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Classification Of Epistaxis

Anterior Epistaxis
When Blood Flows Out from the front of nose with the patient in sitting position
Posterior Epistaxis

Mainly the blood flows back into the throat. Patient may swallow it and later have a “coffee-coloured” vomitus. This may erroneously be diagnosed as haematemesis. The differences between the two types of epistaxis are tabulated herewith (Table 33.1)

Table 33.1 Differences between anterior and posterior Epistaxis

Anterior epistaxis                                    Posterior epistaxis

Incidence

Site                                                             More Common Mostly from                         Less common Mostly From

Little’s area or anterior part                          posterrosu-perior part of nasal cavity;

of lateral wall                                                   often difficult to locallize the bleeding                                                                                                                                                  point

Age                                                 Mostly occurs in children                               After 40 years of age

or young adults

Cause                                          Mostly trauma                                                   Spontaneous; often due to hypertension or

arteriosclerosis

Bleeding                                Usually mid, can be easily                                                                                                                                                                                                                                                            Bleeding is severe,requires hospitaliza-

controlled by local pressure                             tion; postnasal pack often required

or anterior pack

Management

In any case of epistaxis , it is important to know:

1. Mode of onset. Spontaneous or finger nail trauma.

2. Duration and frequency of bleeding.

3. Amount of blood loss.

4. Side of nose from where bleeding is occurring.

5. Whether bleeding is of anterior or posterior type.

6. Any known bleeding tendency in the patient or family.

7. History of known medical ailment (hypertension, leukae-mia, mitral valve disease, cirrhosis and nephritis).

8. History of drug intake (analgesics, anticoagulants, etc. ).

First Aid

Most Of the time, bleeding occurs from the little’s area and can be easily controlled by pinching the nose with thumb and index finger for about 5 min. This compresses the vessels of the Little’s area. In Trotter’s method patiend is made to sit, leaning a little forward over a basin to spit any blood and breathe quietly from the mouth. Cold compresses should be applied to the nose to cause reflex vasoconstriction.

Cauterization

This is useful in anterior epistaxis when bleeding point has been located. The area is first topically anaesthetized and the bleeding point cauterized with a bead of silver nitrate or coagulated with electrocautery.

Anterior Nasal Packing

In cases of active anterior epistaxis, nose is cleared of blood clots by suction and attempt is made to localize the bleeding site. In minor bleeds, from the accessible sites, cauterization of the bleeding area can be done. If bleeding is profuse and/ or the site of bleeding is difficult to localize, anterior packing should be done. For This, use a ribbon Gauze soaked with liquid paraffin. About i m gauze (2.5 cm wide in adults and 12 mm in children) is required for each nasal cavity. First, few centimetres of gauze are folded upon itself and inserted along the floor and then the whole nasal cavity is packed tightly by layering the gauze from floor to the roof vertical layers from back to the front. In that case, systemic antibiotics should be given to prevent sinus infection and toxic shock syndrome.

Posterior Nasal Packing

It is required for patients bleeding posteriorly into the thoroat. A postnasal pack is first prepared by tying three silk ties to a piece of gauze rolled into the shape of a cone. A rub-ber catherter is passed through the nose and its end brought out from the mouth. Ends of the silk threads are tied to it and catheter withdrawn from nose. Pack, which follows the silk thread,is now guided into the nasopharynx with the index finger. Anterior nasal cavity is now packed and silk threads tied over a dental roll. The third silk thread is cut short and allowed to hang in the oropharynx. Its helps in easy removal of the pack later. The bulb is infladed with saline and pulled forward so that choana is blocked and then an anterior nasal pack kept in the usual manner. These days nasal balloons are also avail able.A nasal balloon has two bulls, one for the postnasal space the other for nasal cavity.

Endoscopic Cauterization

using topical or general anaestheaia, bleeding point is localized with a rigid endoscope. it is then cauterized with a malleable unipolar suction cautery or a bipolar cautery. The procedure is effective with less morbididity and decreased hospital stay. The procedure has a limitation when profuse bleeding does not permit localization of the bleeding point.

Elevation Of Mucoperichondrial Flap And Submucous Resection (SMR) Operation

in Case Of persistent or recurrent bleeds from The septum, Just elevation of mucoperichondrial flap and then repositioning it back helps to cause fibrosis and constrict blood vessels. SMR operation can be done to achieve the same result or remove any septal spur which is sometimes the cause of epistaxis.

