Anti-Platelet medications
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
K01
 
 
 
Bleeding controled
 
Bleeding resume
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
L01
 
L02
 
 
 
 
 
 
Evaluate candidency for Embolization or Surgical arterial ligation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E01
 
 
 
Appropriate intervention which may include Embolization, Surgety, Additional packing or cautery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
F01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
G01
 
G02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
H01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I01
 
I02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
J01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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