Epistaxis overview
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Editore in chief : Liudvikas Jagminas, M.D., FACEP [1] Phone: 401-729-2419 Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D.
Overview
Epistaxis is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.
Pathophysiology
All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause tears, while inflammation, coagulation problems, and other disorders may make the injury harder to repair.
Risk Factors
- Vascular abnormalities:.[1] [2]
- Hereditary Hemorrhagic Telangiectasia
- Congestive hearth failure
- Granulomatosis with polyangitis
- Truama
- Infections
- Coagulopathies:
There is not enough evidence that hypertension is a risk factor for epistaxis. The role of lowering blood pressure to control and prevent epistaxis remains controversial.
Diagnosis
Epistaxis has different causes and based on medical history, family history, and physical examination we can find the cause Rhinoscopy is the first option to find the location of bleeding..[1] [3] [4]
- Trauma is the most cause of epistaxis.
Treatment
- Nasal compression for more than 5 minutes is the first action to stop active nose bleeding.[1] [3] [4] [5] [6]
- Rhinoscopy should be performed to find the bleeding site. Lubricants, Topical vasoconstrictors, Nasal cautery are options after finding the bleeding site.
- Nasal packing is used when we couldn't find the bleeding site or when we couldn't stop bleeding with other actions:
- Absorbale packing is preferred in patients with HTT or on anticoagulants and in children.
- Non-absorbable packing is the other option that can be used for other patients.
- In patients on anticoagulant medications, we should evaluate the need for or risk of discontinuation Anti-Coag/Anti-Platelet medications.
Surgery
Embolization and surgical arterial ligation are the last options to stop epistaxis in patients which other actions didn't work.[1] [3] [4]
Primary Prevention
Avoid Nose-picking and using lubricants and nasal saline spray can decrease possibility of epistaxis.[1] [5]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
- ↑ Douglas, Richard; Wormald, Peter-John (2007). "Update on epistaxis". Current Opinion in Otolaryngology & Head and Neck Surgery. 15 (3): 180–183. doi:10.1097/MOO.0b013e32814b06ed. ISSN 1068-9508.
- ↑ 3.0 3.1 3.2 Tunkel, David E.; Anne, Samantha; Payne, Spencer C.; Ishman, Stacey L.; Rosenfeld, Richard M.; Abramson, Peter J.; Alikhaani, Jacqueline D.; Benoit, Margo McKenna; Bercovitz, Rachel S.; Brown, Michael D.; Chernobilsky, Boris; Feldstein, David A.; Hackell, Jesse M.; Holbrook, Eric H.; Holdsworth, Sarah M.; Lin, Kenneth W.; Lind, Meredith Merz; Poetker, David M.; Riley, Charles A.; Schneider, John S.; Seidman, Michael D.; Vadlamudi, Venu; Valdez, Tulio A.; Nnacheta, Lorraine C.; Monjur, Taskin M. (2020). "Clinical Practice Guideline: Nosebleed (Epistaxis)". Otolaryngology–Head and Neck Surgery. 162 (1_suppl): S1–S38. doi:10.1177/0194599819890327. ISSN 0194-5998.
- ↑ 4.0 4.1 4.2 Thornton, M A.; Mahesh, B N.; Lang, J (2005). "Posterior Epistaxis: Identification of Common Bleeding Sites". The Laryngoscope. 115 (4): 588–590. doi:10.1097/01.mlg.0000161365.96685.6c. ISSN 0023-852X.
- ↑ 5.0 5.1 Chaaban, Mohamad R.; Zhang, Dong; Resto, Vicente; Goodwin, James S. (2016). "Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis". Otolaryngology–Head and Neck Surgery. 156 (1): 81–86. doi:10.1177/0194599816667295. ISSN 0194-5998.
- ↑ Viehweg, Tate L.; Roberson, John B.; Hudson, J.W. (2006). "Epistaxis: Diagnosis and Treatment". Journal of Oral and Maxillofacial Surgery. 64 (3): 511–518. doi:10.1016/j.joms.2005.11.031. ISSN 0278-2391.