ENT Emergencies

Internal carotid
External carotid
CLASSIFICATION

I. According to site
Anterior Superior; 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
[3] Idiopathic:
“Spontaneous” is a better description Usually initiated by minor ‘digital’ trauma Often associated with atmospheric drying Wegner's granulomatosis, Osler-Weber-Rendau's syn., atrophic rhinitis
Angiofibroma

Malignant neoplasms:
Basal Cell Ca Squamous Ca Malignant Melanoma
(NB amelanotic variety)
(Nasopharyngeal ca) (Adeno Ca /Adenoid cystic Ca)

Lateral Wall
Frank Netter. Ciba

Vessels Involved
Anterior ethmoid Posterior ethmoid Greater palatine Sphenopalatine Superior labial
REASONS FOR EXCESSIVE BLEEDING
Vascularity of nose Both external and internal carotids. Anastomsis between arteries and veins. Blood vessels run just under the mucosaunprotected. Larger vessels on the turbinate run in bony canals- cannot contract.
•Atherosclerosis •Collagen vascular diseases •Familial Haemorrhagic telangiectasia (Osler-WeberRendu disease)

General Causes
Hypertension, CHF, mitral stenosis, Cirrhosis, Coagulopathies (Haemophilia,

FIRST AID
Position sitting upright inclined slightly forward mouth open spit out any blood vasoconstrictors

Pressure cartilage of nose over Little’s area constant

LOCAL CAUSES
[2] Infections:
Viral:Influenza, measles Diphtheria, lupus vulgaris, leprosy, Parasites, maggots, fungal

LOCAL CAUSES
Carcinom of the Nasopharynx
Leukaemia

Local Causes
[4] Miscellaneos:
Septal spur, foreign bodies

LOCAL CAUSES
[3] BLOOD VESSELS: :
ENT Emergencies
Dr. Mona Ashoor ENT resident, KFHU

Outline
1. 2. 3.
EPISTAXIS Airway obstruction Pediatric emergencies

EPISTAXIS

Children; Foreign body, nose picking, nasal diphtheria. Adults: Trauma, idiopathic. Middle age: tumors. Old age: hypertension.

MANAGEMENT
I] Investigations:

II. PRIMARY & SECONDARY

III. According to Etiology
Local Causes: [1] Trauma
Nose picking, fractures. Nasal surgery Nasal intubation
ICE PACKS

5 minute pressure - correct

Incorrect

DEFINITIVE TREATMENT
Look into the nose. Assess blood loss. Crystalloids or colloids Transfusion Locate the point after packing the nose with 4% xylocaine and 1:1000 adrenaline mixture
Anticoagulants - Warfarin / Heparin Aspirin - platelet function inhibitor Cocaine
-
ischaemia rebound hyperaemia mucosal necrosis

IV. According to Age

LITTLE'S ( KIESSELBACH'S) AREA
90% of epistaxis seen in hospitals 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.
Unconscious head injury;
Dangerous to pack in suspected skull #.
Telengiectasia;
Septodermoplasty.

OTHER TREATMENTS
Ligation of vessels
Maxillary artery Ethmoid arteries External Carotid artery

CRICOTHYRODOTOMY

Tracheostomy

Tracheotomy
•
operative procedure that creates an artificial opening in the trachea.
Tracheostomy
Posterior packing if bleed is posterior. GA. Foley's or other inflatable devices Removed as soon as possible. Antibiotics. Transfuse. Blood gases in children.

OTHER TREATMENTS
Embolization Catheters with iced water lavage 2% lignocaine and adrenaline injection in greater palatine foramen

•
creation of permanent or semi
AIRWAY OBSTRUCTION

How will you manage?
1. 2. 3. 4.
5. 6.
Mouth sweap Jaw thrust Oral airway Endotracheal intubation / Nasotracheal intubation Cricothyrodotomy Tracheostomy

LOCAL CAUSES
[4] Neoplasms:Of Nhomakorabeathe:
nose, nasopharynx and sinuses.

Benign neoplasms:
Antrochoanal polyp “Inverting” papilloma Juvenile angiofibroma
Factor deficiencies, ITTP, Vitamin C & K deficiencies, Severe liver disease)
anemias, purpura, leukemias,

General Causes
Malignancies, Caissons' disease, Endometriosis, Nephritis, Typhoid DRUGS:
FFP.
Purpura;
Platelets