What are the common causes of nosebleeds. How can you effectively stop a nosebleed at home. When should you seek medical attention for a nosebleed. What are the best prevention methods for recurring nosebleeds. How are severe or chronic nosebleeds treated by healthcare professionals.

Understanding Nosebleeds: An Overview of Epistaxis

Nosebleeds, medically known as epistaxis, are a common occurrence affecting individuals of all ages. While often harmless, they can be alarming and, in some cases, require medical attention. This article delves into the intricacies of nosebleeds, providing comprehensive information on their causes, symptoms, and management strategies.

Epistaxis occurs when blood vessels in the nasal passages rupture, leading to bleeding from one or both nostrils. Children are twice as likely to experience nosebleeds compared to adults, but most individuals will have at least one episode in their lifetime.

Prevalence and Demographics

Are nosebleeds more common in certain age groups? Indeed, children and older adults are more prone to experiencing epistaxis. This higher prevalence in children is often attributed to their tendency to pick their noses, engage in rough play, and have more delicate blood vessels. In older adults, factors such as the use of blood-thinning medications and age-related changes in blood vessels contribute to increased susceptibility.

Common Causes of Nosebleeds: From Environmental Factors to Medical Conditions

Understanding the underlying causes of nosebleeds is crucial for effective prevention and management. While some factors are within our control, others may require medical intervention.

Environmental and Lifestyle Factors

• Dry air, especially during winter months
• Excessive nose picking or blowing
• Exposure to irritants and chemicals
• Allergies and sinus infections
• Trauma or injury to the nose

Medical Conditions and Medications

Can certain medical conditions increase the risk of nosebleeds? Yes, several health issues can contribute to an increased likelihood of epistaxis:

• Hypertension (high blood pressure)
• Blood clotting disorders
• Liver disease
• Kidney disease
• Use of blood-thinning medications (e.g., aspirin, warfarin)

It’s important to note that while these factors can increase the risk of nosebleeds, having a nosebleed does not necessarily indicate the presence of a serious underlying condition.

Recognizing the Symptoms: When to Be Concerned About a Nosebleed

While most nosebleeds are benign and easily managed, certain symptoms may indicate a more serious condition requiring medical attention.

Common Symptoms of Nosebleeds

• Bleeding from one or both nostrils
• Blood flowing down the back of the throat
• Coughing or spitting up blood
• Feeling of fullness or pressure in the nose

Warning Signs of Severe Nosebleeds

When should you be concerned about a nosebleed? Seek immediate medical attention if you experience:

• Prolonged bleeding (more than 30 minutes despite applying pressure)
• Heavy blood loss leading to dizziness or fainting
• Difficulty breathing due to blood in the throat
• Nosebleeds accompanied by severe headaches or vision changes
• Frequent recurrence of nosebleeds

Effective Home Remedies: Stopping a Nosebleed Safely

Most nosebleeds can be effectively managed at home using simple techniques. Understanding these methods can help alleviate anxiety and prevent unnecessary medical visits.

Step-by-Step Guide to Stopping a Nosebleed

1. Sit upright and lean slightly forward to prevent blood from flowing down your throat.
2. Pinch the soft part of your nose firmly with your thumb and index finger.
3. Maintain pressure for 10-15 minutes without releasing.
4. Breathe through your mouth during this time.
5. After 15 minutes, gently release the pressure. If bleeding continues, repeat the process.

Additional Home Care Tips

How can you support the healing process after a nosebleed? Consider these additional measures:

• Apply a cold compress or ice pack to the bridge of your nose
• Avoid blowing your nose or inserting anything into the nasal passages for several hours
• Keep your head elevated while sleeping
• Use a humidifier to add moisture to the air
• Apply a thin layer of petroleum jelly inside your nostrils to prevent dryness

Medical Interventions: When Professional Help is Necessary

While most nosebleeds can be managed at home, some cases require medical attention. Healthcare providers have several techniques at their disposal to address persistent or severe epistaxis.

Diagnostic Procedures

How do healthcare providers diagnose the underlying cause of recurrent nosebleeds? Common diagnostic approaches include:

• Physical examination of the nasal passages
• Blood tests to check for clotting disorders or anemia
• Imaging studies (e.g., CT scan) to identify structural abnormalities
• Endoscopy to visualize the interior of the nasal cavity

Treatment Options

What medical interventions are available for severe or recurrent nosebleeds? Healthcare providers may employ various techniques, including:

• Nasal packing with absorbent materials
• Cauterization of bleeding blood vessels
• Embolization procedures for severe cases
• Surgical interventions to correct structural abnormalities
• Medication adjustments for patients on blood thinners

Prevention Strategies: Minimizing the Risk of Future Nosebleeds

While not all nosebleeds can be prevented, there are several steps you can take to reduce their frequency and severity.

Lifestyle Modifications

How can you adjust your daily habits to prevent nosebleeds? Consider implementing these strategies:

• Use a humidifier in your home, especially during dry seasons
• Apply saline nasal sprays or gels to keep nasal passages moist
• Avoid picking your nose or blowing it too forcefully
• Wear protective gear during activities that risk nasal injury
• Quit smoking and limit alcohol consumption

Medical Management

For individuals with underlying medical conditions contributing to nosebleeds, working closely with healthcare providers is crucial. This may involve:

• Regular monitoring of blood pressure
• Adjusting medications that may increase bleeding risk
• Treating allergies or sinus conditions
• Managing blood disorders or other chronic conditions

Special Considerations: Nosebleeds in Children and the Elderly

While the general principles of managing nosebleeds apply to all age groups, there are some special considerations for children and older adults.

Nosebleeds in Children

Why are children more prone to nosebleeds? Several factors contribute to the higher incidence in this age group:

• More delicate blood vessels in the nasal passages
• Tendency to pick their noses
• Increased likelihood of nasal injuries during play
• Higher prevalence of allergies and sinus infections

Parents and caregivers should teach children proper nose-blowing techniques and discourage nose-picking. In cases of frequent nosebleeds, consulting a pediatrician is advisable to rule out underlying issues.

Nosebleeds in the Elderly

Older adults may face unique challenges when it comes to nosebleeds. These can include:

• Increased use of blood-thinning medications
• Age-related changes in blood vessel structure
• Higher prevalence of hypertension and other chronic conditions
• Potential difficulty in applying proper first-aid techniques

Caregivers should be aware of these factors and assist older adults in managing nosebleeds when necessary. Regular check-ups and medication reviews with healthcare providers are essential for this age group.

When to Seek Emergency Care: Recognizing Severe Epistaxis

While most nosebleeds are benign, certain situations warrant immediate medical attention. Understanding these scenarios can help individuals make informed decisions about seeking emergency care.

Signs of Severe Nosebleeds

What symptoms indicate a potentially dangerous nosebleed? Look out for:

• Bleeding that continues for more than 30 minutes despite applying pressure
• Large volume of blood loss leading to lightheadedness or fainting
• Difficulty breathing due to blood in the throat
• Nosebleeds accompanied by severe headaches or vision changes
• Signs of hypovolemic shock (e.g., pale skin, rapid heartbeat, confusion)

Emergency Management

In cases of severe nosebleeds, taking prompt action is crucial:

1. Call emergency services or have someone drive you to the nearest emergency room
2. Continue applying pressure to the nose while en route
3. If possible, sit upright and lean slightly forward to prevent blood aspiration
4. Inform medical personnel of any medications you’re taking, especially blood thinners
5. Be prepared to provide a detailed medical history upon arrival

Remember, while severe nosebleeds are rare, they can be life-threatening if not addressed promptly. When in doubt, it’s always better to err on the side of caution and seek medical evaluation.

Long-Term Management: Living with Recurrent Nosebleeds

For individuals who experience frequent nosebleeds, developing a comprehensive management plan is essential. This approach combines preventive measures, lifestyle adjustments, and ongoing medical care to minimize the impact of epistaxis on daily life.

Developing a Personalized Care Plan

How can you create an effective strategy for managing recurrent nosebleeds? Consider these steps:

1. Consult with an otolaryngologist (ear, nose, and throat specialist) for a thorough evaluation
2. Identify and address any underlying medical conditions contributing to nosebleeds
3. Implement appropriate lifestyle modifications based on professional recommendations
4. Develop an emergency action plan for severe bleeding episodes
5. Schedule regular follow-up appointments to monitor progress and adjust treatment as needed

Coping Strategies for Daily Life

Living with recurrent nosebleeds can be challenging. Here are some strategies to help manage the condition:

• Keep a nosebleed kit readily available at home, work, and while traveling
• Educate family members, friends, and colleagues about your condition and how to assist if needed
• Consider wearing medical alert jewelry to inform first responders of your condition
• Join support groups or online communities to connect with others facing similar challenges
• Practice stress-reduction techniques, as stress can exacerbate nosebleeds in some individuals

By taking a proactive approach to managing recurrent nosebleeds, individuals can significantly improve their quality of life and reduce the anxiety associated with this condition.

