Epistaxis
It was the final year of my M.B.B.S and I was sleeping in my hostel room, when I received a phone call from my friend who was doing engineering. I could feel the terror when he said, “Buddy, I’m bleeding through my nose. Will something happen to me?” He had arrived in Ooty as part of a project. I told him to sit down on a chair, bend his head forward and press on his nose for ten to fifteen minutes using his thumb and index finger, while breathing through his mouth. I assured him that everything would be fine and called him again after half an hour. The bleeding had stopped by then. I have had repeated experiences of patients who were bleeding through their nose while working in the casualty section. Over the years, I have had the occasion to handle several patients who have come to the casualty with the same issue. They rushed in with their bleeding nostrils covered using cotton or pieces of cloths. This condition is seen more in men compared to women and that too in males below the age of ten and above fifty. We can divide “epistaxis” or ‘bleeding through nose’ into two categories -bleeding through the front of the nose and bleeding through the back of the nose. At the edge of the nose ridge, there is a part were tiny blood vessels meet called the “Little’s Area”. Therefore, even minor injuries in this area can result in bleeding. Bleeding from the back of the nose is more serious and difficult to contain. Reasons of bleeding could vary from minor injuries to very serious illnesses. The following are amongst the common reasons.
Injuries due to falling or similar external traumas.
Injuries caused due to inserting external objects. For ex, children can hurt themselves by inserting pencils, toy parts or other small objects while playing.
Common cold, infections in the respiratory tract, sinusitis.
Moving to an area of low atmospheric pressure ( this is what happened to that friend who came to Ooty)
High blood pressure.
Variations in the shape and structure of the nose or blood vessels in the nose.
Formation of small lumps/ cancer could cause bleeding through the nose.
Surgeries in the nose.
Alcohol consumption.
Use of drugs like “Aspirin”
Liver diseases.
Heart diseases
Hormonal fluctuations during pregnancy.
Deficiency of vitamin C, K etc.
Now let’s move to the basic first aid given in the case of nose-bleeding. Applying external pressure helps in containing the bleeding. As mentioned earlier, applying pressure on the ‘Little’s Area’ using thumb and index finger will help to stop the bleeding. Remember to bend the patient’s head a little forward, so as to avoid vomiting and loss of breath due to blood flowing into the stomach and blocking the respiratory tract. There are precautions to be considered in case of epistaxis. One among this is to avoid strongly blowing your nose. It is natural for the patient to feel an urge to blow their nose as it gets filled with blood. But it increases the blood flow, therefore, avoid blowing your nose. Also, avoid bending your head backwards. This can result in the blood flowing down the respiratory tract and into the stomach causing breathing difficulties, stomach ache and vomiting. Therefore, it is ideal to sit erect and bend your head forward. Drugs like “oxymetazoline” and “Phenylephrine” can help in the contraction of blood vessels, thus restricting blood flow. In cases were none of these methods work, techniques like ‘cauterization’ and ‘Packing’ are performed. ‘Cauterization’ is the process of heating the bleeding area using silver nitrate. ‘Packing’ is of two types- performed in the posterior and anterior sides of the nose, which is basically stuffing the bleeding area with cotton. If these techniques also fail in curbing the bleeding, endoscopy is done with the help of anaesthesia and the bleeding is treated as required.