What is Controlling of Nasal Haemorrhage: Overview, Benefits, and Expected Results

Definition & Overview

Nasal haemorrhage is a medical condition characterised by excessive bleeding in the nostril, nasal cavity, and nasopharynx. It is also known as epistaxis or, more commonly, nosebleed.

This condition is quite common and rarely fatal. However, the sight of blood flowing out from one or both nostrils could cause significant emotional distress to patients.

Nasal haemorrhage commonly originates from the anterior portion of the nose where there are a number of blood vessels. When haemorrhage occurs from the posterior part of the nasal septum, it is quite difficult to control and typically lasts longer. This condition occurs when blood vessels in the nasal mucosa rupture. There are certain factors that affect the occurrence of epistaxis. One is the intake of anticoagulant medication that predisposes the patient to this condition.

In some cases, a pseudoepistaxis occurs. This condition is characterised by blood originating from other sources, like the lungs or airway, and gets up into the nasal cavity and out of the nostrils.

Who Should Undergo and Expected Results

Persons who suffered blunt force trauma to the face typically experience fractures in the structures of the nose. This could lead to excessive bleeding that might be difficult to stop.

Nosebleed could also occur in patients with foreign bodies lodged in their nasal cavity. If left unattended, the foreign body could cause extensive damage to the nasal mucosa and may even be fatal if it moves to the airway.

Patients diagnosed with Hemophilia A or B are also prone to excessive nasal bleeding, which may need controlling. This condition is inherited, but there are cases in which it is caused by spontaneous mutation. It is characterised by the inability of the blood to clot.

Another condition similar to haemophilia is von Willebrand disease, which causes the inability of the blood to coagulate and achieve hemostasis, an important stage in healing any wound. Epistaxis is one of the manifestations of this disease.

People who ingested toxic substances could also suffer from nasal haemorrhage. Examples of these substances are nonsteroidal anti-inflammatory agents, warfarin, cocaine, and rodenticides.

Persons suffering from extreme cases of rhinitis and sinusitis might also need to take steps in controlling nasal haemorrhage. Rhinitis is the inflammation of the nasal membranes, characterised by constant sneezing, itching of the eyes and nose, headache, and general malaise. On the other hand, sinusitis is the inflammation of the linings of the paranasal sinuses.

There are several approaches in controlling nasal haemorrhages, and all have high success rates in stopping the bleeding. Patients should rest and are closely monitored a few hours after treatment. Medication to address the cause of the bleeding should also be administered. However, patients should avoid ingesting nonsteroidal anti-inflammatory agents as these can promote another bleeding episode. To avoid recurrence, patients should avoid performing strenuous activities and disturbing the insides of their nasal cavities.

How is the Procedure Performed?

Controlling nasal haemorrhage is achieved through several techniques. The most common initial treatment is manual haemostasis. The physician applies direct pressure, and the nostrils are squeezed together continuously for as long as 10 minutes. The patient should keep the head elevated without extending the neck. A piece of gauze moistened with epinephrine or phenylephrine could also be placed in the nostrils to promote constriction of blood vessels.

Using electrocautery, the physician can also stop nasal haemorrhage by applying a low voltage of electric current to the affected blood vessels. The probe is inserted into the nostril and guided into the source of the bleeding. In some cases, the physician may opt to use chemical cautery. If the bleeding originates from the posterior part of the nostril, such as the Kiesselbach plexus, the physician may use a lunar stick to stop bleeding. The device has silver nitrate, which effectively destroys the bleeding vessels and stops the flow of blood.

Another technique used in controlling nasal haemorrhage is the use of nasal packing. Anterior epistaxis can be stopped by inserting nasal packing filled with antibiotic ointment. The physician first applies local anaesthesia to the affected nostril before inserting the nasal packing. The nasal packing stays inside the nostril for around 12 hours and then discarded. The packing serves both to stop the bleeding and prevent infection at the same time. If the bleeding occurs posteriorly, the physician can also apply gauze packing filled with antibiotics after putting local anaesthesia. Recent advancement involves inserting an inflatable balloon device or catheter to stop bleeding.

For bleeding involving larger blood vessels, arterial ligation may be considered. The patient is placed under local or general anaesthesia, and the surgeon makes an incision to reach the affected blood vessels. Epistaxis can be caused by damage to the external carotid artery, internal maxillary artery, or the ethmoid artery. In most cases, the surgeon can use endoscopy to identify, cut off, and tie the affected artery.

In some cases, the physician may determine that embolisation is the proper technique for treating epistaxis or nasal haemorrhage originating from the internal carotid artery. This option is considered for those who are unsuitable for surgery or when other treatments proved unsuccessful. An embolus is purposely introduced into the artery to block blood flow. A catheter or guidewire is inserted into the blood vessel and guided into the determined location to place the artificial embolus.

