Epistaxis – causes and treatment

Signs of epistaxis sometimes complement the symptoms of the underlying disease, as well as symptoms of acute blood loss. It is necessary to pay attention to such manifestations:

  • dizziness;
  • noise in ears;
  • lowering blood pressure;
  • tachycardia and shortness of breath;
  • pallor of the skin;
  • tickling and itching in the nose;
  • headache ;
  • feeling of weakness.

If there is little bleeding, then signs of blood loss are usually not pronounced. Blood flow can occur both inward and outward. If it does not go out and flows along the posterior wall of the oropharynx, then it can be detected by pharyngoscopy. If significant blood loss has occurred, a person may experience hemorrhagic shock, in which there is a sharp decrease in pressure, a threadlike pulse, and tachycardia.

Bleeding is of the following types: anterior and posterior.

If anterior bleeding occurs, in most cases (approximately 90%) its source is the Kisselbach zone. In this zone, there is a large network of small vessels covered with a thin mucosa with almost no submucosal layer.

In such a situation, blood loss is usually mild. It stops on its own – elementary first aid for bleeding from the nose acts almost immediately. Such a phenomenon is not life threatening.

If back bleeding develops, large vessels that are located deep in the nasal cavity are damaged. This is a dangerous condition for the patient, because the blood itself stops very rarely.

The doctor can determine the type of bleeding by examining the patient, having performed pharyngoscopy and anterior rhinoscopy.

In addition, during the examination, the doctor can determine the development of pulmonary or gastric bleeding, since in such conditions the blood sometimes flows into the nasal cavity. Recognizing pulmonary hemorrhage is not difficult – in such a situation, the color of the blood is bright red, it foams. If the stomach is dark, it resembles coffee grounds.

In the case of very intense bleeding that flows down the back wall, vomiting may develop in which dark impurities are noted.

To find out why bloody discharge from the nose appears, a general examination will help to diagnose the underlying disease.

To assess blood loss, the doctor prescribes a coagulogram, as well as a general blood test.

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Symptoms of nosebleeds, in addition to the fact of blood flow, can be supplemented by symptoms of the underlying disease and signs of acute blood loss:

  • noise in ears
  • dizziness
  • tachycardia (palpitations), shortness of breath
  • lowering blood pressure
  • itchy nose, tickling
  • headache
  • general weakness
  • pallor of the skin (slight)

With low bleeding, symptoms of blood loss usually do not occur. Blood flow can be both outward and inward. When blood enters the back wall of the oropharynx, it does not go outside; it can be detected by pharyngoscopy. With severe blood loss, hemorrhagic shock can develop – a filiform pulse, a sharp drop in pressure, tachycardia.

  • In the anterior – the source in 90% of cases is the Kisselbach zone, an extensive network of small blood vessels that are covered with a fairly thin mucous membrane, almost without a submucosal layer. With such bleeding, there is usually no severe blood loss, it stops on its own and does not threaten a person’s life.
  • In the posterior, large vessels in the deep sections of the nasal cavity are damaged, it is dangerous for the patient and almost never stops on their own.

To determine whether the bleeding is front or back, the doctor examines the patient, anterior rhinoscopy and pharyngoscopy are performed.

  • With gastric and pulmonary bleeding, blood can flow into the nasal cavity and mimic the nasal – this will be seen by the doctor when examining the patient.
  • With pulmonary – the blood foams and is bright scarlet, with a nasal dark red, with a gastric one it is very dark, similar to coffee grounds.
  • With intense nosebleeds running down the back wall, vomiting with dark blood may occur.

To find out what is the main cause of nosebleeds, a general examination and clarification of the symptoms of the underlying disease is required. To assess blood loss, it is necessary to pass a coagulogram and a general blood test.

The condition is characterized by pallor of the skin, then the mucous membrane of the lips takes a similar shade. The level of blood pressure decreases, the patient is disturbed by tinnitus, weakness. Dizziness occurs – it eliminates the possibility of being in a standing position. With hypertension, the patient notes pressure on the eyes, a feeling of the presence of sand in them.

