Epistaxis ( nosebleed ) - Causes, Symptoms and Treatment .MF .
Nosebleeds - discharge of blood from the outside of the nasal passages or through the nasal passages.The nose is part of the body, which is very rich in blood vessels (capillaries) and is in a vulnerable position on the face.As a result, any trauma a person can cause bleeding from the nose.
Nosebleeds may be negligible, in the form of drops, and abundant (profuse), short and long, single and multiple, recurring at different intervals.Nosebleeds can occur spontaneously or under external influence (injury).The most common source of bleeding becomes "Kisselbaha zone" - rich vessels portion of the mucous membrane of the nasal septum in front of her department.
Causes of epistaxis, not caused by disease:
Nosebleeds can occur spontaneously when the nasal membranes dry out, for example, in dry climates or during the winter months when the air is dry and warm from household heaters.People become more sensitive if they are taking medications that interfere with normal blood clotting (Coumadin, warfarin, aspi
1. Prolonged exposure to the sun.
2. The sharp change in the partial pressure of oxygen in the air and atmospheric pressure (from pilots, divers, climbers).
3. Physical and mental stress.
4. Side effects of certain medications (eg, nonsteroidal anti-inflammatory drugs, local hormonal drugs, anticoagulant agents: heparin, fenilina).
5. Alcohol abuse (there is vasodilation and increased permeability of vascular wall).
6. children and adolescents (children capillaries close to the surface, and a thin mucosa, and even a minor injury can cause it to bleed; adolescents to bleeding from the nose predisposes hormonal changes).
diseases, leading to nosebleeds
Causes of nosebleeds can be both general and local.Common causes include diseases in which there is a blood pressure increase, disturbances in systems clotting and blood protivosvёrtyvaniya, increased vascular permeability (hemorrhagic diathesis, arteriosclerosis, leukemia, hypertension, Osler's disease - Osler, liver cirrhosis, typhoid fever, scarlet fever, influenza, brucellosis, malaria, and hypovitaminosis, especially lack of vitamin C, etc.).
Nosebleeds occur in disorders of the menstrual cycle (bleeding vicar), in case of poisoning, septic conditions, intoxication, increased intracranial pressure.
Local causes nosebleeds are injury to the nose, dry mucous membranes, especially the anterior nasal cavity, benign and malignant neoplastic processes of the nasal cavity and paranasal sinuses, the collapse of tuberculous or syphilitic inflammatory formations of the nasal mucosa, penetration of foreign bodies into the cavitynose, and others.
Contributing factors to nosebleeds can be acute and chronic rhinitis, adenoids, and sometimes the curvature of the nasal septum, as well as a sharp blowing the nose, sneezing, coughing.
general condition of the patient, blood pressure, pulse rate, the state of the cardiovascular system in the nosebleeds depend on the volume and rate of blood loss. rapid and profuse bleeding sharply aggravates the patient's condition, up to the collapse and cardiac arrest.
Bow bleeding mild happens much more often and usually do not pose an immediate danger to the life of the patient.Sometimes this bleeding stops spontaneously, but it can often take a long time, leading to a drop in heart rate, general weakness, anemia secondary occurrence.
When nosebleeds moderate observed not only local, but also general symptoms: skin pallor, pulse rate 90 - 100 beats per minute, systolic blood pressure snizheaetsya to 90 - 100 mm.Hg.Art., hematocrit decreases.
When severe epistaxis heavy general condition of patients, heart rate accelerated to 110 - 120 beats per minute or more, the systolic blood pressure is reduced to 80 mm.Hg.Art.and below.By the end of the first day there is a drop in hemoglobin.
What analyzes to hand with epistaxis
Diagnosis of the bleeding does not cause difficulties.In severe cases, it is difficult to determine the specific location of bleeding.
anterior rhinoscopy to determine in the anterior part of the nasal septum bleeding source (Kisselbaha area - distant 1 cm from the entrance to the nasal cavity mucous membrane is thinned with translucent vessels).Bleeding in this zone is not abundant.Profuse epistaxis most often from the back of the nose, which is associated with the location in this area a large number of large vessels.To diagnose the overall condition of the body and the condition of the hemostatic function of blood is carried out laboratory tests.
Laboratory examination methods
1. Complete blood count : decrease in the number of platelets may be anemia (decrease in the number of red blood cells and hemoglobin).
