Presentation On Epistaxis in Children

PRESENTATION ON
EPISTAXIS IN
CHILDREN
PRESENTED BY ADDITI SATYAL (BSN

3RD YEAR )
CONTENT
• INTRODUCTION
• INCIDENCE
• ETIOLOGY
• PATHOPHYSIOLOGY
• CLINICAL FEATURES
• COMPLICATION
• DIAGNOSTIC EVALUATION
• MANAGEMENT
• PROGNOSIS
• REFERENCE
INTRODUCTION
• Bleeding from inside the nose is called
epistaxis.
• Fairly common and is seen all age group.
• “Epistaxis refers to nose bleed or hemorrhage
from the nose.”
• It’s mostly commonly originates in the
anterior portion of the nasal cavity.
Incidence
• Epistaxis is common in children. In infant

almost 30% of children.
• From 0 to 5 year old have epistaxis of nose
bleed 56% for 6 to 10 year old children and 11
to 15 year old children have epistaxis of nose
bleed of 64%
Defination
• When one or two small vein in the nose erupt
the resulting condition is nose bleed or
epistaxis.
• Common site of epistaxis is little area or
kiesselbach’s plexus.
Types of epistaxis:
• Recurrent episode:-In recurrent nose bleed
the episode of blood happen only at certain
periods of time. Recurrent nose bleeding can
be occur in seasonal pattern. Its most happen
when the whether get hot and dry.
• Constant epistaxis:- This is type of nosebleed
that happen for a longer period of time. The
bleeding is continously occur.(45min)
Contd..
• Sudden epistaxis :- These are nosebleeds which
could happen anytimes of the day, regardless of
the activity of the child. whether the child resting
or playing.
• Chronic epistaxis:-condition that are continuously
experienced for more then 6 month. Chronic
bleeding happen as result of a chronic diseases
this include . Chronic liver or kidney disease,
vascular malformation, long term use medication.
Classification
Anterior epistaxis Posterior epistaxis
 More common  Less common
 Mostly in little area or  Mostly from postero
anterior part of lateral wall superior part of nasal cavity.
 Mostly occur in children or  After 40 year of age
young adults  Spontaneous; often due to
 Mostly trauma hypertension or
arteriosclerosis
 Usually mild, can be easily
controlled by local pressure  High bleeding
or anterior nasal packing.. ,Hospitalization required,
Posterior nasal packing
Pathophysiology
• Due to external trauma,forein bodies, blarring of
nose, picking of nose.
• Allergic rhinitis or sinusitis.
• Result in strain of emotional excitement or physical

exercise may be enough to start nose bleeding
Contd..
• A circulatory renal or emotional condition that
produce elevated BP may couse nasal
hemorrhage.
• It leads to rheumatic fever a blood dyscrasia

or an infection
Causes
• The common causes of children are:-
 Major trauma
 Nose picking
 Foreign body in the nose
 Nasal injury
 Nasal polyp
 Rhinitis
 Nasal diphtheria
 Nasopharyngeal tumor
 Nasal spray abuse
 Hot summer month
Other systemic causes:-
• Leukemia
• Hemophilia
• Ingestion of aspirn
• Vitamin k deficiency
• Ca deficiency
• Nephritis
• Overdose of drugs
o Anticoagulant
o Steriod
o Analgesics
Contd..
• solar radiation
• Acute infection
• Thrombocytopenia
• Liver cirrhosis
Signs and symptoms
Signs of excessive blood loss include:
• Dizziness
• Weakness
• Confusion
• Fainting
Complication
• Hypotension
• Shock
• Anemia
• Secondary infection
Diagnostic evaluation
• Blood pressure
• Complete blood count
• Coagulation studies
• Angiography
• MRI
• X ray
• Endoscopy
Management
First aid management:-
• Keep the patient quiet
• Place the patient in sitting position, leaning
forward ,semifowler position.
• Apply direct pressure by pinching the entire soft
lower portion of the nose for 10 to 15 min.
• Apply icepack to the nose and check area.
• Loosing clothes and giving reassurance.
Management
• Partially insert a small gauze pad into the nose
bleeding continues.
• Take medical treatment if bleeding does not
stop.
Medical management
• Identification of bleeding sites by a nasal
speculum or headlight.
• Little’s area- pinching the nose with thumb
and index finger for about 5 minutes
compression of vessels
TROTTER’S METHOD
Anterior Nasal packing
• If bleeding is profuse and/ or the site of bleeding is
difficult to localize ,anterior packing should be done.
• Ribbon gauze soaked with liquid paraffin or
neosporin cream.
• Gauze is removed after 24 hours if bleeding has
stopped.
• If it has to be kept for 2 to 3 days: systemic
antibiotics should be given to prevent sinus
infection and toxic shock syndrome.
Posterior nasal packing
• For patient bleeding posterior into the throat.
• Patients requiring postnasal pack should
always be hospitalized.
• folley;’s catheter can also be used
• Nasal balloons are also available.
Cauterization
In anterior epistaxis
• Anaesthetize bleeding point
• Cauterize with bead of sliver nitrate / coagulate with electric
surgery.
Endoscopic cautery
• For posterior bleeding point after locating with
endoxcope
Nursing management
• Monitor vital signs.