With massive blood loss, bruises and circles appear under the eyes; facial features are sharpened. Nausea and vomiting accompany the deviation of the pressure indicators in any direction from the norm. Psycho-emotional state is characterized by excitement, distraction, fear of death. Patients (especially children) are afraid of the appearance of blood – this causes additional stress.

When blood enters the stomach, prolonged, debilitating vomiting occurs. The phenomenon contributes to the development of epistaxis at night, involuntary swallowing of the allocated masses. Also, improper first aid is associated with the movement of blood into the stomach. In particular, when it is recommended to tilt your head back, and not tilt forward, as the standard for hemostatic actions suggests.

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If the blood does not stop

If a person suffers from frequent sudden nosebleeds that cannot be stopped for a long period, then you need to seek help from a doctor. Such a pathological condition due to large blood loss can provoke the development of anemia.

If nose bleeds constantly, what should I do? First of all, it is necessary to be examined in a medical institution, so that the specialist identifies the root cause that provoked this symptom. Most often, these include: high blood pressure, poor coagulability, as well as conditions during which the vessels in the anterior part of the nasal cavity become very thin.

We continue to consider the features of nosebleeds. If this symptom is also accompanied by an increase in body temperature, then you must contact the clinic as soon as possible. This condition can be very dangerous not only for children, but also for an adult, as it is considered a signal of a serious health problem.

What are the causes of nosebleeds in the morning immediately after waking up? Most often, this symptom is observed in those patients who suffer from diabetes mellitus or hypertension. These two ailments provoke thinning and fragility of capillaries. In the case of high blood pressure, the fluid can escape from the nose in the form of a powerful jet, therefore urgent measures should be taken to stop the bleeding.

We continue to consider why there is blood from the nose. The doctor should deal with the treatment of this ailment. If bleeding does not go away for a long time, then this can be triggered by an injury to the Kisselbach plexus, which is located on the wall of the nasopharynx. If the patient has pathologies of the hematopoietic system or liver, then the loss can be observed for a long time.

Arterial hypertension, hypertensive crisis are the causes of nosebleeds in adults in more than half of cases. Against the background of high numbers of blood pressure, the thin walls of the capillaries in the nose can not withstand the load and are torn, which leads to bleeding. Usually it is this mechanism that underlies nasal bleeding with excitement, stress, excessive physical exertion, and overwork.

Blood from the nose in hypertensive crisis – a protective reaction of the body,
saving from hemorrhage in the brain. Similar “bloodletting”
allows you to slightly reduce the overwhelming pressure figures and save
cerebral vessel integrity. Unfortunately similar
“Fuse” does not work for everyone.

As a rule, drug pressure reduction quickly leads to the cessation of bleeding. For the prevention of nosebleeds, it is extremely important to monitor the level of pressure daily and maintain it at the optimal level using non-drug and medical methods.

    In case of nosebleeds, it is necessary to give the victim a semi-sitting or semi-recumbent position. Tilting the head back allows you to slightly reduce the blood supply to the nasal mucosa. However, it is advisable to avo >

Blood can flow from the nose at absolutely any pressure. With hypertension, its influx to the head will occur under pressure, and the walls of the vessels of the mucosa burst as a result of such a pathological effect.

In the case of low pressure, the capillaries are gradually compressed, the integument becomes pale. After some time, bleeding begins. Particularly dangerous are sudden changes in pressure indicators, as they contribute to the rapid deterioration of blood vessels.

Causes of blood from the nose: the influence of external factors

Develop as a result of inferior rest (uncomfortable bed, noisy environment, hot air), increased blood pressure. Hypertension causes a sharp upright position. Since morning in many people is associated with drinking coffee, drinking too strong a drink can also cause nasal bleeding. Other causes – pregnancy and concomitant intoxication, vitamin deficiency, the presence of inflammatory processes in the nasal sinuses.

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First aid for epistaxis

In the anterior section of the nasal septum there is a fairly tender area, where many capillaries are located. It is from this part of the nose that nose bleeds in children occur in 90% of cases. Such nosebleeds are harmless and can be stopped quite quickly.

