Nose Procedures

trauma (digital, injury, foreign body), inflammation/crusting

<10 years old epistaxis occurs how?

atruamatic, winter months, medications/comorbidities

70-79 years old epistaxis occurs how?

digital manipulation

What is #1 local cause of epistaxis?

digital manipulation

deviated nasal septum

foreign body

trauma

inhaled corticosteroid use

inhaled cocaine use

dry air exposure like environmental and nasal oxygen

rhinosinusitis

environmental inhalants

barotrauma

nasal polyps

nasal malignancies

Local causes of epistaxis?

inherited coagulopathies, hereditary hemorrhagic telangiectasia, acquired, iatrogenic

Systemic causes of epistaxis?

von willebrand disease, hemophilia

Inherited systemic cause of epistaxis?

disorders of platelet numbers/function, hematologic malignancies, chronic renal insufficiency, chronic alcohol use, hyertension

Acquired causes of systemic epistaxis?

aspirin, NSAIDs, other anticoagulants, herbal medications

Iatrogenic systemic causes of epistaxis?

nasal compression minimum of 5 minutes

oxymetazoline or phenylephrine nasal spray

nasal cautery

nasal packing

embolization

surgical artery ligation

Control of epistaxis?

sphenopalatine artery

For surgical artery ligation what artery is usually used?

only if you can see source

When trying to control epistaxis, you only cauterize with silver nitrate when?

2 sprays afrin or neo-synephrine, pledgets with lidocaine with epi or cocaine

What to do for mild nose bleeding?

hold compression for minimum of 5 minutes, angerior cartilaginous aspect of nose, head tilted forward, thumb and middle finger

What to do for significant bleeding?

septal perforation

Electrocautery has increased risk for what?

persistent epistaxis

indications of when to pack?

nasal bone fracture or cribriform plate fracture, uncontrolled airway, hemodynamic instability

Contraindications to packing?

anterior bleeding

What type of bleeding?

• kisselbach plexus

• more bleeding anterior nares

• pack and discharge home if medically stable

posterior bleeding

What type of bleeding?

• sphenopalatine artery

• more bleeding posterior oropharynx

• must occlude choanal arch with packing

• often hospitalized

slide along floor of nasal cavity

How to insert packing anteriorly?

pinch nose

If patient continues bleeding after packing what should they do?

45-90 degree angle

How should patient be positioned for packing?

infection and toxic shock syndrome

septal perforation

airway compromise

nasal packing becomes dislodged or leak

recurrent bleeding

pressure necrosis

severe pain

anxiety

hypoxia

cardiac dysrhythmias

Nasal packing complications?

refer to ENT, needs rhinoscopy

What if a patient has recurrent epistaxis?

any time there is a foreign body in the nose

Indications of nasal FB removal?

patients unable to protect airway

Contraindications of nasal FB removal?

oxymetazoline and lidocaine

For a nasal foreign body removal prepare nose with what?

ENT referral, follow-up care

Post-procedure care for foreign body?