Sites of Epistaxis


1. Little's area. In 90% cases of epistaxis, bleeding occursfrom this site.

2. Above the level of middle turbinate, Bleeding fromabove the middle turbinate and corresponding area onthe septum is often from the anterior and posteriorethmoidal vessels (internal carotid system).

3. Below the level of middle turbinate. Here bleedingis from the branches of sphenopalatine artery. It maybe hidden, lying lateral to middle or inferior turbinateand may require infrastructure of these turbinates forlocalisation of the bleeding site and placement ofpacking to control it.

4. Posterior part of nasal cavity. Here blood flowsdirectly into the pharynx.

5. Diffuse. Both from septum and lateral nasal wall. Thisis often seen in general systemic disorders and blooddyscrasias.

6. Nasopharynx,

Classification of Epistaxis

Anterior Epistaxis
When blood flows out from the front of nose with the patient in sitting position.




Posterior Epistaxis

Mainly the blood flows back into the throat. Patient may swallow it and later have a "coffee coloured" vomitus. This may erroneously be diagnosed as haematemesis.
The differences between the two types of epistaxis are tabulated herewith.

Management

In any case of epistaxis, it is important to know:

1. Mode of onset.

2. Duration and frequency of bleeding.

3. Amount of blood loss.

4. Side of nose from where bleeding is occurring.

5. Whether bleeding is of anterior or posterior type.

6. Any known bleeding tendency in the patient or family.

7. History of known medical ailment (hypertension,leukaemias, mitral valve disease, cirrhosis, nephritis).

8. History of drug intake (analgesics, anticoagulant, etc.)First Aid

Most of the time, bleeding occurs from the Little's area and can be easily controlled by pinching the nose with thumb and index finger for about 5 minutes. This compresses the vessels of the Little's area. In Trotter's method patient is made to sit, leaning a little forward over a basin to spit any blood, and breathe quietly from the mouth. Cold compresses should be applied to the nose to cause reflexi vasoconstriction.

Cauterisation

This is useful in anterior epistaxis when bleeding point has been located. The area is first anaesthetised and the bleeding point cauterised with a bead of silver nitrate or coagulated with electrocautery.


Nasal Packing