TREATMENT OF NOSE BLEEDING (EPISTAXIS)

Nose bleeding may appear at any age. It may originate from any point of thenasalmucosa. Depending on the bleeding site, the classification may be done as anterior and posterior nose bleeding.

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Anterior nose bleeding: It is originated from intense capillary vessel zones located on the middle part of the nose. The vessels on this are are very thin and superficial. They may bleed easily. It is usually seen during childhood and in young adults.

Posterior nose bleeding: It is usually seen in the individuals at middle and advanced age with atherosclerosis or hypertension. Bleeding originates from upper-posterior zones of the nose. It may require hospitalization.

CAUSES OF NOSE BLEEDING

  • Allergy that causes itching inside the nose
  • Nose dryness
  • Hypertension
  • Trauma
  • Nose picking
  • Nasal tumours
  • Sinusitis
  • Strongly blowing the nose
  • Upper respiratory tract infections
  • Coagulation disorders
  • Use of cocaine, alcohol and snuff
  • Nasal deviation
  • Nose medications including cortisone
  • Anticoagulant drugs
  • Hormonal conditions (i.e. pregnancy)
  • Vitamin K deficiency
  • Excessive or long term use of nasal drops
  • Liver diseases
  • High altitude

WHEN A DOCTOR SHOULD BE REFERRED?

  • If bleeding repeats frequently
  • If bleeding is intense
  • If bleeding causes tiredness, exhaustion, block-out and/or nausea
  • If bloody spit or blood in the vomit appears
  • If blood exists in the urine or stool
  • If bleeding causes respiratory difficulty
  • If blood flows from posterior side of the nose towards throat

PRECAUTIONS TO STOP THE BLEEDING

There is an incorrect action which is done during bleeding. The patients put their head to the back to stop bleeding. This causes flow of the blood back along the nasal passage.

The patient should be kept calm in case of bleeding; excitement may cause elevation in blood pressure and increase bleeding.

The individual should sit vertically and lie down while keeping the head upwards if needed. The nasal wings should be covered by the thumb and index finger and kept for 5 to 10 minutes.

Ice compress may also be applied during this period.

After bleeding stops, the nose should not be picked or forced to discharge remaining blood inside the nostrils.

The individual should be careful not to blow and should not make heavy efforts like lifting a heavy object.
Hot foods or hot beverages should be avoided.

If bleeding continues, the inside of the nose should be washed with cold water and nasal wings should be compressed for 5 minutes. This procedure may be repeated several times.

If bleeding persists, a doctor should be referred immediately.

TREATMENT OF NOSE BLEEDING

For anterior nose bleedingwith persistent bleeding or a small intervention may stop bleeding through coagulation of the vessel.

A limited nasal cushion may be done inanterior nose bleedingor the bleeding point may be cauterized. Then softening and wound healing nose creams may be used. Posterior nose bleeding may be usually cured by by eliminating the actual cause.

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