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Nasal Emergencies and Sinusitis

Nasal Emergencies and Sinusitis. Chapter 241. Blood supply and anatomy. Anterior Epistaxis. 90% of nosebleeds (picking zone) Keisselbach’s plexus Treat Direct pressure Vasoconstrictive agents Nasal packing (antibiotics) Cautery. Posterior Epistaxis. More profuse bleeding

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Nasal Emergencies and Sinusitis

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  1. Nasal Emergencies and Sinusitis Chapter 241

  2. Blood supply and anatomy

  3. Anterior Epistaxis • 90% of nosebleeds (picking zone) • Keisselbach’s plexus • Treat • Direct pressure • Vasoconstrictive agents • Nasal packing (antibiotics) • Cautery

  4. Posterior Epistaxis • More profuse bleeding • Elderly with htn and atherosclerosis of sphenopalatine arteries • Consider admission especially with cardiac or respiratory comorbidities • May require urgent ENT consult • Reverse coagulation

  5. Posterior Packings

  6. Nasal Fracture • Swelling, tenderness, crepitance, ecchymosis, and deformity • Not required to get xray • When swelling resolves, refer to ENT/plastics • R/O septal hematoma • Consider other facial fx, cribiform plate fx with CSF leakage and spinal injuries…CT

  7. Nasal Foreign Bodies • Sensation of unilateral nasal obstruction • Persistent, foul-smelling rhinorrhea • Persistent unilateral epistaxis • Remove • Positive pressure technique • Curette • Suction

  8. Sinusitis • Six nasal sinuses • Occurs due to acute obstruction of normal drainage • Viral most common • Bacteria: Strep pneumo, H. flu, M. cat • Acute >7 days <3 wks of symptoms • Chronic >3 wks

  9. Sinusitis Continues • Purulent nasal secretions • Dull aching sinus/facial/dental pain • Routine radiography not recommended • CT if differential unclear or to r/o complications • Bony destruction, abscess, cavernous thrombosis • Antibiotics if sx >7days • Amoxicillin or Bactrim (acute) • Nasal spray and decongestants/antihistamines

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