Techniques of nasotracheal intubation with the fiberoptic bronchoscope

When nasotracheal intubation with a fiberoptic bronchoscope is performed, the tube may be blocked in the nasal cavity or larynx, resulting in several complications including epistaxis and hoarseness. We review the causes and complications of tube blockage and discuss optimal techniques for minimizing it.     

Epistaxis

Epistaxis is a common problem that can affect the whole population. The majority of cases are self-limiting and do not require any medical intervention, but epistaxis can be associated with morbidity and even death in very rare circumstances. If epistaxis does not resolve with first aid measures, or episodes are frequent, patients may require specialist assessment and treatment by ENT, either in the outpatient clinic or via an unscheduled (emergency) admission to the hospital. Here, we provide an overview of the management of epistaxis in the outpatient setting and during an emergency admission in both paediatric and adult patients. We highlight the key considerations in the history and management, covering the common and rare conditions that are associated with epistaxis. This article provides an update from our previous article published in 2018 to include the more recent literature and a useful learning resource for examinations.     

The evolution and value of bleeding assessment tools

Summary. A personal history of excessive mucocutaneous bleeding is a key component in the diagnosis of a number of mild bleeding disorders, including von Willebrand disease (VWD), platelet function disorders (PFD), and coagulation factor deficiencies. However, the evaluation of hemorrhagic symptoms is a well‐recognized challenge for both patients and physicians, because the reporting and interpretation of bleeding symptoms is subjective. As a result, bleeding assessment tools (BATs) have been developed and studied in a variety of clinical settings. This work has been pioneered by a group of Italian researchers, and the resultant ‘Vicenza Bleeding Questionnaire’ stands as the original BAT. In this review, we will discuss the modifications of the Vicenza Bleeding Questionnaire that have taken place over the years, as well as the validation studies that have been published. Other BATs that have been developed and published will be reviewed, as will the special situations of assessing pediatric bleeding as well as menorrhagia. Lastly, the clinical utility of BATs will be discussed including remaining challenges and future directions for the field.     

做作性障碍 —— 一例不明原因的鼻出血的罕见病因

概述:鼻衄或鼻出血是一种常见的疾病,有可能会严重到需要紧急医疗或手术治疗.人为的鼻出血是一种罕见的案例.对患者复杂的行为问题,在大学阶段的培训较少,因此,外科医生常常错过患者一些隐藏的心理问题.在这里,我们给出一例做作性障碍的病例,该案例由于鼻出血而进行手术.经过适当的评估并于耳鼻咽喉科会诊之后,我们采用抗抑郁药物和认知行为治疗成功治愈该患者.     

鼻内镜辅助治疗鼻出血的临床报告

2006—01—2011—12笔者在鼻内镜辅助下应用双极电凝、微波凝固、局部填塞等措施综合治疗鼻出血，效果良好，报告如下。     

Topical tranexamic acid for the treatment of acute epistaxis in the emergency department

Objective

To evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis.

Utilization of Prophylactic Antibiotics After Nasal Packing for Epistaxis

BackgroundThere have been few investigations examining the benefits, consequences, and patterns of use for prophylactic antibiotics for nasal packing in the emergency department setting. Given the frequency of epistaxis in the emergency department, it is an ideal setting to study the efficacy and utilization patterns of prophylactic antibiotics in nasal packing.ObjectiveOur aim was to assess both rates of utilization and evidence of benefit for prophylactic antibiotics in patients with nasal packing for epistaxis.MethodsA single-institution retrospective review of 275 cases of anterior nasal packing in an urban emergency department between September 2013 and April 2017 was performed. Chi-square statistical analysis was used to evaluate results.ResultsAmong 275 cases studied, there were no instances of toxic shock syndrome. Roughly 73% of patients with nonabsorbable packing received prophylactic antibiotics. Only one (1.1%) case of sinusitis was noted among the nonabsorbable packing with prophylaxis group, with no such complication in the nonprophylaxis group. In contrast, 95% of patients with absorbable nasal packing were not given prophylactic antibiotics. Analysis of all cases given prophylactic antibiotics vs. no prophylaxis, regardless of packing type, revealed no statistically significant difference in the development of acute sinusitis (1% vs. 0.56%; p = 0.6793).ConclusionsThere was no observed advantage or disadvantage to using prophylactic antibiotics in anterior nasal packing in the emergency department, regardless of whether patients received absorbable or nonabsorbable packing. However, patients who receive nonabsorbable nasal packing were more likely to receive antibiotic prophylaxis.