Epistaxis Explicado Claramente

Introduction to Epistaxis

Overview of Epistaxis

• Laura Barragán introduces herself as an otorhinolaryngologist and welcomes viewers to a tutorial on internal medicine, focusing on epistaxis.

• Defines epistaxis as nasal bleeding originating from the nasal mucosa due to a disruption in normal hemostasis, affecting 60% of the population but only 6% requiring medical attention.

Incidence and Mortality

• Notes peaks of incidence in children under 10 years and adults aged 45-65, with rare occurrences in those under 2 years; mortality rate is less than 0.01%.

• Most cases (90-95%) are attributed to previous bleeding episodes.

Anatomy and Vascularization of the Nose

Key Arteries Involved

• Discusses the anatomy of nasal vascularization primarily supplied by the internal carotid artery and external carotid artery.

• Details branches such as the anterior ethmoidal artery contributing to septal branches, while the external carotid gives rise to facial arteries that also supply nasal regions.

Important Areas for Bleeding

• Highlights two critical areas:

• The anterior area known as Kiesselbach's plexus.

• The posterior area mainly supplied by the sphenopalatine artery.

Etiology of Nasal Bleeding

Local vs Systemic Causes

• Identifies local causes like trauma, inflammation, foreign bodies, tumors, anatomical alterations, improper use of nasal sprays, and surgery.

• Mentions systemic causes including coagulopathies (e.g., hemophilia), hypertension, drug use (anticoagulants), infections, malnutrition, alcohol use, and allergies.

Specific Conditions

• Describes juvenile nasopharyngeal angiofibroma characterized by recurrent unilateral anterior epistaxis in young males.

Treatment Approaches for Epistaxis

Initial Management Strategies

• Emphasizes initial hemodynamic stabilization upon patient arrival at emergency services before detailed history taking regarding bleeding characteristics.

Treatment Techniques

• Differentiates treatment based on whether bleeding is anterior or posterior; anterior bleeds often treated with digital pressure or chemical cauterization.

Advanced Treatment Options

Cauterization Techniques

• Explains chemical cauterization using agents like acetic acid diluted at 80%, noting potential complications such as burns or perforation if not managed properly.

Tamponade Procedures

• Discusses anterior tamponade techniques for active diffuse bleeding when cauterization fails; emphasizes reevaluation after 48 hours for persistent cases.

Surgical Interventions

Indications for Surgery

• Outlines surgical options for patients with persistent bleeding despite proper tamponade placement; ligation of sphenopalatine artery noted as effective in reducing hospitalization time and transfusion needs.