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Spire Clare Park Hospital Crondall Lane Crondall Farnham GU10 5XX
01252 852552 F
Jonathan Hern FRCS (ORL).
Appointed to Frimley Park Hospital in 2003. Special interest in rhinologyincluding rhinoplasty surgery and also voice problems.
David Jonathan FRCS.
Appointed to Frimley Park Hospital in 1991. Special interest in earsurgery, including implantable hearing aids. Involved in the regionaltraining of ENT surgeons.
Andrew McCombe MD FRCS (ORL).
Appointed to Frimley Park Hospital in 1995. Special interest in headand neck surgery. Involved in the management of NHS services.
Special interest in medicolegal work.
Epistaxis can be a significant health risk and prompt and effective
treatment is essential. Please feel free to phone Ward F12A for furtheradvice regarding this common problem.
Epistaxis is bleeding from the nose. Sometimes the blood runs into the back of the throat from the nose.
In young people the bleeding is usually from the front part of the nasal
septum, the partition inside the nose.
The Surrey & Hampshire ENT Partnership
In older people, the bleeding can occur from further back inside the nose.
A nose bleed can occur spontaneously or there are certain specific
British Association of Otorhinolaryngologists
• Nasal infections, such as the common cold
• Blood clotting abnormalities, including medication,
• Abnormalities in blood vessels themselves
Most nose bleeds can be stopped by simple first aid measures.
The majority of nose bleeds respond to either chemical or electric
Whilst sitting up, apply pressure to the front of the nose by gently
cautery or nasal packing within 24 hours. If the nose continues to
squeezing the tip of the nose between the thumb and forefinger for
bleed, then the patient is taken to the operating theatre and the nose
around 5 minutes. Cold compresses around the nose and face may
examined under a general anaesthetic. If a bleeding point is identified,
also help. If you feel faint, lie down with the bleeding side of your
this can be cauterised. If the nasal septum is very bent inside the nose,
nose uppermost. If a nose bleed continues for more than 30 minutes,
then it is advisable to seek medical attention.
On occasion, it is necessary to clip a small vessel in the back of the
If the bleeding is from the front of the nose, the bleeding point can be
nose, which is the main arterial supply to the nose. Very rarely, both
cauterised with silver nitrate, or an electric current, under local anaesthetic.
of these vessels are clipped and in addition vessels entering the nose from the eye may also be clipped. In the majority of cases, these
If the bleeding is from further back in the nose, it is often possible to
measures are successful, but extremely rarely it is necessary for further
visualise the bleeding vessel with an endoscope, which enables cautery.
surgery to stop the bleeding, which may include the ligation of an artery
In certain instances, when a bleeding point cannot be identified, or the
bleeding is too profuse, the nose has to be packed with either a spongeor gauze impregnated with an iodine containing material.
On occasion, if the bleeding is from the back of the nose, a catheter is
inserted into the back of the nose via the nostril and the balloon inflatedwith water. In addition, the front of the nose may also be packed.
Following a significant nose bleed, it is advisable to do the following:
The nose may sometimes need packing on more than one occasion.
If packs are placed in the nose, admission to hospital is advisable.
It may be advisable to stop Aspirin or Warfarin medication for a while:this is usually done in consultation with a physician.
For minor nose bleeds, an antiseptic cream placed into the nose for
• Avoid straining when going to the toilet
Design for All and Assistive Technology for computer science and design studentsIn this article I outline my background in teaching and conducting research on "design for all" and assistive technology. I then discuss definitions of these two terms, which are not straightforward, and present some of the arguments for including them in computing and design curricula. Finally I present a n
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