How does hypertension affect the likelihood of nosebleeds. What are the increased risks for hypertensive patients experiencing epistaxis. How can individuals with high blood pressure manage and prevent severe nosebleeds.

The Connection Between Hypertension and Epistaxis: New Research Findings

A groundbreaking population-based study has shed light on the long-debated relationship between hypertension (high blood pressure) and epistaxis (nosebleeds). The research, conducted by Dr. Jae Ho Chung and colleagues from Hanyang University School of Medicine in Seoul, reveals a significant link between these two conditions.

The study, published in JAMA Otolaryngology–Head & Neck Surgery, utilized data from the Korean National Health Insurance Service–National Sample Cohort. It compared 35,759 hypertensive patients with an equal number of matched controls, following them for a median of 5.5 years.

Key Findings of the Study

• Hypertensive patients experienced a higher rate of nosebleeds requiring clinical care: 32.97 per 10,000 individuals compared to 22.76 per 10,000 in the control group.
• The adjusted hazard ratio for nosebleeds in hypertensive patients was 1.47 (95% CI 1.30-1.66), indicating a significantly increased risk.
• Among those who experienced epistaxis, hypertensive patients were:
  • 2.69 times more likely to visit the emergency department
  • 4.58 times more likely to require posterior nasal packing

These findings suggest that hypertension may indeed be a risk factor for epistaxis, contrary to previous theories that proposed high blood pressure was merely a physiological response to nasal bleeding.

Implications for Patient Care and Management

The study’s results have important implications for both healthcare providers and patients with hypertension. Dr. Chung and his team emphasize the need for medical counseling about epistaxis for individuals with high blood pressure. Additionally, they suggest that the presence of hypertension should be a consideration in the management of nasal bleedings.

Why is this important? While nosebleeds are rarely life-threatening, they can be particularly concerning for elderly patients with cardiovascular disease. Proper treatment and management strategies are essential to minimize risks and complications.

Questions Raised by the Research

1. Can successful management of hypertension reduce the incidence and severity of epistaxis?
2. How should healthcare providers approach nosebleed prevention in hypertensive patients?
3. What additional precautions should individuals with high blood pressure take to minimize their risk of severe epistaxis?

These questions highlight the need for further research and the development of targeted interventions for patients with hypertension who are at increased risk of nosebleeds.

Understanding the Limitations of the Study

While the research provides valuable insights, it’s important to acknowledge its limitations:

• The study relied on public claims data, which may not capture all instances of epistaxis, particularly minor cases that didn’t require medical attention.
• Detailed clinical information on hypertension severity, patient adherence to treatment, specific bleeding foci, and blood loss volume was not available.
• The research did not assess the impact of successful hypertension management on epistaxis risk.

These limitations underscore the need for further studies to refine our understanding of the relationship between hypertension and nosebleeds.

Debunking Myths: Hypertension as a “Silent Killer”

It’s crucial to address a common misconception about hypertension: the belief that it always presents with noticeable symptoms. Contrary to popular belief, high blood pressure is often referred to as a “silent killer” due to its largely asymptomatic nature.

Myth vs. Reality

• Myth: People with high blood pressure will experience symptoms like nervousness, sweating, difficulty sleeping, or facial flushing.
• Reality: In most cases, hypertension does not cause noticeable symptoms, making regular blood pressure checks essential for early detection and management.

This lack of obvious symptoms makes it dangerous to rely on physical sensations as indicators of hypertension. Regular blood pressure monitoring is the most reliable way to detect and manage this condition.

Prevention and Management Strategies for Hypertensive Patients

Given the increased risk of severe nosebleeds in individuals with hypertension, it’s important to consider preventive measures and management strategies:

1. Regular blood pressure monitoring and medication adherence
2. Lifestyle modifications, including:
   • Maintaining a healthy diet low in sodium
   • Regular exercise
   • Stress management techniques
   • Limiting alcohol consumption
   • Quitting smoking
3. Proper nasal care, including:
   • Using a humidifier to prevent nasal dryness
   • Avoiding nose picking and harsh blowing
   • Applying petroleum jelly to the inside of the nose to keep it moist
4. Being prepared for nosebleeds with appropriate first-aid knowledge
5. Regular check-ups with healthcare providers to monitor overall cardiovascular health

By implementing these strategies, individuals with hypertension can potentially reduce their risk of experiencing severe nosebleeds and improve their overall health outcomes.

When to Seek Medical Attention for Nosebleeds

While most nosebleeds can be managed at home, there are situations where professional medical care is necessary, especially for individuals with hypertension:

• Nosebleeds lasting longer than 30 minutes despite applying direct pressure
• Frequent recurrence of nosebleeds
• Heavy blood loss causing lightheadedness or weakness
• Difficulty breathing due to blood flow
• Nosebleeds following a head injury
• Suspicion of a foreign object in the nose

Hypertensive patients should have a lower threshold for seeking medical attention for nosebleeds, given their increased risk of severe episodes.

