Bleeding nose

What is it?

Hemorrhage (bleeding) coming from the nostrils and externalized
– through the nostril or the nasopharynx.

Bleeding can be of two types:

Previous: originates from the anterior portion of the nasal cavity, generally in the area of Kiesselbach above the posterior end of the nasal vestibule or on the anterior end of the inferior turbinate.

Rear: originates from the back of the nasal cavity and nasopharynx, usually in the rear half of the middle turbinate, or nasal cavity ceiling.

Age groups most affected: below 10 and above 50 years.

It will be embroidered from now:
– What cause?
– What are the signs and symptoms?
– What condition can be confused with epistaxis?
– There is need for hospitalization?
– Can complicate? How it evolves?

Causes:
– Unknown most often
– Trauma / Injury mucosal: wiping his nose with his finger, low humidity, foreign object in the nasal passages.
– Rhinitis or sinusitis
– Generalized infections (scarlet fever, malaria, typhoid fever).
– Rheumatic fever
– Abnormalities of vessel
– Nasal Tumor
– High pressure
– Medicines
– heparin and warfarin
– Changes of blood cells
– Leukemia
– Opening of the septum
– leishmaniasis or cocaine use
– Deviated septum
– Endometriosis (endometrium that is found in the nasal passages)

Signs and symptoms:
– Bleeding through the nose or nasopharynx
– Posterior bleeding may have no symptoms or show up in various forms
– To find the bleeding uses
– is light, nasal speculum and vacuum
– clean up the nose, bring the gore with tweezers and asks the patient to blow your nose
– Bleeding spread remember because generalized
– If bleeding on both sides may be difficult to find the specific location

Differential diagnosis:

If further differentiate bleeding hemoptysis (coughing up blood) and hematemesis (vomiting up blood).

Exams (only in selected cases):
– CBC and Coagulation
– Rx of the paranasal sinuses
– Nasal Videoencoscopia with optical fiber

Complications:
– Sinusitis
– Hematoma (collection of blood) or abscess (pus concentration) septal
– during application of the cap
– Disruption of the septum by cauterization
– Necrosis (tissue death) of the septum by high pressure cap or balloon

How to treat the patient?

They may be admitted if bleeding is severe or elderly patients with posterior bleeding.

If previous bleeding, pressing area for 5 to 10 minutes and put compress on the affected area with vasoconstrictor (oxymetazoline or phenylephrine hydrochloride) and local anesthetic (lidocaine). Remove pad and observe if necessary cauterized with silver nitrate.

If subsequent bleeding arises a roll of gauze wrapped and folded 10 cm thick silk tied with two wires. A tip of the wires is tied to a catheter that is introduced in the nasal cavity and removed through the mouth. The cap is fixedin the nasopharynx. Buffering is sustained for 2 to 4 days. This buffering is being replaced by balloon use.

Refractory bleeding (rare cases, especially in the elderly) may be required surgical ligation.

As the patient progresses? Bleeding can come back?

Often bleeding is contained with appropriate treatment, but relapses may occur.

Final considerations:1. When measuring the pressure of the patient, because high pressure is the cause of nosebleeds.2. Bleeding from one side only suggests traumatic cause bleeding or local defect and the two sides may indicate (very high pressure, confusion or blood clotting)