Epistaxis (also known as a nosebleed) a hemorrhage from the nose caused by rupture of tiny, distended vessels in the mucous membrane of any area of the nose, which mostly occurs in the anterior-inferior nasal septum(Kiesselbach’s plexus ) but they may also occur at the point where the inferior turbinates meet the nasopharynx. Most episodes of bleeding from the nose resolve before the patient arrives at the medical care facility, but persistent or recurrent bleeding requires immediate intervention.
Most causes of nasal bleeding can be identified readily through a directed history and physical examination. The patient should be asked about the initial presentation of the bleeding, previous bleeding episodes, and their treatment, comorbid conditions, and current medications, including over the counter medicines and herbal and home remedies. Although the differential diagnosis should include both local and systemic causes, environmental factors such as humidity and allergens also must be considered. Often no cause for the bleeding is identified.
Common Cause of Epistaxis
- Nasal trauma (nose picking, foreign bodies, forceful nose blowing)
- Allergic, Chronic or infectious rhinitis
- Chemical irritants
- Drying of the nasal mucosa from low humidity
- Deviation of the nasal septum or septal perforation
- Bleeding polyp of the septum or lateral nasal wall (inverted papilloma)
- Neoplasm of the nose or sinuses
- Tumors of the nasopharynx especially Nasopharyngeal
- Vascular malformation
- Liver disease(ex.cirrhosis)
- Medication(ex.aspirin,anticoagulants, anti-inflammatory drugs)
- Platelet dysfunction
Labs are only necessary in cases that do not respond to treatment
- CBC with platelet count, PT/PTT and bleeding time
- CT scan or Xray of the sinuses and nasal area to search for neoplasm of the nasopharynx and sinuses
- Consider biopsy of the suspicious regions or nasolaryngoscopy, especially in smokers.
The client with epistaxis usually arrives at the emergency room following unsuccessful attempts to stop the bleeding—signs of airway obstruction. The goals of treatment are to maintain the airway, stop bleeding identify the cause, and prevent a recurrence.
- Tilt head forward to prevent posterior blood drainage
- Apply continuous pressure by pinching nares together for 5-10 minutes
- Pressure applied between the upper lip and gum may help in some difficult cases.
- If no improvement, pack the nose with vasoconstrictor-soaked gauze and a heavy coat of petroleum jelly for 10 minutes
- In severe cases a nasostat is inserted, a foley catheter device that provides direct compression to the site via a balloon.
- Resuscitation with IV fluids or possibly blood transfusion may be necessary for severe blood loss to prevent hypovolemic shock.
- Monitor for patient vital signs assists in the control of bleeding.
- Provides tissues and emesis basin to allow the patient to expectorate any excess blood.
- Administer humidified oxygen by facemask to a patient with posterior packing.
- Assuring the patient in a calm, efficient manner that bleeding can be controlled can help reduce anxiety.
- Teach the patient or caregiver pinching pressure techniques
- Discuss ways to prevent nosebleeds