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What is epistaxis?

Epistaxis is a nosebleed. A nosebleed occurs when the blood vessels near the surface of the nasal cavity are injured or damaged.

What causes epistaxis?

  • Trauma: You can irritate or damage your nose if you pick it. This is the most common cause of epistaxis. Nosebleeds may also be caused by a direct blow to the nose or other injury such as an object stuck in the nose.

  • Dry air: Dry air can dry out your nasal cavity as you breathe. This happens more often during the winter.

  • Common cold or allergies: Irritation from colds and allergies can swell your nasal tissue. Your blood vessels widen and are more likely to bleed if your nose is stuffy. Colds and allergies may also make you blow your nose too hard which can cause more damage.

  • Medicines: Certain medicines can cause your blood to clot more slowly. These include blood thinners, such as warfarin and heparin. These also include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.

  • Alcohol and drugs: Alcohol can also affect how your fast your blood clots if you drink too much or too often. Cocaine may irritate your nose and cause the lining of the nose to become thin.

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.

How is epistaxis diagnosed?

Your caregiver will ask about your medical history and examine you. He will ask about the medicine you take. He may ask about any injury you have had to your face or nose. He will ask about your and your family's history of bleeding problems and any other medical problems you may have. You may also need any of the following:

  • Nasal exam: Your caregiver will use an instrument called a speculum to check the inside of your nose. This gently opens your nostrils so your caregiver can look for blood clots or swelling. He may be able to see what part of your nose is bleeding.

  • Nasal endoscopy: Your caregiver 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. A small camera attached to the scope will take pictures.

What first aid should I do for epistaxis?

  • Sit up and lean forward: This will help prevent you from swallowing blood. Spit blood and saliva into a bowl.

  • Apply pressure to your nose: Use 2 fingers to pinch your nose shut for 10 minutes. This will help stop the bleeding. Breathe through your mouth.

  • Apply ice: Use a cold pack or put crushed ice in a bag, cover with a towel, and place on the bridge of your nose. This will help decrease any swelling.

  • Nasal packing: Pack your nose with a cotton ball, tissue, tampon, or gauze bandage to stop the bleeding.

How is severe epistaxis treated?

You may need any of the following if the bleeding does not stop after first aid is done.

  • Medicines: Your caregiver may apply or spray medicines in your nose to decrease congestion and pain and stop bleeding. If bleeding is severe, medicine may be injected into a blood vessel in your nose.

  • Cautery: Your caregiver uses an electrical device or a chemical to seal the injured blood vessels. This may be done to stop bleeding or prevent more bleeding.

  • Balloon device: A balloon device may be placed at the back of your nose to stop the bleeding.

  • Surgery: You may need surgery to tie off 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.

How can epistaxis be prevented?

  • Avoid nose picking and blowing your nose too hard: You can irritate or damage your nose if you pick it. Blowing your nose too hard may cause the bleeding to start again.

  • Avoid irritants: Substances that can irritate your nose should be avoided. These include tobacco smoke and chemical sprays such as cleaners that contain ammonia.

  • Use a cool mist humidifier in your home: This will add the moisture to the air and help your nose stay moist.

  • Put a small amount of petroleum jelly inside your nostrils: You may apply a small amount of petroleum jelly if you do not have a nasal packing. This will help keep your nose from drying out or getting irritated. Do not put anything else inside your nose unless your caregiver tells you to do so.

What are the risks of epistaxis?

Cautery treatment may cause an opening in your nasal septum. The septum is the thin wall in the middle of your nose that separates your nostrils. Nasal packs may cause discomfort or damage to nasal tissues. They may increase bleeding, make it difficult to breath, or lead to a serious infection. Without treatment, your nose may continue to bleed. You may have trouble breathing or you could lose a lot of blood. This can be life-threatening.

When should I contact my caregiver?

Contact your caregiver if:

  • You have a fever and are vomiting.

  • You have pain in and around your nose that is getting worse even after you take pain medicines.

  • Your nasal pack is loose.

  • You have questions or concerns about your condition or care.

When should I seek immediate help?

Seek immediate help or call 911 if:

  • Your nasal packing is soaked with blood.

  • Your nose is still bleeding after 20 minutes, even after you pinch it.

  • You have a foul-smelling discharge coming out of your nose.

  • You feel so weak and dizzy that you have trouble standing up.

  • You have trouble breathing or talking.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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