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    Ita Aprilia Sakti
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    Epistaxis, or nosebleeds, are common and usually not serious. The majority of cases are self-limiting and do not require medical intervention. Around 5-10% of the population experience an episode of epistaxis each year, with 10% seeing a physician. The reported lifetime incidence is approximately 60%. Management of epistaxis involves identifying the source and cause of bleeding through examination and testing. Initial management focuses on controlling active bleeding through local measures like cauterization or nasal packing. Further treatment depends on whether bleeding stops or recurs and addressing any underlying causes.

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    Epistaxis, or nosebleeds, are common and usually not serious. The majority of cases are self-limiting and do not require medical intervention. Around 5-10% of the population experience an episode of epistaxis each year, with 10% seeing a physician. The reported lifetime incidence is approximately 60%. Management of epistaxis involves identifying the source and cause of bleeding through examination and testing. Initial management focuses on controlling active bleeding through local measures like cauterization or nasal packing. Further treatment depends on whether bleeding stops or recurs and addressing any underlying causes.

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    31 views21 pages

    EPISTAXIS - Rifki

    Uploaded by

    Ita Aprilia Sakti
    Epistaxis, or nosebleeds, are common and usually not serious. The majority of cases are self-limiting and do not require medical intervention. Around 5-10% of the population experience an episode of epistaxis each year, with 10% seeing a physician. The reported lifetime incidence is approximately 60%. Management of epistaxis involves identifying the source and cause of bleeding through examination and testing. Initial management focuses on controlling active bleeding through local measures like cauterization or nasal packing. Further treatment depends on whether bleeding stops or recurs and addressing any underlying causes.

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    of 21

    EPISTAXIS

    dr. Rifki Zakaria, Sp. T.H.T.K.L


    Literature Review
    Anterior Epistaxis
    NTRODUCTION

    • Epistaxis is defined as acute haemorrhage from


    within the nasal cavity including the nasopharynx.
    • It is a common condition ranging in severity from a
    single short-lived episode to a less common life-
    threatening haemorrhage.
    • The majority of cases are self-limiting and do not
    require medical intervention.

    McLarnon, 2015
    EPIDEMIOLOGY

    5-10% of the population experience an episode


    of epistaxis each year. 10% of those will see a
    physician.
    The reported incidence of an episode during a
    lifetime is approximately 60%

    60 %
    McLarnon, 2015
    Anatomy of The
    Lateral Nasal Wall

    Concha
    1. Superior
    2. Media
    3. Inferior

    Netter, 2016
    Blood Supply of The Nose

    External Carotid Artery


    -Sphenopalatine
    -Greater palatine
    -Ascending pharyngeal
    -Posterior nasal
    -Superior Labial
    Internal Carotid Artery
    -Anterior Ethmoid
    -Posterior Ethmoid

    Netter, 2016
    Kiesselbach ‘s
    Plexus

    1. Greater Palatine
    2. Superior Labial
    3. Anterior Ethmoid
    4. Sphenopalatine
    Netter, 2016
    Etiology

    1. Local
    2. Systemic

    McLarnon, 2015
    Etiology – Local Factor

    1. Vascular
    2. Infectious/Inflammatory
    3. Trauma (most common)
    4. Iatrogenic
    5. Neoplasm
    6. Dessication
    7. Foreign Bodies/other

    McLarnon, 2015
    Etiology – Systemic Factor

    1. Vascular
    2. Infection/Inflammation
    3. Coagulopathy

    McLarnon, 2015
    Management
    Intial Management :
    • ABC’s
    • Medical history/Med
    • Vital signs—need IV
    • Physical exam
     Anterior rhinoscopy
     Endoscopic rhinoscopy
    • Laboratory exam
    • Radiologic studies

    Porter, 2002
    Management

    1. Control active bleeding

    2. Look for location and cause of bleeding

    Modul Utama Rinologi, 2015


    Most anterior epistaxis is mild
    cases and can often stop
    themselves without the need for
    medical help

    Nguyen, 2018
    EPISTAKSIS

    -Anamnesis riwayat penyakit, tentang perdarahan, riwayat trauma, penggunaan


    obat2an, kebiasaan merokok/ alkohol Syok hipovolemik, penderita tua, risiko perdarahan Resusitasi cairan
    -Pemeriksaan Klinis/ Laboratorium profus

    Identifikasi lokasi perdarahan (rinoskopi anterior, nasoendoskopi rigid/ fleksible):


    -Anterior
    -Posterior
    -Lokasi perdarahan tidak jelas 

    -Evaluasi dan terapi kausa untuk mencegah


    Tindakan lokal menghentikan perdarahan: kekambuhan
    -kauter (kimiawi/ elektrik) Berhasil -Edukasi &self care penderita untuk mencegah
    -tampon hidung ( anterior & posterior) kekambuhan

    Tidak berhasil Tidak ada perdarahan lagi

    Tampon hidung ulang


     Berhasil Angkat tampon
    48-72 jam

    Perdarahan tidak berhenti Perdarahan berulang

    Gangguan faal perdarahan Identifikasi kausa

    Intervensi pembedahan:
    -Septum koreksi
    -Ligasi arteri karotis eksterna
    -Ligasi arteri maxillarisinterna Berhasil
    -Ligasi arteri sfenopalatina
    -Ligasi arteri etmoidalis
    Embolisasi arteri maksilaris & cabangnya
    Radiasi (kasus-kasus malignansi)
    Kasus HHT (Laser, fibrin glue, nasal obliterasi)

    Konsultas-rawat bersama Hematologis-onkologis:


    Koreksi gangguan koagulopati:
    -FFP -vit K
    -cryprecipitate -trombosit
    Penatalaksanaan dengan fibrin glue
    Initial Management
    • Application of direct pressure to the septal area
    continuously for at least five minutes, and for up to 15
    minutes.
    • Tilting the head forward prevents blood from pooling in
    the posterior pharynx, thereby avoiding nausea and
    airway obstruction.
    • Hemodynamic stability and airway patency

    Modul Utama Rinologi, 2015


    Management

    1. Anterior Tampon
    2. Chemical Cautery
    3. Electrocautery
    4. Absorbable Hemostatic

    Modul Utama Rinologi, 2015


    ANTERIOR NASAL PACK

    Anterior Nasal Pack


    Epistat

    Merocel Tampon
    19
    COMPLICATION

    • Cautery : sinechia, septal perforation


    • Anterior Nasal Pack: sinechia, rhinosinusitis, sindroma toxic shock
    syndrome, eustachius tube dysfunction.

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