Symptoms of epistaxis

Important in choosing a method of treatment is the clinical course of the disease. According to the clinical course of the disease, there are:

• single nasal bleeding:
• recurrent nasal bleeding;
• habitual nasal bleeding.

Most of the nosebleeds are single and can be stopped with conservative treatment. Recurrent is bleeding, repeated in a limited time period, disturbing the general condition of the patient and requiring treatment in an ENT hospital. Habitual ones are bleedings repeated several times a year for a long time. The causes of such bleeding are local diseases of the leg cavity, such as atrophic rhinitis, perforation of the septum of the nose, vascular tumors, varicose vasodilation of the nasal mucosa. The emergence of the usual nasal bleeding is possible with general diseases, in particular with hemorrhagic diathesis.

[1], [2], [3]

Urgent measures for the diagnosis and treatment of nasal bleeding

When providing specialized emergency care to a patient with epistaxis need to adhere to a certain algorithm.

Assessment of severity of hemorrhage:

• The main life-threatening factor in blood loss is hypovolemia. It is known that with a 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 a fatal outcome. The degree of givovolemia, that is, the reduction in the volume of circulating blood, can be determined by the patient's general condition, pulse rate, blood pressure, diuresis.
• Emergency compensation for hemorrhage should be made by hemodynamic (anti-shock) blood substitutes (polyglucin, reopolygloid, reomacrodex). When transfusion of blood substitutes, a biological test is necessary: after intravenous administration of the first 10 and subsequent 30 drops of the drug, a break for 2-3 minutes should be made, in the absence of adverse reactions, transfusion can be continued. In the presence of hypertension, hypotensive agents must be administered.

Conducting laboratory studies in the required volume.

• This is a general blood test (determination of the number of platelets); determination of blood glucose, urea, bilirubin, transaminase; blood clotting time; hematocrit; bleeding time according to Duke; definition of the blood group, Rh-accessory; coagulogram (fibrinogen level, soluble fibrin-monomer complexes, activated partial thromboplastin time, prothrombin time) retraction of the blood clot; general urine analysis. Presented laboratory studies allow to estimate the volume of blood loss, the presence of dysfunction of vital organs and determine the violations in those or other links of hemostasis.

Determination of the source of bleeding.

• Before examining the nasal cavity, it must be freed from blood and clots by blinking or using a nasal mirror or an endoscope. Depending on the location of the bleeding vessel and the intensity of bleeding, a method of stopping bleeding

Stopping nosebleeds.

• When the bleeding vessel is located in the anterior part of the nasal cavity (for example, in the Kisselbach zone), one should try to stop the bleeding in a non-stick way. Tamponade of the nasal cavity is used in the case of unsuccessful methods of stopping the nose bleeding, with the location of the source of bleeding in the back of the nasal cavity, with heavy bleeding.

Determination of the volume of necessary hemostatic and etiopathogenetic therapy.

• Drug treatment is prescribed after determining the cause of nasal bleeding and obtaining the results of a laboratory study of the patient.