BLEEDING CONTROL in

EPISTAXIS

Budi Sutikno

Division of Rhinology
Dept. of Otorhinolaryngology Head & Neck Surgery
Faculty of Medicine, Universitas Airlangga/
Dr. Soetomo General Hospital, Surabaya
2 INTRODUCTION
Epistaxis :
A bleeding from inside the
nose
A sign, not a disease
A 60% of population at least
1 episode in life only 6%
need medical management

What should be learnt?

Blood supply of nasal cavity
Underlying cause (etiology)
Management
3 BLOOD SUPPLY OF NASAL
CAVITY
NASAL CAVITY
Nasal septum
Lateral nasal wall
 Blood supply of nasal cavity ...
4

INTERNAL carotid EXTERNAL carotid

artery artery

Int max art (1) Ext max art

(2) Sphenopalatin
e art
Ophthalmic art (facial art)

Septal br of sup labial art

Ant ethmoidal art (1) Vestibular br of facial art
Branches of
Post ethmoidal art (2) sphenopalatine art
 Blood supply of nasal cavity ...
5

Woodr
Littl uffs
es area
are
a

NASAL SEPTUM LATERAL NASAL WALL

6 HISTORY

Previous bleeding episodes (duration,

frequency, quantity, side)
Recent trauma
Familial history
Systemic aspect (hypertension, other
diseases, drug consumption)
7 ETIOLOGY

Attempt of investigation :
Local (in the nose or nasopharynx)
General (systemic etiology)
Idiopathic
 Etiology ...
8

NOSE NASOPHARYNX GENERAL

Trauma Juvenile Cardiovasc.

Infection angiofibroma system
Foreign Adenoiditis Blood/blood
bodies Neoplasms vessel
Neoplasms disorder
Nasal spur Liver disease
Atmosphere Kidney
changes disease
Drugs
Mediastinal
compression
Sepsis
 History ...
9 Mucosal & Arterial Bleeding
 History ...
10 Mucosal & Arterial Bleeding
11 MANAGEMENT

Stabilize patient
First aid
Anterior nasal packing
Posterior nasal packing
Others: cauterization, hot water irrigation,
ligation of vessels
 Management ...
12 First Aid
Simple procedure (TROTTERs method) to control
bleeding due to anterior epistaxis from Littles
area (Kiesselbachs plexus) & its surrounding

Patient is in sitting position

Forced expire & spit out any blood or
blood clot (nasal blowing)
Pinch the nose with thumb & index finger
for a moment
Breathe quietly from the mouth
(cold packing)
 Management ...
13 Anterior Nasal Pack
 Management ...
14 Anterior Nasal Pack

1
2
3
4
 Management ...
15 Anterior Nasal Pack
 Management ...
16 Anterior Nasal Pack
 Management ...
17

Other materials for nasal

pack
 Management ...
18 Posterior Nasal Pack
 Management ...
19 Complication of Nasal Pack

Mucosal lesion synechiae

Mucosal necrosis
Ostial occlusion rhinosinusitis
Otitis media
Toxic shock syndrome
 Management ...
20 Cauterization

Kiesselbachs
plexus
Aspirat
or

Trichloroace
tate (TCA)-
soaked
cotton
21 TAKE HOME MESSAGE

Choose an appropriate management

Avoid use of epinephrine/adrenaline in
patient with hypertension (use
oxymetazoline 0.05% instead of
adrenaline)
Anterior/posterior nasal pack requires
antibiotic
Anterior/posterior nasal pack can be
maintained for 3-5 days
Posterior nasal pack requires
hospitalization
22