2. Coagulation : PTI (prothrombin index) is reduced, the prothrombin time is slowed down, APTT (activated partial thromboplastin time) increases, the amount of fibrinogen decreases, adhesion, platelet aggregation and retraction are reduced during deceleration of blood coagulation function.
3. Biochemical analysis of blood : determine blood electrolytes.
If the bleeding is caused by a disease, it is necessary to carry out specialized tests.
Treatment of epistaxis
Therapeutic tactics in each case is individual and depends on the nature of nasal bleeding, blood loss volume, the data of the clinical analysis of blood, coagulation, blood biochemical studies of the patient's general status indicators.
Therapeutic activities include local hemostatic (hemostatics) therapy and overall treatment is applied to restore the volume of the circulating blood to the required level, drug effects on the blood clotting system, maintenance of the vital functions of the body (the activity of the cardiovascular, urinary, respiratory, and others. Systems), elimination of the causes of epistaxis.
For small bleedings use finger pressing the nose wing.To improve the efficiency techniques previously can be introduced into the nasal vestibule small cotton ball, it may be dry or impregnated with 3% hydrogen peroxide solution.On the bridge of the nose in the cold for an hour is used for 3 - 5 minutes to rest for 3 - 5 minutes.
patient must sit with his head tilted forward or lie down with his head turned to one side.You can not deny the patient's head back, as in this situation the blood will flow down the rear surface of the pharynx.
Very often, when it begins to leak blood from the nose, many reflexively throws back her head back.The obvious delusion that if the blood does not flow from his nostrils, then there is no bleeding.The bleeding will continue, but not "outside" but inside, in the stomach.At least it will cause discomfort.Blood entering the compound with hydrochloric acid of the stomach, forming an irritating compound - hematin hydrochloride.Often it is so irritating to the stomach wall, which causes vomiting.A muscle strain and neck chest abdomen vomiting may further aggravate bleeding from the nose.
Upon termination of this makes sense to treat the bleeding site of bleeding, for example, 50% silver nitrate solution.
With the ineffectiveness of finger pressing the nose or wing with significant epistaxis most commonly used front tamponade of the nasal cavity, but it is carried out in the outpatient, rather than at home.Turundy administered to the nasal cavity in stages, starting from the bottom of the nasal passages.Turundy from the nasal cavity are removed more often in a day.If any of the hemostatic sponges may be in the nasal cavity to 2 - 5 days, with daily by injection impregnated swabs solution hemostatics (eg, 40% solution of aminocaproic acid), an antibiotic solution, etc.
front tamponade may not always be effective Prix.moderate and heavy nasal bleeding , so often, without losing any time, hold the back of the nasal cavity tamponade.For its implementation requires a sterile swab, which overtighten three strong strands that serve to secure and retrieve the swab.Following back tamponade carried forward.Depending on the characteristics of epistaxis tampons are removed, usually by 2 - 3 days in some cases it is in the nasopharynx of up to 10 days.Sometimes, when massive bleeding from the back areas of the nasal cavity, where it is difficult to identify the source of bleeding, it is necessary to carry out the back of the nose tamponade both halves.Perhaps the introduction of a large swab densely fill the whole nasopharynx.During the back tamponade prophylactic antibiotics should be prescribed and tools that reduce swelling, which helps prevent the occurrence of complications such as tubo-otitis, acute otitis media, acute pharyngitis.
The front and back of the nose tamponade should be performed by a health worker.Therefore, if the finger pressing the nose wing proved to be ineffective, it is necessary to call an ambulance.
In those situations, when the front and rear tamponade ineffective conduct of surgical treatment is necessary.
from general measures apply direct coagulants (locally) with mild to moderate nasal bleeding: hemostatic sponge, stimulants adhesively-aggregation of platelets (Dicynonum), the drug reduces vascular permeability (ascorbic acid, Ascorutinum), hemostatic agents (epsilonaminokapronovaya acid,ovomin), indirect coagulants (menadione).When
nosebleeds caused by any disease, its treatment is carried out.For this purpose, can be assigned to the preparations reducing pressure, antianginal, anti-bacterial and anti-anxiety drugs.
Minor bleeding from the front of the nose does not represent a great danger.Excessive and frequent bleedings from the nasal cavity can result in the development of secondary anemia.
To what doctor to contact with nosebleeds
Emergency doctor.Can pnadobitsya assistance following physicians: audiologist, internist, hematologist.
therapists Kletkina Y.