EPISTAXIS

 

INTRODUCTION:  Epistaxis is a hemorrhage from the nose caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nasal passage. The anterior septum is the most common site.

RISK FACTORS OF NOSEBLEEDS:  Risk factors include infections, low humidity, nasal inhalation of illicit drugs, trauma (including vigorous nose blowing and nose picking), arteriosclerosis, hypertension, nasal tumors, thrombocytopenia, aspirin use, liver disease, and hemorrhagic syndromes.

MEDICAL MANAGEMENT:  A nasal speculum, penlight, or headlight may be used to identify the site of bleeding in the nasal cavity. The patient sits upright with the head tilted forward to prevent swallowing and aspiration of blood and is directed to pinch the soft outer portion of the nose against the midline septum for 5 or 10 minutes continuously. Alternatively, a cotton tampon may be used to try to stop the bleeding. Suction may be used to remove excess blood and clots from the field of inspection. Application of anesthetics and nasal decongestants (phenylephrine, one or two sprays) to act as vasoconstrictors may be necessary. 

Visible bleeding sites may be cauterized with silver nitrate or electrocautery (high-frequency electrical current). If the origin of the bleeding cannot be identified, the nose may be packed with gauze impregnated with petrolatum jelly or antibiotic ointment. The packing may remain in place for 48 hours or up to 5 or 6 days if necessary to control bleeding. Antibiotics may be prescribed to prevent and manage infection.

 

RELATED;

1.  Anemia

2.  Thrombocytopenia

3.  Medical conditions

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