Posterior bleeding is much less common than anterior bleeding and usually is treated by the ear, nose, and throat surgeon (an otolaryngologist). Posterior nosebleeds involve bleeding from the back of the nasal cavity. Blood flow tends to be heavier than in anterior nosebleeds and hence needs early management. Posterior packing may be accomplished by passing a catheter through one nostril (or both nostrils), into the pharynx, and finally out the mouth. A gauze pack then is secured to the end of the catheter and positioned in the posterior nasopharynx by pulling back on the catheter until the pack is seated in the posterior aspect.
The procedure is done in the following steps:
- After adequate anesthesia has been obtained, a catheter is passed through the affected nostril, into the nasopharynx, and drawn out of the mouth with the aid of ring forceps.
- A gauze pack is secured to the end of the catheter using umbilical tape or suture material, with long tails left to protrude from the mouth.
- The gauze pack is guided through the mouth and around the soft palate using a combination of careful traction on the catheter and pushing with a gloved finger. This is the most uncomfortable (and most dangerous) part of the procedure; it should be completed smoothly and with the aid of a bite block to protect the physician’s finger.
- The gauze pack should come to rest in the posterior nasal cavity. It is secured in position by maintaining tension on the catheter with a padded clamp or firm gauze roll placed anterior to the nostril.
- The ties that protrude from the mouth (which will be later used to remove the pack) are taped to the patient’s cheek.
- Patients with posterior packs for epistaxis may be admitted to the ICU for continuous monitoring due to the risk of life-threatening events.
- The patient will require prophylactic antibiotics while the foreign body is in place. To prevent tissue infection, the packing will need to be removed within 48-72 hours.
- A potential complication of posterior packing that is kept in place for extended periods is toxic shock syndrome (a rare but serious medical condition caused by a bacterial infection).
- The risk of rebleeding and complicated bleeds from posterior nasal bleeds may require otorhinolaryngology consultation. Even when appropriate measures are taken to control a posterior nasal bleed, 25% will not stop.
An otolaryngologist may further perform endoscopic surgery to know the cause of the bleeding. When posterior bleeding is suspected, the general location of the source should be determined. This step is important because different arteries supply the floor and roof of the posterior nasal cavity; therefore, selective treatment may be required. Hot water irrigation has shown promise in reducing discomfort and length of hospitalization in patients with posterior epistaxis. More invasive alternatives include arterial ligation and angiographic arterial embolization.
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Common Medical Abbreviations & Terms
Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include:
- ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of disease.
- ARF: Acute renal (kidney) failure
- cap: Capsule.
- CPAP: Continuous positive airway pressure. A treatment for sleep apnea.
- DJD: Degenerative joint disease. Another term for osteoarthritis.
- DM: Diabetes mellitus. Type 1 and type 2 diabetes
- HA: Headache
- IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract, Crohn's disease and ulcerative colitis
- JT: Joint
- N/V: Nausea or vomiting.
- p.o.: By mouth. From the Latin terminology per os.
- q.i.d.: Four times daily. As in taking a medicine four times daily.
- RA: Rheumatoid arthritis
- SOB: Shortness of breath.
- T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital signs."
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ipratropiumIpratropium is a medication used to relieve runny nose and nasal inflammation (rhinitis) caused by colds and allergies, and as a bronchodilator to relieve bronchospasm and ease breathing in chronic obstructive pulmonary diseases (COPD), including chronic bronchitis and emphysema. Common side effects of intranasal ipratropium include headache, upper respiratory tract infection (URI), nasal bleeding (epistaxis), throat inflammation (pharyngitis), and others. Common side effects of intranasal ipratropium include bronchial inflammation (bronchitis), exacerbation of COPD, sinus inflammation (sinusitis), shortness of breath (dyspnea), cough, flulike symptoms, back pain, and others.
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