The Role of Healthcare Providers in Managing Hypertension-Related Epistaxis

Healthcare providers play a crucial role in addressing the increased risk of nosebleeds in hypertensive patients. Their responsibilities may include:

1. Educating patients about the link between hypertension and epistaxis
2. Providing guidance on nosebleed prevention and first-aid techniques
3. Regularly assessing cardiovascular health and adjusting treatment plans as needed
4. Considering the impact of antihypertensive medications on bleeding risk
5. Collaborating with otolaryngologists for patients with recurrent or severe nosebleeds
6. Developing personalized care plans that address both hypertension management and epistaxis prevention

By taking a proactive approach, healthcare providers can help mitigate the risks associated with hypertension-related nosebleeds and improve patient outcomes.

Future Research Directions and Unanswered Questions

The study by Dr. Chung and colleagues has opened up new avenues for research in the field of hypertension and epistaxis. Some potential areas for future investigation include:

• The impact of different antihypertensive medications on nosebleed risk and severity
• Long-term outcomes for hypertensive patients with recurrent epistaxis
• Genetic factors that may influence the relationship between hypertension and nosebleeds
• Development of targeted interventions to reduce epistaxis risk in hypertensive patients
• The role of vascular changes in the nasal mucosa of hypertensive individuals

Addressing these questions could lead to improved management strategies and better outcomes for patients with hypertension who are at risk for severe nosebleeds.

Potential Implications for Clinical Practice

As research in this area continues to evolve, it may lead to changes in clinical practice, such as:

• Incorporation of epistaxis risk assessment in hypertension management guidelines
• Development of specialized care protocols for hypertensive patients with recurrent nosebleeds
• Enhanced collaboration between primary care physicians, cardiologists, and otolaryngologists
• Implementation of preventive measures as part of routine hypertension care

These potential developments underscore the importance of ongoing research and the need for healthcare providers to stay informed about the latest findings in this field.

Empowering Patients: Self-Management Techniques for Hypertension and Nosebleed Prevention

While medical supervision is crucial, patients with hypertension can take an active role in managing their condition and reducing their risk of severe nosebleeds. Some self-management techniques include:

1. Maintaining a blood pressure log to track trends and identify potential triggers
2. Learning proper techniques for taking blood pressure at home
3. Developing a personalized exercise routine in consultation with a healthcare provider
4. Exploring stress-reduction techniques such as meditation, yoga, or deep breathing exercises
5. Educating family members about hypertension, its risks, and proper nosebleed first-aid
6. Staying informed about the latest research and treatment options

By actively participating in their care, patients can improve their overall health outcomes and potentially reduce the frequency and severity of nosebleeds.

The Importance of Patient Education

Healthcare providers should prioritize patient education to ensure individuals with hypertension understand:

• The link between high blood pressure and increased nosebleed risk
• The importance of medication adherence and lifestyle modifications
• Proper techniques for managing nosebleeds at home
• Warning signs that indicate the need for immediate medical attention
• The potential impact of other health conditions on nosebleed risk

Empowering patients with knowledge can lead to better self-management and improved health outcomes.

Integrating Technology in Hypertension and Nosebleed Management

Advancements in healthcare technology offer new opportunities for managing hypertension and associated risks like severe nosebleeds. Some promising developments include:

• Smartphone apps for blood pressure tracking and medication reminders
• Wearable devices that continuously monitor blood pressure and other vital signs
• Telemedicine platforms for remote consultations with healthcare providers
• AI-powered risk assessment tools for predicting nosebleed likelihood in hypertensive patients
• Virtual reality applications for stress reduction and relaxation techniques

These technological solutions can enhance patient care, improve monitoring, and potentially lead to earlier interventions when nosebleed risks are identified.

Challenges and Considerations

While technology offers many benefits, it’s important to consider potential challenges:

1. Ensuring data privacy and security
2. Addressing the digital divide and ensuring equitable access to technology
3. Validating the accuracy and reliability of new monitoring devices
4. Integrating new technologies into existing healthcare systems and workflows
5. Providing adequate training for both patients and healthcare providers

Overcoming these challenges will be crucial for the successful implementation of technology-based solutions in hypertension and nosebleed management.

