NosebleedDefinition:
Alternative Names: Bleeding from the nose;�Epistaxis
Considerations: Nosebleeds are very common. The nose contains many tiny blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose, forming crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose. The lining of the nose is more likely to become dry and irritated from low humidity, allergies, colds, or sinusitis. Thus, nosebleeds occur more frequently in the winter when viruses are common and heated indoor air dries out the nostrils. A foreign object in the nose or direct impact to the nose can also cause a nosebleed. If you have a deviated septum, you may be prone to frequent nosebleeds. Most nosebleeds occur on the tip of the septum, the cartilage that separates the nasal chambers. The septum contains many fragile, easily damaged blood vessels. This form of nosebleed is usually easy to stop. Less commonly, nosebleeds may occur higher on the septum or deeper in the nose. These higher or deeper nosebleeds may be harder to control. Occasionally, nosebleeds may indicate other disorders such as bleeding disorders or high blood pressure. Hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu syndrome) may be evidenced by nosebleeds. This is a disorder involving a blood vessel growth similar to a birthmark in the back of the nose. Blood thinners such as Coumadin or aspirin may cause or worsen nosebleeds.
Home Care: Sit down and gently squeeze the soft portion of the nose between your thumb and finger (so that the nostrils are closed) for about 5-10 minutes. Lean forward to avoid swallowing the blood and breathe through your mouth. Wait at least 5 minutes before checking if the bleeding has stopped. Almost all nose bleeds can be controlled in this way if sufficient time is allowed for the bleeding to stop. It may help to apply cold compresses or ice across the bridge of the nose. DO NOT pack the inside of the nose with gauze.
Call your health care provider if: Get emergency care if: - The bleeding does not stop after 20 minutes.
- A nosebleed occurs after an injury to the head -- this may indicate a skull fracture. X-rays should be taken no matter how trivial the blow seemed to be at the time.
- Your nose may be broken (for example, it is misshapen after a blow or injury).
Call your doctor if you or your child has repeated nosebleeds, particularly if they are becoming more frequent and are not associated with a cold or other minor irritation.
What to expect at your health care provider's office: The doctor will perform a physical examination. In some situations, you may be monitored for signs and symptoms of hypovolemic shock. The doctor will ask you questions about your nosebleeds, such as: - Is there a lot of bleeding?
- Do the nosebleeds stop quickly, with pressure to the nostrils?
- Did they begin recently?
- Do the occur frequently or repeatedly
- What other symptoms are also present?
- Is there blood in the stools?
- Are you vomiting blood?
- Do you bruise or bleed easily?
- Is there petechiae (pinpoint red or purplish spots in the skin)?
- Are you on blood thinners (Coumadin) or aspirin?
Diagnostic tests that may be performed include: Treatment is usually tailored to the cause of the nose bleeds: - Cauterizing the blood vessel using heat or silver nitrate sticks
- Reducing the amount of blood thinners or stopping Aspirin
- Controlling blood pressure
- Reducing a broken nose or removing a foreign body
- Nasal packing
You may be referred to an ear, nose, and throat (ENT) specialist to diagnose and treat the condition.
Prevention: A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray can help prevent nosebleeds, especially during the winter months.
References: Pallin DJ. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005; 46(1): 77-81. Kucik CJ. Management of epistaxis. Am Fam Physician. 2005; 71(2): 305-311.
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