Sometimes a child can bleed from large vessels of the nose. In such cases, a fairly strong and intense bleeding occurs. Therefore, it is urgent to call a doctor to help with nosebleeds.

It happens that a child has blood flowing from the nose, but other organs are a source of bleeding – the trachea, bronchi, lungs, esophagus or stomach. Therefore, it is so important to understand the cause of nosebleeds in children. With bleeding from the nose, the blood is of the usual color, it flows down the back wall of the pharynx. Very dark, the color of coffee grounds, blood can indicate bleeding from the stomach.

Fast and large blood loss is dangerous for the health and life of the child. With significant blood loss, the child may appear general weakness, dizziness, pallor of the skin, noise and ringing in the ears; dashes in front of the eyes, thirst and palpitations.

Then blood pressure decreases, the child may lose consciousness.

When bleeding from the back of the nose, the child can swallow blood, and only by vomiting with blood clots can you understand that he has nosebleeds.

Damage to the vessels of the nasal mucosa can occur in a child in a variety of cases. Among the main causes of nosebleeds in childhood are the following:

  • injuries to the nose (fracture, bruise, damage to the nose with a foreign object stuck in it);
  • medical operations performed on the nose;
  • tumors, polyps, ulcers in the nose;
  • rhinitis, sinusitis, adenoiditis;
  • curvature of the nasal septum;
  • sun and heat stroke;
  • sudden surges in pressure;
  • intense physical activity for the child’s body;
  • lack of calcium, potassium and vitamin C;
  • low blood coagulability;
  • hormonal changes in adolescence;
  • hepatitis, liver diseases, etc.

To help, you will need ice, a napkin, a chair, cotton wool, ammonia, a section of a bandage, and hydrogen peroxide.

  • Help the patient to take a position on the chair, leaning forward. Wrap the ice with a napkin, attach to the bridge of the nose.
  • Wipe your face with cold water, with a high predisposition to loss of consciousness, moisten a cotton ball with ammonia solution and let it breathe.
  • Press the nose wing of the nostril from which the blood flows to the nasal septum. The patient should inhale the second nostril, exhale through the mouth. Avoid completely blocking the airways. If you hold both nostrils, the child will completely breathe with his mouth, which is unacceptable.
  • When the blood does not stop, plug the canal: roll up a bandage cloth, moisten with 3% peroxide solution, and insert into the nostril.

The period of time for which the blood should stop is 15-20 minutes. If you cannot achieve a positive result, you need to call an ambulance.

Regardless of the root cause of the condition, the child needs to be reassured. The algorithm for providing assistance is no different from the elimination of epistaxis that occurs in an adult.

If the phenomenon is caused by the ingress of a foreign body – in all cases you need to go to the hospital or call an ambulance. This will not allow choking the child, will avoid moving the element into the deeper parts of the nose.

Why does a child often have nosebleeds? It should be noted immediately that this symptom is observed more often in children than in adult patients. This can be explained by the fact that the nasal mucosa in young patients is the thinnest, and the vessels are more fragile.

The main reasons include diseases of the internal organs, disruption of some body systems, and mechanical injuries. Small children often put small toys, pencils, fingers into the respiratory passages. To avoid this, you must carefully monitor your child.

You need to clearly understand what to do with nosebleeds to help both yourself and the child if severe bleeding develops. It is especially important to know how to stop nosebleeds for parents. Indeed, this often happens with children.

    If spotting is noticed in a child or in an adult, you must immediately give him a reclining position – put the patient, tilt his head forward. You can also apply cold for a few minutes on the br >

After the discharge from the nasal cavity has stopped, you do not need to pull out the swab too sharply, as there is a risk of damage to the blood clot, after which the attack may recur. It is better to carefully moisten the swab with hydrogen peroxide, wait until it softens, and only then pull it out.

If even such a case occurred once, it is necessary to take the child to the otolaryngologist to determine the cause of this phenomenon. The doctor will tell you what diseases there are that provoke such a symptom, and prescribe studies to determine the diagnosis and prevent relapse.

