EPISTAXIS IN CHILDREN

Introduction Epistaxis is divided into 2 of the anterior (front) and posterior (rear). Cases of anterior epistaxis is mainly coming from the front of the nose to the origin of bleeding from the plexus kiesselbach. Posterior epistaxis is generally derived from the nasal cavity through the posterior branch a.sfenopalatina. Anterior epistaxis showed a clear clinical symptoms of bleeding from the nostrils. Posterior epistaxis often show symptoms that are not so obvious such as nausea, vomiting blood, coughing up blood, anemia and posterior epistaxis usually involve large blood vessels so bleeding is more severe. What are the symptoms ? Bleeding from the nose, the other symptoms according to the etiology is concerned. Epitaksis weight, although rarely an emergency that threatens the safety of life of patients, it can even be fatal if not quickly rescued. Source of bleeding can be derived from the nose and behind the nose. Epitaksis anterior (front) can be derived from the plexus kiesselbach or from a. etmoid anterior. Kieselbach plexus is often a source epitaksis especially in children and can usually heal itself. Epitaksis posterior (rear) can be derived from a. sfenopalatina and a. etmoid posterior. Bleeding is usually severe and rarely stop myself. Often found in patients with hypertension, arteriosclerosis, or patients with heart disease. Necessary checks are complete and functioning of blood hemostasis. How common is the problem ? Epistaxis is rare in infants, often in children, is rare in young adults, and even more in young adults. Epistaxis or nose bleed occurs in 60% of the reported general population. The peak incidence of epistaxis obtained in the form of two peaks (bimodal), ie at age <10 years and> 50 years. What are the risks ? Treated and given medication before the blood plus the risk of anemia in children and can even cause death of the previous stages of weakness. What should be done ? If the child is exposed to the attacks of epistaxis it would be better if we did put the first aid that is higher than the agency head and squeeze out the nose for several minutes and after that we bring to the doctor to determine further action. What is the treatment ? Blood flow will stop after the blood had frozen in the process of blood clotting. A medical opinion says that when the bleeding occurs, it is better if the head is tilted forward position (sitting position) for blood flow and prevent entry into the esophagus and stomach. First aid in case of a nosebleed is to squeeze the front of your nose for three minutes. During pemencetan should breathe through the mouth. Mild bleeding will usually stop in this way. Do the same thing in case of recurrent bleeding, if it does not stop you should visit a doctor for help. For chronic nose bleeds due to dryness of the nasal mucosa, is usually prevented by spraying saline in the nose up to three times a day. If due to the pressure, the ice pack can be used to shrink blood vessels (vasoconstriction). If it still does not work, can be used tampon nose. Nasal tampons to stop the bleeding and the media is mounted 1-3 days. The three main principles in tackling epitaksis is • Prevent complications Prevent complications such as shock resulting from bleeding or infection • Prevent recurrence of epitaksis If the patient is in a state of emergency such as a better shock or anemia patient's general condition improved once the new combat bleeding from the nose itself. • Stop the bleeding Actively stop the bleeding by using caustic or tampon is much more effective than by administering hemostatic drugs and wait for the blood stop. If patients present with bleeding, the patient should be examined in a state seat, if the patient is too weak to put a pillow was placed behind the back of the patient. Look for sources of bleeding with the help of a vacuum to clean the nose of blood clots, then using a cotton tampon moistened with adrenaline 1/10000 or 2% lidocaine inserted into the nasal cavity to stop bleeding or reduce pain, it can be left on for 3 -5 minutes   Glossary : anterior : bagian depan posterior : bagian belakang hypertension : tekanan darah tinggi arteriosclerosis : pengerasan dan penebalan dinding pembulu darah arteri akibat plak dimulai dari lapisan intima bagian pembuluh darah paling dalam yang kemudian meluas juga ke lapisan media dari pembuluh darah yang terjadi karena proses pengendapan lemak, komplek karbohidrat dan produk darah, jaringan ikat dan kalsium. vasoconstriction : mengecilnya pembuluh darah Nasal tampons : massa dari kapas atau rayon atau campuran dari kedua dimasukkan ke dalam rongga hidung Hemostatic drugs : obat yang digunakan untuk menghentikan pendarahan Reference : Arif,Mansjoer, et al, 1999, Kapita Selekta Kedokteran, Edisi 3, Jilid 1, Media Aesculapius, Jakarta. Johnson. M. Maas. M. Moorhead. S. 2000. Nursing Outcome Classification(NOC). Mosby. Philadelpia.   EPISTAXIS IN CHILDREN