Epistaxis

 Epistaxis

Epistaxis is known as nosebleed, in which active bleeding or acute hemorrhage from nostrils, nostril cavity or nasopharynx.

Epistaxis occurs when the blood vessel inside nose are injured or damaged.

Types of Nosebleed 

There are two types of nosebleeds where they originate;

1. Anterior nosebleed (more common)

2. Posterior nosebleed (less common, but more require medical attention)

1. Anterior nosebleed

Anterior nosebleed occur from front and lower part of nose.

The most common site of anterior bleeding is in nasal septum (bridge of nose).

2. Posterior nosebleed

Posterior nosebleed originates from back of nose.  Blood drain down back of throat.

Posterior nosebleed are more complicated.

Causes of Nosebleed

1. Finger nail trauma

2. Excessive nose picking

3. Trauma to nose

4. Feature of nasal bones

5. Nasogastric and nasotracheal intubation

6. Viral rhinitis

7. Acute sinusitis

8. Atmospheric changes

9. Abnormal growth in nasal cavity; polyps

10. Bleeding disorder/Vascular Abnormality 

11. Topical nasal drugs

Pathophysiology

Repture of tiny blood vessel of nose due to trauma or dry nose irritate lining of nose forming crusts. 

Crust bleed when rubbing, picking.

Clinical Manifestations

1. Trouble breathing

2. Black stool; if blood swallow

3. Headache/Dizziness/ Weakness

If nosebleed heavy, overflow blood into nasopharynx and down into stomach, may cause vomiting.

Diagnostic Evaluation

1. CBC

2. Nasal speculum examination

3. Nasal endoscopy

4. CT scanning

5. ESR test

Management

1. Anterior nosebleed

1. Lean the head, and allow the bleed out from nostril, prevent back of through, breathe through mouth.

2. Inch the lower soft part of nose using thumb and index finger for 5-20 minutes

3. Keep head higher than level of heart, sit calmly

3

4. Ice compression can apply

5.  Cauterization with topical silver nitrate is generally the treatment of choice for anterior epistaxis.

6.  Nasal packing apply to stop bleeding. Nasal packing apply direct pressure inside nostril to promote clotting and stop bleeding.

Petroleum (Vaseline) gauze

7. Antibiotics to prevent sinus infection

8.  Decongestants

2. Posterior nosebleed

1. To control posterior nosebleed, posterior nasal packing will be done.

2. Antibiotics given

Prevention

1. Avoid picking the nose

2. Antibiotics ointment or Petroleum jelly used to keep moist nasal passages

3. During winter use ointment to prevent dry

4. Avoid nose blowing too vigorously

5. Avoid straining while passing stool