Nosebleed Diagnosis and Treatment?

Nosebleed is a very common disease in clinical practice. There are many reasons for nosebleed. Nosebleed may be caused by nasal diseases or systemic diseases. Generally, no matter what causes the nosebleed, everyone needs to pay attention to it, because there may be some hidden disease. Early examination is beneficial for treatment, which can avoid missing the best treatment time for the disease.

Blood flowing out of the anterior or posterior nostril is called epistaxis, also known as nosebleed. Epistaxis is a common emergency. Can occur at any age. The severity of bleeding is related to the bleeding speed and amount. Sometimes the bleeding is not much, but the patient panics and becomes nervous when seeing blood flowing out of the nostrils, which can aggravate the condition.

1. Causes: Common causes can be divided into two categories: local and systemic.

1. Local causes

Among the local causes, nose picking is the most common. From an anatomical point of view, the mucosa in the bleeding-prone area of ​​the nasal septum is thin, rich in blood vessels, superficial, and closely attached to the underlying cartilage. It provides poor cushioning and protection for the blood vessels when traumatized, and the blood vessels in this area also have poor self-contraction ability. From the perspective of the external environment, when the temperature is dry or the patient has a high fever, the nasal mucosa will be dry, uncomfortable and have many crusts, especially in patients with atrophic rhinitis and sicca rhinitis, the nasal mucosa will be even drier. If you pick your nose under these circumstances, it is very easy to damage the nasal septum mucosa and cause epistaxis. Common local causes of epistaxis include nasal septum deviation, benign hemorrhagic tumors in the nasal cavity, sinuses or nasopharynx, or malignant tumors invading and destroying local blood vessels, which can all cause bleeding.

2. Systemic causes

Blood diseases, hypertension, arteriosclerosis, etc. can cause nosebleeds. Liver and spleen diseases, nutritional disorders, vitamin deficiencies, low calcium, etc. can also cause nosebleeds.

2. Clinical manifestations

The clinical manifestations are diverse. In some cases, blood flows out of the anterior nostril and can be visually observed. In some cases, bleeding flows from the posterior nostril into the pharynx. In some cases, bleeding occurs from the anterior and posterior nostrils at the same time. Most patients have unilateral nasal bleeding, while a few have bilateral nasal bleeding. Sometimes, bleeding from one side of the nose can flow through the nasopharynx to the other side of the nose, resulting in simultaneous bleeding in both sides of the nose. When the amount of bleeding is small, there is only blood in the mucus. When the amount of bleeding is heavy, blood will flow out of the nasal cavity on both sides. If a patient has a nosebleed while lying down with the head tilted back, most of the blood may flow backwards into the pharynx and be swallowed, then vomited out, with a small portion spit out through the mouth, resulting in bleeding from the mouth and nose at the same time. When the amount of bleeding is small, the patient has no obvious discomfort. When the amount of bleeding is large and the bleeding speed is fast, the patient may have shock or pre-shock symptoms such as palpitations, pale complexion, thirst, cold sweats, and irritability.

3. Diagnosis

1. Ask about medical history and bleeding in detail

Confirm that the bleeding originates from the nasal cavity or adjacent tissues and exclude hemoptysis and hematemesis.

2. Determine the bleeding site

Combine anterior rhinoscopy, nasal endoscopy and/or CT and MRI examinations to determine the location of the disease.

3. Blood test

A routine blood test is essential for patients with heavy bleeding and suspected blood disease. Patients who are taking anticoagulants or are suspected of having abnormal coagulation function need to have their coagulation function checked.

4. Estimation of bleeding volume

Assess the patient's current circulatory system condition and whether he or she is in hemorrhagic shock; consult with relevant departments if necessary. The amount of bleeding is comprehensively judged based on each bleeding situation and number of episodes, the patient's blood pressure, pulse, general condition and laboratory tests. When the amount of blood loss reaches 500ml, symptoms such as dizziness, thirst, fatigue, and pale complexion may appear; when the amount of blood loss reaches 500-1000ml, sweating, decreased blood pressure, and rapid and weak pulse may appear; if the systolic blood pressure is lower than 80mmhg, it indicates that about 1/4 of the blood volume has been lost.

4. Differential Diagnosis

1. Hemoptysis

It is the coughing up of blood through the mouth after bleeding in the larynx, trachea, bronchi and lungs. It is common in pulmonary tuberculosis, bronchiectasis, lung cancer, lung abscess and pulmonary congestion caused by heart disease. It can be identified based on the patient's medical history, physical signs and auxiliary examinations.

2. Vomiting blood

Vomiting blood is one of the main manifestations of upper gastrointestinal bleeding. When a large amount of blood is vomited, blood may flow out from the mouth and nasal cavity, often accompanied by other symptoms of gastrointestinal diseases. A systemic physical examination may show positive signs, which can be used for identification.

5. Treatment

As long as the treatment measures are appropriate, nosebleeds can be stopped.

1. Comfort and check

Comfort the patient, tell him/her not to be nervous, and carefully examine the patient to determine the exact site of bleeding.

2. Avoid swallowing blood

Instruct the patient to spit out as much blood as possible to prevent irritation of the stomach and vomiting after swallowing, which may aggravate epistaxis.

3. Self-hemostasis

Use the thumb and index finger of one hand to pinch the base of the nostrils on both sides, press on the front and lower part of the nasal septum, and at the same time tilt your head slightly forward and breathe through your mouth. Pinch like this for a few minutes, and the bleeding will usually stop. If you have sterilized cotton on hand, you can roll it into a 2-inch long roll and put it into the nostril on the bleeding side. Then pinch it as mentioned above. The effect will be better. If you use a cool towel or ice bag to cool the back of the nose, root of the nose, back of the neck and forehead at the same time, it can speed up the bleeding process.

4. Seek medical treatment for those with severe symptoms

If the bleeding cannot be stopped after the above treatment, you should go to the hospital for emergency treatment. You can first try to pack the hemostatic sponge. Put a little Yunnan Baiyao on the gelatin sponge, put it into the nasal cavity on the bleeding side, and press the nostril against the nasal septum. The bleeding will stop after 3 to 5 minutes. If there is no gelatin sponge, you can also put a cotton pad soaked in 1% ephedrine or a cotton pad dipped in hemostatic drug into the affected nasal cavity and press for a few minutes to stop the bleeding. When using the cotton pad, be careful not to leave it in place for too long to prevent secondary infection and further bleeding. While stopping the bleeding, the cause of the disease must also be treated. If the amount of bleeding is particularly heavy, blood and fluid replacement should be given to correct shock.