Nosebleed

Most cases of nosebleeds (epistaxis) originate from vessels located on the nasal septum. In relatively young people (under 35 years of age), nosebleeds may originate from a vein located behind the columella (septum) of the nasal vestibule. In older people, nosebleeds are often arterial from Little's area, where the anterior ethmoidal artery, the septal branches of the sphenopalatine artery, the superior labial artery, and the greater palatine artery converge.

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Causes of nosebleeds

Often, nosebleeds are idiopathic (of unknown cause). In older people, nosebleeds are usually caused by degenerative changes in the arteries and hypertension.

Local causes of nosebleeds may include:

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

Of course, we should not forget that nosebleeds can be a manifestation of hemorrhagic diathesis.

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Treatment of nosebleeds

First of all, three conditions must be met: timely recognition of shock and, if necessary, replacement blood transfusion, identification of the source of nosebleed and stopping the nosebleed itself. In elderly people, nosebleeds often lead to shock, which can be fatal. If the patient shows signs of shock, he must be hospitalized and a blood transfusion must be started. Usually, people with nosebleeds are seated on a chair (this reduces venous pressure) and assistance is provided in this position. If the patient is in shock, he should be laid down to maximize cerebral perfusion. If there is no shock or it has been stopped, then the main medical attention should be directed to combating the bleeding. First of all, squeeze the nostril with the thumb and forefinger and hold it for at least 10 minutes; it is advisable to place a bag of ice on the bridge of the nose and ask the patient to clamp, for example, a bottle cork (wine) with his teeth - this may be enough to stop the nosebleed. If the above method does not stop the nosebleed, then the blood clot should be removed from the nose with Luke tweezers or suction. The nasal mucosa should be treated with an aerosol of 2.5-10% cocaine solution - this will anesthetize it and reduce the blood flow to it by contracting the blood vessels. Any bleeding point should be cauterized.

If the bleeding point cannot be found and the nosebleed continues, tamponade the nose with a 1 or 2.5 cm wide strip of gauze soaked in a paste of paraffin and iodoform. The tampon is inserted with special forceps (Tilley). After you perform anterior nasal tamponade, the bleeding stops and the patient can be sent home. The tamponade should not be removed for 3 days. If the nosebleed continues despite the anterior tamponade, posterior nasal tamponade is necessary. It is performed as follows: after removing the anterior tamponade from the nose, a Foley catheter is inserted through the nostril, with its 30-milliliter balloon positioned in the nasopharyngeal space, then the balloon is inflated and the catheter is pulled forward. After this, tamponade the anterior part of the nose. Posterior nasal tamponade is performed for 24 hours, during which the patient must remain in the hospital. If the nosebleed continues, repeated nasal packing is necessary, but this is a very painful procedure and usually demoralizes the patient. In rare cases, it is necessary to resort to ligation of the arteries [the approach to the maxillary artery in case of bleeding from the greater palatine artery and sphenopalatine arteries is carried out through the maxillary (maxillary) sinus; to the anterior ethmoid artery - through the orbit]. To stop ongoing bleeding, it is sometimes necessary to ligate the external carotid artery.