Epistaxis

GENERAL INFORMATION:

What is epistaxis?

• Epistaxis (ep-i-STAK-sis), also known as a nosebleed, is a condition where there is active bleeding from the nose. This occurs when the blood vessels inside the nose are injured or damaged. Epistaxis can be located either anteriorly (front) or posteriorly (back). Anterior nosebleed is usually from the front and lower part of the nose. The most common site of anterior bleeding is in the nasal septum (bridge of the nose). Posterior nosebleed happens when the bleeding starts from the higher and deeper back portion of the nose. The blood usually drains down the back of the throat instead of coming out the nostrils (nose openings). Epistaxis is usually not life-threatening, but prompt treatment is needed to prevent prolonged bleeding and further problems.
  
  
• The nose is the main gateway to the respiratory (breathing) system. The inside of the nose is covered with mucosa (moist, soft tissues) that has a rich blood supply. This warms and moistens the air we breathe. Air passes to and from the lungs through the nostrils. A thin flexible wall called a nasal septum separates the two nostrils.

What causes epistaxis? The following may cause epistaxis or increase your risks of having one:

• Extreme temperatures: Very cold, dry air during winter or very hot, dry air during summer. This may make the inside of the nose dry, crack, and bleed easily.
  
  
• Heavy alcohol drinking: Drinking too much alcohol and too often. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, or other adult drinks. Talk to your caregiver if you drink alcohol.
  
  
• Inflammation: Inflammation (swelling) of the nose may be due to infections, such as colds or allergies. The more your nose is stuffy, the more likely the blood vessels may widen and bleed. This may also make you frequently blow your nose too hard and cause further damage.
  
  
• Medicines: Some medicines may make the blood thinner or clot longer. These may include anticoagulants (clot busters), non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, or steroids.
  
  
• Smoking or illegal drug use: Cigarette smoking or sniffing cocaine may irritate your nose and cause thinning of the lining of the nose.
  
  
• Trauma: Nosebleeds may be caused by an injury or direct blow to the nose. This may occur during a fight, physical abuse, car accident, or contact sports. An object stuck in the nose or frequent picking of the nose may also cause epistaxis.
  
  
• Others: High blood pressure, bleeding problems, abnormal blood vessels in the nose, and tumors.

What are the signs and symptoms of epistaxis? Dark or bright red bleeding from one or both nostrils is the most common sign of epistaxis. You may also have trouble breathing, smelling, or talking if blood clots block your nostrils. If you swallow blood, your stool (bowel movements) may look black. Other symptoms include headache, dizziness, and weakness, especially when you lose a lot of blood.

How is epistaxis diagnosed? Your caregiver will check your health history. This may include details of any injury or present medicines you may be taking. You may also need any of the following:

• Nasal speculum exam: Caregivers will use bright light and an instrument called a speculum to check the inside of your nose. This gently spreads open your nostrils to look for any blood clots or swelling. He may also locate where the bleeding is coming from.
  
  
• Nasal endoscopy: This procedure, also known as anterior rhinoscopy, uses a scope to see the inside of your nose. A scope is made of a long, bendable tube with a light on the end of it. During a nasal endoscopy, pictures are taken by a small camera attached to the scope.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Angiography: This test looks for problems with your arteries in the face, especially around the nose. Before the x-ray, a dye is put into a thin tube through a small cut in your groin. The groin is the area where your abdomen (stomach) meets your upper leg. The dye helps the arteries show up better on these x-ray pictures. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines.

How is epistaxis treated? Treatment for epistaxis aims to control bleeding and treat the underlying cause. You may have any of the following:

• Medicines: Caregivers may directly apply medicines to your nose to relieve congestion, decrease pain, and stop bleeding. Other medicines may also be given to treat the cause of your nosebleed. These may include medicines for high blood pressure, bleeding problems, and kidney and liver diseases.
  
  
• Nasal packing: Caregivers may pack your nose with gauze (bandage) strips to control bleeding and prevent infection. These strips are moistened (wet) with salt solution or antibiotic ointment. A balloon device or rubber tube may also need to be placed at the back of your nose. This may be left in place until the bleeding has stopped.
  
  
• Cautery: This uses an electrical device or a chemical, such as silver nitrate, to seal the injured blood vessels.
  
  
• Embolization: A special substance will be injected into the bleeding vessel. This blocking agent will stop the blood flow.
  
  
• Laser therapy: Laser therapy uses intense light to destroy abnormal blood vessels that cause the bleeding.
  
  
• Surgery: You may need surgery to tie an artery if the bleeding does not stop. Surgery may also be needed to correct a deformity or fix damaged tissues in the nose. Blood clots in the nose may also be removed to prevent infection. Injury to the other parts of the nose, nerves, or blood vessels may also be treated with surgery.

What first aid may be done for epistaxis? You may do the following when your nose bleeds:

• Lean forward to keep blood from going down the back of your throat, and breathe through your mouth.
  
  
• Pinch the lower soft part of your nose tightly using your thumb and index finger for 5 to 20 minutes.
  
  
• While pinching your nose, apply ice to the bridge of your nose to slow down the bleeding.
  
  
• After pinching your nose, release it to check if there is still bleeding. If your nose is still bleeding, repeat pinching your nose and applying ice.

Where can I find more information? Contact the following group for more information about epistaxis:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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