The Global Impact of Hypertension-Related Epistaxis

While the study by Dr. Chung and colleagues focused on a Korean population, the relationship between hypertension and nosebleeds is likely to have global implications. Considering the worldwide prevalence of hypertension, it’s important to examine:

• Variations in nosebleed risk across different ethnic and geographic populations
• The economic burden of hypertension-related epistaxis on healthcare systems
• Cultural differences in perception and management of nosebleeds
• The impact of environmental factors (e.g., climate, altitude) on nosebleed risk in hypertensive patients
• Strategies for implementing findings in diverse healthcare settings globally

Understanding these global perspectives can help develop more comprehensive and culturally sensitive approaches to managing hypertension and its associated risks.

International Collaboration and Research

To address the global impact of hypertension-related epistaxis, international collaboration in research and clinical practice is essential. This may involve:

1. Multinational studies to compare outcomes across different populations
2. Sharing of best practices and treatment protocols between countries
3. Development of global guidelines for managing nosebleeds in hypertensive patients
4. Collaborative efforts to improve access to care in underserved regions
5. International conferences and forums focused on hypertension and epistaxis

By fostering global cooperation, the medical community can work towards more effective strategies for managing hypertension-related nosebleeds worldwide.

Severe Nosebleeds More Common With Hypertension

High blood pressure was linked to a higher risk and severity of nosebleeds, a population-based study showed.

Epistaxis requiring clinical care occurred in 32.97 per 10,000 hypertensive patients, compared with 22.76 per 10,000 matched controls without high BP (adjusted HR 1.47, 95% CI 1.30-1.66), according to Jae Ho Chung, MD, PhD, of Hanyang University School of Medicine in Seoul, and colleagues.

Among those who experienced epistaxis, patients with hypertension were more likely to visit the emergency department (OR 2.69, 95% CI 1.70-4.25) and receive posterior nasal packing (OR 4.58, 95% CI 1.03-20.38) compared with controls.

“To our knowledge, the present study is the first to assess the association between hypertension and epistaxis using a nationwide population-based cohort. The results suggest that hypertension may be a risk factor for epistaxis,” the group wrote in their paper published online in JAMA Otolaryngology–Head & Neck Surgery.

The link has long been debated, they noted, with some suggesting hypertension is not a risk factor but “a physiologic response to nasal bleeding followed by an adrenergic effect.”

“Medical counseling about epistaxis is advisable for individuals with hypertension, and the presence of hypertension should be considered in managing nasal bleedings,” Chung and colleagues concluded. Epistaxis may rarely be life-threatening, but it requires appropriate treatment when it happens, especially in elderly patients with cardiovascular disease, the investigators noted.

One question now is whether successful management of hypertension can reduce the incidence and severity of epistaxis.

The retrospective study drew upon the Korean National Health Insurance Service–National Sample Cohort. Patients in the hypertension cohort (57.6% men, median age 52 years) were matched 1:1 to a comparison cohort (58.5% men, median age 52 years), with 35,759 people in each group. Individuals were followed for a median of 5. 5 years.

Hypertension was defined as having a record of three or more prescriptions of antihypertensive medication and a diagnosis of hypertension.

Patients with other conditions associated with nosebleeds (e.g., sinonasal tumor, facial trauma, coagulation disorder) were excluded from the study.

Repeated episodes of epistaxis (occurring more than 90 days after a prior treatment of epistaxis) were observed in 1.96 per 10,000 persons in the hypertension cohort and 1.59 per 10,000 control patients — not a statistically significant difference between groups.

“It is still theoretically possible, however, that recurrence of epistaxis may be higher for patients with hypertension, which could not be assessed in this study owing to the limitation of public claims data,” study authors wrote.

Their dataset lacked detailed clinical information on severity of hypertension, patient adherence, specific bleeding foci, amount of bleeding, and evaluation of successful management.

The study also did not include patients with nosebleeds minor enough to skip a visit to the doctor’s office or hospital, Chung’s team cautioned.

• Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was supported by the Basic Science Research Program of the National Research Foundation of Korea.

Chung’s group had no disclosures.

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What are the Symptoms of High Blood Pressure?

Looking for a list of symptoms?

If you are looking for a list of symptoms and signs of high blood pressure (HBP or hypertension), you won’t find them here. This is because most of the time, there are none.

Myth: People with high blood pressure will experience symptoms, like nervousness, sweating, difficulty sleeping or facial flushing.

Truth: High blood pressure is a largely symptomless “silent killer.” If you ignore your blood pressure because you think a certain symptom or sign will alert you to the problem, you are taking a dangerous chance with your life.

AHA recommendation

In most cases, high blood pressure does not cause headaches or nosebleeds

• The best evidence indicates that high blood pressure does not cause headaches or nosebleeds, except in the case of hypertensive crisis, a medical emergency when blood pressure is 180/120 mm Hg or higher. If your blood pressure is unusually high AND you have headache or nosebleed and are feeling unwell, wait five minutes and retest. If your reading remains at 180/120 mm Hg or higher, call 911.
• If you are experiencing severe headaches or nosebleeds and are otherwise unwell, contact your doctor as they could be symptoms of other health conditions.