Managing Your Nosebleeds (Epistaxis) – Symptoms & Treatment

What Are Nosebleeds?

Epistaxis, or a nosebleed, is the common event of blood draining from the nose. Most people have at least one nosebleed during their lifetime. They are twice as common in children compared with adults. Most stop with direct pressure on the nose, but some may need medical care.

What Causes Nosebleeds?

A break in blood vessels in the nose, such as from an injury (blow to the nose) causes a nosebleed. Other causes include chemicals, infections, abnormal blood vessels in the nose, and diseases such as high blood pressure or bleeding disorders. The most common cause is dry nasal passages from dry air, especially in winter.

What Are the Symptoms of Nosebleeds?

Symptoms include bleeding from one or both nostrils and bleeding down the back of the throat with spitting, coughing, or vomiting of blood.

Prolonged or recurrent nosebleeds may cause anemia.

After a big nosebleed, dark or tarry bowel movements mean that a large amount of blood was swallowed.

How Are Nosebleeds Diagnosed?

The health care provider will diagnose the nosebleed from a physical examination. Blood work may be done if a large amount of blood was lost or a blood disorder may be causing the nosebleed.

How Are Nosebleeds Treated?

The first treatment is direct pressure. Grasp the nose firmly between the thumb and forefinger and squeeze it for 10 to 30 minutes without stopping.

Putting an ice pack on the neck or bridge of the nose may help slow blood flow. Leaning forward to spit out blood instead of letting it run down the throat and be swallowed may help prevent vomiting. Using salt water nasal sprays and humidifying the air may help dryness.

Sometimes, packing the nose with absorbent gauze may be needed. The health care provider may also cauterize the bleeding site. Some elderly people can have a slowed pulse rate or blood pressure abnormalities from packing and may in some cases need hospitalization.

DOs and DON’Ts in Managing Nosebleeds:

• DO control your blood pressure. High blood pressure may contribute to nosebleeds.
• DO avoid aspirin products if you get many nosebleeds. They may slow clotting.
• DO humidify air in your home and if possible at work, put a little petroleum jelly inside the nostrils, and use a scarf or cloth mask in cold, dry air. Salt water nasal sprays may also help stop nosebleeds caused by dryness.
• DO avoid chemicals or dusts or wear a filter mask. Your health care provider may prescribe a steroid nasal spray if you have infections or allergies.
• DO call your health care provider if blood gushes from your nose or you vomit repeatedly from swallowed blood.
• DO call your health care provider if you cannot control the bleeding or you have repeated nosebleeds in one day.
• DO call your health care provider if you know that high blood pressure or bleeding problems (hemophilia, leukemia) are causing nosebleeds.
• DO call your health care provider if you take aspirin or blood thinners (warfarin, dabigatran, apixaban, and rivaroxaban).
• DO call your health care provider if you have a temperature higher than 102° F, especially if your nose was packed or cauterized.

• DON’T blow your nose hard or pick at any clots, which may restart the nosebleed.

FOR MORE INFORMATION

Contact the following sources:

• American College of Emergency Physicians
  Tel: (800) 798-1822
  Website: http://www.acep.org
• American Academy of Otolaryngology—Head and Neck Surgery
  Tel: (703) 836-4444
  Website: http://www.entnet.org

Thrombocytopenia: Causes, Symptoms & Treatment

Overview

What is thrombocytopenia?

Thrombocytopenia (THROM-bo-sigh-toe-PEE-ne-ah) occurs when your blood platelet count is low. Platelets are also called thrombocytes. This type of blood cell clumps together to form blood clots to help stop bleeding at the site of a cut or wound. Another name for a blood clot is thrombus.

Bone marrow is the soft, spongy tissue inside bones that makes all blood cells including platelets. People who have thrombocytopenia don’t have enough platelets to form a blood clot. If you get a cut or other injury, you may bleed too much and the bleeding can be hard to stop.

Who might get thrombocytopenia?

Thrombocytopenia can affect people of all ages, races and genders. For unknown reasons, approximately 5% of pregnant women develop mild thrombocytopenia right before childbirth.

What are the types of thrombocytopenia?

The three main classes of thrombocytopenia are:

• Platelet destruction such as with an auto-antibody that attaches to the platelet surface.
• Platelet sequestration such as in someone with a large spleen or with liver disease.
• Decreased platelet production as occurs in certain bone marrow diseases.

How common is thrombocytopenia?

It’s unknown how many people have thrombocytopenia. Many people have mild symptoms. They might not even know they have the condition. The autoimmune form of thrombocytopenia, immune thrombocytopenic purpura or ITP, affects approximately three to four out of every 100,000 adults and children.

Symptoms and Causes

What causes thrombocytopenia?

In rare instances, thrombocytopenia is inherited, or passed from parent to child. More commonly, certain disorders, conditions and medications cause a low platelet count. These include:

• Alcohol use disorder and alcoholism.
• Autoimmune disease which causes ITP. ITP is sometimes associated with other autoimmune conditions such as lupus.
• Bone marrow diseases, including aplastic anemia, leukemia, certain lymphomas and myelodysplastic syndromes.
• Cancer treatments like chemotherapy and radiation therapy.
• Enlarged spleen caused by cirrhosis of the liver or Gaucher disease. The enlarged spleen traps platelets and other blood cells and prevents them from circulating in the blood stream.
• Exposure to toxic chemicals, including arsenic, benzene and pesticides.
• Medications to treat bacterial infections (antibiotics), seizures (epilepsy) and heart problems, or the blood thinner heparin.
• Viruses, such as hepatitis C, CMV, EBV and HIV.

What are the symptoms of thrombocytopenia?

Some people with mild cases of thrombocytopenia don’t have symptoms. Often, one of the first signs is a cut or nosebleed that won’t stop bleeding. Other signs of low platelet count include:

Diagnosis and Tests

How is thrombocytopenia diagnosed?

If you have bleeding that’s difficult to stop or other signs of thrombocytopenia, your healthcare provider may do the following:

• Physical exam: The healthcare provider will review your family history and medical history. You’ll discuss medications you take. Your healthcare provider will also check for bruises, rashes (petechiae) and an enlarged spleen or liver.
• Blood count: A complete blood count (CBC) checks levels of platelets and white and red blood cells.
• Blood clot test: A blood clot test measures the time it takes blood to clot. These tests include partial thromboplastin time (PTT) and prothrombin time (PT).

If your platelet count is low, your provider may order more tests to find the cause, such as:

• Bone marrow biopsy: Taking a sample of bone marrow can help diagnose bone marrow diseases or cancer.
• Imaging tests: Ultrasound or CT scan can check for an enlarged spleen, enlarged lymph nodes or liver cirrhosis.

Management and Treatment

How is thrombocytopenia managed or treated?

You might not need treatment if a low platelet count isn’t causing significant problems. Often, healthcare providers can improve platelet counts by treating the underlying cause. This approach may involve changing your medications.

Other treatments include:

• Blood transfusion to temporarily increase platelet levels in your blood. Platelets are transfused only if the platelet count is extremely low. (Transfused platelets only last about three days in the circulation.)
• Splenectomy or removal of the spleen.
• Steroids (prednisone or dexamethasone), immunoglobulins (antibody proteins), and other medications that reduce platelet destruction and stimulate platelet production.

What are the complications of thrombocytopenia?

People with severe thrombocytopenia are at risk for significant internal and external blood loss, or hemorrhage. Internal bleeding into the digestive tract or brain (intercranial hemorrhage) can be life-threatening.

Having a splenectomy makes you more susceptible to infections. Your spleen is part of your immune system. It helps your body fight off germs. For this reason, patients who have to have their spleen remove are given several vaccinations to help prevent infection.

Prevention

How can I prevent thrombocytopenia?

If you’re at risk for thrombocytopenia, these steps may help prevent it:

• Avoid medicines that thin blood and increase bleeding risk, such as aspirin, naprosyn and ibuprofen.
• Take care with contact sports and activities that can cause injuries, bruising and bleeding.
• Minimize contact with toxic chemicals.
• Take extra care when shaving, brushing your teeth and blowing your nose.
• Limit your intake of alcohol which slows down the production of platelets and causes liver damage.

Outlook / Prognosis

What is the prognosis (outlook) for people with thrombocytopenia?

