Nosebleed

Disease Description (Causes and Symptoms)

• Definition: Epistaxis (nosebleed) refers to bleeding from blood vessels within the nasal cavity. It can occur at any age, but anterior bleeding is more common in children, while posterior bleeding is more common in older adults.
• Causes
  • Local: Habit of picking the nose (trauma), deviated nasal septum, inflammation of the nasal cavity or paranasal sinuses, dry environments (cold temperatures and low humidity), tumors, vascular abnormalities (aneurysms), etc.
  • Systemic: Coagulation disorders (von Willebrand disease, hemophilia, etc.), use of anticoagulants or antiplatelet agents, leukemia or blood disorders, kidney failure or liver disease, hypertension, atherosclerosis, hereditary hemorrhagic telangiectasia, etc.
• Pathophysiology: It occurs due to damage to small blood vessels in the nasal mucosa (especially Kiesselbach’s plexus in the anterior nasal cavity) or arterial bleeding from larger posterior blood vessels (toward the posterior nasal cavity). Anterior bleeding is relatively easy to control and is usually localized, whereas posterior bleeding is generally more severe and has a greater risk of rebleeding and being life-threatening.
• Main symptoms: Spontaneous bleeding from the nose (one or both sides), recurrent small-volume bleeding (in children), sudden and profuse bleeding (posterior bleeding or in older adults), vomiting (swallowed blood), dizziness, tachycardia, and hypotension (with massive bleeding).

Treatment Methods

• Emergency First Aid (Self-Emergency Measures)
  • Lean the upper body slightly forward and spit out the blood through the mouth rather than swallowing it.
  • Pinch the slightly soft front part of the nose (the cartilaginous part and nasal tip) continuously with the thumb and index finger for 5–10 minutes.
  • A topical vasoconstrictor (nasal spray) may be used, and applying ice (to the nose and the back of the neck) is recommended.
  • Do not: tilt the head backward, blow the nose forcefully, or swallow the blood.
• Medical Treatment
  • Identify the bleeding site using nasal endoscopy (endoscopy).
  • If the bleeding site is identified, control the bleeding with chemical cauterization (such as silver nitrate) or electrocautery (electrical cauterization or electrochemical hemostasis).
  • If hemostasis fails, perform nasal packing (anterior packing or posterior packing). It is usually maintained for 2–4 days, and antibiotics are often administered during the packing period to prevent infection (according to the judgment of local medical staff).
  • If there is a local or systemic coagulation abnormality, correct the underlying cause (platelet transfusion, rapid correction, etc.) and consult the hematology department.
  • In cases of persistent or massive bleeding, or when the location cannot be identified by endoscopy, consider embolization through angiography (mainly of the sphenopalatine artery, etc.) or surgical arterial ligation.
  • If bleeding recurs due to a repeated local cause (e.g., a deviated nasal septum), consider septoplasty (nasal septal plastic surgery/resection).
  • Medications: Use topical vasoconstrictors (such as menthol and oxymetazoline) and topical hemostatic agents; if necessary, consider tranexamic acid (topical or oral) at the physician’s discretion. Consult the attending physician about whether anticoagulants or antiplatelet agents need to be discontinued or adjusted.
• Prevention of Complications and Precautions
  • Long-term packing may cause nasal necrosis, infection, and aspiration, and may rarely cause toxic shock.
  • Control hypertension, improve dry environments (use a humidifier), keep fingernails clean, and avoid picking the nose.
• When Emergency Transport Is Needed
  • When bleeding does not stop for more than 20–30 minutes; persistent profuse bleeding; symptoms of dizziness, fainting, tachycardia, or hypotension; while taking anticoagulants; or difficulty breathing (during posterior packing), etc.

Checklist Before an Outpatient Visit (Including Sample Questions)

• Items and Information to Prepare and Bring
  • A list of medications currently being taken (especially anticoagulants, antiplatelet agents, and NSAIDs), including the time they were most recently taken
  • Past bleeding history (when it occurred, how often, and whether treatment was received) and a history of related surgery or trauma
  • Underlying diseases (hypertension, liver or kidney disease, blood disorders, etc.) and recent test results (especially INR, CBC, etc.), if available
  • Records of recent blood pressure readings, photographs taken during the bleeding (if possible), and notes on the time the bleeding started, its duration, and the amount of bleeding
  • Allergy history (including antibiotics)
• Sample Questions to Confirm Before the Visit and Items the Patient Should Prepare Independently
  • "When was your most recent nosebleed, and how often have you been having them?"
  • "Are any of the medications you are currently taking likely to affect blood clotting?"
  • "Have you been bruising easily recently? Have you had any other bleeding symptoms, such as bleeding gums or unusually heavy menstrual bleeding?"

Examples of General Questions to Ask the Doctor

• What are the side effects of this medication (which is expected to be prescribed)?
• Should I stop or adjust the anticoagulant (or antiplatelet agent) I am currently taking? What are the risks and benefits?
• What lifestyle habits should I follow to prevent recurrence? When can I blow my nose or exercise again?
• What is the prognosis of this bleeding episode? How likely is it that I will have another severe bleeding episode?
• What constitutes an emergency (what symptoms require going to the emergency room immediately)?

Examples of Disease-Specific Questions

• How can you determine whether my bleeding is anterior (from the front of the nose) or posterior (from the back of the nose)? What tests are needed to confirm this (nasal endoscopy, angiography, etc.)?
• Should I undergo coagulation tests (e.g., INR and platelet count) and tests for blood disorders (peripheral blood tests and, if necessary, hematologic tests)? If I am taking anticoagulants, how should they be adjusted?

(Note: The information above is general medical information, and individual treatment may vary according to the attending physician’s judgment.)