Related Experiment Video
Updated: May 24, 2026
04:46
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Management of intractable spontaneous epistaxis
1Rhinology and Sinus Surgery, Division of Otolaryngology, Department of Surgery, University of Calgary, Alberta, Canada.
American Journal of Rhinology & Allergy
|March 7, 2012
Summary
Severe nosebleeds (epistaxis) often require advanced treatments beyond packing. Endoscopic arterial ligation and embolization offer effective control for intractable cases, guiding clinical decisions for challenging scenarios.
Area of Science:
- Otolaryngology
- Vascular Surgery
- Interventional Radiology
Background:
- Epistaxis is a frequent otolaryngology emergency.
- Initial treatments include cautery, hemostatic agents, and anterior nasal packing.
- A portion of patients experience persistent bleeding requiring advanced interventions.
Purpose of the Study:
- To review and discuss management strategies for intractable spontaneous epistaxis.
- To evaluate the role of endoscopic arterial ligation and embolization in severe cases.
- To provide guidance for challenging clinical scenarios involving persistent nosebleeds.
Main Methods:
- Literature review of epistaxis management.
- Analysis of surgical and endovascular techniques for intractable cases.
- Comparison of transnasal endoscopic sphenopalatine artery ligation and arterial embolization.
Main Results:
- Transnasal endoscopic sphenopalatine artery ligation and embolization demonstrate high control rates for epistaxis.
- Choosing between ligation and embolization can be complex.
- The efficacy of anterior ethmoid artery ligation is less defined but may be useful for localized ethmoid bleeding.
Conclusions:
- Endoscopic arterial ligation and embolization are key options for intractable epistaxis.
- Clinical decision-making should consider the specific bleeding source and available techniques.
- Further clarification on the role of anterior ethmoid artery ligation is warranted.
Related Concept Videos
01:30Epistaxis
Epistaxis, or nosebleeds, occurs when small, swollen blood vessels in the nasal mucous membrane rupture. Typically, the anterior septum is the primary site of occurrence.
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
01:28Esophageal Varices-II: Clinical Features and Management
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway interventions are...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
01:26Tonsillitis II: Management
This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...