Epistaxis (Bleeding from the nose)
Most people go through at least one episode of bleeding from the nose especially during childhood. While an episode is self-contained, it may be the first pointer to serious local or general disease.
Epistaxis is undoubtedly one of the most frequent causes of bleeding. In the majority of the cases, bleeding is in small quantities and self-limited, but sometimes it can be very intense and life-threatening. That's why epistaxis should never be treated as a harmless event either from the diagnostic or therapeutic point of view.
Causes
1. Local:
- a. Spontaneous rupture of a blood vessel.
- b. Injury to the nose, fracture of the base of the skull, foreign body.
- c. Nasal disease e.g. tumour, diptheria, polyp.
2. General
- a. Infective fevers e.g. Influenza, measles, and typhoid:
- b. Liver disease e.g. Jaundice, cirrhosis of the liver
- c. Blood disorders e.g. leukemias.
- d. Drugs
- e. High blood pressure
- f. High altitude sickness, air sickness
Diagnostic Steps of Epistaxis
- History - In the anamnese we should ask for previous bleeding, hypertension, hepatic diseases, use of anticoagulants, nasal trauma, family history of bleeding etc.
- Localize the source of the bleedings and determine its cause.
- Measurement of the blood pressure.
- Analysis of blood coagulation.
- Radiographs of the skull, nose and sinuses and possibly tomograms.
- Exclude generalized causes.
Treatment of Epistaxis
1) General Symptomatic Treatment
- Calming the patient (if necessary with medication).
- The patient should sit with the upper part of the body tilted forward and the mouth open so that he can spit out the blood and don’t have to swallow it.
- Cold compresses are applied to the nape of the neck and also to the dorsum of the nose.
- Lowering of blood pressure in hypertension.
- Discontinuation of anticoagulants.
- Administration of fluid expanders in severe bleeding.
2) Local Procedure
- Digital compression for several minutes.
- Cautery of the hemorrhagic point - When visible the bleeding site may be cauterized with silver nitrate or electrocautery.
- Anterior Nasal Packing - Sometimes it is required to achieve hemostasis in more intense bleeding.
- Posterior Nasal Packing - It’s used when the bleeding is intense and from the posterior part of nasal cavity. When we use nasal packing we should use antibiotics to avoid sinuses infection..
- Vascular ligation - This procedure is used for uncontrolled life-treating epistaxis if the methods described before have not been effective.
After control of epistaxis, the patient is advised to avoid vigorous exercise for several days. Avoidance of hot or spicy food and tobacco is also advisable as they may cause vasodilation. Avoiding nasal trauma, including digital self-trauma is an obvious necessity.
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