Epistaxis (Nose Bleeds)

What is Epixtaxis?

Epistaxis is a bloody nose.  For the vast majority of persons, nose bleeds are not a big deal.  Hot humid days can trigger a bloody nose.  Some persons get random nose bleeds.  It just happens.

For many children, what causes nose bleeds? You guessed it.  Picking the nose with their little fingers.

 

 

Quickcare or ER?

Red Flags that will send you to the ER:

• Bleeding Persists. Even after the following tips described below
• If you are on blood thinners such as coumadin.
• If you are elderly and have a history of  high blood pressure.

What will the doctor ask?

 

Your doctor will want to know your symptoms.  Remember, a symptom is your description of your condition to your doctor.  It is your story.

Answers to the following questions will help your doctor:

• When did it start?
• What makes it better?
• What made it worse?
• Was there any trauma or injury?
• Did picking the nose cause this?

 

 

 

 

What will the doctor look for?

 

Your doctor will look for signs. Remember, signs are objective findings that a doctors sees during the examination.

After making sure that the patient is stable, then a doctor needs to look into the nose to find out where it is bleeding.

A little anatomy…..the front part of the nose is a crisscross of veins called a plexus. Specifically, Kieselbach’s plexus.

This is where the vast majority of bleeds stem from.

Goal is to find the source of bleeding.  This may involve using a suction to clear away the blood and find the origin.

 

What is the doctor thinking?

 

Your doctor will create a mental list of possible reasons for your signs and symptoms.  This list is called a differential diagnosis.

The doctor has to determine if  this is bleed from the back of the nose (posterior bleed) or from the front of nose at Keisselbach

Bleeds in the back are rare but very dangerous.  Normally, the posterior bleeds are seen the sick or elderly patients.  Posterior bleeds need seen by specialist right away.

 

What is the treatment of nose bleeds?

This can be very messy.

DON’T LEAN YOUR HEAD BACK!!   It will pool the blood in the back of the nose and do nothing to stop the bleeding

DON’T LEAN YOUR HEAD BACK!!

How to stop nose bleeds?

One of the most basic tricks to resolving nose bleeds is squeezing the top of the nose and lean your head slightly FORWARD.

Key is to hold it for 10 minutes.  Don’t let go.

Silver Nitrate.

Once in the clinic or ER setting, another treatment is using silver nitrate.  This should be done by your doctor. In the US, the silver nitrate is on the tip of  a stick.  The stick can then be placed inside the nose and burn (cauterize) the vessel that is bleeding.  Yes, it does hurt

Cocaine.

One other treatment is cocaine.  Yes, cocaine! This is done by a doctor as well.  The cocaine comes in a liquid form.  A little of the cocaine is mixed with neosynephrine.  A cotton ball soaked with this combination is placed in the nose.   It will contract the bleeding vessel.

If none of this works and the bleed is in the front of the nose, then a special balloon (rhino rocket) needs to be placed in the nose and inflated.  Again, this is done by a doctor.

 

How long will  you have a nose bleed?

If the bleed is in the front of the nose (Keisselbach’s Plexus), they can resolve with the treatments spelled out.  Many, many times it starts up again when exposed to humidity.  This was common in Ohio where I did my residency

Posterior bleeds are different.  They need a Ear Nose and Throat specialist right away.  Special packings or surgery are done.  Their treatment length are determined by your specialist.

Let me tell you a story

All around us are heroes.  We don’t need to read a history book.  We don’t to hear about a Medal of Honor winner.  The heroes around us are everyday people doing their job in a persistent, humble manner.

One such hero is Ismael, the tow-truck driver.  He came to me greasy from head to toe.  His boots were worn out at the tips which indicates he works on his knees scraping his feet along the ground.  He must spend a lot of time crawling around  cars.

This little greasy guy was a true hero.  It was not uncommon for him to get a call in the middle of the night.  He has to leave his beautiful wife and warm bed, put on his overalls, and rush to the scene of a stranded driver.  One night it’s an accident.  Another night its a person who locked their keys in the car.

Can you imagine these poor motorists on the side of the road?  It’s dark out.  Other cars are zipping by.  No one is stopping to help.  The motorists have to naturally think, “Where are all my friends when I need them?”   Nowhere!!!

Out of the darkness comes the headlights of little Ismael’s tow truck.  Ready to serve.  He even keeps a Thermos of hot coffee for his stranded lonely customers

“Ismael,” I ask. “Are people happy to see you when you arrive?”

“Doc, some cry.  They call me their ‘savior.’ They give me tips all the time,” he said.  Smiling ear-to-ear, I can see that Ismael was very proud of the work.

Unfortunately, Ismael had chronic nose bleeds.  Every time he had exposure to hot and humid weather, then bleeding was sure to follow.

After pinching it for 10 minutes, he came to me for his routine cauterization.  This time, however, it did not stop. Without any cocaine or neosynephrine, I  had to use a balloon (rhino rocket).

Not the most comfortable thing to have in a nostril; But, it did the trick.  He was fine and back on the road the next day.

 

I hope this helps

 

DR

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