• Assisting in the control of bleeding.
• Provide tissue paper and cotton
• To instructed child to avoid aspiration of blood.
• Nasal packing may alter respiration status so closly
monitor respiration rate , heart rate, rhythm
• Instruct the child to avoid vigorous nasal blowing,
strenuous activity , or lifting straining for 4-6 weak.
Contd..
• Also instructed to avoid nasal blowing or
picking nose after nosebleed.
• Instruction to be given to the parents to apply
lubricant nasal septum twice daily to reduce
dryness.
• Advice to were lose garment.
Prognosis
For most of the general population, epistaxis is
merely a nuisance. However, the problem can
occasionally be life- threatening , especially in
younger children. Fortunately, mortality is rare
and is usually due to complication from
hypovolemia, with severe hemorrhage or
underlying disease states.
Contd..
• Overall, the prognosis is good but variable; with
proper treatment, it is excellent. When adequate
supportive care is provided and underlying
medical problems are controlled, most patients
are unlikely to experience any rebleeding. Others
may have minor recurrences that resolve
spontaneously or with minimal self-treatment. A
small percentage of patients may require
repacking or more aggressive treatments.
MCQ
1)What is the medical term for a
nosebleed?
a) Psoriasis
b) Ptosis
c) Epistaxis
d) pronation
Contd..
2)The site of epistaxis are all except
a)little’s area c)middle meatus
b)woodruff’s area d)superiorlabial artery
Contd ..
3)The most common cause of bleeding in
children;-
a) Tumor
b)Hypertension
c) Nose picking
d)None
4)Nasal bleeding can be treated with
a)Nasal packing
b)Cautery
c)Use of thrombin
d)All of the above
contd..
5)The most common cause of

epistaxis in a 3 year old child :-
a)Nasal polyp
b)Foreign body
c)Upper respiratory catarrh
d)Atrophic rhinitis
Contd..
6) Which of the following should you NOT
do if you have a nosebleed?
a) Relax
b) Sit-down
c) Lean slightly forward
d) Put your head back
Contd..
What is epistaxis? Classify its types and

medical management?
Reference
• Uprety k.2020 essentialof child health nursing
(2nd edition ),akshav publication (kathmandu)
pg no 640-641
• Ghai, o.p. gupta. p and paul v.k.(2004)
essential pediatrics (6th ed) New DELHI;CBS
• https://www.slideshare.net/ drlogeskwary/
impetigo -75016575
• www://youtu.be/sj5NX2wILVw
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PRESENTATION ON

PRESENTED BY ADDITI SATYAL (BSN

• Epistaxis is common in children. In infant

• Allergic rhinitis or sinusitis.

• Result in strain of emotional excitement or physical

• It leads to rheumatic fever a blood dyscrasia

• Monitor vital signs.

5)The most common cause of

What is epistaxis? Classify its types and

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