Other inconclusively related symptoms

A variety of symptoms may be indirectly related to, but are not always caused by, high blood pressure, such as:

• Blood spots in the eyes
  : Blood spots in the eyes (subconjunctival hemorrhage) are more common in people with diabetes or high blood pressure, but neither condition causes the blood spots. Floaters in the eyes are also not related to high blood pressure. However, an eye doctor (ophthalmologist) may be able to detect damage to the optic nerve caused by untreated high blood pressure.
• Facial flushing:
  Facial flushing occurs when blood vessels in the face dilate. It can occur unpredictably or in response to certain triggers such as sun exposure, cold weather, spicy foods, wind, hot drinks and skin-care products. Facial flushing can also occur with emotional stress, exposure to heat or hot water, alcohol consumption and exercise — all of which can raise blood pressure temporarily. While facial flushing may occur while your blood pressure is higher than usual, high blood pressure is not the cause of facial flushing.
• Dizziness
  : While dizziness can be a side effect of some blood pressure medications, it is not caused by high blood pressure. However, dizziness should not be ignored, especially if the onset is sudden. Sudden dizziness, loss of balance or coordination and trouble walking are all warning signs of a stroke. High blood pressure is a leading risk factor for stroke.

Nosebleed causes & treatments | NHS inform

Most nosebleeds can be stopped without the need for medical attention, but occasionally further treatment may be required.

What to do

To stop a nosebleed:

• sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 minutes
• lean forward and breathe through your mouth – this will drain blood into your nose instead of down the back of your throat
• place an ice pack or bag of frozen vegetables covered by a towel on the bridge of your nose
• stay upright, rather than lying down as this reduces the blood pressure in the blood vessels of your nose and will discourage further bleeding

If the bleeding eventually stops, you won’t usually need to seek medical advice. However, you should still follow the recovery advice outlined below.

When to seek medical advice

Contact your GP or call the NHS 111 service if:

• you’re taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn’t stop
• you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion
• a child under two years of age has a nosebleed (this is rare and there’s a chance it’s caused by something serious)
• you have nosebleeds that come and go regularly

Ask someone to drive you to your nearest accident and emergency (A&E) department or call 999 for an ambulance if:

• the bleeding continues for longer than 20 minutes
• the bleeding is heavy and you’ve lost a lot of blood
• you’re having difficulty breathing
• you swallow a large amount of blood that makes you vomit
• the nosebleed developed after a serious injury, such as a car crash

Find your nearest A&E department

Medical treatment

If you see your GP or go to hospital with a nosebleed, you will be assessed to determine how serious your condition is and what’s likely to have caused it. This may involve looking inside your nose, measuring your pulse and blood pressure, carrying out blood tests and asking about any other symptoms you have.

The main treatments that your GP or hospital doctor may use to stop your nose bleeding are described below.

Antibiotic ointment

Your doctor may prescribe an antibiotic ointment. This should be applied by squeezing a pea-sized amount onto the front of the nasal septum (wall between the nostrils).

This can reduce the inflammation and crusting in the nose and reduce the severity and frequency of nosebleeds.

Antibiotic ointment is particularly effective in children.

Cautery

If your doctor is able to identify exactly where the bleeding is coming from, they may carry out a minor procedure to seal the bleeding blood vessel by cauterising (burning) it.

This is normally done using a stick of a chemical called silver nitrate. A local anaesthetic will be sprayed into your nose to numb it and the silver nitrate stick will be held against the bleeding point for up to 10 seconds.

Nasal packing

If cautery is ineffective or your doctor is unable to identify a specific bleeding point, they may recommend packing your nose with gauze or special nasal sponges to stop the flow of blood by applying pressure to the source of the bleeding.

Packing will usually be carried out after local anaesthetic has been sprayed into your nose. The gauze or sponges often need to be left in place for 24-48 hours before being removed by a health professional. You’ll usually need to be admitted to hospital to be monitored during this time.

Further treatment

If the treatments above don’t help, you may be referred to a hospital specialist such as an ear, nose and throat (ENT) doctor for further treatment.