A low platelet count increases your risk of hemorrhage or severe bleeding. Excessive bleeding — whether internal or external — can be life-threatening. Many people with thrombocytopenia have mild to moderate symptoms. Platelet levels often go up when you treat the underlying cause or change medications.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Blood in stool, urine or vomit.
• Excessive bleeding or bleeding that won’t stop.
• Extreme fatigue and weakness.
• Nausea and vomiting.
• Severe headaches.
• Skin rash (petechiae).
• Unexplained bruising.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• Why did I get thrombocytopenia?
• What is the best treatment for me?
• Are there any treatment risks or side effects?
• What changes can I make to minimize bleeding and bruising?
• Should I watch for signs of complications?

A note from Cleveland Clinic

If you have conditions that increase your risk for thrombocytopenia, it’s important to take precautions to protect your health. A low platelet count can put you at risk for excessive bleeding and bruising. Your healthcare provider can explain what’s causing the low platelet count and discuss treatment options. If your condition is severe, you may need to avoid activities that increase your risk of injury and bleeding.

Epistaxis – Nose Bleeding Reasons, Causes, Symptoms & Treatment

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Epistaxis – red flag symptoms

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Red flag symptoms

• Haemorrhagic shock
• Bleeding not stopped by direct pressure
• Recurrent unilateral epistaxis
• Nasal obstruction, rhinorrhoea, facial pain, facial numbness or diplopia
• Signs suggestive of a bleeding disorder
• Anticoagulant therapy

Epistaxis prevalence is increased in children under the age of 10 years and in adults aged over 35 years.

Possible causes

• Idiopathic
• Trauma – nose picking, facial injury, postoperative
• Foreign body
• Inflammation/infection – allergic rhinosinusitis, nasal polyps
• Neoplasia – squamous cell carcinoma
• Drugs – topical decongestants, anticoagulants, antiplatelets, cocaine
• Haematological – coagulopathies, acquired coagulopathies caused by liver or renal disease, thrombocytopenia, platelet dysfunction in von Willebrand disease

Most nasal bleeding is idiopathic; trauma to the nasal mucosa may damage superficial blood vessels.

Rarely, recurrent unilateral epistaxis may be suggestive of an underlying malignancy. Local damage of blood vessels may be caused by squamous cell carcinoma. Malignancy of the sinonasal tract may present with nasal obstruction, rhinorrhoea, epistaxis, headaches and facial pain.

There should be a high index of suspicion if there is unilateral facial swelling, diplopia, unilateral proptosis or cranial neuropathies.

Classification

The nose has a blood supply arising from the internal and external carotid arteries. Epistaxis may be classified as anterior or posterior.

The ethmoidal arteries, which arise from the internal carotid artery, supply the area above the middle turbinate.

The sphenopalatine artery, which arises from the external carotid artery, supplies most of the nasal septum and turbinates on the lateral wall.

Most nasal bleeding is anterior and often arises from Kiesselbach’s plexus on the lower part of the anterior septum (Little’s area). Approximately 10% of nosebleeds are posterior bleeds, which are more common in older patients.

Clinical assessment

It is important to establish whether the nosebleed started on one or both sides and how long it lasted. If the bleeding has stopped, it is helpful to ask how the patient tried to stop it.

Establishing previous epistaxis is useful, as well as its frequency and severity. There may have been a trigger, such as sneezing, or nose blowing or picking preceding the episode.

Associated factors include symptoms of URTI, nasal obstruction or facial pain. It may be relevant to ask about excessive bleeding with minor trauma, easy bruising and haemoptysis.

The medical history may reveal a background of bleeding disorders or other conditions which can result in platelet dysfunction or coagulation. The latter includes malignancy, cirrhosis and pregnancy. A detailed drug history should be taken.

Examination

Physical examination should include assessing vital signs, as resuscitation may be required.

There could be signs to indicate the presence of a bleeding disorder, such as petechiae or purpura. If there is unexplained bruising, bleeding and/or petechiae an urgent blood test should be arranged to exclude leukaemia, other features such as fever and a history of infection may be present.

Telangiectasia may be visible in the mouth. The head and neck should be examined and it may be relevant to carry out cranial nerve examination. Nasal endoscopy could be warranted, depending on the clinical presentation.

Management

If there is active bleeding, this needs to be stopped in the first instance; resuscitation may be necessary. Most anterior nosebleeds are self-limiting and do not require intervention.

Pinching the anterior part of the nose for 15 minutes can stop bleeding by providing tamponade for the anterior septal blood vessels. Ideally, this should be performed with the patient sitting upright.

Examination usually reveals an anterior bleeding site. Anaesthetic and vasoconstrictor topical sprays can be used, for example, oxymetazoline spray. A cotton pledget impregnated with a vasoconstrictor and a topical anaesthetic may be inserted into the nose.

In the acute setting, it is important to identify a bleeding point, so that chemical or electrocautery can be carried out. Chemical cautery is performed using a silver nitrate stick, which is applied to the bleeding point for five seconds with firm pressure. Normal saline may be used to neutralise staining.

Only one side of the nasal septum should be treated, due to the risk of septal perforation. If this is unsuccessful, anterior packing, compressive balloons, posterior packing or embolisation may be required.

In the primary care setting, nasal tampons can be used. It is worth excluding high BP as a possible contributing factor, although the relationship between the two is controversial.

If there are symptoms or signs of a bleeding disorder, blood tests, such as FBC and coagulation screen, may be required.

• Dr Kochhar is a GP in Bexhill, East Sussex. This article was first published in 2016 and updated in December 2020

Further reading

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Nose Bleeds: Causes, Symptoms and Treatment

A nose bleed is called epistaxis, and this is a fairly common condition. If you have ever had a nose bleed, you probably did not even realize that only one nostril was bleeding. The blood comes from the tissue that lines the inside of the nostrils. Nosebleeds are more common in people who live in dry climates, and they occur more often during the winter months. Children ages 2 to 10 and adults ages 50 to 80 are at the highest risk for having a nose bleed, and these are most likely to happen during the morning hours (doctors are not sure why).

Causes and Concerns

The majority of time, a nose bleed is not serious. There are only a few reasons why a nose bleed could be serious and even life threating. There are several reasons why you may experience a nose bleed. The blood from an anterior nosebleed comes from in the nasal septum. The nasal septum is made up of tiny little blood vessels that all join together in the area of the septum called the Kiesselbach plexus. Almost 90% of all nose bleeds come from this area. This type of nose bleed can be treated at home, most of the time, but occasionally, a trip to the hospital or doctor’s office is necessary.

Posterior nosebleeds are rare compared to anterior nosebleeds. With this type, the bleeding starts from an artery in the back of the nose. This is more common in elderly people, and posterior nose bleeding requires hospitalization. 

Other causes of nose bleeds include:

• Dry nostril passages
• Sinus infections
• Nasal passage infections (virus, bacterial or fungi)
• Excessive or hard nose blowing
• Allergies
• Deviated nasal spectrum (nasal septum is out of placed on one side)
• Cocaine use
• Foreign object in the nose (children love to put things in their noses)
• Recent nasal surgery (medical related or plastic surgery)
• Secondary to a disease or condition that has not been diagnosed yet
• Certain prescription medications (Coumadin, aspirin and anti-inflammatory medications)
• Antihistamines
• High blood pressure
• Anxiety
• Blunt force trauma to the face (car accident, hit with a baseball, trauma)
• Broken nose

Symptoms and Signs

If you or your child has frequent nose bleeding, you should consider seeing a nose and throat specialists. There are accompanying symptoms and signs that indicate an underlying problem. These include:

• Persistent dry nose
• Frequent nasal infections
• Stuffy nose and colored drainage
• Itchy, watery eyes
• Inability to smell and loss of taste
• Difficult breathing through the nose
• Mouth breathing, especially at night

Solutions and Options

When the nose bleeds, it should not last longer than 10 or 15 minutes, although it can bleed for as long as 30 minutes. If the nose bleed has not stopped within 30 minutes, medical attention is required. Most nose bleeds can be treated at home. Young children and even some adults will start to panic if they have a nose bleed. Keeping them calm is priority. When a person gets upset, and the flight or fight response occurs, the adrenaline starts to pump. This can cause the nose to bleed more or for a longer period of time. Some tips for caring for a nose bleed include:

• Pinch the soft spot on the bridge of the nose using your index finger and thumb.
• Sit up or stand up (never lie down during a nosebleed).
• Lean forward slightly, so the blood does not drain down the back of the throat.
• If you have nasal spray, squirt a few drops in the nostril that is bleeding.

Additional Reading:

http://www.emedicinehealth.com/nosebleeds/article_em.htm

http://www.entnet.org/HealthInformation/Nosebleeds.cfm

Nosebleed (Epistaxis). Causes and treatment of headaches

Introduction

The classification of nosebleeds is as anterior or posterior, depending upon the source of bleeding. The blood supply to the nose is derived from branches of the internal (anterior and posterior ethmoid arteries) and external carotid arteries (sphenopalatine and branches of the internal maxillary arteries). Bleeding usually occurs when the mucosa is eroded and vessels become exposed and subsequently break.

