鼻出血英文

4/99,Raza M. Jafri, FRCS.pk,1,EPISTAXIS,Raza M. Jafri, FRCSAsst. Prof. Of OtolaryngologyHamdard University,4/99,Raza M. Jafri, FRCS.pk,2,REASONS FOR EXCESSIVE BLEEDING,Vascularity of noseBoth external and internal carotids. Anastomsis between arteries and veins.Blood vessels run just under the mucosa-unprotected.Larger vessels on the turbinate run in bony canals- cannot contract.,4/99,Raza M. Jafri, FRCS.pk,3,LITTLES ( KIESSELBACHS) 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.pk,4,Lateral Wall,Frank Netter. Ciba,4/99,Raza M. Jafri, FRCS.pk,5,Blood supply Septum,Frank Netter. Ciba,4/99,Raza M. Jafri, FRCS.pk,6,Littles area,Confluence of :Anterior Ethmoidal a.Greater Palatine a.Sphenopalatine a.Sup. Labial a.,4/99,Raza M. Jafri, FRCS.pk,7,CLASSIFICATION,4/99,Raza M. Jafri, FRCS.pk,8,I. According to site,AnteriorSuperior; 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.pk,9,II. PRIMARY & SECONDARY,4/99,Raza M. Jafri, FRCS.pk,10,III. According to Etiology,Local Causes: 1 TraumaNose picking, fractures.,4/99,Raza M. Jafri, FRCS.pk,11,LOCAL CAUSES,2 Infections:Viral:Influenza, measlesDiphtheria, lupus vulgaris, leprosy, Parasites, maggots, fungal,4/99,Raza M. Jafri, FRCS.pk,12,LOCAL CAUSES,3 Idiopathic: Wegners granulomatosis, Osler-Weber-Rendaus syn., atrophic rhinitis,4/99,Raza M. Jafri, FRCS.pk,13,LOCAL CAUSES,4 Neoplasms: Of the nose, nasopharynx and sinuses.,Angiofibroma,Carcinom of the Nasopharynx,4/99,Raza M. Jafri, FRCS.pk,14,Local Causes,4 Miscellaneous: Septal spur, foreign bodies,4/99,Raza M. Jafri, FRCS.pk,15,General Causes,Hypertension, CCF, mitral stenosis, Cirrhosis, coagulopathies, anemias, purpura, leukemias,4/99,Raza M. Jafri, FRCS.pk,16,General Causes,Malignancies, Caissons disease, Endometriosis, Nephritis, Typhoid,4/99,Raza M. Jafri, FRCS.pk,17,IV. According to Age,Children; Foreign body, nose picking, nasal diphtheria.Adults: Trauma, idiopathic.Middle age: tumors.Old age: hypertension.,4/99,Raza M. Jafri, FRCS.pk,18,MANAGEMENT,I Investigations:CBC,Bleeding profile, BT, CT, PT, APTT, PlateletsHb.,4/99,Raza M. Jafri, FRCS.pk,19,II. TREATMENT,First aidDefinitive treatmentPrevention of recurrences,4/99,Raza M. Jafri, FRCS.pk,20,FIRST AID,Make the patient sit up, pinch nose, open mouth and breath.Ice on fore head.,4/99,Raza M. Jafri, FRCS.pk,21,DEFINITIVE TREATMENT,Look into the nose.Assess blood loss.Crystalloids or colloidsTransfusionLocate the point after packing the nose with 4% xylocaine and 1:1000 adrenaline mixture,4/99,Raza M. Jafri, FRCS.pk,22,CAUTERIZATION,1) Chemicals; Silver Nitrate stick, chromic acid bead.2) Electrical Apply ointment and advise against blowing and nose picking.,ANTERIOR PACKING,Unable to control bleeding.Ribbon, tampon, splints.BIPP, Polyfax,4/99,Raza M. Jafri, FRCS.pk,24,4/99,Raza M. Jafri, FRCS.pk,25,4/99,Raza M. Jafri, FRCS.pk,26,POSTERIOR PACKING,Posterior packing if bleed is posterior.GA.Foleys or other inflatable devicesRemoved as soon as possible. Antibiotics. Transfuse.Blood gases in children.,4/99,Raza M. Jafri, FRCS.pk,27,Complications,Infection, loose pack obstructing airway.,4/99,Raza M. Jafri, FRCS.pk,28,SPECIAL CASES,Haemophilia; Replace factor VIII, or fresh blood.Other clotting deficiency; FFP.Purpura; Platelets,4/99,Raza M. Jafri, FRCS.pk,29,SPECIAL CASES,Anticoagulants; Stop drug, or titrate. Heparin is reversed with protamine sulphate, warfarin with vitamin KUnconscious head injury; Dangerous to pack in suspected skull #.Telengiectasia; Septodermoplasty.,4/99,Raza M. Jafri, FRCS.pk,30,OTHER TREATMENTS,Ligation of vessel