Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed.The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring into discussion the treatment applied for patients diagnosed with hereditary hemorrhagic telangiectasia.
In Romania, after completion of the Faculty of Medicine, the next step in the training of future doctors is passing the residency exam. Once they have acquired the status of resident physician, they receive all necessary information corresponding to the chosen specialty for the training period, such as duration, curricula, stages included by the respective discipline and the skills that must have been acquired at the end of training period.For the ENT specialty, the training duration of resident doctors is four years, during which they must acquire medical-surgical knowledge regarding the pathology of the ear, nose, paranasal sinuses, oral cavity, pharynx, larynx, trachea, cervical esophagus, but also the borderline pathology associated to some specialties such as neurology and neurosurgery, oral-maxillofacial surgery, thoracic and vascular surgery, or gastroenterology. As a result of changes occurred 7 years ago in the curricula for residency training in the specialty of otorhinolaryngology, by modifying the duration of studies from 5 to 4 years, we believe we are deprived of a significant period of deepening the essentials for a so complex specialty. By consulting the website UEMS and the European curricula in the field, we notice that the duration of residency training is 5 years with the exception of 4 countries (Spain, Lithuania, Estonia and Switzerland), and Romania further appears with a 5-year studies duration, although the duration is of 4 years in this specialty beginning with 2010.Since the experience acquired during this residency rebounds on the entire career of an ENT physician, but also to increase medical performance, we consider inappropriate a training of only 4 years. The ENT specialty is a complex one, of which more supra-specializations or competences derive (rhinology, laryngology, phoniatrics, otology, neurotology, vestibulology, head and neck oncology, facial plastic surgery, pediatric ENT), which is why we consider necessary some additional time for the accumulation of sufficient knowledge for this professional orientation. The stage of pediatric ENT of only 1 month is absolutely insufficient for the familiarization with the information regarding the ENT pathology in children.In the syllabus for this discipline, the resident doctor has an interval between 2 weeks and 1 month for the disciplines complementary to ENT, such as neurosurgery, oral and maxillofacial surgery or thoracic surgery. Unfortunately, the duration of each training stage is limited, the pathology being a vast one, with multiple connections to the ENT field; therefore, there is not enough time to accumulate thorough knowledge allowing the resident doctor to conduct their activity with full knowledge of the facts. For example, the General Surgery stage of only 1 month, taking into consideration that the ENT specialty is a surgical one, is not acceptable for acquiring the basic skills necessary for surgical interventions in the ENT field. Moreover, adding the concepts of electrophysiology, somnology, genetics, etc., would ...
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