EPISTAXIS ( NOSEBLEED )

EPISTAXIS ( NOSEBLEED )

Epistaxis is bleeding from the nose. Bleeding could be from the anterior or posterior aspect of the nasal cavity. Anterior bleeding is usually from the little’s area which is network of blood vessels located about one-third from the nasal septum.

CAUSES
*Idiopathic- no known cause

*Congenital causes 
1. Osler - Rendu - Weber Syndrome (Congenital Teleangectasis-localised collection of distended blood vessels)
2. Haemophilia- a disorder in blood clotting

Acquired causes
*Trauma – nose picking, foreign body in nose, sports, assault, road traffic accidents, instrumentation from surgeries etc

*Inflammatory conditions
1. Acute Inflammatory conditions-Infective Rhinosinusitis
2. Chronic Inflammatory conditions-Atrophic rhinitis, Tuberculosis (Nasal TB), Syphilis etc

*Chemical lesions - Inhalation of irritant chemicals, gases etc

*Neoplasm of the Nose / Sinuses
1. Benign tumours - eg, Nasal polyps
2. Malignant tumours of nasal cavity or sinuses

*Enviromental / climatic changes - Dry hazy and low relative humid weather conditions.

*Generalized conditions- Diseases with vascular changes (Ateriosclerosis, Hypertention)

*Diseases of the Blood- Leukemia, thrombocytopenia (low platelets)

*Prodromal stage of certain Infectious diseases - Diphtheria, Measles, Varicella,Chicken pox

*Conditions of Organ failure –hepatic, renal failures

*Physiological conditions- Vicarious menstruation (menstrual bleeding from a part of the body other than the vagina-nose, nipple, mouth etc)

MANAGEMENT
1. Pinching of the nose for about 2-3 minutes whiles using the mouth for breathing is the single most important first step to take.
2. Nasal packing - this is a process of packing the nasal cavity tightly with a sterile gauze applying the pressure technique to stop bleeding.
3. If bleeding doesn’t stop after this rush immediately to a nearby hospital.
4. Do not try to drain the blood into your mouth- the bleeding will not stop and you may aspirate the blood into your lungs.
5. Cauterization (using heat or chemicals to destroy tissues by direct application of heat or chemicals) –in this case to prevent bleeding.
6. Arterial Ligation- suturing of the bleeding vessels.

PREVENTION
1. Avoid nose picking- it is the most common cause of nose bleeding (from injury to the complex network of blood vessels in the little’s area or Kiesselbach’s plxus).
2. Take your drugs regularly if you are hypertensive.
3. Protect your face in contact sports.
4. Do not ignore recurrent bleeds. Have a doctor work-up on you for possible causes and management.