Nose Bleed
Epistaxis is the medical
term for nosebleeds.
Epistaxis usually refers
to major nosebleeds that are difficult to
stop or recurrent nosebleeds.
Rare, easy to stop
nosebleeds or simple blood tinged nasal
secretions rarely come to the attention of
the doctor. Most of these are caused by
nasal dryness or minor trauma to the nose,
such as frequent picking. Major or
recurrent epistaxis may suggest a more
serious cause or one that requires the
intervention of a physician.
Epistaxis can be
classified as anterior, when it arises in
the front of the nasal cavity, or
posterior, when it arises in the back of
the nasal cavity.
Fortunately,
anterior epistaxis is more common. It is
usually much easier to treat. The most
common cause of anterior epistaxis is
nasal dryness. Nosebleeds are most common
in the winter months when the humidity is
low and certain types of heating may
further dry the air indoors.
The second most common
cause of anterior epistaxis and the most
common cause of posterior epistaxis is
vascular disease with or without high
blood pressure. As blood vessels become
damaged due to high blood pressure, high
cholesterol or aging, they become brittle
and break more frequently.
If the blood pressure is
high, the epistaxis will be more difficult
to stop. Other causes of epistaxis are
nasal trauma, nasal tumors, or abnormal
blood clotting due to medicines, such as
aspirin or Coumadin, or due to diseases,
such as leukemia or liver failure.
The first step in
treating epistaxis is to stop the
bleeding. This is usually done in a
stepwise fashion that may include the
following: chemical cautery with silver
nitrate, electrocautery, anterior nasal
packing, posterior nasal packing, and
surgery, such as septoplasty, further
cautery and packing, or major vessel
ligation. Once the bleeding is stopped,
the goal is to determine the cause of the
epistaxis and to attempt to prevent it
from recurring. This may involve nasal
endoscopy, lab work to check hematocrit,
platelet count and function, clotting
studies and liver functions, and possibly
radiologic studies, such as CT scans or
angiograms.
Nasal saline spray and a
humidifier will help to keep the nasal
mucosa moist and diminish the risk of
nosebleeds. Nasal decongestant sprays,
such as Neo-synephrine or Afrin, are often
recommended for three to five days after
epistaxis, to keep the blood vessels
constricted until they can clot and heal.
These sprays should not be used after five
days because of the significant rebound
congestion that will occur. Certain
precautions such as refraining from nose
blowing and strenuous activity are
important to keep the blood pressure down.
Of course, controlling
the blood pressure is paramount, and any
prescribed medication should be taken as
directed. Direct pressure to the nostrils
and nasal tip will stop most minor
epistaxis. If it persists, then medical
attention should be sought immediately.
Nose bleed care:
DO NOT blow your nose
until 12 hours have passed.
DO NOT pick or rub your
nose. DO NOT use aspirin,
anti-inflammatory medication, or drink
alcohol for two to three days.
DO NOT do strenuous
activity. DO use a humidifier or vaporizer
in your home. This will increase the
moisture and help prevent future
nosebleeds.
DO take any
medication prescribed in the emergency
department for the problem. If the
bleeding starts again, sit up and lean
forward. Breathe through your mouth. Pinch
the soft part of your nose tightly for 10
minutes without letting go. If a gauze
pack was put in your nose by the doctor,
you will need to return to have it
removed. Do not pull it out yourself. If
part of the packing starts to come out,
gently tuck it back it.
Return immediately to
the emergency department if you: have
unexplained bruises or bleeding from other
parts of your body. have a fever. have
uncomfortable bleeding from the nose.