Epistaxis
Nosebleed, or epistaxis, may either be a primary disorder or occur secondary to another condition. Such bleeding in children generally originates in the anterior nasal septum and tends to be mild. In adults, such bleeding is most likely to originate in the posterior septum and can be severe. Epistaxis is twice as common in children as in adults.
Causes
Epistaxis usually follows trauma from external or internal causes: a blow to the nose, nose picking, or insertion of a foreign body. Less commonly, it follows polyps; acute or chronic infections, such as sinusitis or rhinitis, that cause congestion and eventual bleeding from capillary blood vessels; or inhalation of chemicals that irritate the nasal mucosa. It may also follow sudden mechanical decompression (caisson disease) and violent exercise.
Predisposing factors
Such factors include anticoagulant therapy, hypertension, chronic aspirin use, high altitudes and dry climates, sclerotic vessel disease, Hodgkin’s disease, neoplastic disorders, scurvy, vitamin K deficiency, rheumatic fever, blood dyscrasias (hemophilia, purpura, leukemia, and anemias), and hemorrhagic telangiectasia.
Signs and symptoms
Blood oozing from the nostrils usually originates in the anterior nose and is bright red. Blood from the back of the throat originates in the posterior area and may be dark or bright red (it’s commonly mistaken for hemoptysis because of expectoration).
Epistaxis is generally unilateral, except when caused by dyscrasia or severe trauma. In severe epistaxis, blood may seep behind the nasal septum; it may also appear in the middle ear and corners of the eyes.
Associated effects
Clinical effects depend on the severity of bleeding. Moderate blood loss may produce light-headedness, dizziness, and slight respiratory difficulty; severe hemorrhage causes hypotension, rapid
and bounding pulse, dyspnea, and pallor. Bleeding is considered severe if it persists longer than 10 minutes after pressure is applied. If severe, blood loss can be as great as 1 L/hour in adults.
and bounding pulse, dyspnea, and pallor. Bleeding is considered severe if it persists longer than 10 minutes after pressure is applied. If severe, blood loss can be as great as 1 L/hour in adults.
Diagnosis
Although simple observation confirms epistaxis, inspection with a bright light and nasal speculum is necessary to locate the site of bleeding.
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