Rhinology Emergencies

I .

Epistaxis

Anatomy Kiesselbach plexus

·

: Canterior

Woodruff's plexus < posterior

Read ...

(self-limiting)

> ↑ suscept to dry out

, .

(If not humidified]

Rendu-Osler-Weber syndrome

Heridatary haemorrhagic telangiectasis

1
(Birth trauma recurrent
dilated BV
-
mouth epistaxis

blanch wh
Hypertensive emergency -
GIT

septumosactasis fa
↑ hole in septum
compr
<

Epistaxis:tacky, -

visa versa?

Lead to : Anemia , chronic bleeding

> Massive tumour of BV No contractile tissue
L AKA Osler-Rendu-Weber's disease .
Always pubertal males in BV wall
electrolytesarea D
area
Will bleed a lot !
-NEPO UBE :

Factor VIII < Vit . K , clotting factors Have to hemo-dialysis

Heparin giving
:. MORE BLEED !!!

Factors
complicating management Hypertension
·

disorders
Bleeding
Liver failure
NSAIDS [VCOX1 protection]

clopedogri 3
* · Asprin > Give : TXA (cyclokapion) (x fibrinolysis)
Vit K
Alcohol ·
Heparin/Warfarin < Give : . .

tumeric ,
·

Ginger
Meds
,

cinnamon

not tell you

Does
fx of platelets
BUT .... If Ph : then
you
Tx
M
RBC

LocalDigitalPresent
Ask for smear
FBC
:

Investigations
· ·
know !
: : platelets
fragmentPay
·

·
·

H/E
PackingBIPPgaeices > INR-
·

PI/PTT
Ask about :

Clotting profile
·

Meds
·

Grandpa (Asprin LFT liver failure

antibiotics oral or topical <

use
Platelet function
factors
clotting ·

FFP ·
Warfarin ifpt on NSAIDs
give cyklokapron
Wit K
< [smear]
Tranexamic Acid Cyclokapron ·
Clexane
bruising
TREATMENT ·
fam hx : bleeding ,

SurgicalSphenpalatine
-

le
a

ABC's . Meds
3
Follow up
:
Antibiotic
No
blowing
blood from throat]
of nose for a week
AB Coral topical) [Augmentin]
Sit forward [keep
ointment
·

Airway
·
:
1
clotting factors
.

Review after why

·

Circulation Stop bleed ffP platelets

Endoscopy
+
.
2 : ·

Vit K
CT to exclude neoplasm
Digital of sides
.

Local (x2
sinuses
·

*
pressure
: ·

the bone
TXA (Cyclokapron)
3
for 7 min Don't press on

Pain meds :
Paracetamol IV tramadoe
bleeds]
·

Silver nitrate (smaller

,
·

[Thromboxane]
Electro Only x1 side : necrosis
·

cautery

*
Packing : BIPP gauze wI TXA/Adrenaline + galine <
4
. Surgical
Anterior
N
iodine : ↓ risk for infection ·

Sphenopalatine a.
Clip
stick to floor B and push
septum
Give 24 hrs : earlier-trauma
·

Maxillary a. Clip
lignocaine
Preformed devices (Merocell) S . follow-up
V

* Packing :
Folley Catheter
Septum cartilage

Posterior [Bloodstream
necrosis

tureCommon :Post Packingteal

in nasopharynx]
,
canulas
 2 Infections :

Complicateda Uncomplicated
> Sinusitis

Acute chronic
& sinusitis
Meningitis
·

Brain abscess
Orbital abcess and cellulitis
Cavernous sinus thrombosis
Mastoiditis

Examination
Tx
Surgical
Cr fallout !
·

: Ess
of orbital abscess
Drainage
L of brain abscess
Drainage
Medical Antibiotics forNasal sinus
+a anaerobes
to others
should also
pass BBB
gram ,

1 Thin
plate btw . frontal sinus

Investigations :RadiologyCMR
.

brain & .

, pas
swab
2
. Thin cribriform plate a brain

.
3 Thin lamina propria a eye

(nasolacrimal duct)

① Can see

it's blocked .

Treatment

② Medical

Augmentin (Gram Q)
-

Flagil (anaerobel
(metronidazole)
-

Leftriaxone (BBB)
-

Cortisone