Nosebleed (Epistaxis) is the blood draining out from the nose. Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting. It is rarely fatal.
The causes of nosebleeds
- Blunt trauma (usually a sharp blow to the face such as a punch, sometimes accompanying a nasal fracture)
- dry air, or heated indoor air
- Foreign bodies (such as fingers during nose-picking)
- Inflammatory reaction (e.g. acute respiratory tract infections, chronic sinusitis, allergic rhinitis or environmental irritants)
- Anatomical deformities (e.g. septal spurs or Hereditary hemorrhagic telangiectasia)
- Insufflated drugs (particularly cocaine)
- Intranasal tumors (e.g. Nasopharyngeal carcinoma or nasopharyngeal angiofibroma)
- Low relative humidity of inhaled air (particularly during cold winter seasons)
- Nasal cannula O2 (tending to dry the olfactory mucosa)
- Nasal sprays (particularly prolonged or improper use of nasal steroids)
- Otic barotrauma (such as from descent in aircraft or ascent in scuba diving)
- Consumption of tainted whey protein supplements that contain arsenic
- Surgery (e.g. septoplasty and Functional Endoscopic Sinus Surgery)
- Leech infestation
- Drugs — Aspirin, Fexofenadine/Allegra/Telfast, warfarin, ibuprofen, clopidogrel, prasugrel, isotretinoin, desmopressin, ginseng and others
- Alcohol (due to vasodilation)
- Liver diseases – Hepatic cirrhosis
- Connective tissue disease
- Blood dyscrasias
- Envenomation by mambas, taipans, kraits, and death adders
- Heart failure (due to an increase in venous pressure)
- Hematological malignancy
- Idiopathic thrombocytopenic purpura
- Pregnancy (rare, due to hypertension and hormonal changes)
- Vascular disorders
- Vitamin C and Vitamin K deficiency
- von Willebrand’s disease
- Recurrent epistaxis is a feature of Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu syndrome)
- Mediastinal compression by tumours (raised venous pressure in the nose)
- Vicarious Menstruation
Treatment/How to stop nosebleed
1. Hold a tissue or soft cloth to your nose
2. Lean forward and pinch your nostrils shut for 10 minutes
NEVER tilt your head back.
3. Apply a cold compress over the bridge of your nose
4. Know when to call a doctor. Most nosebleeds aren’t serious, and don’t require emergency medical care. Some do, though, so here’s when you should get help:
- You’re still bleeding after 20 minutes.
- Bleeding started after a head injury.
- Your nose was hit, and you suspect it’s broken
5. Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy; and DO NOT blow, rub, or pick your nose for several days.
How to prevent nosebleed
1. Combat dryness.
- Run a humidifier. Humidifiers are available cheaply, and they’re easy to manage. Run one while you sleep and turn it off while you’re gone during the day.
- Use a nasal saline spray. Saline spray doesn’t have anything in it but — you guessed it — salt, so its primary purpose is simply to wet your nasal passages. Use it a few times a day.
2. Keep your cool. Heat can sometimes lead to nosebleeds, so take steps to keep your body and your environment a little cooler.
- Run fans or air conditioning inside your house.
- Wear breathable cotton clothing.
- Stay hydrated and drink cool water.
- Run cool water over your wrists.
3. Don’t Pick! Picking often leads to nose bleeds
Nosebleeds in Children / What To Do?
- Don’t panic. It is much easier for your child to listen to your instructions if you appear calm.
- Hold a tissue or soft cloth to your childs nose
- Lean his/her forward and pinch your childs nostrils shut for 10 minutes
- NEVER tilt your child’s head back. This will only make the blood flow down the throat to the stomach, or into the lungs. Your child may vomit blood later due to irritation of blood in the stomach.
- After 5-10 minutes release the pressure. If the bleeding has not stopped then repeat pinching your child’s nose for another 10 minutes.
- Don’t pick the nose after a nosebleed.
- After the bleeding is controlled, do NOT let your child blow the nose or the clot may be released and the bleeding may reoccur.
- If the bloody nose follows an accident or injury to the head then seek medical attention immediately.
- If your child’s nosebleed does not stop after a second or third try, please seek medical attention immediately.
How might an emergency room doctor treat the nosebleed?
The doctor will ask you questions about your nosebleed and examine your nose to try to determine the source of the nosebleed. He or she will use a small speculum to hold the nose open and can use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but need not be painful. Occasionally x-rays or blood tests are ordered.
Treatments, depending on the cause, could include:
- Cauterization – the application of a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
- Nasal packing – the placement of strips of gauze into the nasal cavity to create pressure on the bleeding site. Alternately, other materials that promote clotting may be used.
- Medication adjustments – reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary.