La maniobra del taponamiento puede requerir asegurar la vía aérea Dentro del control de la epistaxis, el taponamiento anterior y la compresión nasal. EPISTAXIS Department of Otorhinolaryngology J.J.M. Medical College. Nasal septum:Internal carotid system:a) Anterior ethmoidal artery. Al comparar ambos grupos de epistaxis, ve- mos que en las anteriores, el tratamiento más realizado ha sido el taponamiento anterior (43,3%).
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Surgical Management of Severe Epistaxis. Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local dpistaxis of vasonstrictors.
Is antibiotic prophylaxis in nasal packing for anterior epistaxis needed?
Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source.
Less common sources of severe epistaxis are also discussed in this article. Directory of Open Access Journals Sweden.
Full Text Available Introduction: Epistaxis is one of the most common medical emergencies, making the management of posterior epistaxis a challenging problem for the ear, nose, and throat ENT surgeon. In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high.
The objective of this study was to assess the effectiveness of endoscopic sphenopalatine artery SPA cauterization in patients with refractory posterior epistaxis. Between April and January27 patients 15 males and 12 females with refractory posterior epistaxis underwent endoscopic SPA cauterization in two tertiary referral hospitals in Shiraz.
Three patients underwent bilateral cauterization.
Four patients from 30 arteries had new epistaxis after surgery, three experienced subsequent epistaxis requiring medical treatment, and one patient had a minor epistaxis not needing treatment. The SPA electrocoagulation technique seems to be safe, simple, fast, and effective with low rates of morbidity and complications for the management of refractory posterior epistaxis.
Endoscopic SPA cauterization should be considered as anterir immediate second-line management when conservative treatment as first-line management fails. Risk factors for recurrent e;istaxis epistaxis.
To identify risk factors associated with spontaneous recurrent epistaxis. This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having epistaxis between January 1,and January 1, There were cases with at least 2 episodes of spontaneous epistaxis within 3 years and controls with only 1 episode in the same time frame.
More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of epistaxis recurrence.
Traditional risk factors for epistaxisincluding nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrenceindependent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence.
Few major adverse cardiovascular events were observed within 30 days of the first epistaxis event. Congestive heart failure is an underappreciated risk factor for recurrent epistaxis.
Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent epistaxis to prevent major adverse cardiovascular events. Published by Elsevier Inc.
Full Fpistaxis Available We present a case of a Rendu-Osler-Weber disease patient with recurrent life threatening epistaxis demanding multiple blood transfusions despite of repetitive endoscopic laser and electrocoagulations, endovascular embolisation, septodermoplasty, and long-term intranasal dressings. The therapy was very well tolerated, no acute toxicities occurred. Two weeks after the last radiation dose had been applied, the nasal dressing could be removed without problems.
Endoscopical control revealed an almost avascular white mucosa without any trace of bleeding spots; previously existing hemangiomas and crusts had disappeared. After a 1-year-follow up, the patient had no significant recurrent epistaxis.
Is antibiotic prophylaxis in nasal packing for anterior epistaxis needed?
Efficacy and safety of thalidomide for the treatment of severe recurrent epistaxis in hereditary hemorrhagic telangiectasia: Summary Background Hereditary hemorrhagic telangiectasia HHT is a genetic disease that leads to multiregional angiodysplasia. Severe recurrent epistaxis is the most common presentation, frequently leading to severe anemia. Multiple therapeutic approaches have been tried, but they are largely palliative with variable results.
We aimed to assess the efficacy of thalidomide in reducing epistaxis in patients with HHT refractory to standard therapy. Methods HHT patients with severe recurrent epistaxis refractory to mini-invasive surgical procedures were included in an open label, phase II, prospective, non-randomized, single-centre study.
After response achievement, patients were treated for eight to16 additional weeks. Monthly follow-up was based on the epistaxis severity score and transfusion need, with adverse events being reported ClinicalTrials.
Treatment significantly increased hemoglobin levels pepistaxis in HHT patients, allowing for a rapid, often durable clinical improvement. Efficacy and safety of thalidomide for the treatment of severe recurrent epistaxis in hereditary haemorrhagic telangiectasia: Hereditary haemorrhagic telangiectasia is a genetic disease that leads to multiregional angiodysplasia.