Ligation Of Vessels

1. External Carotid. when bleeding is from the external carotid system and the conservaitve measures have failed, ligation of external carotid artery should be done. It is avoided these days in favour of embolization on ligation of more peripheral of sphenopatine artery.

2. Maxillary artery

Ligation Of this artery is done in uncontrollable posterior epistaxis. Approch is via caldwell-Luc-opration. posterior wall of maxillary sinus is removed and the maxillary artery or its branches are blocked by applying clips. This procedrue is now superceded by trans-nasal endossocopic artrery light ( TESPAl).

3. Ethmoidal artery

In anterrosuperier bleeding above the middle turbinate, not controlled by packing, anterior and posterior ethmoidal arteries, WHICH SUPPLY this area, can be lighted. The Vessels are expossed in the medail wall of the orbit by an external ethmiod (Lynch) incision.

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Anterior Epistaxis
When Blood Flows Out from the front of nose with the patient in sitting position
Posterior Epistaxis

Mainly the blood flows back into the throat. Patient may swallow it and later have a "coffee-coloured" vomitus. This may erroneously be diagnosed as haematemesis. The differences between the two types of epistaxis are tabulated herewith (Table 33.1)

Anterior epistaxis Posterior epistaxis

Site More Common Mostly from Less common Mostly From

Little's area or anterior part posterrosu-perior part of nasal cavity;

of lateral wall often difficult to locallize the bleeding point

Age Mostly occurs in children After 40 years of age

or young adults

Cause Mostly trauma Spontaneous; often due to hypertension or

arteriosclerosis

Bleeding Usually mid, can be easily Bleeding is severe,requires hospitaliza-

controlled by local pressure tion; postnasal pack often required

or anterior pack

In any case of epistaxis , it is important to know:

1. Mode of onset. Spontaneous or finger nail trauma.

2. Duration and frequency of bleeding.

3. Amount of blood loss.

4. Side of nose from where bleeding is occurring.

5. Whether bleeding is of anterior or posterior type.

6. Any known bleeding tendency in the patient or family.

7. History of known medical ailment (hypertension, leukae-mia, mitral valve disease, cirrhosis and nephritis).

8. History of drug intake (analgesics, anticoagulants, etc. ).

Most Of the time, bleeding occurs from the little's area and can be easily controlled by pinching the nose with thumb and index finger for about 5 min. This compresses the vessels of the Little's area. In Trotter's method patiend is made to sit, leaning a little forward over a basin to spit any blood and breathe quietly from the mouth. Cold compresses should be applied to the nose to cause reflex vasoconstriction.

This is useful in anterior epistaxis when bleeding point has been located. The area is first topically anaesthetized and the bleeding point cauterized with a bead of silver nitrate or coagulated with electrocautery.

In cases of active anterior epistaxis, nose is cleared of blood clots by suction and attempt is made to localize the bleeding site. In minor bleeds, from the accessible sites, cauterization of the bleeding area can be done. If bleeding is profuse and/ or the site of bleeding is difficult to localize, anterior packing should be done. For This, use a ribbon Gauze soaked with liquid paraffin. About i m gauze (2.5 cm wide in adults and 12 mm in children) is required for each nasal cavity. First, few centimetres of gauze are folded upon itself and inserted along the floor and then the whole nasal cavity is packed tightly by layering the gauze from floor to the roof vertical layers from back to the front. In that case, systemic antibiotics should be given to prevent sinus infection and toxic shock syndrome.

It is required for patients bleeding posteriorly into the thoroat. A postnasal pack is first prepared by tying three silk ties to a piece of gauze rolled into the shape of a cone. A rub-ber catherter is passed through the nose and its end brought out from the mouth. Ends of the silk threads are tied to it and catheter withdrawn from nose. Pack, which follows the silk thread,is now guided into the nasopharynx with the index finger. Anterior nasal cavity is now packed and silk threads tied over a dental roll. The third silk thread is cut short and allowed to hang in the oropharynx. Its helps in easy removal of the pack later. The bulb is infladed with saline and pulled forward so that choana is blocked and then an anterior nasal pack kept in the usual manner. These days nasal balloons are also avail able.A nasal balloon has two bulls, one for the postnasal space the other for nasal cavity.