To prevent a baby’s dry nose, blood crusts, speed up the healing process and reduce the likelihood of relapse, you should lubricate the mucous membrane with Bacitracin, Neomycin or Vaseline ointment twice a day. During the heating season, you can instill in your nose funds based on sea water (Salin, Aqua Maris).

In severe cases, when it is not possible to cope with the situation on their own, experts anemize the mucosa with a solution of epinephrine or ephedrine. If the front tamponade is ineffective, the posterior tamponade is performed. However, in most cases, both in children and in older people, anterior tamponade helps with posterior bleeding.

If relapses occur very often or tamponade is ineffective, surgical intervention is necessary. For people who are concerned about the frequent manifestation of anterior bleeding, coagulation and endoscopic cryodestruction will be effective methods. Also in such a situation, sclerotizing drugs are sometimes administered, drugs that increase blood coagulation are prescribed.

Sometimes, if a person has weak vessels or suffers from other diseases, you should not wait until the bleeding stops – you need to immediately call for emergency help so that the doctor helps the patient. This is necessary if the following occurs:

  • blood pressure rises;
  • there was a nose injury;
  • the patient has diabetes;
  • the person has fainted;
  • very severe bleeding was noted, in which there is a threat of great blood loss;
  • if for a long time a person has been taking or is currently taking Heparin, NSAIDs, Aspirin, or the patient has problems with blood coagulation;
  • if vomiting with blood is noted, which may indicate damage to the stomach, esophagus, lungs;
  • if along with blood secretions a clear fluid flows in a person after a head injury – this may indicate a fracture of the base of the skull.

If an adult or a child has severe bleeding from the nasal cavity, he will be hospitalized in the inpatient department. Even if you managed to cope with the problem yourself, then you need to consult with the otolaryngologist later.

If the cause of the problem cannot be detected, and such manifestations are constantly manifested, you need to be examined by a number of specialists – an endocrinologist, hematologist, neurologist.

If blood appears from the Kisselbach zone, then this area is burned to prevent relapse. If necessary, the otolaryngologist practices the following measures:

  • removes polyps or a foreign body from the nasal cavity;
  • conducts anterior or posterior tamponade, which is impregnated with a 1% solution of feracryl, canned amnion, epsilon-aminocaproic acid;
  • in order to cauterize the vessel, a tampon with trichloroacetic acid and vagotil is introduced;
  • practices coagulation using electric current, silver nitrate, laser, ultrasound, liquid nitrogen, or conducts cryodestruction;
  • uses a hemostatic sponge;
  • introduces sclerosing drugs, an oily solution of vitamin A;
  • if the blood loss is very serious, the doctor uses freshly frozen plasma, a blood transfusion, administers hemodesis, reopoliglyukin and aminocaproic acid intravenously.

If all these methods are ineffective, then they perform a surgical operation – embolization of large vessels in the area of ​​the nasal cavity where problems are noted.

Drugs that increase blood coagulability are also prescribed – these are calcium chloride, vitamin C, Vikasol, calcium gluconate.

If nosebleeds have occurred, you should not eat hot food and drink hot drinks after that, do not practice serious physical exertion in order to prevent the reappearance of this problem.

  • To give an adult or child a semi-recumbent position, it is best to put a person and tilt his head forward.
  • Apply cold on nose bridge for 10 minutes.
  • You can instill vasoconstrictor drops (galazolin, naphthyzine, nazivin, etc.), in their absence 3% hydrogen peroxide, pinch your nostrils with your fingers.
  • If this does not help, then apply drops (or a weak solution of hydrogen peroxide) on a cotton swab (ball) and insert it into the nostril, pressing it to the nasal septum.
  • If blood flows from the nose from the right nostril – raise the right hand up, while holding the nostril with the left, if from both, then the patient raises both hands up, and the assisting person presses both nostrils.
  • If these activities do not help after 15-20 minutes, then you should call an ambulance.

