Nasal bleeding( blood from the nose) - Causes, symptoms and treatment. MF.

Nasal bleeding - allocation of blood from the external nasal passages or through the nasopharynx. 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 to the face can cause bleeding from the nose.

Nasal bleeding may be minor, in the form of drops, and abundant( profuse), short-term and prolonged, single and multiple, recurring at various intervals. Nasal bleeding can occur spontaneously or with external effects( trauma).Most often the source of bleeding is the "Kisselbach zone" - a vascular rich area of ​​the nasal septum mucosa in its anterior part.

Nasal bleeding causes not caused by the disease:

Nasal bleeding can occur spontaneously when the nasal membranes dry up, for example, in dry climates or in the winter months when the air is dry and warm from household heaters. People become more sensitive if they take medications that interfere with normal blood clotting( Coumadin, warfarin, aspirin or any anti-inflammatory drug).Predispose to epistaxis:

1. Prolonged exposure to the sun.
2. A sharp change in the partial pressure of oxygen in the air and atmospheric pressure( for pilots, divers, climbers).
3. Physical and mental stress.
4. Side effects of certain medications( eg, non-steroidal anti-inflammatory drugs, local hormonal drugs, anticoagulant drugs: heparin, phenylin).
5. Alcohol abuse( vasodilatation and vascular wall permeability increase).
6. Children and adolescents( in children, the capillaries are located close to the surface, and the mucous membrane is thin, and even minor injuries can lead to bleeding, in teenagers, hormonal reorganization predisposes to bleeding from the nose).

Diseases leading to nasal bleeding

Causes of epistaxis can be either general or local. Common causes can be diseases in which there is an increase in blood pressure, disorders in blood clotting and anticoagulation systems, increased vascular wall permeability( hemorrhagic diathesis, atherosclerosis, leukemia, hypertension, Osler-Randu disease, cirrhosis, typhoid fever, scarlet fever, influenza, brucellosis, malaria, as well as hypovitaminosis, especially the lack of vitamin C, etc.).

Nasal bleeding occurs in disorders of the menstrual cycle( bleeding), poisoning, septic states, intoxications, increased intracranial pressure.

Local nasal bleeding causes nasal trauma, dryness of the mucous membrane, especially the anterior sections of the nasal cavity, benign and malignant tumor processes of the nasal cavity and its adnexal sinuses, the disintegration of tubercular or syphilitic inflammatory formations of the nasal mucosa, the ingress of foreign bodies into the nasal cavityetc.

Predisposing causes for epistaxis can be acute and chronic runny nose, adenoids, sometimes curvatures of the nasal septum, as well as a sharp barking, sneezing, coughing.

General condition of the patient, blood pressure, pulse rate, cardiovascular system with nasal bleeding depends on the volume and rate of blood loss. Rapid and copious bleeding drastically aggravates the patient's condition, including collapse and cardiac arrest.

nasal bleeding is much more frequent and usually does not pose an immediate danger to the life of the patient. Sometimes such bleeding stops spontaneously, but can often last a long time, leading to a drop in the pulse, general weakness, the occurrence of secondary anemia.

With , moderate to severe nosebleeds show not only local, but also general symptoms: blushing of the face skin, the pulse speeds up to 90 - 100 beats per minute, systolic blood pressure is reduced to 90 - 100 mm.gt;the hematocrit index decreases.

With severe nasal bleeding , the general condition of patients is severe, the pulse is accelerated to 110 - 120 beats per minute or more, systolic blood pressure is reduced to 80 mm.gt;Art.and below. By the end of the first day there is a drop in hemoglobin.

What tests to take with nosebleeds

Diagnosis of the bleeding itself does not cause difficulties. In severe cases it can be difficult to determine the specific place of bleeding.

Anterior rhinoscopy allows you to determine the source of bleeding in the anterior part of the nasal septum( Kisselbach zone - a thin, mucosal membrane with radiating vessels removed 1 cm from the entrance to the nasal cavity).The bleeding of this zone is not abundant. Profuse nasal bleeding most often comes from the back of the nose, which is associated with the location in this area of ​​a large number of large vessels. To diagnose the general condition of the body and the state of the hemostatic function of the blood, a laboratory examination is carried out.

Laboratory testing methods

1. General blood analysis : decrease in the number of platelets, there may be anemia( decrease in the number of red blood cells and hemoglobin).
2. Coagulogram : PTI( prothrombin index) decreases, prothrombin time slows down, APTT( activated partial thromboplastin time) increases, fibrinogen decreases, adhesion, aggregation and retraction of platelets decrease with decreasing blood coagulation function.
3. Biochemical blood test : determine blood electrolytes.