using topical or general anaestheaia, bleeding point is localized with a rigid endoscope. it is then cauterized with a malleable unipolar suction cautery or a bipolar cautery. The procedure is effective with less morbididity and decreased hospital stay. The procedure has a limitation when profuse bleeding does not permit localization of the bleeding point.

in Case Of persistent or recurrent bleeds from The septum, Just elevation of mucoperichondrial flap and then repositioning it back helps to cause fibrosis and constrict blood vessels. SMR operation can be done to achieve the same result or remove any septal spur which is sometimes the cause of epistaxis.

1. External Carotid. when bleeding is from the external carotid system and the conservaitve measures have failed, ligation of external carotid artery should be done. It is avoided these days in favour of embolization on ligation of more peripheral of sphenopatine artery.

Ligation Of this artery is done in uncontrollable posterior epistaxis. Approch is via caldwell-Luc-opration. posterior wall of maxillary sinus is removed and the maxillary artery or its branches are blocked by applying clips. This procedrue is now superceded by trans-nasal endossocopic artrery light ( TESPAl).

In anterrosuperier bleeding above the middle turbinate, not controlled by packing, anterior and posterior ethmoidal arteries, WHICH SUPPLY this area, can be lighted. The Vessels are expossed in the medail wall of the orbit by an external ethmiod (Lynch) incision.

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Epistaxis is defined Blood Supply of Lateral Wall Of Nose

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Mainly the blood flows back into the throat. Patient may swallow it and later have a "coffee-coloured" vomitus. This may erroneously be diagnosed as haematemesis.

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A PLUS FORUM THE FILIPINO CHANNEL HISTORY & PINOY TV

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A PLUS FORUM THE FILIPINO CHANNEL HISTORY & PINOY TV

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A plus Forum the worldwide known platform for watching Pinoy TV. Filipinos say about this the hub of watching all Pinoy1tv shows of GMA network and ABS-CBN Pinoy tambayan Shows.TFC is The Filipino Channel situated in California, this is an entertainment channel which on airs Pinoy Tv Shows and Replays on Daily Basis. People of philippines. This channel is owned by Filipino media network ABS-CBN.

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On January 24, 2012 A Plus Forum was launched very first time. Now it is on air globally in countries of United States, Middle East, Europe, Australia, Canada, and Japan. this is also known as Pinoy Tv.

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# data[].attributes.attachment_link.readable_text
A plus Forum the worldwide known platform for watching Pinoy TV. Filipinos say about this the hub of watching all Pinoy1tv shows of GMA network and ABS-CBN Pinoy tambayan Shows.TFC is The Filipino Channel situated in California, this is an entertainment channel which on airs Pinoy Tv Shows and Replays on Daily Basis. People of philippines. This channel is owned by Filipino media network ABS-CBN.

On January 24, 2012 A Plus Forum was launched very first time. Now it is on air globally in countries of United States, Middle East, Europe, Australia, Canada, and Japan. this is also known as Pinoy Tv.

ABS - CBN is now very popular in overseas UAE and Saudi Arabia countries as most of the Filipino People are located in these countries due to low economy of philippines. That is why people moved mostly in UAE and Saudia for jobs and business.

A Plus Forum 2018 TV Schedule
Aplusforum brings many Tv series on daily basis, Following shows are being on air from Monday to Friday from 11 AM to 11 Pm. These shows are much popular in all over the world due to fantastic story and direction.A Plus Forum on air romantic, thriller, comedy, suspense, action and horror series.

This Pinoy Channel Tv shows are provided on our site, we provide full hd video for Pinoy Tv Replay Tv shows and drama series, You can watch and Download all pinoy tv shows episodes online here.

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A Plus Forum The Filipino Channel History & Pinoy Tv Schedule

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A plus Forum the worldwide known platform for watching Pinoy TV. Filipinos say about this the hub of watching all Pinoy1tv shows of GMA network and ABS-CBN Pinoy tambayan Shows.TFC is The Filipino Channel situated in California, this is an entertainment channel which on airs Pinoy Tv Shows and Replays on Daily Basis.