Additional treatments that may be used in hospital include:

• electrocautery – an electric current running through a wire is used to cauterise the blood vessel where the bleeding is coming from
• blood transfusions – a procedure to replace the blood you’ve lost
• tranexamic acid – medication that can reduce bleeding by helping your blood to clot
• packing under anaesthetic – your nose is carefully packed with gauze while you are unconscious from general anaesthetic
• ligation – an operation using small instruments to tie off bleeding blood vessels in the back of your nose

Recovery

Once your nose has stopped bleeding, you should follow the advice below to reduce the risk of your nose bleeding again and to stop you picking up an infection:

• avoid blowing or picking your nose, heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot drinks for 24 hours
• don’t remove any crusts that form inside your nose – these may be unpleasant, but they’re a useful part of the healing process
• if you need to sneeze, try to sneeze with your mouth open to reduce the pressure in your nose
• avoid people with coughs and colds

If you see a GP or a hospital doctor about your nosebleed, they may give you a prescription for an antiseptic nasal cream once the bleeding stops. This should be applied to the inside of your nostrils several times a day for up to two weeks to help prevent further bleeding.

If your nose does start to bleed again, follow the first aid advice above and seek medical advice if the bleeding doesn’t stop.

Nosebleeds: Causes and Treatment – familydoctor.org

Nosebleed treatment

A nosebleed can be scary to get — or see — but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home.

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will slow the bleeding. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean back, you may swallow the blood. This can irritate your stomach.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. Don’t let go for at least 5 minutes. If it’s still bleeding, hold it again for another 5 to 10 minutes.

Once the bleeding stops, wait a few hours before doing anything that might make it start again, such as bending over or blowing your nose.

See your doctor if:

• The bleeding goes on for more than 20 minutes.
• The bleeding was caused by an injury, such as a fall or something hitting your face. In some cases, this may be a sign of internal bleeding.
• The amount of blood makes it hard to breathe.
• A child under 2 has a nosebleed.
• You’re taking a blood thinning medicine.
• You get nosebleeds weekly.

Your doctor will try to find out where the bleeding is coming from in your nose. He or she will probably ask you some questions and examine your nose. If the bleeding doesn’t stop on its own or when pressure is applied, your doctor may cauterize the bleeding vessel or pack your nose to stop the bleeding. Cauterization involves using a special solution called silver nitrate or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure. Packing the nose involves putting special gauze or an inflatable latex balloon into the nose so that enough pressure is placed on the vessel to make it stop bleeding

What you need to know about nosebleeds

Image Source

The nose is an incredibly vascular structure, and the Kiesselbach’s plexus in the front part of the nose is the most common site for epistaxis, or nosebleeds, in children.

Epistaxis can result from trauma to the nose, mucosal irritation, inflammatory disease and septal or vasculature abnormality. In adults, hypertension (high blood pressure) can also contribute to nosebleeds. This is rare in children.

It’s important to remember that children with bleeding disorders are often at risk for recurrent nosebleeds. On the other hand, nosebleeds in children with no symptoms of bleeding disorders (easy bruising, family history) don’t require further investigation or testing.

Most of the time, bleeding occurs after trauma to the nose from placement of fingers in the nostrils. Additionally, allergies and infection can introduce crusty mucus and nasal itchiness, prompting injury to the mucosa when trying to remove the mucus.

How do I manage a nosebleed at home?

Epistaxis is typically self-limited, and the best bleeding control is achieved by applying pressure over the affected area. It’s important to tip the head forward instead of leaning the head back, which will cause blood to run down the throat and can further lead to nausea and airway obstruction.

It’s recommended to pinch the soft, front part of the nose, without stopping, for 10 minutes while breathing through the mouth. It’s critical to hold pressure without stopping, and these steps might need to be repeated. Decongestant nasal spray (i.e. Afrin) can be used to promote the vasoconstriction and might help stop the bleeding.

If the bleeding doesn’t stop, we recommend seeking help from a medical professional. 

How can I prevent future nosebleeds?

Avoid blowing and rubbing of the nose, and try sneezing with the mouth open. Using nasal saline sprays can help keep the inside of the nose moisturized, and petroleum jelly can be used as lubrication. In addition, an at-home humidifier can help by adding moisture to the air, especially in dry climates and during winter when home heating systems are used more regularly.

What do I do if the nosebleeds are recurrent?

If your child is suffering from recurrent nosebleeds, seek evaluation from an otolaryngologist. Sometimes, antibiotic ointment is required to reduce infection and promote lubrication and healing. If dilated blood vessels are seen, chemical cautery can seal the area. In necessary cases, nasal electrocautery is performed under general anesthesia.

If you’re interested in making an appointment with Texas Children’s Otolaryngology Division, feel free to give us a call at 832-822-2778.

Nosebleed, First Aid: Condition, Treatments, and Pictures – First Aid Guide

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First Aid

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Images of Nosebleed, First Aid

Overview

Nosebleeds either occur spontaneously or are the result of some sort of trauma, such as a hit to the face. Things that cause nosebleeds are certain medical conditions (eg, colds, allergies, high blood pressure, and bleeding abnormalities such as hemophilia or von Willebrand disease), extreme cold and/or dry air, nose picking, strenuous activity, certain medications (eg, nasal sprays), and being hit in the nose.

