Blood from the nose

Most cases of the emergence of blood from the nose (epistaxis) comes from the vessels located on the nasal septum. In relatively young people (younger than 35 years), blood from the nose can occur from the vein located behind the columella (septum) of the vestibule of the nose. In the elderly, blood from the nose is often arterial from the Little area, where the anterior articular artery meets, the septal branches of the main palatine artery, the upper labial artery and the large palatine artery.

[1], [2], [3]

Causes of blood from the nose

Often the blood from the nose is idiopathic (an unidentified cause). In the elderly, blood from the nose is usually due to degenerative changes in the arteries and hypertension.

Local causes of blood from the nose can be:

• atrophic rhinitis,
• hereditary telangiectasia,
• tumors of the nose and sinuses.

Of course, we should not forget that the blood from the nose can be a manifestation of hemorrhagic diathesis.

[4], [5], [6], [7], [8], [9], [10]

Treatment of blood from the nose

First of all, it is necessary to fulfill three conditions: in time to recognize the shock condition and make if necessary a blood transfusion, to identify the source of blood from the nose and stop the blood from the nose. In the elderly, nosebleeds often cause a shock, which can be fatal. If the patient has signs of shock, he must be hospitalized and blood transfusion started. Usually, people with nasal bleeding are seated on a chair (this reduces venous pressure) and in this position is assisted. If the patient is in a shock state, it should be laid to maximize the perfusion of the brain. If there is no shock or it was managed to stop, then the main medical attention should be directed to the fight against bleeding. First of all, squeeze the nostril with your thumb and index finger and hold it for at least 10 minutes; it is advisable to place an ice bag on the back of the nose and ask the patient to clench his teeth, for example, a stopper from a bottle (wine) - this may be enough to stop nosebleeds. If the above method stops the nosebleeds, you should remove the blood clot from the nose with Luke's tweezers or suction. The nasal mucosa needs to be treated with an aerosol of 2.5-10% cocaine solution - it will anesthetize it and reduce the flow of blood to it due to the reduction of blood vessels. Any bleeding point should be burned.

If the bleeding point can not be detected, and the blood from the nose continues, tamp the nose with a strip of gauze 1 or 2.5 cm wide impregnated with paraffin and iodoform paste. The tampon is inserted with special forceps (Tilley). After you hold the front tamponade of the nose, the bleeding stops and the patient can be released home. The tampon should not be removed within 3 days. If the nosebleeds continue, despite the anterior tamponade, a posterior tamponade of the nose is necessary. It is performed as follows: after removal of the front tampon from the nose through the nostril, the Foley catheter is carried out, while its 30-ml balloon is located in the nasopharyngeal space, then the balloon is inflated and the catheter is pulled anteriorly. After that, the front of the nose is plugged. The posterior tamponade of the nose is carried out for 24 hours, during which the patient must be in the hospital. If the blood from the nose still continues, you need to re-tampon the nose, but this is a very painful procedure, and it usually demoralizes the patient. In rare cases it is necessary to resort to ligation of the arteries [the approach to the maxillary artery with bleeding from the large palatine artery and the main palatine arteries is carried out through the maxillary (gimorovu) sinus; to the front latticed artery - through the orbit]. To stop the ongoing bleeding, sometimes you have to ligate the external carotid artery.