Women

In addition to the common causes that can provoke bleeding, representatives of the fair sex under certain conditions have additional circumstances that can lead to such a pathological condition. These include:

  1. Compliance with various illiterate diets that cause a deficiency of fats, proteins and vitamins in the body.
  2. Diseases characterized by disorders relative to the hormonal background.
  3. The use of medications for the treatment of thrombophlebitis with varicose veins, which contribute to blood thinning.
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Pregnant women

When carrying a baby, many problems with a woman’s body manifest themselves in the form of this symptom. If a few drops appear, this will not be a cause for concern, but the observing specialist should nevertheless tell about this.

Constant bleeding is considered very dangerous for the health of a pregnant woman. Causes may include hormonal changes in the body, calcium deficiency, severe toxicosis, hypertension, heat stroke, infection, as well as prolonged exposure to the sun.

How to stop

Help should be quick but competent. Epistaxis is eliminated by exposure to cold, by blocking the respiratory canal in order to avoid massive blood loss. Providing the patient with a torso forward position allows blood circulation to be distributed throughout the body. There is no concentration in a certain part.

In men

Often, specialists associate bleeding with nose injuries. As a rule, this is considered a direct consequence of active games in youth or childhood. In addition, smoking, alcohol and hypertension, which is diagnosed more often in men than in the fair sex, can affect the state of the body and the health of the nasopharynx. This is what distinguishes them from other groups of patients.

If blood discharge is repeated, profuse, accompanied by painful sensations, then it is necessary to examine the body.

Which doctor to contact

  • high blood pressure (blood pressure)

Back tamponade
Click to Enlarge

Most often, blood flows from the Kisselbach zone, in order to prevent new cases, this place is cauterized. An ENT doctor can do the following:

  • remove polyps, foreign body
  • back or front tamponade soaked in 1% solution of feracryl, epsilon-aminocaproic acid, canned amnion
  • insert a swab with vagotil or trichloroacetic acid to cauterize the vessel
  • coagulation using one of the modern methods: electric current, laser, ultrasound, silver nitrate, liquid nitrogen, chromic acid, or endoscopic cryodestruction
  • possible the introduction of an oily solution of vitamin A, sclerosing drugs
  • use a hemostatic sponge
  • with severe blood loss, the use of freshly frozen plasma, transfusion of donated blood, intravenous administration of hemodesis, reopoliglyukin and aminocaproic acid is indicated
  • if the above methods did not have an effect, surgical intervention is possible – embolization of large vessels (ligation) in the problem area of ​​the nasal cavity
  • the purpose of blood clotting drugs is vitamin C, calcium chloride, calcium gluconate, Vikasol.

After nosebleeds, it is not advisable to use hot dishes and drinks, you can not play sports for several days, since this contributes to a rush of blood to the head and can provoke a second.

If a traumatic brain injury occurred, the help of a neurosurgeon is needed. In the presence of infection (meningitis, encephalitis) treatment is carried out by an infectious disease specialist. The epistaxis caused by ENT diseases (sinusitis, sinusitis) is eliminated by the otolaryngologist. If the state is associated with an increase in blood pressure, the therapy is performed by a cardiologist with the participation of an ENT doctor. If neoplasms are detected in the brain, the help of an oncologist will be needed.

Treatment for nosebleeds

Different methods of stopping bleeding and preventing the development of possible repeated cases are the tactics for treating nasal bleeding. Relapse prevention is associated with the treatment of diseases against which they can occur.

Stopping methods depend on the location and severity of the process. Epistaxis from the anterior section can be stopped independently. To do this, it is enough to slightly press the corresponding wing of the nose to the septum, and later introduce a tampon with a hemostatic agent. And yet, despite the majority of successful outcomes, with nosebleeds, you need to consult an otorhinolaryngologist. Especially, this is important when relapses and severe blood loss are observed.

Stopping nosebleeds can be done in several ways:

  • Mechanical involves anterior or posterior plugging, during which hemostatic sponges or cartridges are installed in the nasal passages;
  • Chemical shutdown is performed using various chemical materials;
  • The physical method involves the local action of different temperatures, as well as sealing vessels using an electrocoagulator;
  • Pharmacological stop is carried out by the appointment of drugs that improve blood coagulation;
  • An operational, surgical method is indicated for recurrent and severe processes with severe blood loss. It can be carried out through intersection, ligation of arteries and blood vessels, as well as through embolization.
  • Mixed combines all the possible options.

