Epistaxis Epistaxis Interact A mother walks in with

Epistaxis Interact! A mother walks in with a 2 year old child whose nose

What to ask ? • • • First time/ recurrent Bleeding tendency in the

Classification of Epistaxis • Primary –no obvious cause • Mild – no hemodynamic alteration

Evaluate • History • Airway , Breathing , Circulation • Hemodynamics – BP, O

*ABC- Assess for hypovolemic shock (start IV fluids) History of Active bleeding ABC *

When to refer ? • • • Recurrent epistaxis Uncontrollable epistaxis Posterior epistaxis Haemotympanum

Some don’t’s • Don’t sneeze. If unavoidable, try to sneeze with the mouth open.

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Epistaxis

Epistaxis Interact! A mother walks in with a 2 year old child whose nose is bleeding profusely • What questions will you ask? • How will you manage?

What to ask ? • • • First time/ recurrent Bleeding tendency in the family Foreign body insertion Infectious (RTI ) H/o trauma /nasal picking Use of drugs*

Classification of Epistaxis • Primary –no obvious cause • Mild – no hemodynamic alteration • Anterior : Kiesselbach’s plexus/Littles area • Seasonal : cold dry months • Unilateral : one nostril bleed • Secondary-cause present • Moderate to severe- hemodynamically unstable • Posterior : Woodruff's plexus • Perennial: throughout year • Bilateral : bleeds into throat or from both nostrils

Evaluate • History • Airway , Breathing , Circulation • Hemodynamics – BP, O 2, CRT, • Skin and retina – erythema, rash, petechial

Management

*ABC- Assess for hypovolemic shock (start IV fluids) History of Active bleeding ABC * Ice pack Pinch nostrils 5 -20 min child will be breathing through mouth Apply Vasoconstrictors Oxymethazoline one to two squirts into the bleeding side of the nose with 0. 05 percent Steps in Managing Refer epistaxis

When not to ignore ? ?

When to refer ? • • • Recurrent epistaxis Uncontrollable epistaxis Posterior epistaxis Haemotympanum Facial trauma Polyps / tumors.

Some don’t’s • Don’t sneeze. If unavoidable, try to sneeze with the mouth open. • Don’t drink or eat anything hot for 24 hours after a nosebleed, hot drinks can expand the blood vessel in the lining of your nose and cause fresh Bleeding. • Don’t attempt to remove any packing applied by a doctor • Don’t lift heavy objects or attempt strenuous exercise for one week. • Don’t bathe with hot water for 24 hours • Don't underestimate the amount of blood that can be lost from epistaxis.