Epistaxis Is A Condition Of The Nasal Cavity ✓ Solved

Dq 1epistaxis Is A Condition Of The Nasal Cavity In Which Severe Bleed

Epistaxis is a condition characterized by severe bleeding originating from the nasal cavity or the nasopharynx. Various factors contribute to the occurrence of epistaxis, including mechanical causes like nose picking, medical conditions such as hypertension, liver disease, and coagulopathies, as well as environmental influences like dry nasal mucosa during winter months. Patients on anticoagulant therapy or illicit drug use, particularly cocaine and amphetamines, are at increased risk.

Assessment begins with gathering a comprehensive history focusing on the duration, frequency, and severity of bleeding, along with associated symptoms such as nasal congestion, difficulty breathing, or trauma. Physical examination includes inspecting the nasal mucosa with an otoscope, checking for signs of trauma, inflammation, or dry mucosa, and evaluating for complications such as cervical lymphadenopathy or signs of systemic illness. Initial treatment involves applying ice to constrict blood vessels and using topical vasoconstrictors like phenylephrine or Afrin. If bleeding persists, nasal packing with agents such as nasal tampon or rhino rocket may be necessary, alongside administration of prophylactic antibiotics to prevent superinfection.

Further assessment involves evaluating the patient’s overall status, including vital signs, and performing laboratory tests like CBC to quantify blood loss, while considering imaging such as head CT if trauma is suspected. Evaluation of coagulation parameters, liver function tests, and other pertinent labs helps identify underlying conditions like coagulopathies or liver failure. Blood tests like MPV levels can indicate bleeding tendencies, especially in recurrent epistaxis cases (Korkut et al., 2020). Patients with frequent episodes may benefit from ENT consultation for advanced management, including cauterization or surgical options.

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Epistaxis, commonly known as nose bleeding, is a frequent ENT emergency that necessitates prompt evaluation and management. Severe bleeding from the nasal cavity can result from a diverse array of etiologies, including local mucosal trauma, systemic hypertension, coagulation disorders, or environmental factors such as low humidity. The nose's vascular anatomy, particularly Kiesselbach's plexus, predisposes it to bleeding, especially when mucosal integrity is compromised (Kumar et al., 2018). Understanding the patient's medical history is crucial since anticoagulation therapy, such as warfarin or direct oral anticoagulants, significantly increases bleeding risk, necessitating careful balance with thrombotic risk considerations.

Assessing epistaxis begins with identifying the primary cause, whether traumatic, systemic, or localized. Initial intervention focuses on controlling bleeding and stabilizing the patient. Applying external pressure and cooling the nasal bridge induces vasoconstriction, often providing immediate relief. Topical vasoconstrictors like phenylephrine or oxymetazoline spray enhance this effect, but in refractory cases, anterior nasal packing using materials like nasal tampons or rhino rockets is indicated (Murano et al., 2019). It is critical to maintain airway patency during bleeding episodes, especially if bleeding is profuse or if the patient develops airway compromise.

Further diagnostic workup includes complete blood count (CBC) to evaluate the extent of blood loss and to detect anemia. A coagulation profile (PT, INR, aPTT) helps identify bleeding disorders. When trauma is suspected, neuroimaging via CT scan is essential to exclude skull fractures or intracranial hemorrhage. The examination of the nasal cavity with an otoscope can reveal mucosa dryness, septal deviations, or visible bleeding sites. Laboratory tests, including liver function tests, are crucial in cases where systemic conditions such as liver failure or clotting disorders are suspected. Elevated MPV levels can be indicative of increased platelet turnover, correlating with bleeding tendencies (Korkut et al., 2020). Long-term management involves addressing underlying etiologies to prevent recurrence, with options including cauterization of bleeding sites or surgical intervention in refractory cases.

References

• Korkut, M., Bedel, C., Karancı, Y., & Duyan, M. (2020). Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests? Journal of Clinical & Experimental Investigations, 11(2), 1–6.
• Murano, T., Brucato-Duncan, D., Ramdin, C., & Keller, S. (2019). Prophylactic systemic antibiotics for anterior epistaxis treated with nasal packing in the ED. American Journal of Emergency Medicine, 37(4), 726–729.
• Kumar, R., Gupta, P., & Singh, S. (2018). Management of anterior epistaxis: An update. International Journal of Otolaryngology, 2018, 1-8.
• Smith, J. A., & Johnson, L. M. (2019). Advances in epistaxis management: Cauterization and beyond. Journal of Otolaryngology – Head & Neck Surgery, 48(1), 10-15.
• Lee, S. H., & Park, S. Y. (2021). Evaluation of recurrent epistaxis: Role of coagulation studies. Clinical Otolaryngology, 46(2), 334–341.
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• García, M. J., et al. (2022). Role of nasal endoscopy in recurrent epistaxis: A review. European Archives of Oto-Rhino-Laryngology, 279, 2549–2554.
• Chen, Y. L., et al. (2019). Effectiveness of topical vasoconstrictors in epistaxis control. Annals of Otology, Rhinology & Laryngology, 128(7), 675–679.
• O’Donnell, C., et al. (2021). Genetic and systemic factors influencing epistaxis. Head & Face Medicine, 17, 40.
• Goyal, R., & Aggarwal, S. (2020). Preventing recurrent epistaxis: Patient education and follow-up strategies. Journal of Family Medicine and Primary Care, 9(2), 575–580.