Most nosebleeds occur in the front of the nose when there is damage to the blood vessels. Other nosebleeds occur in the back of the nose, causing bleeding into the throat.

First Aid Guide
The following self-care measures are recommended:

1. Have the person suffering the nosebleed sit upright and lean forward. He/she should breathe out of his/her mouth.
2. If there are any clots in the nostril, have the person gently blow them out.
3. Firmly pinch the soft part of the nose, and place a cold compress on the bridge of the nose. This should be done continuously for 15 minutes. Do not release the pressure on the nose.
4. If the person’s nose is still bleeding, repeat the above steps one more time.

Note: If the person’s nose is still bleeding after repeating the above steps one time, seek medical care.

In the case of an object lodged in the nose, removing the object promptly is important in avoiding infection as well as the possibility of the object moving further back into the nose. The below self-care measures should be attempted to remove the object.

1. Determine which nostril is affected.
2. Put gentle pressure on the opposite nostril using 1 finger.
3. Have the person blow their nose.
4. Encourage the person to sneeze by having him/her sniff pepper.

Note: Do not stick anything in the nose (eg, tweezers, pliers) to attempt to pull out the object.

In the case of a suspected broken nose, seek medical care. While awaiting medical care, the following self-care measures can be followed:

1. Have the person breathe out of his/her mouth.
2. Have the person sit upright and lean forward to help keep blood from going down the back of the throat.
3. Apply a cold compress to the nose.

Note: Do not attempt to straighten a broken nose.

The following can help prevent nosebleed recurrence:

• Avoid physical activity for 12 hours after a nosebleed.
• Touch the nose as little as possible for 24 hours after a nosebleed.
• Avoid hot beverages, alcoholic beverages, smoking, and aspirin for a full week after a nosebleed.
• When lying down, elevate the head with pillows.
• Breathe from the mouth rather than the nose.
• Use a humidifier.

Who’s at risk?

Those people living in cold, dry climates; those who suffer from colds and/or use nasal sprays; those with certain medical conditions, such as bleeding abnormalities; and those who disturb the blood vessels in the nose by picking are prone to nosebleeds.

Additionally, people who participate in strenuous activity or exercise, such as athletes, are prone to nosebleeds.

Signs and Symptoms

Typically, a nosebleed involves blood rapidly dripping out of the nose in droplets.

A nosebleed caused by a broken nose may or may not look misshapen.

In the case of a nosebleed caused by an object lodged in the nose, the foreign object may or may not be visible.

When to Seek Medical Care

Seek emergency medical care if a neck injury or serious head injury is suspected.

Get medical help if the person bleeds or bruises easily, is on any blood-thinning medication (eg, large dose of aspirin, warfarin [Coumadin®]), has high blood pressure, or if the nosebleed continues after 30 minutes of the self-care measures discussed in the First Aid Guide.

If the nosebleed is occurring in the back of the nose, into the throat, bleeding will be hard to stop and the person should likely seek medical care.

If you suspect a nosebleed caused by a broken nose, seek medical care; a broken nose that heals improperly can affect breathing and appearance.

If the nosebleed is caused by an object lodged in the nose and it cannot be removed by the self-care measures discussed in the First Aid Guide, seek medical care.

Treatments Your Physician May Prescribe

The physician may pack the nose with gauze or an inflatable latex balloon to properly put pressure on the blood vessel(s) to stop the bleeding.

If you have frequent nosebleeds, your physician may need to burn (cauterize) the blood vessel(s) with electric current, silver nitrate, or a laser on the inside of the nose that are causing the problem.

Trusted Links

MedlinePlus: Nose Disorders

Nosebleeds | HealthLink BC

Do you have a nosebleed problem?

How old are you?

Less than 4 years

Less than 4 years

4 years or older

4 years or older

Are you male or female?

Why do we ask this question?

The medical assessment of symptoms is based on the body parts you have.

• If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
• If your symptoms aren’t related to those organs, you can choose the gender you identify with.
• If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had a head injury in the past 24 hours?

Yes

Head injury in past 24 hours

No

Head injury in past 24 hours

Have you had a nose injury in the past 2 weeks?

Yes

Nose injury in past 2 weeks

No

Nose injury in past 2 weeks

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

No

Difficulty breathing more than a stuffy nose

Can you stop the bleeding?

No

Unable to stop bleeding

Have you kept the nose pinched shut for at least 20 minutes?

Yes

Has tried to stop nosebleed with direct pressure for at least 20 minutes

No

Has tried to stop nosebleed with direct pressure for at least 20 minutes

Do you feel light-headed or dizzy, like you are going to faint?

