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A nosebleed, or epistaxis, refers to bleeding from the nostrils of the nose. Sometimes, nosebleeds can present as blood in the mouth or oral cavity, which can be confused as bleeding from different sites like the digestive tract (hematemesis) or the respiratory tract (hemoptysis). Nosebleeds are of two types – anterior nosebleeds and posterior nosebleeds. Anterior nosebleeds are more common and occur in young people due to nasal dryness, whereas posterior nosebleeds are less common and occur due to more serious underlying causes like high blood pressure and heart disease, and affect the elderly. Anterior nosebleeds generally present with bright red bleeding that appears suddenly, whereas the bleeding in posterior nosebleeds is far more profuse and needs hospital admission.

Common signs and symptoms of a typical nosebleed are:

  • Bleeding from one or both nostrils of the nose
  • A feeling of warm liquid flowing or trickling at the back of the throat
  • Dizziness
  • Agitation
  • Panic
  • Fainting in severe cases
  1. When a nosebleed becomes a medical emergency
  2. What to do in case of a nosebleed
  3. Complications of a nosebleed
  4. Prevention of nosebleeds

If any of the following conditions are associated with a nosebleed, the patient should immediately be taken to the nearest hospital for emergency medical care:

  • If bleeding from the nose occurs for more than 20 minutes (it is likely to be a posterior nosebleed)
  • Heavy bleeding that has resulted in a lot of blood loss
  • Any difficulty breathing
  • Large amount of blood being swallowed, resulting in vomiting 
  • A nosebleed that starts after a serious accident or an injury to the head or face
  • Patient is taking blood-thinning medicines (anticoagulants) such as warfarin
  • Patient has a known clotting disorder such as hemophilia and the bleeding doesn't stop
  • Symptoms of anemia such as heart palpitations, shortness of breath and a pale complexion
  • A child under two years of age has a nosebleed
  • Foreign object stuck in a child’s nose
  • Frequent nosebleeds that come and go regularly
  • Nosebleed after a recent surgery of the head or neck

Steps to follow while giving first aid for a nosebleed are as follows:

  • Try to ke ep  the patient calm.
  • Sit the patient down.
  • Pinch the soft lower part of the nose between the thumb and index firmly. Keep the pressure applied steadily and continuously for at least 15 minutes. Make sure to pinch the soft part of the nose (the cartilage) and not the hard bony part of the nasal bridge as the common site of nosebleeds is present in the septal cartilage.
  • Lean the patient’s head forward and make them breathe through their mouth. This will drain blood into the nose instead of down the back of the throat.
  • After the bleeding is controlled, place an ice pack or clean cloth soaked in cold water on the nose. This will cause the bleeding blood vessels in the nose to constrict.
  • Keep the patient upright or standing, as this will reduce the pressure on bleeding blood vessels. Lying down can make the patient aspirate and choke on the blood from the nosebleed.

In case of a serious nosebleed (refer to the conditions that constitute a medical emergency given above), immediate hospital care is essential.

  • Persistent nosebleeds may be treated with nasal cautery, where the bleeding vessel in the septum of the nose is identified and sealed by electric current, silver nitrate or a laser, or nasal packing, where the nose is packed with special gauze or an inflatable latex balloon. Nasal packing can be uncomfortable and painkillers and antibiotics are prescribed afterwards.
  • Hospital admission, evaluation and treatment: Nosebleeds due to underlying problems like uncontrolled high blood pressure, heart disease or blood clotting disorders will need special treatment.
  • In case of a foreign body in the nostril causing a nosebleed, it will have to be removed.

Usually, nosebleeds are short-lived and, after proper first aid, resolve on their own. Sometimes, complications can occur after a nosebleed or its treatment, including:

  • Hemorrhagic shock
  • Pneumocephalus: The presence of an air bubble in the skull, after a nosebleed related to an injury to the nasal bone, is possible.
  • Bacterial infection can be transmitted by improper medical treatment and nose packing and result in: 
  • Septal pressure necrosis
  • Neurogenic syncope (fainting) during packing of the nose
  • Epiphora or watering of eyes (from blockage of the lacrimal duct)
  • Hypoxia or low blood oxygen saturation (from impaired nasal air movement)

In some cases, nosebleeds can be prevented by taking simple measures like:

  • Stopping picking the nose and keeping nails trimmed
  • Sleeping with a humidifier can prevent nasal dryness 
  • In case of allergies or sinusitis, nasal saline drops or petroleum jelly can be used to keep the nasal passage moist 
  • Avoid dehydration
  • Use appropriate protective face gear like helmets when playing aggressive contact sports
  • Quit smoking
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