Paeds Vivas · ent-hearing-and-oral-health
Epistaxis in children — branching viva
Branching viva from a four-year-old with an active profuse nosebleed brought in tilted backward, through correct first-aid technique and the common errors, the stepwise escalation to cautery and packing, with a pivot to a seven-year-old with recurrent epistaxis, bruising and a family history of bleeding testing the bleeding-disorder work-up, and a final probe on an adolescent boy with unilateral progressive epistaxis and obstruction pointing to juvenile nasopharyngeal angiofibroma.
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Opening — the four-year-old with a profuse nosebleed
Examiner: A four-year-old is brought to the emergency department with brisk nasal bleeding for twenty minutes. His father has him tilted backward in a chair, pressing a towel against the bony bridge of the nose, and the child has just vomited a small amount of swallowed blood. Talk me through your immediate thoughts and actions. [4]
Candidate should cover: recognition of the two first-aid errors — tilting backward, which sends blood to the stomach causing vomiting and aspiration risk, and pinching the bony bridge, which does not compress the Little's area vessels; the correct technique of sitting upright, leaning forward and applying firm continuous pressure to the soft, cartilaginous lower part of the nose for at least 10 to 15 minutes while breathing through the mouth; and immediate assessment of airway, breathing and circulation with intravenous access. [8]
References9ShowHide
- [1]Svider P; Arianpour K; Mutchnick S; et al Management of Epistaxis in Children and Adolescents: Avoiding a Chaotic Approach. Pediatr Clin North Am, 2018.PMID 29803286
- [2]Tunkel DE; Anne S; Payne SC; et al Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg, 2020.PMID 31910111
- [4]Béquignon E; Teissier N; Gauthier A; et al Emergency Department care of childhood epistaxis. Emerg Med J, 2017.PMID 27542804
- [5]Alsaif A; Karam M; Alhaider A; et al The addition of silver nitrate cautery to antiseptic nasal cream for patients with epistaxis: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol, 2020.PMID 32998847
- [6]Link TR; Conley SF; Flanary V; et al Bilateral epistaxis in children: efficacy of bilateral septal cauterization with silver nitrate. Int J Pediatr Otorhinolaryngol, 2006.PMID 16621035
- [8]Sowerby L; Rajakumar C; Davis M; et al Epistaxis first-aid management: a needs assessment among healthcare providers. J Otolaryngol Head Neck Surg, 2021.PMID 33573695
- [9]Boldes T; Zahalka N; Kassem F; et al Epistaxis first-aid: a multi-center knowledge assessment study among medical workers. Eur Arch Otorhinolaryngol, 2024.PMID 38748311
- [11]Kubba H; MacAndie C; Botma M; et al A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood. Clin Otolaryngol Allied Sci, 2001.PMID 11843924
- [12]Singh RK; Lakhkar BB; Patwa PA; et al Juvenile nasopharyngeal angiofibroma. BMJ Case Rep, 2022.PMID 35260405