Possible Risks and Complications

One common complication of controlling nasal haemorrhage is the formation of scar tissue in the affected treatment site. This can happen after the patient undergoes cauterisation or was inserted with nasal packing in the anterior or posterior part of the nasal cavity. Rhinosinusitis or the infection of the nasal sinuses can also occur after treatment. This is characterised by the presence of thick nasal mucus, pain in the face, and a plugged nose.

Ligation of the blood vessels can also result in adverse reaction to anaesthesia and numbness in certain parts of the face, particularly the cheek.

Embolisation carries the risk of facial paralysis and recurring pain.

References:

• Cummings CW. Epistaxis. Cummings. Otolaryngology: Head and Neck Surgery. 4th ed. Philadelphia, Pa: Elsevier, Mosby; 2005. Chap 40.

• Padgham N. Epistaxis: anatomical and clinical correlates. J Laryngol Otol. 1990 Apr. 104(4):308-11. [Medline].

• Guarisco JL, Graham HD 3rd. Epistaxis in children: causes, diagnosis, and treatment. Ear Nose Throat J. 1989 Jul. 68(7):522, 528-30, 532 passim.

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## Controlling Nasal ⁤Haemorrhage: Overview, Benefits, and Expected Results



Nasal haemorrhage,⁢ commonly referred to as nosebleed, is⁢ a⁤ prevalent condition that can range from a minor inconvenience to a life-threatening emergency. Understanding the ‍methods to ‌control nasal haemorrhage is​ crucial for healthcare professionals and individuals ⁤experiencing this condition.



**Overview of ‌Nasal Haemorrhage**



Nasal haemorrhage occurs​ when the blood vessels in the ⁣nose⁢ rupture, causing bleeding‌ that can ‌be anterior (coming from the front of the nose) ‍or posterior (originating from deeper within the nasal cavity). Common causes include:



– Trauma

– ‌Dry and irritated‍ nasal mucosa

– Certain medications

– Blood clotting disorders



**Benefits of Controlling Nasal Haemorrhage**



Controlling⁤ nasal haemorrhage offers several benefits:



– **Prevent blood loss:** Uncontrolled bleeding can ⁤lead to significant blood loss, which can cause anemia and other complications.

– **Reduce⁤ discomfort:** Nosebleeds can ‍be painful and uncomfortable, affecting daily life.

– **Prevent ⁣secondary complications:** Prolonged bleeding ‍can ​lead to ⁣infections, scarring, and other nasal problems.



**Expected Results of Controlling Nasal Haemorrhage**



With prompt ⁤and effective control, nasal haemorrhage typically resolves⁤ within‍ a​ short period. Expected results include:



– Cessation of bleeding: The bleeding should stop within a few minutes of‍ applying control ⁢measures.

– Reduction of pain and discomfort: Patients ⁤should⁣ experience relief from ⁣the pain and discomfort associated with the bleeding.

– Prevention ‍of complications: By⁤ stopping the ⁣bleeding, it minimizes the risk of complications such as infections or further ⁢tissue​ damage.



**Methods for Controlling⁢ Nasal Haemorrhage**



Several methods are⁢ used to control nasal haemorrhage, tailored to ⁢the ​severity and cause ⁤of the bleeding:



**1.‌ Direct Pressure:**



-‍ Apply firm, direct pressure to the soft part of the nose using a clean tissue or gauze.

– Maintain pressure for at least 10-15 minutes to allow the blood‍ vessels to clot.



**2. Nasal Packs:**



– When direct pressure is insufficient, nasal packs may be inserted⁢ into the nasal cavity⁣ to compress the bleeding vessels.

– Packs should be left in place for ⁤several hours‌ or ⁤days, depending on ⁤the severity ⁤of the⁢ bleeding.



**3. Vascular‍ Cautery:**



– ‍In cases ‌of persistent bleeding,​ vascular‍ cautery may be used to seal the⁤ affected blood vessels.

– This involves using⁢ heat⁤ to cauterize the vessels‌ and stop the bleeding.



**4. Medications:**



– Certain medications, such as‍ decongestants and vasoconstrictors,‍ can help constrict blood vessels and reduce ​bleeding.

– These medications are typically applied topically ‍or systemically.



**5. Surgery:**



– In rare cases⁣ where other methods fail, surgery⁣ may ​be necessary to ligate ⁢the affected blood vessel and stop ⁤the bleeding.



**Conclusion**



Controlling nasal haemorrhage is essential for preventing ⁤excessive blood loss, reducing discomfort, and minimizing ​complications. ‍Various methods are available, ranging from simple direct pressure to more advanced surgical interventions. By understanding the causes and⁣ methods of controlling ⁣nasal haemorrhage, healthcare professionals and individuals can effectively⁣ manage this condition and ensure ‌optimal outcomes.