EPISTAXIS:TREATMENT

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For proper management and treatment of epistaxis, it is very important to know about the mode of onset,duration & frequency of bleeding,amount of blood loss,side of the nose from where bleeding is occurring,whether the bleeding is occurring from front[anterior] or back[posterior] part of the nose.

It is also imperative to know whether the individual presenting with epistaxis has any personal or family history of bleeding tendency.History of known medical conditions like hypertension,mitral valve disease,cirrhosis,nephritis,leukemia etc. and drug intake history like analgesics,anticoagulants like warfarin are also very important for proper management.

FIRST AID

In majority of the occasions,bleeding occurs from the little's area,which is located in anterior part of the nose.This can be easily controlled by by pinching the nose with thumb and index finger for about 5-10 minutes.Application of cold compress to the nose may also help by causing blood vessel constriction.

Cauterisation:This method is useful in anterior epistaxis.After applying local anaesthesia,the bleeding vessel is coagulated with bead of silver nitrate or with the help of electrocautery.

Anterior nasal packing:If bleeding from anterior part of the nose is profuse and/or the bleeding vessel is not visualised then anterior nasal packing may be done.This is usually done with ribbon gauze soaked in liquid paraffin.The pack is usually removed 24 hours after,if bleeding has stopped.If the pack is kept more than 24 hours,then oral antibiotics may be given.

Posterior nasal packing may be required in individuals bleeding posteriorly into the throat.

Posterior epistaxis can sometimes be dealt with endoscopic cautery .

Ligation of blood vessels:

If the bleeding is from the external carotid blood vessel system & the bleeding is not being controlled by conservative measures then in some instances ligation of the external carotid artery may be done.This is usually not done nowadays.in favour of embolisation or ligation of more peripheral branches.

Sometimes in cases of uncontrollable posterior epistaxis,ligation of the maxillary artery may be done.

In occasional instances of antero-superior bleeding,ligation of ethmoidal arteries may be required.

However ligation of blood vessels are required on rare occasions,as most of the episodes of epistaxis can be managed by conservative measures.

The immediate responsibility of an individual suffering from epistaxis & his/her family members ,is to compress the nose as mentioned above,apply some cold compress, and immedietely shift the individual to the nearest health centre.

Note of caution:In elderly individuals hypertension or rise in blood pressure is a fairly common cause of epistaxis.

also read:CAUSES OF EPISTAXIS

Please corroborate these informations with other reliable internet resources.For any more information on this,please consult with your doctor or may post your querry in the comment section.

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CAUSES OF EPISTAXIS

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Bleeding from inside the nose is called epistaxis .It can occur in any age group namely children,middle aged and elderly.Epistaxis is a very common cause of emergency visits.

In this post i'll briefly review the causes of epistaxis.

Trauma in the form of finger nail trauma,nose injury,fractures of middle third of the face or the base of the skull is a very common cause of epistaxis.

Infections like acute sinusitis,viral rhinitis, nasal diphtheria,atrophic rhinitis,tuberculosis,granulomatous lesions of the nose like rhinosporidiasis can also cause epistaxis.

Any neglected foreign body in the nose can also cause epistaxis.In certain situations organisms like maggots,leeches get implanted in the nose and cause epistaxis.

Epistaxis may also occur in atmospheric changes like high altitude,sudden decompression as seen in Caisson's disease.[I'll later post an article explaining caisson's disease]

Deviated nasal septum is also a very common cause of nose bleeding...

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Certain tumours of the nose and paranasal sinuses like haemangioma,papilloma[benign];carcinoma,sarcoma[malignant] can also present with
epistaxis.

Some systemic diseases can also be responsible for epistaxis.

CARDIOVASCULAR:hypertension,arteriosclerosis,mitral stenosis etc.

LIVER DISEASE:hepatic cirrhosis may occasionally cause nose bleeding due todeficiency of clotting factors like factor2,7,9,10.

Vicarious menstruation may also cause epistaxis.[nose bleeding at the time of menstruation]

For any more information on this,please consult your doctor or you may post the question in the comments section.

also read EPISTAXIS:TREATMENT

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