– Dangerous to pack in suspected skull #.
Telengiectasia;
– Septodermoplasty.
4/99 Raza M. Jafri, FRCS docraza@.pk 29
OTHER TREATMENTS
Ligation
4/99
Raza M. Jafri, FRCS docraza@.pk
8
II. PRIMARY & SECONDARY
4/99
Raza M. Jafri, FRCS docraza@.pk
9
III. According to Etiology
of vessels
– Maxillary artery – Ethmoid arteries – External Carotid artery
4/99
Raza M. Jafri, FRCS docraza@.pk
30
OTHER TREATMENTS
Embolization Catheters

4/99
Raza M. Jafri, FRCS docraza@.pk
21
CAUTERIZATION
1) Chemicals;
Silver
Nitrate stick, chromic acid bead. Apply ointment and advise against blowing and nose picking.
4/99
Raza M. Jafri, FRCS docraza@.pk
6
CLASSIFICATION
4/99
Raza M. Jafri, FRCS docraza@.pk
7
I. According to site
Anterior Superior;
Children; – Foreign body, nose picking, nasal diphtheria. Adults: – Trauma, idiopathic. Middle age: – tumors. Old age: – hypertension.

4/99 Raza M. Jafri, FRCS docraza@.pk 17
Raza M. Jafri, FRCS docraza@.pk 22
2) Electrical

4/99
ANTERIOR PACKING
Unable to control bleeding. Ribbon, tampon, splints. BIPP, Polyfax
EPISTAXIS
Raza M. Jafri, FRCS Asst. Prof. Of Otolaryngology Hamdard University
4/99
Raza M. Jafri, FRCS docraza@.pk
1
REASONS FOR EXCESSIVE BLEEDING


Vascularity of nose Both external and internal carotids. Anastomsis between arteries and veins. Blood vessels run just under the mucosaunprotected. Larger vessels on the turbinate run in bony canals- cannot contract.

4/99
Raza M. Jafri, FRCS docraza@.pk
24
4/99
Raza M. Jafri, FRCS docraza@.pk
25
POSTERIOR PACKING
Posterior packing if bleed is posterior. GA. Foley's or other inflatable devices Removed as soon as possible. Antibiotics. Transfuse. Blood gases in children.
28
SPECIAL CASES
Anticoagulants;
– Stop drug, or titrate. – Heparin is reversed with protamine sulphate, – warfarin with vitamin K
Unconscious
head injury;
15
General Causes
Malignancies, Caissons'
disease, Endometriosis, Nephritis, Typhoid
4/99
Raza M. Jafri, FRCS docraza@.pk
16
IV. According to Age
Anterior ethmoid ( bleeding is from above ant. half of middle turbinate) Inferior; Greater palatine, Posterior; Sphenopalatine (Bleeding is from below anterior half of middle turbinate
4/99
Raza M. Jafri, FRCS docraza@.pk
2
LITTLE'S ( KIESSELBACH'S) AREA
1/2
inch from the caudal border of the septum antero-inferiorly. Vessels anastomosing are; Anterior ethmoid, greater palatine, and sphenopalatine, and septal branch of superior labial. Bleeding may be arterial or venous.

4/99
Raza M. Jafri, FRCS docraza@.pk
12
LOCAL CAUSES
[4] Neoplasms:
Of the
– nose, – nasopharynx and – sinuses.
Carcinom of the Nasopharynx
Angiofibroma
First
aid Definitive treatment Prevention of recurrences
4/99
Raza M. Jafri, FRCS docraza@.pk
19
FIRST AID
– Make the patient sit up, pinch nose, open mouth and breath. – Ice on fore head.
27
SPECIAL CASES
Haemophilia;
– Replace factor VIII, or fresh blood.
Other
clotting deficiency;
– FFP.
Purpura;
– Platelets
4/99
Raza M. Jafri, FRCS docraza@.pk

4/99 Raza M. Jafri, FRCS docraza@.pk 26
Complications
Infection,
loose
pack obstructing airway.
4/99
Raza M. Jafri, FRCS docraza@.pk
14
General Causes
Hyperl stenosis, Cirrhosis, coagulopathies, anemias, purpura, leukemias,
4/99
Raza M. Jafri, FRCS docraza@.pk
Frank Netter. Ciba
4/99 Raza M. Jafri, FRCS docraza@.pk 5
Little’s area
Confluence
of :
– Anterior Ethmoidal a. – Greater Palatine a. – Sphenopalatine a. – Sup. Labial a.
measles
vulgaris, leprosy, Parasites, maggots, fungal
4/99 Raza M. Jafri, FRCS docraza@.pk 11
LOCAL CAUSES
[3] Idiopathic:
Wegner's granulomatosis, Osler-Weber-Rendau's syn., atrophic rhinitis
4/99
Raza M. Jafri, FRCS docraza@.pk
20
DEFINITIVE TREATMENT
Look into the nose. Assess blood loss. – Crystalloids or colloids – Transfusion Locate the point after packing the nose with 4% xylocaine and 1:1000 adrenaline mixture
MANAGEMENT
I] Investigations:
CBC,
Bleeding