Nosebleeds Overview I am writing this article because there is little or no awareness about epistaxis (nose bleed) in children. My 9-year-old daughter had her first episode 4 years ago while on holidays in Spain. We put it down to excessive heat. This year it re-occurred, with episodes at least once a week, 3 times a day.
She’s seen our General Practitioner and has been placed on Bactroban Nasal Ointment.
Nosebleeds can be dramatic and frightening. Luckily, most nosebleeds are not serious and can be handled fairly easily. They are divided into 2 types, depending on whether the bleeding is coming from the anterior (front of the nose) or posterior (back of the nose).
Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually comes from a blood vessel at the very front part of the nose. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor.
Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually comes from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).
Frequency: In the US: Epistaxis occurs in 1 of every 7 people.
In the UK: No literature found about the statistics
Mortality/Morbidity: Mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states.
Increased morbidity is associated with nasal packing. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.
Sex: No sex predilection exists.
Age: Bimodal incidence exists, with peaks in those aged 2-10 years and 50-80 years.
Nosebleeds Symptoms Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the nostril on the affected side and overflow within the nasopharynx (the area inside the nose where the 2 nostrils converge), spilling into the other nostril to cause bleeding from both sides. Blood can also drip back into the throat or down into the stomach, causing a person to spit or even vomit blood.
Signs of excessive blood loss include dizziness, light-headedness, confusion, and fainting. Excessive blood loss from nosebleeds does not often occur.
Additional bleeding from other parts of the body, such as in the urine or bowels, or easy bruising may indicate an inability of the blood to clot. Additional bleeding or easy bruising is a sign of a more significant medical problem.
When to call the doctor Repeated episodes of nosebleeds
Additional bleeding from places other than the nose, such as in the urine or stool
Bruising easily
If you are on any blood-thinning medications, including aspirin or warfarin (Coumadin)
If you have any underlying disease that may affect your blood clotting, such as liver disease, kidney disease, or hemophilia (inability of blood to clot)
If you recently had chemotherapy.
Causes: Most cases of epistaxis do not have an easily identifiable cause.
Local trauma (ie, nose picking) is the most common cause, followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. A disturbance of normal nasal airflow, as occurs in a deviated nasal septum, may also be a cause of epistaxis.
Iatrogenic causes include nasogastric and nasotracheal intubation.
Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI).
Oral anticoagulants and coagulopathy due to splenomegaly, thrombocytopenia, platelet disorders,or AIDS-related conditions predispose to epistaxis.Epistaxis is more prevalent in dry climates and during cold weather.
Vascular abnormalities that contribute to epistaxis may include the following: Sclerotic vessels
Hereditary hemorrhagic telangiectasia
Arteriovenous malformation
Neoplasm
Septal perforation, deviation
Nosebleeds Treatment Self-Care at Home A small amount of bleeding from a nosebleed requires little intervention. A common scenario is when a person with a cold or a sinus infection blows his or her nose vigorously and notices some blood in the tissue. Avoiding any more vigorous nose blowing, sneezing, or nose picking is usually enough to keep the bleeding from getting worse.
How to stop a nosebleed Remain calm.
Sit up straight.
Lean your head forward. Tilting your head back will only cause you to swallow the blood.
Pinch the nostrils together with your thumb and index finger for 10 minutes. Have someone time you to make sure you do not release the nostrils any earlier.
Spit out any blood in your mouth. Swallowing it may make you vomit.
Further Outpatient Care: Patients discharged with anterior packing should receive follow-up care with an ENT specialist within 48-72 hours. Nasal packing increases the risk of sinusitis or toxic shock syndrome.
Patients discharged with nasal packing should be prescribed a penicillin or first-generation cephalosporin. Oral analgesics should also be prescribed.
Advise patients to avoid aspirin, aspirin-containing products, and NSAIDs.
Patients who take warfarin may generally continue their current regimen unchanged. Temporary discontinuation of warfarin or active reversal of coagulopathy is indicated only in cases of uncontrolled hemorrhage and supratherapeutic INR.
Give patients specific written follow-up instructions.