If bleeding is caused by a disease, then a specialized examination is necessary.

Treatment of nasal bleeding

The therapeutic tactics in each case are individual and depend on the nature of nosebleeds, the amount of blood loss, the data of the clinical blood test, coagulogram, biochemical blood tests, and the indicators of the general condition of the patient.

Therapeutic measures include local hemostatic( blood-resuscitating) therapy and general treatment, used to restore the volume of circulating blood to the required level, drug exposure to the blood clotting system, maintenance of vital body functions( cardiovascular, urinary, respiratory, etc. systems), elimination of the causes of nosebleeds.

For minor bleeding, is applied with a finger pressure on the wing of the nose. To increase the effectiveness of the technique, you can first introduce a small cotton swab on the threshold of the nose, it can be dry or impregnated with a 3% solution of hydrogen peroxide. On the bridge of the nose for an hour, the cold is applied for 3 to 5 minutes with rest for 3 to 5 minutes.

The patient should sit with his head tilted forward or lie with his head turned to his side. You can not turn the patient's head back, since in this position the blood will flow down the back surface of the pharynx.

Very often, when the blood begins to flow from the nose, many reflexively tilt the head back. Obvious self-deception, that if the blood does not flow from the nostrils, then there is no bleeding. Bleeding will continue, but not "out" but inside, into the stomach. This will at least cause unpleasant feelings. Blood, entering into a connection with hydrochloric acid of the stomach, forms an irritating compound - hydrochloric acid hematin. Often it is so irritating to the walls of the stomach that it causes vomiting. And the tension of the muscles of the abdomen of the chest and neck during vomiting can further aggravate the bleeding from the nose.

After the termination of such bleeding, it makes sense to treat the bleeding site, for example, with a 50% solution of silver nitrate.

In case of ineffectiveness of the finger pressing of the nose wing or with a significant nosebleed , the front tamponade of the nasal cavity is most often used, but it is carried out already in a polyclinic rather than at home. Turundu is injected into the nasal cavity in stages, starting from the lower nasal passages. Turundas from the nasal cavity are removed most often in a day. If there is a violation of hemostasis, tampons can stay in the nasal cavity for up to 2 to 5 days, while daily injections are impregnated with tampons with a solution of hemostatics( eg 40% aminocaproic acid solution), antibiotic solution, etc.

Anterior tamponade can not always be effective with moderate severity and severe nasal bleeding , so often, without wasting time, spend the posterior tamponade of the nasal cavity. For its implementation, a sterile swab is needed, which is pulled by three strong threads, which serve to secure and remove the tampon. Following the posterior tamponade, hold the anterior one. Depending on the features of epistaxis, swabs are removed, most often on days 2 to 3, in some cases it is in the nasopharynx up to 10 days. Sometimes, with massive bleeding from the back of the nasal cavity, when it is difficult to identify the source of bleeding, it is necessary to carry out a back tamponade of both halves of the nose. It is possible to introduce a large tampon that fills the entire nasopharynx densely. When carrying out a back tamponade for preventive purposes, it is necessary to prescribe antibacterial drugs and agents that reduce edema, which helps to prevent the occurrence of such complications as tubo-otitis, acute otitis media, acute pharyngitis.

The front and back tamponades of the nose should only be performed by a medical professional. Therefore, if the finger compression of the wing of the nose was ineffective, you need to call an ambulance.

In situations where the front and back tamponades are ineffective, surgical treatment is necessary.

Of the general measures for mild to moderate nasal bleeding, direct coagulants( topically) are used: hemostatic sponges, stimulants of adhesive-aggregation function of platelets( dicinone), drugs reducing vascular wall permeability( ascorbic acid, ascorutin), haemostatic drugs( epsilonaminocaproic acid, ovomin), indirect coagulants( vicasol).
With nasal bleeding caused by a disease, it is treated. For this purpose, drugs that reduce blood pressure, antianginal, antibacterial and sedative drugs may be prescribed.

Complications of nasal bleeding

Minor bleeding from the forelegs of the nose is not a serious danger. Abundant and frequent bleeding from the nasal cavity can lead to the development of secondary anemia.

Which doctor should I use for nasal bleeding

An ambulance doctor. The following doctors may need help: an otolaryngologist, a therapist, a hematologist.

Physician therapist Kletkina Yu. V.