Epistaxis

(Nosebleed)
 Epistaxis:

•
Epistaxis (or a nosebleed) is the relatively
common occurrence of hemorrhage from the
nose, usually noticed when the blood drains out
through the nostrils. There are two types:
anterior (the most common), and posterior (less
common, more likely to require medical
attention). Sometimes in more severe cases,
the blood can come up the nasolacrimal duct
and out from the eye.
 Epistaxis is a frequent complaint
 60% of the populationwill with suffer from a
nose bleed during their lifetime, and 6% will
require medical attention.
 Majority of epistaxis occurs between the ages
of 2-10 and 50-80 years old.
 Epistaxis results from an interaction of factors
that damage the nasal mucosal lining, affect the
vessel walls, or alter the coagulability of the
blood.
 Environmental:

• Dry cold conditions (presentations increase

during winter)
• Prolonged inhalation of dry air (Oxygen)
 Causes of Epistaxis:
The cause of nosebleeds can generally be divided into two categories, local
and systemic factors, although it should be remembered that a significant
number of nosebleeds occur with no obvious cause.

• Local trauma:
• Nose picking
• Facial trauma
• Foreign bodies
• Nasal or sinus infections
• Nasal septum deviation
 Most common factors
 Blunt trauma (usually a sharp blow to the face,
sometimes accompanying a nasal fracture)
 Foreign bodies (such as fingers during nose-
picking)
 Inflammatory reaction (e.g. acute respiratory
tract infections, chronic sinusitis, allergic rhinitis
or environmental irritants)
 Allergies
 Infectious diseases (e.g. common cold)
 Hypertension also allergic to aspirin
 Other possible factors

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)

Surgery (e.g. septoplasty and Functional Endoscopic Sinus Surgery)
 Leech infestation
epistaxis
 This picture shows
prominent
anterior(up-front)
septalvessels which
will bleed easily. This
type of nose bleed
(epistaxis) usually
occurs in children.
 These pictures show
a posteriornosebleed
(epistaxis) with a
large clot on the floor
of the nose. This
type of nose bleed
usually occurs in
adults with high
blood pressure. Note
the blood coming out
from under the
middle turbinate.
 his patient presented
with left sided
epistaxisand was found
to have a mass in her
nasalcavity. The mass
was an inverted
papilloma. This is a
locally invasive tumor
which is treated with
surgical resection.
Endoscopic sinus
surgery can be used to
remove this growth. In
this procedure fiberoptic
scopes are placed in
the nose and the growth
is resected without any
external surgical
incisions.
Prominent Anterior Nasal
Septal Vessels. In young
children nasalbleeding is
often caused by chronic
nasalinflammation and
rupture of small blood
vessels located on the
anteriornasal septum. The
picture on the far right
shows prominent vessels
on the nasal septum. This
vascular formation is often
called Kiesselbach's
plexus. The same child
was seen a week later
just after a nose bleed.
The picture on the left
shows the source of
bleeding.
 Treatment

•
The flow of blood normally stops when the blood
clots, which may be encouraged by direct
pressure applied by pinching the soft fleshy part
of the nose.
•
This applies pressure to Little's area, the source
of the majority of nose bleeds and promotes
clotting. Pressure should be firm and be applied
for at least five minutes and up to 20 minutes;
tilting the head forward will help decrease the
chance of nausea and airway obstruction.
•
Swallowing excess blood can irritate the
stomach and cause vomiting. Local application
of an ice pack to the forehead or back of the
neck or sucking an ice cube has seen
widespread practice, but has been shown to not
have any statistically significant effects on nasal
mucosal blood flow.
•
There are conflicting opinions in the use of ice
or nasal packing in the treatment of nose
bleeds. Most suggest there is no detriment to
using ice or nasal packing when initial efforts to
pinch the nose fail, while others advise against
it.
 Epistaxis, treatment of: To stop
epistaxis (a nosebleed), you
should:
1. Pinch all the soft parts of the nose together between your thumb
and index finger.
2. Press firmly toward the face - compressing the pinched parts of
the nose against the bones of the face.
3. Hold the nose for at least 5 minutes (timed by the clock).Repeat as
necessary until the nose has stopped bleeding.
4. Sit quietly, keeping the head higher than the level of the heart; that
is, sit up or lie with the head elevated. Do not lay flat or put your
head between your legs.
5. Apply ice (crushed in a plastic bag or washcloth) to nose and
cheeks.
 Nosebleeds: First aid
To take care of a nosebleed:
•
Sit upright and lean forward. By remaining
upright, you reduce blood pressure in the
veins of your nose. This discourages further
bleeding. Sitting forward will help you avoid
swallowing blood, which can irritate your
stomach.
•
Pinch your nose. Use your thumb and index
finger to pinch your nostrils shut. Breathe
through your mouth. Continue to pinch for five
to 10 minutes. This maneuver sends pressure
to the bleeding point on the nasal septum and
•
To prevent re-bleeding after bleeding has
stopped, don't pick or blow your nose and
don't bend down until several hours after the
bleeding episode. Keep your head higher
than the level of your heart.
•
If re-bleeding occurs, blow out forcefully to
clear your nose of blood clots and spray both
sides of your nose with a decongestant nasal
spray containing oxymetazoline (Afrin,
others). Pinch your nose in the technique
described above and call your doctor.