It’s normal for some people to feel a little light-headed when they first stand up. But anything more than that may be serious.

Do you take a medicine that affects the blood’s ability to clot?

This may include blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. These medicines can cause bleeding and can make it harder to control bleeding.

Yes

Takes medicine that affects blood’s ability to clot

No

Takes medicine that affects blood’s ability to clot

Have you had more than 1 nosebleed in the past 24 hours?

Yes

More than 1 nosebleed in past 24 hours

No

More than 1 nosebleed in past 24 hours

Are you having nosebleeds more often than is normal for you?

Some people get nosebleeds from time to time. What you are looking for is an increase in how often they occur.

Have you had more than 4 nosebleeds in 1 week?

Yes

More than 4 nosebleeds in 1 week

No

More than 4 nosebleeds in 1 week

Are you bleeding anywhere else?

Yes

Bleeding from other sites

No

Bleeding from other sites

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

• Your age. Babies and older adults tend to get sicker quicker.
• Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
• Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
• Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
• Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

• Try home treatment to relieve the symptoms.
• Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

To stop a nosebleed:

• Sit up straight, and tip your head slightly forward. (Do not tilt your head back. This may cause blood to run down your throat and make you vomit.)
• Pinch the soft part of your nose shut with your thumb and index finger for 10 full minutes.
• After 10 minutes, check to see if your nose is still bleeding. If it is, pinch it shut for 10 more minutes. Most nosebleeds will stop after 10 to 20 minutes of pressure.

Symptoms of difficulty breathing can range from mild to severe. For example:

• You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
• It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Severe trouble breathing means:

• You cannot talk at all.
• You have to work very hard to breathe.
• You feel like you can’t get enough air.
• You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

• It’s hard to talk in full sentences.
• It’s hard to breathe with activity.

Mild trouble breathing means:

• You feel a little out of breath but can still talk.
• It’s becoming hard to breathe with activity.

Severe trouble breathing means:

• The child cannot eat or talk because he or she is breathing so hard.
• The child’s nostrils are flaring and the belly is moving in and out with every breath.
• The child seems to be tiring out.
• The child seems very sleepy or confused.

Moderate trouble breathing means:

• The child is breathing a lot faster than usual.
• The child has to take breaks from eating or talking to breathe.
• The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

• The child is breathing a little faster than usual.
• The child seems a little out of breath but can still eat or talk.

A nosebleed is severe if:

• You have moderate to large amounts of blood even after you have pinched the nose shut for 10 minutes.
• Your nose is still bleeding even after 20 full minutes of direct pressure.

A nosebleed is moderate if:

• You have some bleeding, but direct pressure stops it within 20 minutes.
• The nose bleeds small amounts of blood more than 3 times in 24 hours.

A nosebleed is mild if:

• You have a little bleeding, but direct pressure stops it within 10 minutes.
• The nose bleeds no more than 3 times in 24 hours, and each time the bleeding is mild.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Feeling very dizzy or light-headed, like you may pass out.
• Feeling very weak or having trouble standing.
• Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Being very sleepy or hard to wake up.
• Not responding when being touched or talked to.
• Breathing much faster than usual.
• Acting confused. The child may not know where he or she is.

Abnormal bleeding means any heavy or frequent bleeding or any bleeding that is not normal for you. Examples of abnormal bleeding include:

• Nosebleeds.
• Vaginal bleeding that is different (heavier, more frequent, at a different time of month) than what you are used to.
• Rectal bleeding and bloody stools.
• Bloody or pink urine.
• Gums that bleed easily when you eat or gently brush your teeth.

When you have abnormal bleeding in one area of your body, it’s important to think about whether you have been bleeding anywhere else. This can be a symptom of a more serious health problem.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

• Call your doctor now to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care in the next hour.
• You do not need to call an ambulance unless:
  • You cannot travel safely either by driving yourself or by having someone else drive you.
  • You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

• Call your doctor today to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care today.
• If it is evening, watch the symptoms and seek care in the morning.
• If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

• Make an appointment to see your doctor in the next 1 to 2 weeks.
• If appropriate, try home treatment while you are waiting for the appointment.
• If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Nose Injuries

Head Injury, Age 4 and Older

Head Injury, Age 3 and Younger

90,000 Blood from the nose: the danger of the red carpet

Two scarlet rivulets from nostrils are far from a harmless phenomenon. Frequent bleeding is a signal of distress for a dysfunctional organism. In the spring, the condition of weakened people worsens. What to do so that the “bodily abyss” does not open up? How to “get by with a little blood” in the fight for health? The otolaryngologist of the 24th City Polyclinic for Special Medical Examinations Irina Denisova helped the observer of the portal www.interfax.by to understand the difficult situation.

