Epistaxis (Nose bleed)

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nose bleed
nose bleed

Epistaxis Definition

Epistaxis is the medical term for nosebleed. It usually happens when the blood drains out of the nostrils.

Information on Epistaxis

Nose bleeds are not that fatal and only accounts for 4 out of 2.4 million deaths in different cases in the last decade. If death occurs, it usually happens from hypovolemia or loss of blood volume in the body. Epistaxis does not choose a particular sex and age. It usually peaks for those people at the age of 2-10 and 50 to 80 years old. Less than 10% meanwhile seek medical attention from professionals.

There are two types of epistaxis: anterior epistaxis and posterior epistaxis. Among the two, the anterior epistaxis is more common and the other one most especially needs medical attention.

Usually, the blood vessels in the nose are small and it bleeds easily. Crusts are formed when the membrane becomes dry causing the linings to be irritated. The nose bleeds when a person is rubbing or picking or blowing the nose that is dry and irritated.

Epistaxis Causes

Most causes of epistaxis are not identified easily but here are some possible causes why nose bleeds.

  • Upper respiratory tract infection such as common colds, bronchitis, allergic rhinitis and others
  • When an object is stuck inside the nose.
  • When blowing the nose very hard in cases of flu or colds
  • Facial and local trauma such as nose picking because there is an interruption of the normal nasal flow.
  • Nasogastric and nasotracheal intubation in patients that can hardly eat or in coma
  • Irritation due to chemicals.
  • Taking topical medicines applied directly to the nasal area such as antihistamine and corticosteroids.
  • Taking anticoagulant drugs that can lessen the coagulation time of the blood such as aspirin and other conditions such as splenomegaly, platelet disorders, liver disease and even AIDS-related conditions.
  • When living in a dry and humid environment.
  • Surgery to the face and to the nose.

Nosebleed in Children

A bleeding nose is common in children but this problem is easily treated and not fatal. Unless there are underlying causes, nose bleeding can easily be stopped through first aid treatment. In some cases, nose bleeding can happen more to other children because of the location of the veins near the mucous membranes. When provoked or touched, nosebleed can happen.

First aid treatments can be administered to a patient. But for prolonged episodes, medical assistance is required. You will know that you need medical assistance:

  • If the child has problem breathing
  • If he or she gets nosebleed and it takes more than 10 minutes to stop
  • If the child bleeds profusely
  • If the nose is broken or injured
  • If there is a foreign body stuck in the nose
  • If bleeding happens elsewhere such as the gum, ears or even coming out of the lacrimal ducts.

Differential Diagnosis of Epistaxis

To diagnose epistaxis, there are many laboratory tests that must be done such as obtaining a complete blood count, bleeding time, hematocrit count, the INR or international normalized ration or the PT or prothrombin time. This is done to find out if the patient took warfarin or anticoagulant or if the patient has hepatic problems. Imaging studies are also done such as CT scans, nasopharyngoscopy or angiography may also be done.

How to Stop Nose Bleed

  • Keep the patient calm and not panic.
  • Let the patient sit and as him or her to lean forward never let him lean back with the head hyperextended.
  • Put pressure on the site by pinching or pressing the nostrils
  • Apply cold compress.
  • If it does not stop bleeding, put a clean gauze on the nostril and apply pressure on the area.

Here are some Considerations to Children with Bleeding Nose

  • Put pressure to the nose of the child for 10 minutes before letting  go
  • To divert the attention of the child, make him or her watch television to divert the attention.
  • Do not let the child play rough or physical games after the nose bleed after a couple of hours.
  • Tell the child not to pick, rub or blow their nose after a few days
  • Call the doctor if the bleeding does not stop.

Nose Bleed Treatment

There are some cases that a patient may be brought to the emergency room to treat a bleeding nose. Some of these things can happen:

  • If the patient has severe hemorrhage, intravenous line and crystalloid infusion is ordered to keep the patient hydrated. Cardiac monitory and pulse oximetry must also be attached to the patient.
  • Pledgets soaked with anesthetic vasoconstrictor solution should be placed inside the nasal cavity for 10 to 15 minutes.
  • If all of these did not stop, a chemical cautery may be done by the physician to stop bleeding. It uses topical anesthesia so as not to feel the pain. However, if bleeding is becoming aggressive, thermal cautery is done which uses local or general anesthesia.
  • After the patient was discharged, follow-up check-ups will be done by the EENT within 48-72 hours. Antibiotics and oral analgesics are given to ensure there will be no infection and to manage the pain.

Nosebleed Remedies

Here are some tips and remedies to fight off nose bleeds:

  • Elevated the head at about 30 to 45 degrees
  • Stop or avoid smoking
  • Try not to strain or carry heavy equipments
  • Keep the head higher than the level of the heart
  • Do not take any blood thinners such as aspirin
  • Use some lubricating ointment prescribed by the doctor to keep the nasal from drying

References

http://www.netdoctor.co.uk/health_advice/facts/nosebleedchildren.htm

http://emedicine.medscape.com/article/764719-treatment

http://en.wikipedia.org/wiki/Epistaxis

http://www.medicinenet.com/nosebleed/article.htm

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