• Anterior haemorrhage – the source of bleeding is visible in about 95% of cases – usually from the nasal septum, particularly Little’s area which is where Kiesselbach’s plexus forms (an anastomotic network of vessels on the anterior portion of the nasal septum)^[1].
• Posterior haemorrhage – this emanates from deeper structures of the nose and occurs more commonly in older individuals. Nosebleeds from this area are usually more profuse and have a greater risk of airway compromise.

Epidemiology

Epistaxis is extremely common. The majority of people will have had at least one nosebleed, usually as a result of trauma, in the course of their lifetime. The actual incidence of epistaxis in children is unknown, as only a small number will seek medical attention compared to nosebleeds in adults.

It has peaks of incidence at age 2-10 and 50-80 years. Both sexes are equally affected. Children with migraines actually have a higher incidence of recurrent epistaxis than children without migraines.

Aetiology

Epistaxis is usually benign, self-limiting and spontaneous. The majority of nosebleeds are caused by simple trauma. Although most incidents are not life-threatening, they can cause significant parental concern when they occur in children.

Occasionally a nosebleed indicates a more serious underlying disease. Often no cause is found.

Causes include:

• Trauma to the nose (the most common cause) – especially nose picking! Insertion of foreign bodies and excessive nose blowing may also be seen as trauma. The latter is likely to occur with a cold when the nasal mucosa is congested. Sinusitis causes nasal congestion.
• Disorders of platelet function – thrombocytopenia and other causes of abnormal platelets, including splenomegaly and leukaemia. Waldenström’s macroglobulinaemia may present with nosebleeds. Idiopathic thrombocytopenic purpura (ITP) can occur in children and young adults.
• Drugs – aspirin and anticoagulants.
• Disorders of platelets are more likely to be a problem than clotting factor deficiency.
• Abnormalities of blood vessels in the elderly arteriosclerotic vessels prolong bleeding. Hereditary haemorrhagic telangiectasia (Osler-Rendu-Weber syndrome) causes recurrent epistaxis from nasal telangiectasias.
• Malignancy of the nose may present with bleeding – juvenile angiofibroma is a highly vascular benign tumour that typically presents in adolescent males.
• Cocaine use – if the septum looks sloughed or atrophic ask about use of cocaine. The drug is usually taken by inhalation and it has a very strong vasoconstrictive effect that can lead to complete obliteration of the nasal septum.
• Other conditions – granulomatosis with polyangiitis and pyogenic granuloma – can present as an epistaxis.

Although hypertension is common when patients present with acute bleeding, the incidence of undiagnosed hypertension found on follow-up is no higher than would be expected in the general population. A systematic review found that six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population^[2]. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis (because of confounding stress and possible white coat phenomenon) but may lead to initial diagnosis of an already installed arterial hypertension. It is, however, known that patients with established hypertension are at higher risk of epistaxis and appear to have more severe episodes^[3].

History

^[1]

• Determine if blood is running out of the nose and one nostril (usually anterior) or if blood is running into the throat or from both nostrils (usually posterior).
• Ask about trauma (including nose picking).
• Note family or past history of clotting disorders or hypertension.
• Note whether there has been previous nasal surgery.
• Discuss medication – especially clopidogrel, warfarin, aspirin.
• Enquire about any facial pain or otalgia – these may be presenting signs of a nasopharyngeal tumour
• In young male patients ask about nasal obstruction, headache, rhinorrhoea and anosmia – signs of juvenile nasopharyngeal angiofibroma.

Investigations

• These are unnecessary in most (mild) cases but recurrent or severe cases require at least FBC, coagulation studies and blood typing.
• Quite marked anaemia can result but a haematological malignancy may also be revealed.
• Any suspicion of malignancy of the nose or other abnormality should require referral to an ENT surgeon. CT scanning and/or nasopharyngoscopy are the investigations of choice.

Management

Initial assessment – first aid

• Resuscitate the patient (if necessary) – remember the ABCD(E) of resuscitation.
• Ask the patient to sit upright, leaning slightly forward, and to squeeze the bottom part of the nose (NOT the bridge of the nose) for 10-20 minutes to try to stop the bleeding. The patient should breathe through the mouth and spit out any blood/saliva into a bowl. An ice pack on the bridge of the nose may help.
• Monitor the patient’s pulse and blood pressure.
• If bleeding has stopped after this time (as it does in most cases) proceed to inspect the nose, using a nasal speculum; consider cautery.
• If the history is of severe and prolonged bleeding, obtain expert help – and watch carefully for signs of hypovolaemia.

Cautery

• Nasal cautery is a common treatment of epistaxis. A caustic agent such as silver nitrate (chemical cautery) or an electrically charged wire such as platinum (electrocautery) is used to stop bleeding in the nasal mucous membrane.
• Chemical cautery of the visible blood vessels on the anterior part of the nasal septum is the most popular treatment method for idiopathic recurrent nosebleeds.
• Carefully examine the nasal cavity, looking for any bleeding points, which can usually be seen on the anterior septum – either an oozing point or a visible clot. Note whether there is any pus, suggesting local bacterial infection.
• Blowing the nose decreases the effects of local fibrinolysis and removes clots, permitting a clearer examination. Applying a vasoconstrictor before examination may reduce haemorrhage and help locate the bleeding site. A topical local anaesthetic reduces pain from examination and nasal packing.
• Apply a silver nitrate cautery stick for ten seconds or so, working from the edge and moving radially – never both sides of the septum at the same session.
• 75% silver nitrate has been shown to be more effective than 95% silver nitrate at two weeks following application^[4].
• Topical application with 0.5% neomycin + 0.1% chlorhexidine cream or with Vaseline® petroleum jelly are alternative topical treatments^[4].
• If bleeding continues, packing may be considered.
• A topical application of injectable form of tranexamic acid has been shown to be better than anterior nasal packing in the initial treatment of idiopathic anterior epistaxis^[5].
• It may be necessary to ligate the sphenopalatine artery endoscopically, or occasionally the internal maxillary artery and ethmoid arteries, or perform endovascular embolisation of the internal maxillary artery, when packing fails to control a life-threatening haemorrhage^[6]. Ligation of the external carotid artery is a last resort.

Complications of packing
These include:

• Anosmia.
• Pack falling out and continued bleeding.
• Breathing difficulties and aspiration of clots.
• Posterior migration of the pack, causing airway obstruction and asphyxia.
• Perforation of the nasal septum or pressure necrosis of cartilage.
• Nasal packs are usually left for two or three days and the patient should see an ENT specialist. The blood is an excellent culture medium for bacteria and so broad-spectrum antibiotics like amoxicillin are usually given.

Prognosis

Mortality is rare. It is usually associated with hypovolaemia secondary to severe bleeding or in patients with comorbidities. Most episodes of epistaxis resolve spontaneously, normally without treatment. 

Nosebleeds (Epistaxis) – Managing Side Effects

What Are Nosebleeds (Epitaxis)?

Nosebleeds occur when there is enough trauma or injury to the tissues
in your nose to cause it to bleed. This is also called epistaxis.

Bleeding in the front of the nose will cause you to see the blood more easily. These
nosebleeds are usually more common.

Bleeding in the back of the nose may result in slow but steady bleeding. This is
more severe than bleeding in the front of your nose. Nosebleeds of this type
are usually a result of injury, such as being hit on the head by a blunt object,
or from contact sports.

Causes of Nosebleeds:

• People with low blood platelets,
  or a bleeding disorder, are more likely to have nosebleeds (epistaxis).
• High blood pressure.
• You have had trauma or injury
  to the head, face or nose areas, from an accident or from falling down.
• You may have been struck by a blunt object.
• You may cause damage to the membranes in your nose from blowing your nose, picking
  your nose, or blowing your nose forcefully. This is especially common if the lining
  of your nose is irritated from a virus or bacterial infection (or the common cold).
  If you have had prior problems with nosebleeds, you may be at risk for them to recur.
• Breakdown of the membranes, or irritation of the membranes, may be a result of dry
  or non-humidified air. People will encounter nosebleeds more often in the winter
  months, when the air is drier.
• People who have frequent nosebleeds, or begin bleeding easily, may have problems
  with how their blood
  clots, or a tendency bleeding easily as well. If you notice that you are bruising or bleeding easily,
  notify your health care provider so that you can be evaluated for potential bleeding problems.

