Epistaxis resident survival guide: Difference between revisions
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==Treatment== | ==Treatment== | ||
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according | Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according to the [...] guidelines. | ||
Statement Action Strength | Statement Action Strength | ||
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{{familytree | | | | | D01 | | | | | | | | | | | D02 | |D01=Yes→Nasal compression for≥5 min| D02=No}} | {{familytree | | | | | D01 | | | | | | | | | | | D02 | |D01=Yes→Nasal compression for≥5 min| D02=No}} | ||
{{familytree | | |,|-|-|^|-|.| | | | | | | | | | |!| | | | }} | {{familytree | | |,|-|-|^|-|.| | | | | | | | | | |!| | | | }} | ||
{{familytree | | E01 | | E02 | {{familytree | | E01 | | E02 |-|-|-|-|-|-|-|-|-| E03 | | | | |E01=Bleeding resume|E02=Bleeding stopped|E03=Rhinoscopy to identify location of bleeding}} | ||
{{familytree | | |!| | | | | | | | | | | | | | | |!| | | {{familytree | | |!| | | | | | | | | | | | | | | |!| | | | | | }} | ||
{{familytree | | | F01 | | | | | | | | | | | | | {{familytree | | | F01 | | | | | | | | | | | | | |F02 | | |F01=Risk assesment (Assess for Hereditary Hemoragic Telangiectasia|F02=Bleeding site identified?}} | ||
{{familytree | | | |!| | | | | | | | | | |,|-|^|-|.| | {{familytree | | | |!| | | | | | | | | | | |,|-|-|^|-|-|.| | | }} | ||
{{familytree | | | | G01 | | | | | {{familytree | | | | G01 | | | | | | | | G03 | | | | | | G04 | | | |G01=Rhinoscopy to identify location of bleeding| G03=<div style="float: left; text-align: left; height: 7em; width: 14em; padding:1em;"> '''Yes→ Three options:'''<br> | ||
{{familytree | | |,|-|^|-|.| | | | | | |!| | | | | ---- | ||
{{familytree | | | H01 | | H02 | | | | | | ❑ 1=Lubricants <br> ❑ 2=Topical vasoconstrictors <br> ❑ 3=Nasal cautery </div>| G04=No}} | ||
{{familytree | | | |!| | | |!| | | | | | | | {{familytree | | |,|-|^|-|.| | | | | | | |!| | | | | | | }} | ||
{{familytree | | | I01 | | |!| | | | | | | {{familytree | | | H01 | | H02 | | | | | H03 | | | | | | |H01=Bleeding site Identified|H02=Bleeding site not identified| H03=Decision for nausal Cautery? | H04= }} | ||
{{familytree | |,|-|^|-|.| |!| | | | | | | | {{familytree | | | |!| | | |!| | | | |,|-|^|.| | | | | | | | | | }} | ||
{{familytree | J01 | | J02 |!| | | | | | | | {{familytree | | | I01 | | |!| | | | I02 | | I03 | | I04 | | | |I01=Anestesia bleeding site and limit nasal cautery to site|I02=Yes→ Anestesia bleeding site and limit nasal cuatery to site | I03=No | I04= }} | ||
{{familytree | |!| | | |!| |!| | | | | | | | {{familytree | |,|-|^|-|.| |!| | | | | | | | | | | | | | | | |}} | ||
{{familytree | J01 | | J02 |!| | | | | | | | | | | | | | | |J01=Bleeding stopped|J02=Bleeding resume|J03=J03|J04=J04}} | |||
{{familytree | |!| | | |!| |!| | | | | | | | |!| | | |!| | |}} | |||
{{familytree | K01 | | | K02 | | | | | | | | | |!| | | K02 | |K01=K01|K02=Suspected Bleeding site HHT* or Anticoagulants?}} | {{familytree | K01 | | | K02 | | | | | | | | | |!| | | K02 | |K01=K01|K02=Suspected Bleeding site HHT* or Anticoagulants?}} | ||
{{Familytree | | | | |,|-|-|^|-|-|.| | | | | |!| | }} | {{Familytree | | | | |,|-|-|^|-|-|.| | | | | |!| | }} | ||
| Line 96: | Line 98: | ||
{{Familytree | | | | | G01 | | G02 | | |!| | |!| |G01=G01| G02=G02}} | {{Familytree | | | | | G01 | | G02 | | |!| | |!| |G01=G01| G02=G02}} | ||
{{Familytree | | | | | |!| | | |!| | | |!| | |!| | }} | {{Familytree | | | | | |!| | | |!| | | |!| | |!| | }} | ||
{{Family tree | |!| | | |!| |!| |!| | | |!| | |!| | }} | {{Family tree | |!| | | |!| |!| |!| | | |!| | |!| | }} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 09:43, 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
- Local trauma
- Acute sinusitis
- Allergic rhinitis
- Anticoagulation
- Aspirin
- Chronic rhinitis
- Chronic sinusitis
- Cocaine
- Common cold
- Foreign bodies
- Nose-picking
- Neoplasia
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 to 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 | Bleeding site identified? | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhinoscopy to identify location of bleeding | Yes→ Three options: ❑ 1=Lubricants ❑ 2=Topical vasoconstrictors ❑ 3=Nasal cautery | No | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding site Identified | Bleeding site not identified | Decision for nausal Cautery? | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Anestesia bleeding site and limit nasal cautery to site | Yes→ Anestesia bleeding site and limit nasal cuatery to site | No | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleeding stopped | Bleeding resume | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.