Epistaxis

The clinical term for a bloody NOSE. The inner nasal passages have a rich and plentiful supply of BLOOD vessels, and there are many causes for epistaxis. During an episode of epistaxis, blood may come from the nostrils or from the back of the nose and into the nasopharynx (back of the THROAT). Most people who have normal clotting do not lose a significant amount of blood during an epistaxis episode, even when bleeding appears profuse. Blood loss often appears greater than it is because the blood mixes with nasal secretions.

To slow or stop epistaxis:

1. Keep the head upright.
2. Apply firm pressure to both nostrils using the thumb and forefinger.
3. Hold the pressure for at least 10 minutes without release.

The most common causes of epistaxis are injuries due to local irritation (notably insertion of fingers, especially in children, and presence of foreign objects in the nasal passages), BREATHING dry and especially cold air, heavy sneezing, nasal polyps, and external trauma such as a blow to the nose or face. Epistaxis may also indicate deviated septum, which alters the flow of air through the nostrils and exposes the nasal lining to chronic irritation.

People who have bleeding disorders, regularly take NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) including aspirin, or who have uncontrolled HYPERTENSION (high BLOOD PRESSURE) are more likely to experience heavy epistaxis, though these circumstances do not usually cause the bleeding. Epistaxis is usually self-limiting (the bleeding stops following initial treatment) and does not require a doctor’s attention.

A doctor should evaluate bleeding that persists after taking basic measures to stop the nosebleed. A heavy blood flow may require, with local anesthetic, cauterization to seal the bleeding area or medicated packing (gauze strips, absorbent pledgets, or nasal tampons) placed into the area of the bleeding to hold continuous pressure against the blood vessels. Doctors typically prescribe a course of oral ANTIBIOTIC MEDICATIONS when it is necessary to place nasal packing, to safeguard against SINUSITIS (bacterial INFECTION of the SINUSES) or TOXIC SHOCK SYNDROME (a serious systemic bacterial infection). The doctor must remove any nasal packing, typically three days after its placement.

When extended treatment becomes necessary, the doctor will also request blood tests to assess blood cell counts and CLOTTING FACTORS and may choose to admit the person to the hospital for monitoring of the bleeding as well as the ability to maintain adequate breathing. Severe bleeding may require BLOOD TRANSFUSION or infusions of clotting factors. Rarely surgery is necessary to halt the bleeding, usually when the cause is external trauma or there are underlying health conditions that prevent the body’s clotting mechanisms from properly functioning. Most often epistaxis is a minor problem that quickly resolves, though a doctor should evaluate recurring nosebleeds.