It is important to eliminate not only the epistaxis, but also the violation that caused it. Depending on the root cause, hormone therapy, antibiotic treatment, and vitamins are used. Additionally, washing the nasal cavity with antiseptic solutions and the use of drops to improve the tone and elasticity of blood vessels are prescribed.

Conservative treatment involves the introduction of hemostatic drugs. In the form of an injection, dicinone, sodium ethamylate, calcium chloride are administered. In severe clinical cases, an infusion of aminocaproic acid is necessary. With an increase in blood pressure, magnesium sulfate is administered, with hypotension, caffeine-based drugs.

Coagulation is an alternative method to eliminate systematic blood secretion. Indication – lack of effectiveness from conservative treatment. Cauterization is performed by low-voltage electric current, ultrasound, but the modern method is based on the use of a laser. A high-energy beam is characterized by a targeted action and a low probability of complications.

Oxygen therapy

The method involves the use of moistened oxygen. Indication – atrophy or increased dryness of the nasal mucosa. The doctor connects a special cannula to the patient’s nose, then you need to take a moderate breath and calm exhale. Actions should be as close as possible to the natural process of breathing. The duration of 1 procedure is 5-10 minutes. The number of repetitions depends on the severity of the patient’s condition.

Nasal swab

The procedure is performed by a doctor. Distinguish between anterior and posterior tamponade of the nose. Apply a hemostatic sponge (a means to stop blood) or a bandage folded in the form of a tampon. In the second case, a piece of gauze is treated with a special paste. The swab made with tweezers is advanced into the deep sections of the nose. An alternative to pasta is sterile petroleum jelly.

To protect the blocked channels, a sling-like bandage is applied to the patient’s nose. The performance indicators of the performed tamponade are the absence of even a slight discharge of blood to the outside and along the back wall of the pharynx. Tampons are removed only according to indications, the procedure is performed by an ENT doctor. The front tamponade involves blocking the channels for 1-2 days, the back – up to 7-9 days.

Surgery is carried out only with the ineffectiveness of conservative treatment. The doctor bandages the blood vessels, thereby preventing massive blood loss. Indications for nasal dermoplasty are often repeated epistaxis. A segment of the nasal mucosa is excised, replacing it with tissue from the behind-the-ear area.

With nosebleeds, it is necessary to stop the bleeding as soon as possible in order to prevent blood loss. Next, you need to eliminate the cause of the bleeding – for example, to normalize blood pressure. It is necessary to prevent the possible consequences of acute blood loss (reducing the volume of circulating blood, for example), to conduct hemostatic therapy.

What can not be done?

  • In the case of blood from the nasal cavity, you can not lie down or throw your head back – this will only worsen the situation, and blood in such poses can flow into the airways or into the esophagus. If it enters the respiratory tract, it suffocates, if it enters the stomach, it leads to nausea and vomiting.
  • It is also impossible to blow out oneself, as this can displace the clot that has formed.
  • If a foreign body enters the nose, do not remove it yourself – this should be done by a specialist.

When this unpleasant symptom appears, in no case should you throw your head back, as this can provoke swallowing of blood clots that flow down the back of the nose. When bleeding is necessary to sit down, press the chin to the chest. Something cold must be applied to the bridge of the nose. After this, vasoconstrictors should be instilled into the respiratory passages.

In order to prevent damage to the mucous membrane in the airways in the winter, when heating devices are turned on, it is recommended to use humidifiers in the room. Thus, the walls in the nose will dry out less. In addition, sea buckthorn or rosehip oil should be instilled daily into the nose. After instillation, it is necessary to press the nostril so that the oil does not flow back.

If you are faced with constant bleeding that does not stop for a long time, then you need to see a doctor for help. Based on the results of the tests, the doctor will prescribe the appropriate treatment.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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