Question 1

What causes epistaxis and nosebleeds?

Accepted Answer

Epistaxis occurs when small, distended blood vessels in the nasal mucous membrane rupture. Common causes include trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, inhalation of corticosteroids or illicit drugs, overuse of decongestant sprays, nasal surgery, and anatomic malformation. High blood pressure, tumors, and systemic infections may also trigger nosebleeds.

Question 2

How should you position a patient experiencing a nosebleed?

Accepted Answer

Position the patient in a sitting posture, leaning slightly forward with the head tilted forward. This positioning prevents swallowing and aspiration of blood into the airway. Maintaining this upright position is the first critical step in managing epistaxis before applying direct pressure or administering medications.

Question 3

What is the first-line treatment for controlling epistaxis?

Accepted Answer

Apply direct pressure by pinching the nose's soft outer portion against the midline septum continuously for 5 to 10 minutes. If ineffective, administer nasal decongestants such as phenylephrine, which act as vasoconstrictors to reduce bleeding. These initial measures control most anterior nosebleeds without requiring further intervention.

Question 4

When is nasal packing used to treat epistaxis?

Accepted Answer

Nasal packing is the preferred treatment for posterior nasal septum bleeds when initial measures fail. Compressed nasal sponges or epistaxis balloons are inserted into the nares and advanced along the nasal cavity floor. As sponges absorb moisture, they expand to fill the cavity and provide hemostasis, typically remaining in place for 3 to 4 days.

Question 5

What advanced interventions stop severe epistaxis?

Accepted Answer

For severe bleeding with visible bleeding sites, chemical cauterization using silver nitrate or thermal cauterization may be applied. Absorbable materials such as oxidized cellulose or gelatin-thrombin combinations can also be applied as supplemental patches to promote clotting and protect the nasal mucosa from further injury.

Question 6

What patient education prevents epistaxis rebleeding?

Accepted Answer

Advise patients to avoid forceful nose blowing, straining, intense exercise, nose picking, and smoking. Patients should refrain from vigorous exercise for several days and avoid hot or spicy foods that cause vasodilation. Ensure adequate nasal humidification and moisturize the nose with petroleum jelly to prevent dryness and rebleeding.

Question 7

Why do patients with posterior nasal packing require close monitoring?

Accepted Answer

Patients with posterior packing should be placed in a monitored unit due to increased risk of complications. Vigilantly monitor level of consciousness, heart rate, rhythm, respiratory rate, and oxygen saturation using pulse oximetry. Observe for signs of breathing or swallowing difficulties. Antibiotics may be prescribed to prevent iatrogenic rhinosinusitis and sepsis, similar to management approaches used in acute pharyngitis.

Epistassi: introduzione e gestione

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