Symptoms of Nosebleeds:

• You may have nosebleeds frequently or begin bleeding easily. This may be a sign
  of a blood clotting disorder or
  low blood platelets.
• You may have tiny red dots on your skin, called petechiae (pe- TEEK- ee- ay). These
  are commonly found on your lower legs. This is a sign of low blood platelets.
• You may be overly tired, or very weak (fatigued), if you have anemia due to your
  bleeding problems, or another underlying disorder. It may be hard for you to do
  any of your normal activities.
• For many individuals, frequent, unexplained bruising or nosebleeds are the first sign of a bleeding disorder.
  Some people feel relatively well, with no other symptoms of bleeding problems.

Things You Can Do To Manage Nosebleeds:

If you have nosebleeds:

• Do not lie down. Sit straight up in bed or in a chair, so that if blood is going
  down the back of your throat, you do not cough or choke.
• Using your thumb and index (first) finger, pinch your nose. Hold pressure for at
  least 10 minutes, holding your head up straight, tilting it back slightly, if tolerated.
• If you are bleeding in the front of your nose, place a moist cotton ball in your
  nose. Do not remove the cotton ball if you think the bleeding is stopped.
  If a blood clot has formed, you may dislodge it.
• If you have nosebleeds that do not stop after 15 or 20 minutes at the most, and
  especially if you have low blood
  platelets or a blood clotting disorder, you should seek emergency assistance.
• If you notice that you are bruising
  or bleeding easily, notify your health care provider of potential bleeding problems.
• If you have pain, you may take Acetaminophen (Tylenol^®)
  up to 4000 mg per day (two extra-strength tablets every 6 hours). As with
  all medications, you should check with your health care provider before taking any
  medications.
• If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory
  (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood
  platelets, or accentuate your bleeding problems.
• Make sure you tell your doctor, as well as all health care providers, about any
  other medications you are taking (including over-the-counter, vitamins, or herbal
  remedies). Do not take aspirin or products containing aspirin unless your
  health care provider permits this.

Drugs or Recommendations That May Be Prescribed By Your Doctor:

Treatment for nosebleeds consists of identifying and treating the cause of
the nosebleed. If nosebleeds are due to trauma, applying ice packs, pressure and
Tylenol for comfort is suggested. If nosebleeds persist after 15 minutes, you may
have significant damage.

Seek emergency assistance if you have unexplained nosebleeds. You may have
an underlying bleeding disorder, such as low blood platelets, blood clotting disorder or problems with
your blood clotting factors. Your health care provider may treat your disorder with
additional medications such as:

• Nasal sprays – such as normal saline sprays, may work to moisten,
  irrigate or “flush” the mucous membranes inside your nose. If you have frequent
  nosebleeds, your doctor may prescribe this. Discuss with your doctor or health care
  provider the proper technique and dosage schedule for your medication (each is different).
  A common nasal spray may include Ocean spray.
• Tylenol – If you have pain at the site where you bleeding problems, you may
  take Acetaminophen (Tylenol) up to 4000 mg per day (two extra-strength tablets every
  6 hours). It is important not to exceed the recommended daily dose of Tylenol, as
  it may cause liver damage. Discuss this with your health care provider.

If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory
(NSAID) drugs, as well as aspirin, because these drugs may interfere with blood
platelets, and accentuate bleeding problems.

When to Contact Your Doctor or Health Care Provider:

• If nosebleeds do not stop after 15 minutes.
• Bleeding that does not stop after a few minutes, or new, unexplained bruising.

Other Common Bleeding Problems:

Bruising (Hematoma)|
Injury | Nosebleeds
(Epistaxis) | Rectal Bleeding
| Vaginal Bleeding

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website about epistaxis and other medical conditions is meant
to be helpful and educational, but is not a substitute for medical advice.

90,000 Treatment of nosebleeds in children and adults

Treatment of nosebleeds in ENT clinic №1

Service cost

Therapeutic manipulations

Advantages

• European level equipment

• Friendly team of experienced doctors

• Home call ENT doctor

• Online consultation

• Reception of ENT doctors around the clock!

• An interdisciplinary approach to patient care

Bleeding from the nose is never an independent disease, it is only a symptom of a general or local pathological process. Bleeds from the nose are quite common in ENT practice. Most often, patients with nosebleeds do not go to the doctor for help, but use simple methods to stop the bleeding.

Causes of bleeding

The immediate cause of bleeding is damage to the vessels of the nasal mucosa.

These injuries are caused by various factors:

• nasal injuries
• medical manipulations (with probing, endoscopy)
• chronic inflammatory diseases of the nasopharynx (sinusitis, adenoiditis)
• neoplasms of the nasal cavity (tumors, hemangiomas, granulomas, etc.)).

Common diseases that are accompanied by nosebleeds include:

• Various diseases of the heart and blood vessels (vascular anomalies, atherosclerosis, hypertension, heart defects)
• Systemic blood diseases (coagulopathy)
• Abnormal vasodilation due to overheating or acute intoxication.

Also, the cause of nosebleeds can be:

• sudden changes in pressure (in divers, pilots, climbers)
• hormonal disorders (often occur during pregnancy).

The risk of nosebleeds largely depends on the severity and volume of blood loss. Most often – in 90% of cases, bleeding is observed from the antero-lower part of the nasal septum. But the most severe bleeding is from the posterior parts of the nasal cavity, where large vessels are located.

Methods for stopping bleeding

The simplest household method for stopping bleeding is a sitting or horizontal position of the patient with a raised head.

However, the head does not need to be thrown back, as this can only increase the bleeding.

Cotton balls or turundas with any vasoconstrictor (nasivin, otrivin) or with hydrogen peroxide can be gently inserted into the nasal passages.

If all these methods proved to be ineffective within 15-30 minutes, then it is necessary to urgently consult an ENT doctor and carry out an anterior tamponade, which consists in the careful introduction of a turunda moistened with hemostatic drugs into the nasal cavity.

If the bleeding after the application of the anterior tamponade continues along the posterior wall of the pharynx, then the posterior tamponade is performed.After such manipulations, the removal of tampons is possible only on the second or third day in order to enable high-quality hemostasis.

If, even a few days after removing the tampons, the bleeding continues, then surgical methods of treatment are used, which include:

• in the introduction of various sclerosing drugs
• electrocoagulation and cryodestruction of the vessels of the mucous membrane
• blood loss, complex therapy is carried out to normalize the general condition of the body.

  Procedures for the treatment of nasal
  bleeding in the “ENT clinic number 1”

  In the “ENT clinic number 1” highly qualified specialists will be able to conduct a comprehensive examination
  ENT organs, correctly diagnose, determine the tactics of further
  treatment, if necessary, prescribe additional research methods and consultations
  related specialists.

  Also in our clinic are carried out as
  physiotherapy procedures aimed at strengthening the vascular wall
  (laser therapy, photochromotherapy), and procedures to stop
  nosebleeds and avoid it in the future (mucous
  shells with Vagotil solution, Mardil-zinc, cauterization of blood vessels on the Fotek apparatus).

  It should be noted that all treatment procedures
  nosebleeds are absolutely painless for the patient.

  doctor’s appointment – DokDok St. Petersburg

  90 130 Laura (otolaryngologists) St. Petersburg – latest reviews

  They called the doctor at home.I liked the doctor very much. Attentive, neat with a child, kind. Oleg Petrovich examined the ears, nose and throat, diagnosed and prescribed the necessary treatment. I recommend this specialist.

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  01 November 2021

  The reception went well.Oleg Nikolaevich listened to me and examined the ear. The specialist performed the manipulation to clean the ear. An attentive specialist. The doctor gave his recommendations. I recommend it to my friends. Everything suited me.

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  September 22, 2021

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  28 november 2019

  I found the doctor by location and free appointment.Reception was a little late for half an hour, they promised to make a discount, but apparently they forgot. Yana Aleksandrovna listened to my complaints, carried out an examination, made a diagnosis and prescribed the necessary treatment. Polite, attentive doctor, pleasant to talk to. I made an appointment with this specialist again. I would recommend a doctor to my friends, if necessary.

  Moderation,

  02 November 2021

  Angela Alexandrovna is a competent doctor. I am very pleased! I was prescribed treatment and additional examinations. The doctor also told me to have my stomach checked as the back of my throat is inflamed. Enough time was given to me and we 100% discussed all the information. I will apply again.

  Moderation,

  01 November 2021

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  01 November 2021

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  October 30, 2021

  Yuri Vladimirovich is a calm and competent doctor who knows his business.Communicates well-mannered, on you. At the reception, the doctor examined, gave recommendations and prescribed treatment. I did not register anything superfluous. I listened, did not interrupt, as many doctors do. I did not try to ascribe a new, some other, incomprehensible diagnosis or rip off the money. I didn’t impose. Out of a thousand doctors, the most adequate doctor. I will contact a specialist again and recommend it to my friends.

