Definition of Epistaxis Our Nosebleed Main Article provides a comprehensive look at the who, what, when and how of Nosebleed Definition of Epistaxis Causes of a Heart Attack Slideshow Epistaxis: Medical term for nosebleed . The nose is a part of the body that is very rich in blood vessels (vascular) and is situated in a vulnerable position on the face. As a result, any trauma to the face can cause bleeding, which may be profuse. Nosebleeds can occur spontaneously when the nasal membranes dry out, crust, and crack, as is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible if they are taking medications which prevent normal blood clotting ( warfarin [Coumadin], clopidogrel bisulfate [Plavix], aspirin, or any anti-inflammatory medication). Other predisposing factors include infection, trauma, allergic and non-allergic rhinitis, hypertension, alcohol abuse, and inherited bleeding problems. "Epistaxis" is a Greek word meaning "a dripping," especially of blood from the nose.

Last Editorial Review: 5/13/2016 Nose Bleed Epistaxis Pocket Case Study A 34 female presents to ED at 2am, post waking up with blood all over her pillow, and a continuos ooze of blood from her right nostril. On examination the patient is alert and oriented, BP 110/60, pulse 95, respiratory rate 22, Sp02 98% room air, and has no past medical history. The patient reports having a sinus infection of late which she’s has been using an antihistamine nasal spray to treat. Image from: Epistaxis: Epistaxis is a frequent complaint 60% of the populationwill with suffer from a nose bleed during their lifetime, and 6% will require medical attention. Majority of epistaxis occurs between the ages of 2-10 and 50-80 years old. Epistaxis results from an interaction of factors that damage the nasal mucosal lining, affect the vessel walls, or alter the coagulability of the blood.

Emergency physicians have a 90% success rate at treating epistaxis in emergency department, and only have to refer 10% to ENT for further assessment and management Causes of Epistaxis: Controversial topic and is often misunderstood in epistaxis – see Hypertension and Epistaxis. Hypertension is rarely a direct cause of epistaxis Epistaxis is however more common in hypertensive patients this is postulated to be caused from long standing hypertension causing vascular fragility of the blood vessels. Epistaxis in patients presenting to ED, will generally have an associated anxiety that will increase blood pressure. Despite multiple causes for epistaxis, literature shows that in 85% of cases no causes in found. Anatomy and Physiology of Epistaxis: The nose is supplied with an extensive vasculature with multiple anastomosis. 90% of epistaxis occurs in the anterior nasal septum, from Littles area which contains the Kiesselbach plexus of vessels. The other 10% occur posteriorly, along the nasal septum or lateral nasal wall.

The blood supply of the nasal septum is from the internal carotid through the anterior and ethmoidal arteries, and from external carotid through the greater palatine, spenopalatine and superior labial arteries. Anatomy of the Nasal Cavity: Image from: Assessment of the patient presenting with Epistaxis: History: Physical Examination: Focus on trying to identify if the bleed is coming anteriorly or posteriorly. Suctioning or blowing of the nose to clear away clots, and application of topical vasoconstrictors or anaesthetics will help with visualisation Gently insert nasal speculum and spread naris vertically, a good light source will be also required to assist visualisation of bleeding area. A posterior source of bleeding is suggested by failure to visualise an anterior source, bleeding from both nares, and the visualisation of blood in the posterior pharynx. Investigations: Patients will large amounts of bleeding should have a full blood count to check haemoglobin level, and a group and hold incase transfusion is required. Patients taking warfarin should have an INR checked.

Coagulation studies are only of benefit in patients with a known coagulopathy or chronic liver disease, and should not be routine in patients presenting with epistaxis. Other bloods test should only be ordered if past medical history warrants further investigation (renal failure = U&E, chronic alcohol abuse = LFTs), and literature has shown they rarely change your management and add considerably to the cost of treating these patients. Radiological investigations have little role in the management of epistaxis, CT scan is indicated if neoplasm suspected, and would generally be arranged post consultation with your ENT specialist. Emergency Department Management: Good effective first aid should stop 90-95% of nose bleeds. Provide a calm and quite area for the patient to decrease anxiety The patient should position them self either forward or backward, which ever provides the most comfort and prevents the patient from swallowing or aspirating any blood draining into the pharynx. Tip: Fresh blood is irritating to the stomach and will cause nausea and vomiting. Pressure should then be applied by pinching the anterior aspect of the nose for 15-20mins, which provides tamponade to the anterior septal vessels.