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PinoyTV is already considered as one great part of entertainment for many individuals especially for Filipinos. In every Filipino household, watching television is one among the best sources of entertainment and fun. Almost all Filipinos are into being addicted with watching different shows in television. All over the Philippines, one among the most widely chosen network to watch pinoy1tv shows is GMA 7. It provides numbers of unique and meaningful TV shows that make every pinoy be addicted on watching television and so proud being a Filipino as well.

Most Filipinos are really fanatic of TV show that’s why it could be frustrating on their part if they couldn’t watch their favorite shows. But due to some reasons like busy schedules some Filipinos don’t have time to watch their favorite television shows. Good to know that with the help of latest technology and Internet pinoys are provided with the chance of watching the missed episodes of their favorite shows. Through the use of Internet, different TV shows of GMA 7 and TV 5 could be replayed anytime and anywhere. Even those that are not in the Philippines could be provided with the chance to be updated with current news and interesting pinoy tv shows.

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Free pinoy 1 TV shows are provided by aplusforum.com knowing that almost every Filipino is almost addict of televisions shows. Our site offers different shows from news, game show, pinoytv drama and a lot more of exciting TV shows. We do not actually own every video that is being posted in our site since all of the videos being posted here are as well available on some other video streaming websites like YouTube. The only difference is that we provide high quality videos or replays of GMA network as well as TV 5 shows that will definitely satisfy every viewer. If looking for a pinoy channel that will offer you TV shows that will make you proud of becoming a Filipino then aplusforum.com could be the best option. aplusforum.com will be forever dedicated with providing free pinoy TV Shows Replay for every Filipino around the globe.

# data[].attributes.attachment_link.readable_text
PinoyTV is already considered as one great part of entertainment for many individuals especially for Filipinos. In every Filipino household, watching television is one among the best sources of entertainment and fun. Almost all Filipinos are into being addicted with watching different shows in television. All over the Philippines, one among the most widely chosen network to watch pinoy1tv shows is GMA 7. It provides numbers of unique and meaningful TV shows that make every pinoy be addicted on watching television and so proud being a Filipino as well.

Most Filipinos are really fanatic of TV show that's why it could be frustrating on their part if they couldn't watch their favorite shows. But due to some reasons like busy schedules some Filipinos don't have time to watch their favorite television shows. Good to know that with the help of latest technology and Internet pinoys are provided with the chance of watching the missed episodes of their favorite shows. Through the use of Internet, different TV shows of GMA 7 and TV 5 could be replayed anytime and anywhere. Even those that are not in the Philippines could be provided with the chance to be updated with current news and interesting pinoy tv shows.

If your are looking for as site that will provide you free pinoy tv shows then definitely we are the perfect place to visit. Pinoy tv replay is considered as the best site to visit once you want to watch replays of television shows online particularly shows of GMA 7 and TV 5. The goal of pinoy tambayan is to simply provide every Filipino with free Pinoy TV through the use of Internet especially those that are working as OFWs who could not regularly watch pinoy shows. Through the use of Internet our goal will surely be achieved and we will continue providing numbers of Filipino viewers with the chance of watching Filipino shows. Pinoy tambayan is perfectly created for Filipinos getting so much happiness from different television shows.

Free pinoy 1 TV shows are provided by aplusforum.com knowing that almost every Filipino is almost addict of televisions shows. Our site offers different shows from news, game show, pinoytv drama and a lot more of exciting TV shows. We do not actually own every video that is being posted in our site since all of the videos being posted here are as well available on some other video streaming websites like YouTube. The only difference is that we provide high quality videos or replays of GMA network as well as TV 5 shows that will definitely satisfy every viewer. If looking for a pinoy channel that will offer you TV shows that will make you proud of becoming a Filipino then aplusforum.com could be the best option. aplusforum.com will be forever dedicated with providing free pinoy TV Shows Replay for every Filipino around the globe.

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The Filipino Channel Online History & Pinoy 1 Tv Schedule

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PinoyTV is already considered as one great part of entertainment for many individuals especially for Filipinos. In every Filipino household, watching television is one among the best sources of entertainment and fun. Almost all Filipinos are into being addicted with watching different shows in television.

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World No.1 Best Songs Movies & Entertianmint Forum the ultimate entertainmint portal is an entertainment portal which provides different types of content for its valuable visitors.