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  October 29, 2021

  The doctor is sociable, pleasant. All is well, courteous. I had otitis media. At the reception, Daria Vasilievna conducted an examination and consultation. As a result, I received treatment, procedures, drugs. She explained everything about the case. The result is already there, I’m better. To this specialist because she was free that day. I like it.

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  October 28, 2021

  Show 10 reviews of 2788 90,000 The doctor told about the possible danger of nosebleeds – Rossiyskaya Gazeta

  Nosebleeds may indicate serious health problems.In some cases, even immediate hospitalization is required.

  As the otolaryngologist Anna Kolesnikova told Channel Five, nosebleeds occur due to damage to the blood vessel wall as a result of mechanical action or for other reasons that should not be ignored.

  Bleeding can be caused by so-called local causes. These are sinusitis, allergic rhinitis, atrophic rhinitis, curvature of the nasal septum, injuries that can be associated with ordinary nose picking, foreign bodies and a fracture of the nasal bones.

  Also for local reasons, the expert considers tumors of the nasal cavity, nasopharynx and paranasal sinuses, a bleeding polyp of the septum of the nose and angiofibroma of the base of the skull.

  High body temperature caused by illness, heat or sunstroke, as well as cardiovascular disease are systemic or general causes of nosebleeds. Also, this symptom may indicate blood diseases (thrombocytopenic purpura, sickle cell anemia, leukemia, thrombasthenia, myeloproliferative diseases) and problems with the endocrine system.Nosebleeds can occur during pregnancy and with adrenal tumors.

  Specialists subdivide bleeding into anterior and posterior. In the first case, blood flows from the anterior third of the nasal septum, where the most delicate and vulnerable vessels are concentrated. Such bleeding usually stops quickly.

  “But posterior bleeding is quite serious when blood flows from large vessels of the nasal cavity. Due to the large diameter of the vessels themselves, such bleeding is usually massive.The patient can swallow blood in a sufficiently large volume. And such bleeding is life threatening. They almost never stop on their own and are the reason for urgent hospitalization, “says Anna Kolesnikova.

  She mentions the so-called signal bleeding, which may indicate a violation of the integrity of a large arterial vessel in the nasal cavity, skull bones, skull base, in severe trauma, a vascular aneurysm or a disintegrating malignant tumor.In such cases, surgery is required.

  For questions related to health, you should seek the advice of a doctor.

  Nosebleeds – what can cause this symptom – treatment in CELT

  Nasal bleeding (epistaxis) – bleeding from the nose to the outside or into the pharynx as a result of vascular damage caused by injury or disease. Slight bleeding in violation of the integrity of the capillaries of the anterior part of the nose is not dangerous and usually goes away on its own.If larger vessels are affected, then large blood loss can threaten health and even life and require immediate medical attention. Regardless of the frequency and volume of bleeding, it is important to establish their cause and choose the optimal set of therapeutic and preventive measures. A timely visit to the ENT doctor is a guarantee of health and prevention of complications.

  At CELT you can get advice from an otorhinolaryngologist.

  • Initial consultation – 3 000 90 200
  • Repeated consultation – 2 000 90 200

  Make an appointment

  Causes of nosebleeds

  The nasal cavity is supplied with blood from the external and internal carotid artery system.The vessels of both arteries are connected in the area of ​​the nasal septum. The sites of the anastomoses are distinguished by a thinner vascular wall and are covered with a membrane that is almost devoid of a submucosa, therefore, the vessels in these areas are prone to destruction of various etiologies. Epistaxis is a symptom of many diseases. Local and general causes of the symptom in question can be distinguished.

  Local factors

  • Injuries to the nose * are the most common cause of epistaxis. In addition to injuries due to impact, compression and other types of mechanical damage, tissue integrity may be compromised due to the ingress of a foreign body into the nose.
  • Iatrogenic factors, or injuries caused by medical intervention: postoperative complications, damage as a result of medical and diagnostic procedures – endoscopy, catheterization, puncture of the paranasal chambers, installation of probes, nasotracheal intubation.
  • Inflammatory diseases accompanied by hyperemia and irritation of the nasal mucosa (rhinitis, sinusitis, adenoiditis). Inflammation affects the coagulation properties of blood, and sneezing and increased blowing of the nose are an additional physical factor contributing to damage to the vascular wall.
  • Tumors of the nose. Angioma, polyp, specific granuloma, malignant tumors (sarcoma, mucosal cancer) can lead to disruption of mucosal trophism and damage to blood vessels.
  • Curvature of the nasal septum. According to medical observations, a straight septum is fixed in no more than 20% of patients. The pathology can be assumed, given the visible curvature of the nasal dorsum, persistent congestion, wheezing, nocturnal snoring. Significant deformations of the septum can cause regular headaches, otitis media, sinusitis, pharyngitis, bronchial asthma and other pathological conditions.Bleeding is caused by constant irritation of the mucous membrane on the side of the bulge: it becomes thinner and easily injured. A sharp-edged spine or ridge on the coulter (posterior part of the nasal cavity) is especially dangerous, since these formations can injure sufficiently large vessels.
  • Aneurysm of the adducting vessels of the nose is dangerous by spontaneous massive blood loss. Deformation occurs due to high pressure in the vessel and the weakness of its wall.
  • Long-term local use of vasoconstrictor, antihistamines and corticosteroid drugs.Such drops and sprays cause atrophic processes in the mucous membrane, and sometimes in deeper tissues, causing increased bleeding.
  • Dryness, thinning of the mucous membrane and increased fragility of blood vessels as a result of inhalation of excessively dry and / or cold air, chemical irritants entering the nasal cavity (at work or when inhaling drugs).

  Systemic factors

  • Diseases of the hematopoietic system (hemophilia, blood cancer and others) are accompanied by a violation of the volume, structure and function of platelets, a decrease in the concentration of prothrombin and other blood coagulation factors, which provokes regular nosebleeds.At the same time, hematomas of various localization and profuse bleeding with minor injuries are observed.
  • Cardiovascular pathology (hypertension, atherosclerosis, vasculitis). According to various sources, epistaxis occurs in 40-60% of hypertensive patients in case of changes in the weather, stress or physical fatigue. However, there is no direct relationship between blood pressure and bleeding. Atherosclerosis (deposition of cholesterol plaques) in the arteries of the head contributes to hypoxia and degeneration of tissues, in particular the nasal mucosa, causing bleeding.
  • Sun / heatstroke causes hyperthermia of the body, vasodilation of the head, impaired blood coagulation mechanisms, which can lead to nosebleeds, especially in children, the elderly, and hypertensive patients.
  • Lack of vitamin C in the body increases the permeability of the vascular walls. Deficiency of vitamin K complicates the process of blood clotting, calcium – inhibits the production of prothrombin.
  • Taking anticoagulants and antiplatelet agents – drugs that reduce blood clotting (warfarin, dicumarin, fraxiparin, aspirin, clopidogrel, etc.)).
  • Fluctuations in hormone levels in pregnant women, adolescents.

  Types of bleeding

  In 70 – 90% of cases, the discharge of blood from the nose is caused by damage to the vessels of its anterior part. Anterior nosebleeds are quickly thrombosed due to adhesion and aggregation of platelets. In the middle section, the diameter of the vessels increases, and, therefore, the blood pressure in them. Posterior bleeding is provoked by the rupture of rather large vascular trunks deep in the nasal cavity, which threatens with profuse blood loss and requires comprehensive medical care.

  Blood loss can be roughly estimated using the following scale:

  • Minor – up to 50 ml.
  • Moderate – up to 200 ml.
  • Moderate severity – up to 1300 ml.
  • Heavy – over 1300 ml.

  The first two stages do not cause significant changes in the body of an adult. With a loss of more than 200 ml of blood, pallor of the skin, tachycardia, a person’s head is dizzy, and unpleasant sensations in the ears appear.With a loss of 1 liter of blood, acrocyanosis is noted with increasing pallor, dizziness, hypotension, and the pulse rate increases. In the case of severe blood loss, symptoms of hemorrhagic shock occur: confusion, lethargy, threadlike pulse, blood pressure is reduced to critical values.

  First aid for nosebleeds

  Before proceeding, it is worth paying attention to the nature of the blood discharge. Blood from the vessels of the nose is of normal color, comes out in drops or in a trickle.Leakage of scarlet frothy blood from the nose is possible if the lung or bronchi are damaged. If blood from the stomach enters the nasal cavity, it is dark in color and may contain clots. Bloody vomiting may indicate severe posterior bleeding or damage to another organ, in which case you need to call an ambulance.

