Nosebleed Classification and external resources
Nosebleed as a result of fracture through a rugby union impact. A bone fracture (sometimes abbreviated # or Fx or Fx) is a medical condition in which a Bone is cracked or broken Overview See also Playing rugby union A rugby union match lasts for 80 minutes (plus stoppage time with a short
ICD-10	R04.0
ICD-9	784.7
DiseasesDB	18327
eMedicine	emerg/806  ent/701, ped/1618
MeSH	C08.460.261

Epistaxis (or a nosebleed in plain English) is the relatively common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings R00-R69 - Symptoms and Signs (R00-R09 Circulatory and Respiratory systems ( Abnormalities of Heart beat The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Plain English (sometimes referred to more broadly as Plain language) is a communication style that focuses on considering the audience's needs when writing Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Anatomically a nose is a protuberance in Vertebrates that houses the Nostrils or nares which admit and expel air for respiration in conjunction with the There are two types: anterior (the most common), and posterior (less common, more likely to require medical attention). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. The nasolacrimal duct (sometimes called tear ducts) carries Tears from the Lacrimal sac into the Nasal cavity. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort It accounts for only 0. 001% of all deaths in the U. S.

Contents 1 Etiology 1.1 Local factors 1.2 Systemic factors 2 Pathophysiology 3 Treatment 4 Notes 5 See also 6 External links

Etiology

The cause of nosebleeds can generally be divided into two categories, local and systemic factors, although it should be remembered that a significant number of nosebleeds occur with no obvious cause.

Local factors

• Anatomical deformities, such as septal spurs or Osler-Weber-Rendu Syndrome
• Chemical inhalant
• Inflammatory reaction (eg. In Medicine, hereditary hemorrhagic telangiectasia (HHT also known as Osler - Weber -Rendu syndrome, is an Autosomal dominant acute respiratory tract infections, chronic sinusitis, allergic rhinitis and environmental irritants)
• Foreign bodies
• Intranasal tumors (Nasopharyngeal carcinoma in adult, and nasopharyngeal angiofibroma in adolescent males)
• Nasal prong O₂ which tends to dry the nasal mucosa
• Nasal sprays, particularly prolonged or improper use of nasal steroids
• Surgery (such as septoplasty and endoscopic sinus surgery)
• Trauma (usually a sharp blow to the face)
• Nose-picking
• Low relative humidity of air breathed occurring especially during winter seasons. In Physiology, a foreign body (Latin corpus alienum) is any object originating outside the body Nasopharyngeal carcinoma (NPC is a Cancer originating in the Nasopharynx, the uppermost region of the Pharynx or "throat" where the nasal Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma is a histologically Benign but locally aggressive vascular tumor that grows in the back of the Treatment of physical trauma is described here and in First aid. Nose-picking, or rhinotillexis ( Greek, rhino "nose" + tillexis "habit of picking" is the act of extracting mucus
• Otic barotrauma from descent in aircraft or scuba diving.

Systemic factors

• Drugs - Aspirin, Fexofenadine/Allegra/Telfast, warfarin, ibuprofen, clopidogrel, isotretinoin, desmopressin and others
• Alcohol (due to vasodilation)
• Allergies
• Blood dyscrasias
• Heart failure (due to an increase in venous pressure)
• Hematological malignancy
• Hypertension
• Infectious diseases
• Narcotics, particularly insufflated cocaine
• Pregnancy
• Vascular disorders

Pathophysiology

Nosebleeds are due to the rupture of a blood vessel within the richly perfused nasal mucosa . Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Fexofenadine hydrochloride (brand names include Allegra and Telfast) is an Antihistamine drug used in the treatment of Hayfever Fexofenadine hydrochloride (brand names include Allegra and Telfast) is an Antihistamine drug used in the treatment of Hayfever Warfarin (also known under the brand names Coumadin, Jantoven, Marevan, and Waran) is an Anticoagulant. Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal Clopidogrel is a potent oral antiplatelet agent often used in the treatment of Coronary artery disease, Peripheral vascular disease, and Cerebrovascular Isotretinoin ( INN) (aɪsoʊtrɨˈtɪnoʊɨn or /ˌaɪsoʊtrɨˈtɪnoʊɨn/ is a Medication used for the treatment of severe acne. Drunkenness or inebriation is the state of being intoxicated by consumption of Alcoholic beverages to a degree that mental and physical faculties are noticeably Allergy is a disorder of the Immune system often also referred to as Atopy. Dyscrasia, is a concept from Ancient Greek Medicine with the word "dyskrasia" meaning bad mixture Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Hematological malignancies are the types of Cancer that affect Blood, Bone marrow, and Lymph nodes As the three are intimately connected through Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic The term narcotic (ναρκωτικός is believed to have been coined by the Greek physician Galen to refer to agents that benumb or deaden causing loss Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Rupture may be spontaneous or initiated by trauma. An increase in blood pressure (eg due to general hypertension) or local blood flow (for example following a cold or infection) will increase the likelihood of a spontaneous nosebleed. Anticoagulant medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. The elderly are also more prone to prolonged nose bleeds as their blood vessels are less able to constrict and control the bleeding. The vast majority of nose bleeds occur in the anterior (front) part of the nose from the nasal septum. This area is richly endowed with blood vessels (Kiesselbach's plexus). Kiesselbach's area, also Kiesselbach's plexus and Little's area, is a region in the anteroinferior part of the Nasal septum, where the following arteries This region is also known as Little's area. Kiesselbach's area, also Kiesselbach's plexus and Little's area, is a region in the anteroinferior part of the Nasal septum, where the following arteries Bleeding further back in the nose is known as a posterior bleed and is usually due to rupture of the sphenopalatine artery or one of its branches. The sphenopalatine artery ( nasopalatine artery) is an Artery of the head commonly known as the artery of epistaxis. Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth.