Patients should be shown the correct was to apply pressure by avoiding the nasal bones, by pressing more distally the nasal ala against the septum. Some authors advocate placing ice pack to the nape of the neck with belief it produces a reflex vasoconstriction in the nasal mucosa, however there is little research or evidence to support this. Initial Management and Resuscitation: In extreme cases patients can present with uncontrolled haemorrhage, standard resuscitation principles should be applied. Airway: Risk of airway obstruction from blood in the posterior pharynx, or decreased level of consciousness from hypovolaemia. Place patient in postion to assist in managing the blood loss, may require frequent suctioning.

Be prepared to secure and place a definitive airway (ETT) Breathing: Assess depth of breathing and respiratory rate, Remember a noisy airway is an occluded airway Provide high flow oxygen via non rebreather mask Circulation: Assess heart rate, blood pressure and capillary refill Patient at risk for severe haemorrhage place x2 large bore IV, check HB, cross match blood, and start fluid resuscitation Disability: Monitor patients level of consciousness this help determine the severity of haemorrhage Exposure: Keep patient warm to prevent coagulopathy If epistaxis is caused by major trauma, always examine from for other injuries Patients can and have died from epistaxis be prepared to resuscitate!!! Vasoconstriction: Vasoconstriction can be achieved by the application of agents topically or soaked cotton pledgets inserted into the nasal cavity. Local anaesthesia (Lignocaine) should be used were possible to provide analgesia. Agents available include 1:1000 Adrenaline, Co-Phenylcaine, and Oxymetazoline, and are used for their vasoconstriction properties.

Pledget inhalation is a risk especially in patients with decreased level of consciousness and children. Vasoconstrictors have been shown to be extremely effective in anterior epistaxis, aid in the visualisation of the bleeding site, and assist if packing is required. Following successful application of topical vasoconstriction, patients should be encouraged to apply topical steroid creams, and petroleum jelly to the nasal cavity weekly for six weeks, this has been shown to have a 94% success rate of resolution of symptoms. Suction: Suction should be available and easy accessible to help remove clots. Getting the patient to blow their nose can also be an effective form of suction An angled Fraser sucker, 10-12 French gauge, is preferred to allow evacuation of the anterior and middle nasal cavity Cautery: Chemical: Chemical cautery involves the application of silver nitrate sticks, by wiping the tip of the silver nitrate stick over littles area until it becomes discoloured and grey. The area should be suctions and as dry as possible to maximise the effectiveness of silver nitrate sticks, localised pain can occur on application. The sticks should be applied for 4-5secs until a grey residue or eschar develops.

Only one septum should be cauterised using silver nitrate, as bilateral can cause sepal perforation Generally effective in anterior bleeds, however there is a risk of rebleeding. Electrocautery: Genrally performed by ENT specialist after effective topical anaesthetic needs to be provide first. The red-hot electrocautery loop is passed over the mucosal blood vessels effecting cautery. Topical antibiotics and/or petroleum jelly can be used postoperativley. Packing: Anterior packing is required when the bleeding fails to stop with vasoconstrictors and cautery. Options include traditional nasal packing, a prefabricated nasal sponge, an epistaxis ballon, or absorbable materials.

Nasal tampons that are moistened, gel-coated, with an inflatable balloon are less painful and show equal effectiveness when compared to dry hydrophilic nasal tampon Types of packs: Traditional Vaseline gauze packing: generally not used these days, as have been supplanted by readily available and more easily placed tampons and balloons.It consist of ribbon gauze soaked in petroleum jelly, and is placed in the back of the nasal cavity as far back as possible, and layered into the naris until it is completely packed. Need to allow both ends of the gauze protrude from the nose to allow ease of removal. Compressed sponge/tampon: Merocel is a dehydrated polyvinyl polymer sponge, formed into flat tampons of various sizes. These are inserted into the nasal cavity, and then rehydrate by blood or saline, causing then to expand up the three time their original size, filling the nasal cavity and compressing the source of bleeding.The advantage of these of gauze packing is that they are technically easier to insert, however literature shows no difference in patient pain, and ease of removal compared to gauze packing.

