Front and rear nose tamponade: indications and procedure

Nasal packing is used in traumatology and otorhinolaryngology to stop nasal bleeding of various etiologies. And if the front tamponade – it's a pretty common procedure, the rear is only made “favourites”. Those who have the blood won't stop under any pretext, or to those whose injuries are much more serious than it seems at first glance.

Epistaxis

Called Nasal bleeding from nasal cavity when the fluid flows through the nostrils on the face or through hoany the back of the throat. There are two types of bleeding: front and rear. In some cases, the blood into the nasolacrimal duct (due to suction effect) and flows out through the eye socket. This can mislead eyewitnesses of this phenomenon and doctors providing first aid.

Fresh blood and blood clots can get through the esophagus into the stomach, causing nausea or even vomiting. Very rarely a nosebleed can be fatal. Referred to in the literature leader Attila, who choked on his own blood in a dream in the wedding night.

Nasal packing is required to stop epistaxis. Perhaps the loss of liquid while small, but the presence of complications makes this state of emergency.

Causes

The Choice of procedure (anterior or posterior nasal packing is required the patient) depends on what vessels are damaged. This is the only criterion. But factors that can provoke bleeding, quite a lot. They are divided into local and systemic.

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Local include:

• Trauma to the nose;
• A foreign body;
• Inflammation and swelling of the mucosa of the nasal passages.

These are the three most common factors that cause nosebleeds. There are more exotic:

• Anatomical deformity;
• Inhalation drugs;
• Cancer processes in the cavity of the nose;
• Cold and dry air;
• Abuse of nose drops;
• Barotrauma, and surgery.

Systemic factors include allergies, a permanent increase in blood pressure, the presence of colds. In addition, bleeding from the nose is possible as a result of nonsteroidal anti-inflammatory drugs, alcohol, problems with the coagulation system, a deficiency of vitamins K and C, systemic autoimmune diseases.

Pathophysiology

In order to bleed, you need to damage the vessel wall. Nasal mucosa is very well vascularized, so even a small force is enough that the blood flowed.

Often nosebleeds occur in children under ten years of age and in people older than sixty usually in men.

Against the background of increased pressure bleeding occurs spontaneously and can be quite long, if not timely take action. In old age the mucous membrane is so thin that even basic hygiene procedures can provoke the rupture of the vessel.

In 95% of cases the source of bleeding is anteroinferior Department of the nasal septum. There is the so-called Kisselbach plexus. There is also a “signal” bleeding. They are characterized by spontaneity, brevity and abundant. These episodes can be caused by damage to the large vessels on the face, rupture of the aneurysm or disintegrating tumor.

The Front nose tamponade

The Front nose tamponade for bleeding is the most commonly used. This "love" of doctors to this procedure due to the fact that the vast majority of cases, damaged vessels of the anterior nasal cavity, and the need for other ways no.

As a rule, such bleeding are not independent diseases. They are only symptoms of more global changes of the body. Therefore, when frequent recurrent bleeding need to think about what other changes occurred in your health and have a reason to visit the doctor.

Etiology

Isolated traumatic cause of bleeding. They include injuries of any origin, including surgical intervention. And is symptomatic of causes that are associated with manifestations of systemic diseases with anatomic integrity of the nose.

Women occur concentrada (that is running simultaneously with menstruation) and the vicar (that is, the residual function of the menstrual) bleeding. The mechanism of their formation is not well understood.

Anyway, whatever the reasons for the appearance of blood from the nasal passages, it is necessary to stop its expiration.

Methods to stop bleeding from the nose

Today, there are many ways to stop the bleeding. The choice depends on the massiveness and causes of this condition. Not necessarily as the primary method should be used nasal packing. Algorithm relief bleeding consists of the following steps:

1. To detect bleeding.
2. To determine the cause.
3. To determine the damaged vessel.
4. To stop the bleeding for the most convenient and fast way.
5. Monitor the patient's condition.

Self-correcting slight epistaxis is possible in the following ways:

1. Tamponade of the nose. The technique is simple: in the lumen of the turbinate is inserted with a cotton or gauze swab soaked in 3 % hydrogen peroxide.

2. Pre-moisten a cotton turundas in vasoconstrictor drops, and then enter in the nostril from which the blood flows.

3. Ask the patient to take a deep breath through the nose, exhale through the mouth and simultaneously put ice on the nose and the back of the head.

When carrying out any procedure the patient must sit or take a half upright position, and head drop forward. This is to ensure that the blood did not flow at the back of the throat to the stomach.

Equipment front tamponade

If all of the above methods prove ineffective, runs the front nose tamponade. Her technique is simple to perform. First and foremost, the physician should make local anesthesia of the nasal cavity with a solution of lidocaine or procaine (a preliminary Allergy tests, of course). Then the doctor inserts bleeding in the course of sterile gauze soaked in hemostatic drug or vaseline ointment. Length gauze can be about seventy inches, but width is only one and a half. Turundas placed in the form of an accordion so as to completely fill the nasal cavity.

A tampon left almost three days, and after this term is removed. Under especially heavy bleeding, gauze can be left on for seven days, but in this case it must be moistened with solutions of antibiotics and aminocaproic acid.

Reasons for holding back tamponade

The Front nose tamponade may not give the expected results. Or the source of the bleeding may be further away than first thought. In such cases, resort to more time-consuming but effective method.

Rear nose tamponade is done to stop epistaxis if:

1. The patient was a direct blow to the nose or the nasal passage got a foreign body.
2. If bleeding is caused by the long flowing rhinitis or sinusitis.
3. In cases where high systemic blood pressure does not subside the walls of the vessel and prevents the formation of a blood clot.
4. The cause of bleeding – a disintegrating tumor.
5. The patient has blood diseases.

Technique nose tamponade

To Perform this manipulation can only a trained technician should not try to self-medicate at home. In addition to physician, this action still involved two or even three people. One of them is needed in order to maintain the correct head position of the patient. The second takes the swabs and helps to fix them, and the third is preparing a new sterile swabs if necessary.

Before starting the procedure, the patient is administered any sedative to relax it and reduce the gag reflex. Then into the oral cavity through the nose introduces a soft catheter, lubricated with sterile liquid paraffin. By the end of this tube is tied gauze of appropriate size. Swab there are three threads: two recorded on the catheter, and one remains in the mouth, and then fastened to the cheek with plaster. The next stage – the removal of a catheter through the nose. The swab is pressed to hounam and fully closes the nasopharynx. Then do the front tamponade of the front and tie the remaining two threads. Remove the swab through two or three days.

Complications

Tamponade of the nasal cavity, like any other manipulation, can cause complications. They include such phenomena as necrosis of the nasal mucosa. This is due to prolonged compression of blood vessels and nerves...