Treatment

The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure applied by pinching the soft fleshy part of the nose. Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Emergency bleeding control is the steps or actions taken to control Bleeding from a Patient who has suffered a Traumatic injury or who has a medical condition This applies pressure to Little's area, the source of the majority of nose bleeds and promotes clotting. Kiesselbach's area, also Kiesselbach's plexus and Little's area, is a region in the anteroinferior part of the Nasal septum, where the following arteries Pressure should be firm and be applied for at least 10 minutes while keeping the head in the neutral position and spitting out any blood which flows into the mouth. There is no benefit to pinching the bridge of the nose or to tilting the head backwards or forwards. Swallowing excess blood can irritate the stomach and cause vomiting. Local application of an ice pack to the forehead or back of the neck or sucking an ice cube has seen widespread practice, but has been shown to not have any statistically significant effects on nasal mucosal blood flow. ^[1]. In the past, it was commonly thought that the ice would help by promoting constriction of local blood vessels and thus reducing blood flow to slow down the bleed. Do not pack the nose with tissues or gauze. ^[2]

The local application of a vasoconstrictive agent has been shown to reduce the bleeding time in benign cases of epistaxis. The drugs oxymetazoline or phenylephrine are widely available in over-the-counter nasal sprays for the treatment of allergic rhinitis, and may be used for this purpose. Oxymetazoline is a selective alpha-1 agonist and partial alpha-2 agonist Topical decongestant, used in the form of Oxymetazoline Hydrochloride, in products such Phenylephrine or Neo-Synephrine is an α1-adrenergic receptor Agonist used primarily as a Decongestant, as an agent to dilate the Hay Fever is a comic play written by Noel Coward in 1924 and first produced in 1925 with Marie Tempest as the first Judith Bliss ^[3]

Other products available promote coagulation include Coalgan (in Europe) or NasalCEASE (in the US). These are a calcium alginate mesh that is inserted in the nasal cavity to accelerate coagulation.

If these simple measures do not work then medical intervention may be needed to stop bleeding, possibly by an otolaryngologist (ENT doctor). Otolaryngology is the branch of Medicine that specializes in the diagnosis and treatment of Ear, Nose, Throat, and head and neck disorders In the first instance this can take the form of chemical cautery of any bleeding vessels or packing of the nose with ribbon gauze or an absorbent dressing (called Anterior nasal packing). Such procedures are best carried out by a medical professional. Chemical cauterisation is most commonly conducted using local application of silver nitrate compound to any visible bleeding vessel. This is a painful procedure and the nasal mucosa should be anaesthetised first, preferably with the addition of topical adrenaline to further reduce bleeding. If bleeding is still uncontrolled or no focal bleeding point is visible then the nasal cavity should be packed with a sterile dressing, which by applying pressure to the nasal mucosa will tamponade the bleeding point. Ongoing bleeding despite good nasal packing is a surgical emergency and can be treated by endoscopic evaluation of the nasal cavity under general anaesthesia to identify an elusive bleeding point or to directly ligate (tie off) the blood vessels supplying the nose. These blood vessels include the sphenopalatine, anterior and posterior ethmoidal arteries. More rarely the maxillary or external carotid artery can be ligated. The bleeding can also be stopped by intra-arterial embolization using a catheter placed in the groin and threaded up the aorta to the bleeding vessel by an interventional radiologist. Continued bleeding may be an indication of more serious underlying conditions. ^[4]

Chronic epistaxis resulting from a dry nasal mucosa can be treated by spraying saline in the nose three times per day, lubricating the nose with ointment/creams like vasoline and installing a humidifer in the bedroom. In Medicine, saline (also saline solution) is a general term referring to a sterile solution of Sodium chloride (table Salt) in water

Application of a topical antibiotic ointment to the nasal mucosa has been shown to be an effective treatment for recurrent epistaxis. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa ^[5] One study found it to be as effective as nasal cautery in the prevention of recurrent epistaxis in patients without active bleeding at the time of treatment (both had a success rate of approximately 50 percent. )^[6]

Nosebleeds are rarely dangerous unless prolonged and heavy. Nevertheless they should not be underestimated by medical staff. Particularly in posterior bleeds a great deal of blood may be swallowed and thus blood loss underestimated. The elderly and those with co-existing morbidities, particularly of blood clotting should be closely monitored for signs of shock.

Recurrent nosebleeds may cause anemia due to iron deficiency. Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative

Notes

See also

• Kiesselbach's plexus
• Nosebleed section

External links

• National Library of Medicine - Describes causes, solutions, and prevention of nosebleeds

Kiesselbach's area, also Kiesselbach's plexus and Little's area, is a region in the anteroinferior part of the Nasal septum, where the following arteries The phrase nosebleed section is applied Tongue-in-cheek to those seats of a public arena usually an athletic Stadium or Gymnasium that are highest

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