Anterior epistaxis ballons: Rapid Rhino consist of an outer layer of carboxycellulose that promotes platelet aggregation, with an inflatable balloon that compresses the nasal cavity upon inflation tamponading the bleeding site. Rapid Rhino have been shown to be as effective as nasal tampons and allow for superior patient comfort on insertion and removal. Absorbable materials: various non-absorbable packing materials are available, including carboxymethycellulose sponges, and calcium alginate dressings and wicks. These dressing can be left in place for between 1-5 days, but remember the longer the packing is left insitu the increase risk of developing toxic-shock syndrome. Posterior Packing/ Ballon Catheters: Posterior nasal bleeds can be difficult to manage related to the relatively inaccessible site of bleeding and generally don’t respond the above standard medical treatment and packing. Analgesia will be required for patients with posterior packing and ballon catheters Double balloon catheters consist off of a posterior and anterior balloon, are relatively easy to insert, although cost may limit their use. Generally used in difficult posterior epistaxis.

The catheter is inserted to the back of the nasopharyngeal space, and then inflate the posterior balloon first and bring forward sealing off the postnasopharyngeal space. Then inflate the anterior ballon to apply pressure to the internal cavity of the nose. Saline is preferred over air to inflate balloon as air can leak out causing deflation and further rebleeding. Avoid over-inflating ballon catheters as will cause increased discomfort, rupture of the ballon, or pressure necrosis of the nasal mucosa. A foley catheter can be used 10-14 French with 30ml balloon as an alternative. Image from: Disposition: Arrange admission for patients with posterior packing, requiring oxygen, and patients with difficult to manage bleeds. Patient with anterior packing can generally be discharged home, with packing insitu, with follow up arranged in 48-72 in the ENT clinic. Provided antibiotics and oral analgesia. Patients with chronic epistaxis should receive medical followup to investigate anaemia from chronic blood loss, and coagulopathies.

Uncontrolled severe epistaxis can sometimes require endoscopic cautery, embolization or artery ligations, patients at risk should receive early ENT review. Consider Tranexamic acid is severe epistaxis as it works as a potent competitive inhibitor of plasminogen activator and thus of the fibrinolytic system, and may therefore prevent clot disintegration and reduce the likleylihood of rebleed. Medico-legal Pitfalls: Nasal packing can lead to serious infection (Toxic shock syndrome), most of literature and ENT specialist recommend prophylactic antibiotics, until evidence supports or refutes this practise its most probably best practise to follow this and treat with broad spectrum antibiotics. Posterior nasal packing places the patient at risk of hypoxia and hypoventilation, monitoring for this, and implement treatment promptly should it occur. Nasal packing generally slows or causes cessation of haemorrhage, failure to control haemorrhage should prompt urgent ENT review. Recurrent unilateral epistaxis should prompt further investigation to rule out neoplasm. “Nose bleeds occur in those who are beginning to have feeling of lust or who are getting the signs of manliness.” Hippocrates 4th century BC1.

Epistaxis: What Causes Nosebleeds And How You Can Stop Them Epistaxis: What Causes Nosebleeds And How You Can Stop Them Jun 18, 2013 12:38 PM By Susan Scutti Close E-mail Epistaxis is the Greek word for 'nosebleed' and it is the word doctors use to describe this common occurrence. Hippocrates recognized that placing pressure on the alae nasi, or the wing of the nose, was an effective method for controlling epistaxis. Ancient Egyptians preferred to mix the ashes of papyrus with vinegar for use in a compress, while in some areas of Nigeria, "efirin leaf," a local herb, has been passed down through the ages as a way to arrest bleeding from the nose. In the U.S., the prevalence of nosebleeds has been reported to occur in up to 60 percent of the general population, though affected persons usually do not seek medical attention, particularly if the bleeding is minor. The condition of epistaxis has a 'bimodal' distribution, meaning that the frequency of occurrence peaks twice: around the age of 10 years and older than 50 years.

Generally, males more than females find themselves with a nosebleed, and this happens more often during winter months or in climates with low humidity. Most cases of epistaxis are minor, but in rare cases they can be a sign of some deeper cause. When massive bleeding or repeated occurrence is involved, a sufferer should seek medical care. In such cases, a doctor will assess the condition based on its origin: Is the cause of the nosebleed local or systemic? Epistaxis, or bleeding from the nose, affects roughly 60 percent of Americans; although most of the time, their origins and treatments are simple, in rare cases they can be a sign of a deeper cause. Ragesoss, Creative Commons Local Causes Simple trauma, inflammatory reactions, anatomic deformities, and intranasal tumors are the most common local — those that affect only the nose — causes of epistaxis. Simple and direct trauma, such as a blow to the nose, often elicits immediate bleeding and thankfully this most often occurs in the under 10 population.

