Perspective

Epistaxis

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“Good afternoon house. Please what is the remedy for running nose with blood just coming out? Though the running nose is an everyday affair. His age is 19’’ This is a quote from a social medium chat group. As expected several useful hints were offered by various contributors…

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Barely 24 hours after the above was posted, my attention was called to a similar case. Mrs XX, developed nose bleeding (not due to injury) about 2 hours earlier. She is a known hypertensive who has been having recurrent history of same over the last 5 years. For her it is almost always indicative of a spike in her blood pressure…

What it is

Bleeding from the nostrils otherwise called Epistaxis or nosebleed simply means that blood is coming out of the inside of the nose. EPISTAXIS is to be distinguished from EPISTASIS. The former is nosebleed while the latter refers to the action of one gene upon another. Bleeding usually occurs only from one nostril. If the bleeding is heavy enough, the blood can fill up the affected nostril and overflow into the nasopharynx (the area inside the nose where the two nostrils converge), causing simultaneous bleeding from the other nostril as well. Generally speaking, Nosebleeds tend to occur more often during winter months (in the Western world), and in dry, cold climates (Hamartan in Africa). They can occur at any age, but are most common in children aged 2 to 10 years and adults aged 50 to 80 years. For unknown reasons, nosebleeds most commonly occur in the morning hours.

Categories

Nosebleeds are categorized based on where they originate, and are described as either anterior (originating from the front of the nose) or posterior (originating from the back of the nose). Anterior nosebleeds make up most nosebleeds. The bleeding usually originates from a blood vessel on the nasal septum (the bone and cartilage in the nose that separates the nasal cavity into 2 nostrils), where a network of blood vessels converge. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a health care practitioner. Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually originates from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).

The causes

Most nosebleeds do not have an easily identifiable cause. However injury to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by injury to the outside of the nose from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include: exposure to warm, dry air for prolonged periods of time, nasal and sinus infections, allergic rhinitis, nasal foreign body (object stuck in the nose), vigorous blowing of the nose, surgery on the nose, deviated or perforated nasal septum cocaine use, Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel bisulfate , nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin, topical nasal medications, such as corticosteroids and antihistamines. Furthermore, Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds, Vascular malformations in the nose and nasal tumors are rare causes. Hypertension may contribute to bleeding, but is rarely the sole reason for a nosebleed. Epistaxis is more common in hypertensive patients, perhaps owing to vascular fragility (weakness of the blood vessels) from long-standing disease. More commonly, epistaxis and the associated anxiety may cause a further acute elevation of blood pressure.

The symptoms

Apart from visible nasal bleeding, blood can also drip into the back of the throat or down into the stomach, causing a person to spit up or even vomit blood. There could also be dizziness, weakness, confusion and fainting. Excessive blood loss from nosebleeds does not often occur.

How to stop a nosebleed at home

A small amount of bleeding from a nosebleed requires little intervention. For example, if a person with a cold or a sinus infection blows his or her nose vigorously and notices some blood in the tissue, one should avoid forceful nose blowing, sneezing, and nose picking. This is usually enough to keep the bleeding from getting worse.
• Try and be calm.
• Sit up straight and lean slightly forward.

• Lean your head forward. Tilting your head back will only cause you to swallow the blood.
• Pinch the nostrils together and apply direct pressure with the thumb and index finger for approximately 10 minutes. Time it to make sure the nostrils are not released earlier.
• Spit out any blood in the mouth. Swallowing blood may cause vomiting.
• This technique will stop the majority of simple nosebleeds.

What to do when the bleeding has ceased

• Once the bleeding has stopped, try to prevent any further irritation to the nose, such as sneezing, nose blowing, or straining for 24 hours.
• Ice packs do not help nosebleeds.
• Exposure to dry air may worsen it but humidified air relieves. Air can be humidified by boiling water (without a lid), as it evaporates it adds moisture to the air. Above all, visit the nearest hospital as soon as possible if bleeding persists after the above measures.

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