The nosebleed or also known as epistaxis is the bleeding from the nose, and in severe case it may present as bleeding from the eyes or even mouth. The nosebleeds are rarely life-threatening, they are spontaneous and self-limiting, and however recurrent ones can be a reason for concern. Epistaxis can be divided into 2 categories, based on the site of bleeding as, anterior bleeds and posterior bleeds.
Most of the nosebleeds are anterior epistaxis, which occurs from the Little’s area, wherein the External and internal carotid arteries anastomose, thus the bleeds are constant ooze rather than pulsatile bleed. Posterior bleed arise further back in the nasal cavity, are usually more profuse, and are often of arterial origin, and are even more dangerous than the anterior nosebleeds. The most probable cause of nosebleed is the mucosa is eroded by cold and dry climate, exposing and subsequently rupturing the blood vessels.
Local trauma is the most common cause, followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. Children usually present with epistaxis due to local irritation or recent upper respiratory infection. While, the systemic causes include; blood dyscrasias, arteriosclerosis, hereditary hemorrhagic telangiectasia, drug abuse and idiopathic causes. The peak incidence is seen among the children of 2-10 years mostly due to self-inflicted local trauma, and also in elderly 50-80 years due to systemic and cancerous growths.
The management includes, first calm down the patient, then apply direct pressure over the soft and fleshy part of the nose hold it from about 5minutes and up to 20minutes, never hold your head back instead tilt it forward which helps decreasing the chances of nausea and airway obstruction. The nosebleed that do not subside within 20minutes require medical attention, this involves local application of vasoconstrictor or the use of silver nitrate to cauterize bleeding blood vessels. Rarely might require surgical ligation of the blood vessels.
-Koya Satyasri
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