Treatment of Nose Bleed in India

By Swapna SachdevReviewed by Dr. Bhawana Mittal

Epistaxis is a medical term used for nosebleed or bleeding from the nose. It is a very common complaint which is caused due to the bursting of a blood vessel within the nose, this can be spontaneous or caused by trauma

What Is Epistaxis

It is a medical term used for nosebleed or bleeding from the nose. It is a very common complaint which is caused due to the bursting of a blood vessel within the nose, this can be spontaneous or caused by trauma. It is hardly ever life threatening but it can cause significant anxiety, mostly among parents& kids. Most of the cases of nose bleeding are benign, self-limiting, and spontaneous, but some can be recurrent.

Overview of Nose

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Overview of nose

Nasal cavity lies sandwiched between the base of the brain (skull base) and above the oral cavity and palate below. Nose is lined with a number of blood vessels, which make them extremely vascular . Function of the nose is to warm and humidify the air that we breathe in. Nose can be divided into

External nose
Internal nose

The internal nose is richly supplied by blood vessels. Main bleeding sites are:-

Little's area - bleeding occurs anteriorly.
Woodruff's plexus- bleeding is from posterior part of nose through the mouth.
Retrocolumellar vein.

Types of epistaxis

It is of two types, based on the site of bleeding:

Anterior -(In front of the nose )this is most common in occurrence but it is not very serious. Blood is seen oozing out from the nostril
Posterior -(At the back of the nose ) more serious than anterior epistaxis. Blood oozes out down at the back of the throat .

Causes of epistaxis

Causes of epistaxis can be divided into

local causes
systemic causes
idiopathic (unknown) cause

SIGNS AND SYMPTOMS

If there is an anterior nosebleed then blood is usually seen running out of the nose. In this case:

> If the area of bleeding is close to the nostril: Then bright red blood can be seen.

> If the area of bleeding is deeper in the nose: the blood is mostly dark red.

> If a large amount of blood is lost then the patient can experience following symptoms :

Dizziness
Rapid heartbeat
Shortness of breath

DIAGNOSIS

Diagnosis is based on

Detailed patient history, about any bleeding tendencies running in the family.
Any history of hypertension or trauma to the nose.
Physical examination-It includes complete nose examination along with other systems indicated by the history given by the patient.

TREATMENT

Direct pressure is mostly effective for stopping epistaxis by applying pressure to the front of the nose. The treatment includes:-

General measures taken during epistaxis are

Make the patient sit up with a back rest ,and record any blood loss taking place through spitting and vomiting
Reassure the patient
Mild sedation should be given
Keep check on pulse, b.p and respiration
Maintain hemodynamic
Blood transfusion may be required
Antibiotics maybe given to prevent sinusitis, pack is to be kept beyond 24hrs
Intermittent oxygen maybe required in patients with bilateral packs
Investigate and treat for any under lying local or general cause

Emergency care

If bleeding does not stop after 20-30 minutes, call the physician or go to the emergency room for evaluation

Reassure the patient
Cauterization : It is done in anterior type of epistaxis where the bleeding point is seen.
Nasal packing : is either anterior nasal pack or posterior nasal pack.
Endoscopic cauterization
Sub mucous resection operation
Ligation of vessels - in severe cases where bleeding does not stop.
External carotid
Maxillary artery