Symptoms of a nosebleed

The clinical course of the disease is important when choosing a treatment method. According to the clinical course of the disease, the following are distinguished:

• single nosebleeds:
• recurrent nosebleeds;
• habitual nosebleeds.

Most nosebleeds are single and can be stopped with conservative treatment. Recurrent - these are bleedings that repeat in a limited time period, disrupting the general condition of the patient and requiring treatment in an ENT hospital, Habitual - these are bleedings that repeat several times a year over a long period of time. The causes of such bleeding are local diseases of the nasal cavity, such as atrophic rhinitis, perforation of the nasal septum, vascular tumors, varicose veins of the nasal mucosa. The occurrence of habitual nosebleeds is also possible with general diseases, in particular with hemorrhagic diathesis.

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Emergency measures for diagnosis and treatment of nosebleeds

When providing specialized emergency care to a patient with a nosebleed, a certain algorithm must be followed.

Assessment of the severity of blood loss:

• The main life-threatening factor in blood loss is hypovolemia. It is known that with the loss of 2/3 of the volume of red blood cells, the victim can survive, while the loss of 1/3 of the plasma volume leads to death. The degree of hypovolemia, that is, a decrease in the volume of circulating blood, can be determined by the general condition of the patient, pulse rate, blood pressure, and diuresis.
• Emergency compensation for blood loss should be performed with hemodynamic (anti-shock) blood substitutes (polyglucin, rheopolygluin, rheomacrodex). When transfusing blood substitutes, a biological test must be performed: after intravenous administration of the first 10 and subsequent 30 drops of the drug, a break of 2-3 minutes should be taken; if there are no side effects, the transfusion can be continued. In the presence of arterial hypertension, hypotensive agents must be administered.

Conducting laboratory tests in the required volume.

• This is a complete blood count (platelet count); determination of blood glucose, urea, bilirubin, transaminase levels; blood clotting time; hematocrit; Duke's bleeding time; determination of blood type, Rh factor; coagulation test (fibrinogen level, soluble fibrin-monomer complexes, activated partial thromboplastin time, prothrombin time); blood clot retraction; complete urine analysis. The presented laboratory tests allow us to assess the volume of blood loss, the presence of dysfunction of vital organs, and to determine disorders in certain hemostasis links.

Determining the source of bleeding.

• Before examining the nasal cavity, it is necessary to clear it of blood and clots by blowing your nose or using a nasal mirror or endoscope. Depending on the location of the bleeding vessel and the intensity of the bleeding, a method for stopping the bleeding should be chosen.

Stopping nosebleeds.

• If the bleeding vessel is located in the anterior part of the nasal cavity (for example, in the Kiesselbach zone), an attempt should be made to stop the bleeding without a tampon. Tamponade of the nasal cavity is used in case of failure of tampon-free methods of stopping nosebleeds, if the source of bleeding is located in the posterior parts of the nasal cavity, or if there is profuse bleeding.

Determination of the volume of necessary hemostatic and etiopathogenetic therapy.

• Drug treatment is prescribed after determining the cause of the nosebleed and receiving the results of the patient's laboratory tests.