Nosebleed

Introduction

Epistaxis, or nosebleed, is a common presentation that is usually benign, self-limiting and spontaneous.

• It most commonly occurs in children aged 2-10 years, with peak incidence between 3 and 8 years of age.

Aetiology

The primary cause of epistaxis is minor trauma.

• Typical examples include falls, sports injuries or motor vehicle accidents.

Environmental factors such as changes in temperature and humidity can lead to mucosal drying and epithelial damage, increasing susceptibility to nosebleeds.

• Other contributing factors include exposure to chemicals and cigarette smoke.

Less common causes include liver disease [causing clotting factor deficiencies (II, VII, IX, X)], anatomic deformity and pathological changes such as benign or malignant tumours.

NOTE: Systemic medications (e.g. anticoagulants, antiplatelets and NSAIDs) and bleeding disorders (e.g. haemophilia) should also be ruled out.

Management

For an active nosebleed,

• Sit upright with the upper body tilted forward and the mouth open to minimize swallowing blood.
• Apply sustained compression to the soft part of the nose (just below the bony bridge) for at least 10 minutes without interruption.
• Encourage breathing through the mouth while pinching the nostrils.

Nose pinching is likely to resolve bleeding. However, if bleeding persists,

• Consider nasal cautery with a siler nitrate stick.
• If unavailable or unsuccessful, nasal packing may be required.

Summary

Nasal obstruction, shortness of breath, frequent nosebleeds and heavy blood loss are red flags that warrant immediate medical attention.

External Links

• NHS UK - Nosebleed
  
• Better Health Channel - Nosebleeds
  
• Cleveland Clinic - Nosebleed (Epistaxis)
  
• What to Do When Your Nose Bleeds, 2018