Hall A C, Simons M, Pilgrim G, Theokli C, Roberts D, Hopkins C
Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Laryngol Otol. 2014 Jan;128(1):82-5. doi: 10.1017/S0022215113003137. Epub 2013 Dec 2.
To assess management of epistaxis at a tertiary ENT referral hospital against a recently published standard of best practice.
Fifty consecutive cases of acute epistaxis that required admission to Guy's Hospital in 2009 were evaluated. Epistaxis education sessions were held to introduce our algorithm of best practice in tandem with an emphasis on emergency department care. Similar retrospective reviews were carried out in both 2010 and 2011 (on groups of 50 patients).
The first audit cycle demonstrated that only 8 per cent of patients underwent a suitable nasal examination in the emergency department prior to transfer, with no documented attempts at nasal cautery. Surgical intervention procedures were performed on only 40 per cent of eligible patients. The audit cycles that followed the introduction of the epistaxis algorithm demonstrated continued improvement in initial evaluation and management of epistaxis. In select patients, sphenopalatine artery ligation can provide timely, definitive management of refractory epistaxis.
依据最近发布的最佳实践标准，评估一家三级耳鼻喉科转诊医院鼻出血的处理情况。
对2009年连续50例需入住盖伊医院的急性鼻出血病例进行评估。举办了鼻出血教育课程，介绍我们的最佳实践方案，同时强调急诊科护理。2010年和2011年也进行了类似的回顾性研究（每组50例患者）。
首个审核周期表明，仅8%的患者在转院之前在急诊科接受了适当的鼻腔检查，且没有记录显示尝试过鼻腔烧灼止血。仅40%的符合条件的患者接受了手术干预。引入鼻出血处理方案后的审核周期显示，鼻出血的初始评估和处理持续改善。对于部分患者，蝶腭动脉结扎术可为难治性鼻出血提供及时、有效的处理。
