EPISTAXIS (Bleeding form
Epistaxis is defined as any bleeding from
the nostril, nasal cavity, or nasopharynx. It is a very common problem in
children and sometimes in adults too. This is a very common emergency
department complaint and often promotes significant anxiety in patients and
clinicians. However, an emergency physician may successfully treat more than
90% of patients who present to the emergency department with epistaxis
picture shows prominent anterior (up-front) septal vessels, which will bleed
Inside of the nose is covered with moist,
delicate skin (mucous membrane) that has a rich supply of blood vessels. There are two areas that are often implicated
in nosebleeds where a plexus of anastomotic vessels can
be found, One in the front, mobile
part of the septum – midline partisan in nose - which is called as Little’s
area About 90% of nosebleeds originate from the
nasal septum and erupt when the relatively thin
nasal mucosa overlying a dilated septal vessel dries, scabs, and falls (or is
picked) off. Woodruff's plexus is
the second common sit of bleeding, which is located over the posterior middle
turbinate. In these cases, the site of bleeding is
higher and deeper within the nose and the blood flows primarily down the back
of the throat. Only rarely, a nosebleed is life threatening or actually fatal.
In most cases of life-threatening nosebleeds, some underlying health problem
(hypertension, a bleeding disorder, use of anticoagulant medication) is working
against the clotting process.
risk factors for nosebleeds include:
also commonly are caused by trauma, such as nose picking, forceful blowing of
Hot, dry climate — Nose bleeds are more
common in hot, dry climates as these climates lead to drying of the nasal
mucosa, stasis of secretions, infection and inflammation which leads to increased vascularity as well as cracking of
the mucosa, both of which increase chances of bleeding.
Colds and allergies — Both upper respiratory tract infections and allergies trigger
nasal inflammation, which can increase the risk of bleeding. Strenuous nose
blowing to clear the nose also can cause a nose to bleed or to start bleeding
again after a nosebleed has been controlled.
A deviated septum — A nasal septum that is shifted away from the midline (deviated)
produces an uneven airflow pattern within the nostrils. The altered airflow
pattern causes the skin on one side of the nasal septum to become dry and
cracked, increasing the risk of bleeding. These bleeding episodes are usually
incited by local intranasal factors such as deviated nasal septum with
crusting, drying, and subsequent ulceration.
Exposure to irritating chemicals —cigarette smoke, even passive cigarette smoke. Workers also may
develop nosebleeds from on-the-job exposure to sulphuric acid, ammonia,
gasoline or other chemical irritants.
Medical conditions — Examples include chronic renal disease (kidney failure),
thrombocytopenia (low levels of the blood platelets needed for clotting) and
hereditary bleeding disorders, such as haemophilia. Despite a strong
association with nasal haemorrhage, hypertension is rarely a direct cause of
epistaxis. Vascular fragility secondary to chronic hypertension probably
increases occurrence of epistaxis in these patients. In arteriosclerosis and
hypertension, bleeding may be heavier.
Heavy alcohol use — Alcohol seems to interfere with the normal activity of platelets
in the blood, and this increases the time needed for blood clots to form. It
also makes superficial blood vessels dilate, making them more likely to bleed.
Medications that interfere with
blood clotting — These include prescription
anticoagulants (blood-thinners) and nonsteroidal anti-inflammatory drugs
(NSAIDs), such as aspirin and ibuprofen (Advil, Motrin and others).
can help to prevent nosebleeds by:
· Not picking your nose
· Gently Blow your nose
one by one, not both at the same time.
· Keep your mouth open, when you have sneezing.
· Not smoking
· Using a humidifier if
your indoor climate is dry
· Applying a dab of
butter / petroleum jelly to the inside of your nostrils before bedtime
Avoid aspirin and other non steroidal
anti inflammatory drugs like Diclofenic sodium, Ibu brufen etc.
you are bleeding from the front of your nose, begin by trying the following
· Sit up so your head is
above the level of your heart, lean forward slightly and breathe through your
· Pinch the entire front
of your nose, just above your nostrils, and hold it for ten minutes.
· Apply an ice pack or a
plastic bag of crushed ice to your nose to slow the blood flow.
· After you have pinched
your nose for ten minutes, release it to see if bleeding continues.
· If your nose is still
bleeding, pinch it for an additional 10 minutes.
· After 10 minutes,
release your nose again. If you are still bleeding, go to the emergency
department to seek medical help.
simple first aid does not stop a nosebleed, your doctor may treat the problem
- Cauterising (sealing off) the
injured blood vessel with a chemical, such as silver nitrate, or with an
- Packing your nose with gauze
- Applying medication directly to
the inside of your nose to stop the bleeding
- Using other
methods, such as cryo therapy (using cold temperature to freeze the site
of bleeding), laser therapy (using a laser beam to seal the bleeding blood
vessel) or, in rare cases, embolization (injecting a special plug into the
bleeding vessel to block blood flow) or surgery to ligate bleeding
- Ligating the internal maxillary artery
and its branches or packing the posterior part of the nasal cavity is
required to control the bleeding
- Do not pick your nose after cauterization.
It takes seven to ten days to completely heal the torn blood vessels. If
you pick your nose you will peel the scab off and cause another nosebleed.
- After cauterization, you will get scab in
nose. Do not peel off. Allow it to fall off by it self. You can apply some
cream, butter or Vaseline to avoid dryness and help to prevent irritation
a little patience and localized pressure, most of uncomplicated anterior
nosebleeds respond to simple first-aid measures. But if it is recurrent, please
get advise from your doctor. Even the rare nosebleed that requires a doctor's
care usually can be treated successfully with cauterisation, packing, or
general, hospital treatment for a severe nosebleed is most likely in people
older than 60. Among those who use anticoagulants to treat circulatory
problems, nosebleeds can be a persistent problem.