  In case of nosebleeds, you need to sit the person down, do not throw your head back. A tampon moistened with hydrogen peroxide or a vasoconstrictor is placed in the nasal passage.The wing of the nose is pressed with a finger for 10 – 15 minutes. Cold can be placed on the bridge of the nose. If bleeding continues in the event of repeated bleeding, you should seek qualified help. The doctor will anemize the mucous membrane, as well as perform anterior tamponade. The procedure consists in deeply placing a gauze turunda with a hemostatic agent in the nasal cavity. The indication for posterior tamponade is massive, life-threatening bleeding. In this case, a tampon with the help of a catheter is inserted into the nasopharynx, behind the soft palate.

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  Diagnostics

  In a clinic, the patient is examined: the clinical picture allows you to estimate the approximate volume of blood loss. The ENT doctor conducts the determination of the source of bleeding using anterior and posterior rhinoscopy. In some cases, X-ray and CT may be required.With the help of laboratory blood tests, the degree of post-hemorrhagic anemia and the state of hemostasis are assessed.

  If the pathology of the nose is excluded, the patient is sent for examination to other specialists – a therapist, surgeon, pulmonologist, hematologist, gastroenterologist – to clarify the diagnosis.

  Patient examination and treatment

  In case of recurrent nasal bleeding, it is necessary to establish and eliminate their cause.

  At the initial stage, the following types of diagnostics are used:

  • examination of an ENT doctor, rhinoscopy;
  • consultation of a therapist, blood pressure measurement;
  • general blood test, determination of the content of erythrocytes, hemoglobin, platelets;
  • blood clotting studies: coagulogram.

  To stop the flow of blood from the nose, apply:

  • electrocoagulation;
  • cauterization of the bleeding area of ​​the mucous membrane with silver preparations;
  • Radio wave coagulation of a mucosal area with bleeding.

  Submucosal resection of the nasal septum, ligation of the vessel, selective embolization and many other techniques are possible, selected depending on the cause of the bleeding and the location of the source.

  General treatment of nosebleeds is aimed at restoring the volume of circulating blood, increasing the coagulation function, and stabilizing the patient’s condition.

  Experienced doctors work in the multidisciplinary clinic CELT, modern diagnostic equipment has been installed. We carry out consultations and examinations of specialist doctors, carry out almost all modern diagnostic studies. This makes it possible to successfully diagnose both local and systemic diseases that cause nosebleeds.After determining the cause of the nosebleeds, the doctor selects the most effective treatments for the patient.

  The multidisciplinary clinic CELT is a modern high-level medicine.

  90,000 Blood from the nose: what to do?

  September 1, 2021

  Nosebleeds, or epistaxis, are unexpected and even frightening.

  Should you be on your guard when such an unpleasant symptom appears, what factors provoke it and how can you help in such a situation? Let’s figure it out further.

  Why can a nose bleed?

  Bleeding from the nose is classified as anterior or posterior. In the first case, the cause is damage to small blood vessels, this type is usually easy to stop. The second case is considered more dangerous, bleeding occurs due to trauma to large vessels located deeper in the nose, so it cannot be dealt with at home. If the blood is “gushing” – this is a reason for an urgent call for an ambulance.

  Causes of nosebleeds include:

  • nose injuries;
  • Thinning of the mucous membrane;
  • inflammatory processes in the nasal cavity;
  • fragility of blood vessels, diseases of the heart and blood;
  • a sharp increase in blood pressure;
  • uncontrolled intake of certain medications (anticoagulants, NSAIDs, vasoconstrictor drops from the common cold).

  How to act if a nosebleed?

  The moment the bleeding begins, it is important to try not to be nervous, as excitement makes our heart beat faster, which leads to more blood loss.

  The algorithm for stopping bleeding is as follows:

  • Sit up straight, tilt your head forward.
  • You should be comfortable: loosen the belt and collar, if necessary, open the window.
  • Place a cold wet towel or ice on your nose and place a warm heating pad on your feet.This will help narrow the vessels in the nose and dilate the vessels in the legs, which will help reduce bleeding.
  • Pinch the bleeding vessel: squeeze the wings of the nose with your fingers for 3-5 minutes, the blood should stop. Also for this purpose, you can insert a gauze swab previously soaked in hydrogen peroxide into the nostril.

  If you have followed all of the above points and the blood continues to flow, call an ambulance immediately, because even a small loss of blood can lead to fainting.

  What should be remembered for nosebleeds?

  • Do not lie down and do not let your feet go higher than your head – this will increase bleeding;
  • Do not tilt your head back: large amounts of blood in the stomach may cause vomiting, and blood may leak into the windpipe and make breathing difficult.
  • After the blood has stopped, refrain from food and caffeinated beverages to avoid high blood pressure and new bleeding.

  Prevention of nosebleeds

  Remember, frequent nosebleeds are a reason to see a doctor. The specialist will identify the cause of the problem and prescribe a treatment in which hemostatic agents can be used, as well as medicines that improve blood circulation.

  For the prevention of re-bleeding, a specialist may recommend:

  1. Taking medications, as well as vitamins to strengthen blood vessels.
  2. Correct diet. Adding foods rich in vitamins K and C to the menu. Vitamin K is responsible for blood clotting, parsley, spinach, basil, bananas, avocados, broccoli, bran, etc. paprika, currants, citrus fruits, etc.
  3. Activity and moderate physical activity: light exercises in the morning, daily walks in the fresh air, swimming, etc.

  Be healthy!

  90,000 Epistaxis (nosebleeds): causes and treatment

  From overdried mucous membranes due to insufficient air humidity to cancer, from taking aspirin to liver diseases. .. Why is there a nosebleed? It will take a long time to just list the reasons.

  Start panicking when it occurs, or treat it as a minor incident? And finally, what if it happened?

  With questions about the problem of nosebleeds, we came to see our permanent expert, otolaryngologist LLC “Clinic Expert Kursk” Emelyanova Alexandra Nikolaevna.

  – Alexandra Nikolaevna, how common is the problem of nosebleeds in your patients?

  Doctors encounter this pathology quite often.According to the open information of domestic and foreign researchers, epistaxis occurred at least once in the life of 60% of people. 6% of them went to doctors, about 1.6 out of 10,000 required inpatient treatment. According to other sources, about 5-10% of people have an annual episode of nosebleeds. At the same time, less than 10% of them go to the doctor, and only 1% of these 10 require hospitalization.

  – Is nosebleeds somehow reflected in the ICD-10?

  Yes, its code is R04. 0

  – What are the reasons for nosebleeds? When can nose bleed at night?

  Most often it is not an independent disease, but a manifestation of some other pathology or influence.

  What causes nosebleeds? The reasons can be divided into two groups: local and general (systemic).

  The first includes trauma to the nasal mucosa (including finger), foreign bodies, operations, infectious diseases of the airways, allergic processes, nasal polyps, low air humidity, neoplasms (in particular, juvenile nasopharyngeal angiofibroma, nasal hemangioma, papilloma, esthesioneuroblastoma), inhalation of irritants (including cocaine).

  The second group includes an increase in blood pressure, disorders of blood coagulation processes (including those associated with liver diseases, chemotherapy and anticoagulant therapy), acquired disorders of platelet function (for example, after using acetylsalicylic acid and other similar drugs), uremia, pathology vessels, hereditary hemorrhagic telangiectasia, pathological changes in collagen, vasculitis, systemic infections (for example, typhoid fever, nasal diphtheria, congenital syphilis, tuberculosis and others).

  Thus, nosebleeds can be a sign of serious pathological conditions and therefore requires mandatory clarification of the cause that caused it.

  There are no special reasons for the nominal nocturnal nosebleeds.

  – Are the causes of nosebleeds the same in children, adolescents and adults? Or are they different?

  In principle, they are the same. However, there are some features – for example, juvenile angiofibroma or bleeding associated with changes in hormonal status during adolescence.In addition, compared with adults, in childhood, bleeding occurs more often against a background of trauma to the nasal mucosa (for example, finger), infectious pathologies, leukemia (leukemia).

  – Alexandra Nikolaevna, do you need to see a doctor for every nosebleed?

  If it is insignificant, arose once, and it was successfully stopped at home, then there is no reason for an immediate visit to a doctor in order to stop bleeding.

  But even here, clarification of the cause of bleeding is necessary, not to mention all their other cases (insignificant in volume, but often repeated, or simultaneous profuse bleeding). Why? Because without this, one cannot be completely sure how dangerous the cause that caused it is. Therefore, in any case, a person cannot do without a trip to the doctor.

  – What research methods are used to clarify the cause of nosebleeds?

  These are various laboratory and instrumental methods.

  Laboratory methods are aimed, in particular, at the search for disorders of the blood coagulation system (study of its plasma, platelet link).

  Instrumental examinations include examination of the nasal cavity (rhinoscopy), including with the help of endoscopic techniques, magnetic resonance imaging and computed tomography of the nasal cavity and nasopharynx.

  Of course, a rational algorithm for diagnostic search and necessary research should be selected by the doctor depending on the specific clinical situation.