Adult Epistaxis, Epidemiology and Management at the University Hospital of The West Indies.
Severe recurrent epistaxis is the most common presentation, frequently leading to severe anaemia. Several therapeutic approaches have been investigated, but they are mostly palliative and have had variable results. We aimed to assess the efficacy of thalidomide for the reduction of epistaxis in patients with hereditary haemorrhagic telangiectasia that is refractory to standard therapy. We recruited patients aged 17 years or older with hereditary haemorrhagic telangiectasia who had severe recurrent epistaxis refractory to minimally invasive surgical procedures into an open-label, phase 2, non-randomised, single-centre study at IRCCS Policlinico San Matteo Foundation Pavia, Italy.
After patients had achieved a response, they continued treatment for additional weeks. The primary spistaxis was the efficacy of thalidomide measured as the percentage of patients who had reductions of at least one grade antwrior the frequency, intensity, or duration of epistaxis. We followed up patients each month to assess epistaxis severity score and transfusion need, and any adverse events were reported. We included all patients who received any study drug taponamientl who participated in at least one post-baseline assessment in the primary efficacy population.
The safety population consisted of all patients who received any dose of study treatment. This trial is registered with ClinicalTrials. Between Dec 1,and May 12,we enrolled 31 patients. Recurrent epistaxis following nasotracheal intubation–a case report. Epistaxis is one of the common complications of nasotracheal intubation.
Clinical patterns of all nasal bleeding are mild and may stop spontaneously in most patients. Serious nasal bleeding requiring hospitalization are rare. Nasal bleeding occurs more frequently in children than in adults. Among adults, men have a higher incidence than women. Although numerous publications have reported the cases of initial epistaxis caused by nasotracheal intubation, recurrent epistaxis was reported rarely.
We experienced a case of recurrent epistaxis occurring in the 6th, 8th, 15th and 18th day after nasotracheal intubation. Herein, we describe the clinical events and discuss the causes of epistaxis. A year-old man, taonamiento no previous history of epistaxiswas hospitalized at our facility for left recurrent posterior epistaxis.
The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the Epistaxis is a common clinical condition that can be challenging.
Anterior epistaxis is managed by compression, cauterization or diathermy. Merocel and Rapid Rhino nasal packs are often successfully used. Refractory posterior epistaxis should be handled by otorhinolaryngologists. The patient underwent surgical treatment three times and only the operator’s experience and radiological support cranial angiography allowed us to control the epistaxis and stop the bleeding. When bleeding seems to come epistaxix the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.
Full Text Available A year-old man, with no previous history of epistaxiswas hospitalized at our facility for left recurrent posterior epistaxis. An epistaxis severity score for hereditary hemorrhagic telangiectasia. Hereditary hemorrhagic telangiectasia HHT -related epistaxis leads to alterations in social functioning and quality of life. Because no standardized method exists to measure epistaxis severity antrrior, the purpose of this study was to determine factors associated with patient-reported severity to develop a severity score.
HHT care providers and a focus anterio of patients were interviewed to determine epistaxis -associated factors. From this, an electronic survey was developed and administered to patients with HHT. Descriptive analyses were performed with calculations of means and medians for continuous and proportions for categorical variables.
Multiple ordinal logistic and linear regression models were developed to determine risk factors for epistaxis severity. Nine hundred respondents from 21 countries were included. The mean standard deviation age was Independently associated risk factors for self-reported epistaxis severity included epistaxis frequency odds ratio [OR] 1.
From these factors, an epistaxis severity score will be presented. Good equipment, readily available, and organized management are essential for successful control of epistaxis without exacerbating the patient’s trauma. Epistaxis most commonly results from localized causes but can reflect systemic disease. The author describes practical management of epistaxisparticularly for acute problems in the emergency room.
To compare the outcome of children with anterior epistaxis treated intraoperatively with either bipolar electrocautery or silver nitrate chemical cautery.
Case series with chart review. Tertiary-care pediatric otolaryngology practice. Children aged 2 to 18 years treated with either intraoperative bipolar electrocautery or silver nitrate chemical cautery of the anterior nasal septum for recurrent anterior epistaxis. Any epkstaxis bleeding event after surgery was recorded. The mean time from surgery to recurrent epistaxis was compared between groups.