“Non-independent” symptom

Persistent nosebleeds not associated with trauma are not a diagnosis, but one of the manifestations of a specific disease. The most commonplace of them is chronic rhinitis (runny nose). More serious causes of local blood loss are hypertension, atherosclerosis, blood diseases, liver dysfunction, viral infections, nasopharyngeal tumors.

When blood disappears into the stomach, vomiting often appears. Prolonged bleeding can lead to a drop in blood pressure and cause light-headedness.Anatomical prerequisites for “bloody relapses” – curvature of the nasal septum, pathology of the nasal valve zone. In some cases, the patient’s discomfort is a consequence of surgical operations to remove polyps and adenoids.

The loss of a strategically important fluid sometimes occurs when atmospheric pressure changes rapidly. The nose can “leak” when the body temperature rises. Unaccustomed physical activity provokes bleeding. It is also not useful to “melt” under the southern sun at noon.The permeability of blood vessels increases in spring, during the period of allergies and vitamin deficiency.

“Red nuisance” often worries nose-picking enthusiasts. Alternative “archaeologists” now and then injure the delicate mucous membrane. Young “experimenters” sometimes stick foreign objects into their noses. Blows and fractures of the maxillofacial skeleton are among the “sad five” external causes of bleeding.

However, only post-traumatic and annoying repeated bleeding is dangerous.”Blood from the nose” at high pressure “saves” the patient from cerebral hemorrhage.

Threat, explicit and latent

Experts distinguish between two types of nosebleeds. Scarlet “rain” from the anterior sections of the nasal septum is a less alarming symptom. Flowing blood is visible on the face. In addition, a visible enemy is less of a concern. Salty streams from the back of the nose often turn into a strong stream.

Blood “tears” invisible to the world flow down the throat.An eerie process may indicate an injury to large vascular trunks. “Back” bleeding can lead to a significant loss of “life-giving moisture”. If such a situation arises, you should consult a doctor as soon as possible. Trying to block back bleeding at home is life threatening. This kind of trouble often happens to the elderly. In elderly patients, the vessels of the posterior parts of the nasal cavity are devoid of elasticity. Children are most susceptible to “front” bleeding.Young people have nosebleeds twice as often as adults.

First aid

“Operational arrest” of escaping blood is a simple matter. In case of bleeding from the anterior sections of the nasal septum, the patient should not be placed on his back. It is best to seat the patient so that the head is higher than the body. In this case, you do not need to throw your head back. It is necessary to tilt it forward a little and press the wing of the nose against the septum for 5-10 minutes. In this position, the blood will not “flood” the nasopharynx.

To speed up the process, it is recommended to close the nasal passages with cotton swabs. It is advisable to treat temporary “plugs” with a 3% solution of hydrogen peroxide or nasal drops, which will constrict blood vessels. Adults “sufferers” will be helped by mini-bundles 1-1.5 cm thick, young ones – only 0.5 cm thick. A cold compress on the back of the head and the bridge of the nose will help calm the “bloody rivers”. The ice procedure is best done within 20 minutes. If, despite your efforts, the bleeding does not stop, you need to see a specialist.

When you can’t do without a doctor

An urgent reason for a medical examination is prolonged bleeding that does not go away after proper “independent work”. An additional risk factor is concomitant diseases (leukemia, diabetes mellitus, hypertension). It is not uncommon for nosebleeds to occur in patients who regularly take aspirin, ibuprofen, and heparin. These drugs provoke repeated bleeding. Removal from fainting and getting rid of bloody vomiting is urgent.

In a hospital, nasal tamponade is carried out with gauze turundas with antibacterial ointment. “Blocking objects” are left in the nose for 1–2 days. In case of “posterior” bleeding, you will have to go through the tamponade of the nasal cavity through the mouth. The “saving” turunda will remain in the body for 3-5 days. “Mechanical” treatment is often supplemented with medication. Doctors prescribe antibiotics to patients.

Frequent nosebleeds are a good reason for testing. Painful “scarlet showers” can be the first sign of cardiovascular disease, liver and kidney dysfunction, “incipient” tuberculosis.

Keep blood locked up

No matter how commonplace, the best prevention of “blood incontinence” is a healthy lifestyle. To strengthen blood vessels, you need to be in the fresh air more often, do morning exercises and take vitamins. In spring and autumn, it is useful to drink a decoction of wild rose, mountain ash and viburnum. In winter, you should use oxolinic ointment. It will help protect the mucous membrane from “seasonal” drying out. The “drying” effect of hot batteries is useful to mitigate with humidifiers.And, of course, the main medical advice – avoid overwork and be sure to get enough sleep.

Tatiana Fedina

90,000 why does it occur and how to eliminate the causes?

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