Nose Bleeding and its management

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Anterior & Posterior epistaxis illustrated

Epistaxis (or a more commonly known as nosebleeding) is the common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, more likely to require medical attention). Patient with epistaxis is in state of anxiety, frightened and apprehensive and in need of reassurance.

AETIOLOGY

Local:

  1. Trauma & nose picking (commonest).
  2. Nasal and sinus infection.
  3. Neoplasms of nose and sinuses.

Systemic:

1-   Hypertension (commonest).

2-   Bleeding disorder.

3-   Hepatic disorder.

4-   Renal disorder.

5-   Drugs, e.g., aspirin, NSAIDs, anticoagulants etc.

Idiopathic:

In majority of cases, no cause can be found.

 

TREATMENT

Treatment of epistaxis depends upon certain factors, which are;

1-   Amount of blood loss.

2-   General condition of patient at presentation.

3-   Age of patient.

4-   Cause of epistaxis.

Minor Nose Bleed:

Conservative Measures:

1-   Reassurance

2-   Cold sponging of nose and face.

3-   Nose pinching.

4-   Placing cotton plug soaked in Xylocaine 4 % with adrenaline for 5-10 min. (if patient is not hypertensive).

 

Active Anterior Epistaxis

 

1-   Identify bleeding points and cauterize them with chemical (silver-nitrate 20%) or electric diathermy.

2-   If bleeding point is not identified, anterior nasal packing soaked with polyfax skin ointment & liquid paraffin or BIPP (Bismuth iodoform paraffin paste).  Admit the patient and INFORM THE CONSULTANT.

3-   Set up & maintain I/V line and take blood samples for Hb, Blood for Grouping & cross-matching if required.

4-   Monitor Vital Signs: Pulse, BP, respiratory rate, temperature.

5-   Assess amount of blood loss by clinical signs & history.  While awaiting blood transfusion, transfuse ringers lactate.

If Bleeding Not Controlled By Above Measures;

 

1-   Posterior nasal packing.

2-   Consider vessel ligation (Internal maxillary, external carotid, anterior ethmoidal arteries.

3-   Embolization of bleeding vessels & discuss with ENT consultant.

If found, the cause of epistaxis should be treated accordingly