  – How can nosebleeds be stopped at home?

  First aid for nosebleeds consists in pinching the nose (pressing the wings of the nose against the nasal septum) for 5-20 minutes. If there are nasal vasoconstrictor drops, then you can first put a little cotton wool or, preferably, gauze dipped in 3-4 drops of this drug into the nasal cavity, and then pinch the nose.

  It must be remembered that vasoconstrictor drops can increase blood pressure (therefore, be sure to see the instructions for specific drops), and therefore may be contraindicated in hypertension.Therefore, with nosebleeds and at the same time high blood pressure, these drops should not be used.

  – What should not be done with nosebleeds?

  When there is a nosebleed, you must not throw your head back. This is one of the most common mistakes. Why shouldn’t this be done? This can lead to the ingress of blood into the esophagus and further into the stomach, causing bloody vomiting, or into the respiratory tract, with the subsequent development of suffocation. For the same reason, you cannot go to bed.

  During the onset of bleeding and for some time after, hot drinks and food should not be consumed.

  It is necessary to exclude the influence of the factor, presumably causing the nosebleeds: for example, go into the shade, if it happened in the sun, stop working, especially if it was a physical activity.

  – How to properly prevent nosebleeds?

  Proper hygiene in the home and workplace must be ensured.First of all, it is cleanliness and normal air humidity. If there are occupational hazards in the form of polluted air, use personal protective equipment. Be sure to undergo scheduled medical examinations and preventive examinations. If an episode of bleeding occurs, you should see an ENT doctor to find out the cause of the bleeding and adhere to his recommendations.

  For information:

  Emelyanova Alexandra Nikolaevna

  Candidate of Medical Sciences, otolaryngologist LLC “Clinic Expert Kursk”.

  Graduated from Kursk State Medical University. Passed primary specialization in residency in the specialty “otorhinolaryngology”. In the same educational institution she completed full-time postgraduate studies.

  Other interviews with Emelyanova A.N .:

  How to treat sinusitis at home?

  Why can’t the ear hear?

  The nose is stuffy, but there are no drops at hand?

  90,000 Nosebleeds: symptoms and emergency care

  What you need to know

  Bleeding of various localization is often the reason for seeking emergency medical help.There are various reasons for bleeding. From a banal trauma to more serious health problems. It is far from always possible to establish the cause of bleeding if it is not known beforehand about any chronic disease that caused this condition. Then they are limited to specifying the localization and severity of bleeding, local pre-medical measures are taken to stop bleeding and combat the consequences of blood loss.

  Each of us at least once in our life faced nosebleeds, either from ourselves or from someone around.The situation is simple, but its health consequences can be quite serious and even dangerous. Let’s figure out together what are nosebleeds, what are their causes and possible consequences, and also consider the rules for providing emergency care for nosebleeds.

  Among spontaneous upper respiratory tract bleeding, nosebleeds are in the first place in frequency. The nasal membrane is rich in blood vessels, which determines the frequency of nosebleeds in different categories of persons.

  However, not all bleeding from the outer openings of the nose is indicative of nosebleeds. The latter can often be bleeding from the deeper respiratory tract, as well as from the esophagus or stomach.

  In children or debilitated patients, bleeding may go unnoticed if blood flows down the throat. In such cases, bloody vomiting or coughing up blood is often the first sign of nosebleeds.

  Also, all nosebleeds can be divided according to the degree of localization:

  1. Anterior , occupying almost 90% of all nosebleeds.Localized in the anterior part of the nasal septum. The mucous membrane in this place is thin, does not have a submucous layer, and is rich in a network of capillary vessels. Such bleeding is not life-threatening, not long-term, and can be easily stopped.
  2. Posterior , caused by damage to larger vessels. Lead to significant blood loss, can be life threatening.

  By severity:

  1. Minor;
  2. Light (up to 500 ml).There is noticeable weakness, pallor. Tachycardia up to 100. The skin is warm. There may be flashes of flies in front of the eyes.
  3. Medium (20% blood). Great weakness. Shortness of breath appears. Blood pressure drops. The skin is cool and damp.
  4. Severe (more than 20% blood). Hemorrhagic shock. Threaded pulse.

  Reasons

  Local

  • Traumatic injuries of the nose. Ranked first among all causes of bleeding. Minor injuries include scratches, abrasions, damage to the nasal membrane with the patient’s fingers when removing crusts, as well as injuries during sports or other activities.
  • Acute and chronic rhinitis. Epistaxis is a frequent companion of chronic sinusitis, rhinitis, adenoids. May occur when the nasal septum is curved.
  • Foreign bodies in the nasal cavity and sinuses. At the time of the introduction of a foreign body, the nasal mucosa is damaged, causing minor bleeding. Bleeding can also occur after a long stay of a foreign body in the nasal cavity, with the formation of granulations.
  • Surgical interventions.
  • Bleeding due to ulceration in the nasal cavity. Occasionally seen in chrome workers or people who work with strong acids.
  • Infiltrates of the nasal mucosa of a tuberculous or syphilitic nature can cause a small bloody discharge.
  • Benign or malignant neoplasms. Of the benign tumors, the most common cause is a bleeding polyp of the nasal septum, as well as papillomas, lymphomas, angiomas.Serious bleeding should be attributed to angiofibromas of the nasopharynx (often in men from 13-26 years old). The first sign of this disease is frequent nighttime bleeding.

  General

  • Cardiovascular diseases (hypertension, atherosclerosis, heart defects).
  • Infectious diseases (typhoid fever, flu, scarlet fever, malaria, as well as whooping cough during severe cough).
  • Hormonal imbalance. Observed in adolescent girls with menstrual irregularities.Often found in amenorrhea, hypomenstrual syndrome.
  • Diseases associated with stagnation in the circulatory system (emphysema of the lungs, liver and kidney disease, as well as pregnancy).
  • Hemorrhagic diathesis (hemophilia, vasculitis, Verlhof’s disease, thrombasthenia).
  • Diseases of the hematopoietic organs (leukemia, hemocytoblastosis).
  • Bleeding due to changes in atmospheric pressure while in the mountains, deep under water.
  • Uncontrolled use of drugs – anticoagulants.
  • Heat or sunstroke

  Symptoms

  Stopping nosebleeds

  Nasal bleeding in some cases can begin suddenly, against the background of complete health, sometimes even in a dream, in other cases, patients note increasing symptoms: headache, tinnitus, fatigue, dizziness, weakness. Blood with nosebleeds is clear, bright red. If the bleeding was preceded by a head injury, and the blood from the nasal cavity flows out of a yellowish color, it is necessary to urgently consult a doctor, as this may indicate a fracture of the base of the skull.Sometimes bleeding can stop spontaneously, but sometimes it can continue for a long time, causing a drop in the pulse, fainting.

  Some bleeding may pass unnoticed, due to the flow of blood along the back of the pharynx. Such bleeding is mainly typical for children or bedridden patients. Increasing paleness, weak, rapid pulse, and bloody vomiting indicate the presence of such bleeding.

  The diagnosis is not particularly difficult.It is more difficult to identify the source of the bleeding. In cases where a bleeding area cannot be detected in the nasal cavity, it is necessary to find out whether this is nasal bleeding, or indicates deeper lesions of other organs or systems.

  Treatment of nosebleeds in adults and children consists in various methods of stopping existing bleeding, as well as in the timely treatment of chronic diseases that cause these phenomena.

  Emergency

  Emergency care for nosebleeds

  1. Sit down the patient.Calm down. Press the wing of the nose against the nasal septum with your finger. Keep your head straight, do not allow the head to be thrown back.
  2. Put cold on the bridge of the nose (ice from the refrigerator, frozen food, a lump of snow, a wet cold towel).
  3. Insert a cotton swab dipped in 3% hydrogen peroxide or aminocaproic acid into the nasal passage. You can remove the tampon after 10-15 minutes.
  4. If all of the above measures are not successful, then a small piece of hemostatic sponge should be inserted into the nasal passage.You do not need to retrieve it later.
  5. Provide peace to the victim, and for children distracting activities in a calm environment (reading books, watching a cartoon) so that the child does not move or stand for half an hour.
  6. After the cessation of bleeding, you should consult a doctor for a more detailed examination of the causes of this condition. If you have any chronic medical condition, tell your doctor.

  Under no circumstances:

  • In case of bleeding, throw your head back;
  • Take a horizontal position;
  • Instill any drops in the nose;
  • After stopping the bleeding, blow your nose, check the nasal passage with your fingers;
  • During the next day, perform intense physical exercises, especially those associated with head tilting, lifting weights;

  The prognosis of nosebleeds, if they are not profuse, are rarely repeated and do not affect the general condition, most often favorable.