Another common cause of nose bleeds in children, especially during the winter months, is irritation, usually by a finger or small object, to the nasal septum (the cartilage that divides left and right airways of the nose). Another source of epistaxis, common among adults as well as children, is the improper use of topical nasal sprays; repeated trauma to the surface cells of the nasal septum from sprays consistently directed toward the same area of the nose can cause intermittent epistaxis. Simple instruction to direct the spray away from the midline septum can alleviate this problem. Septal deflections, bony spurs, and fractures are the most common anatomic deformities that will predispose a patient to epistaxis. Intranasal masses, including aneurysms, encephaloceles, hemangiomas, and adenocarcinomas, may also give rise to nosebleeds. In particular, juvenile nasopharyngeal angiofibroma, though benign, is a locally aggressive vascular tumor that most commonly affects adolescent boys. Growing in the back of the nasal cavity, such tumors often cause one-sided nasal obstruction and recurrent bleeding.

Finally, postsurgical nosebleeds are often caused by the use of nasal cannula (a device used to deliver supplemental oxygen or airflow to a patient or person in need of respiratory help). Systemic causes The most common systemic — those that affect the entire physical system or body — causes of epistaxis include hypertension, aberrations in clotting ability, inherited bleeding tendencies, and vascular/cardiovascular diseases. Although a complete understanding of the relationship between hypertension and epistaxis is frequently debated, they are associated; in cases of severe or resistant to ending epistaxis, hypertension is the most common related issue. Both medication-induced clotting aberrations and liver dysfunction are common systemic factors influencing epistaxis. Medications commonly associated with epistaxis are aspirin, clopidogrel, nonsteroidal anti-inflammatory drugs, and warfarin. Chronic alcoholism and renal dysfunction can also cause platelet dysfunction and result in an inability to form clots. Of the inherited bleeding disorders associated with epistaxis, the most common are hemophilia A, hemophilia B, and von Willebrand disease. Inheritance of these disorders is sex-linked; only males are affected.

Finally, vascular and cardiovascular diseases such as congestive heart failure, arteriosclerosis, and collagen abnormalities may also cause nosebleeds. Doctors manage nosebleeds through medical therapy, conservative therapy, and arterial embolization. Cures Most cases of epistaxis are not only minor but also manageable; they require only that you sit down, breathe through your mouth, lean back your head, and pinch the soft part of your nose. Sometimes nasal irrigation with saline or topical ointments might be necessary to create a humidified nasal environment that will prevent further episodes. If bleeding persists, a topical nasal decongestant is often used. In unusual cases, a doctor may recommend medical therapy, which involves identifying and correcting the cause directly. For instance, in the case of hypertension and other causes stemming directly from the blood, a doctor will work to correct the underlying condition, usually by prescribing medication. Once the hypertension is corrected, any newly occurring nosebleeds will in all likelihood be alleviated in the usual manner of gently pinching the nostrils. Conservative therapy includes cautery and nasal packing. Nasal cautery is currently performed with chemicals or controlled temperature.

Nasal packs may be either anterior (at the front of the nose) or posterior (at the back). Depending on where the bleeding begins or if blood slides down the back of the nose and worsens after application of an anterior pack, the first method, an additional posterior pack may be required. Posterior packs sometimes include balloon structures and Foley-type catheters. Surgical therapy for epistaxis has largely been supplanted by the use of arterial embolization, which is performed by interventional radiologists. This relatively new technique involves performing diagnostic angiograms to assess the vascular anatomy. Brisk bleeds will show up as blushes and can be selectively embolized where the radiologist injects special materials that form a blockage to close off (occlude) the blood supply. In conclusion, epistaxis or the common nosebleed may look frightening and may even cause a terrible mess, but most of the time it will end quickly if you sit down, breathe through your mouth, lean your head back, and pinch your nostrils. If you are still bleeding after 15 minutes or if a massive amount of blood flows, seek medical care immediately from your physician or an emergency room. Sources: Nwaorgu OGB.

Epistaxis: An Overview. Annals of Ibadan Postgraduate Medicine. 2004. Fatakia A, Winters R, Amedee RG. Epistaxis: A Common Problem. The Ochsner Journal. 2010. Kucik CJ, Clenney T. Source: Management of Epistaxis. American Family Physician. 2005. 7 Tips On How to Stop a Nosebleed Fast Medical Author: John P. Cunha, DO, FACOEP John P. Cunha, DO, FACOEP John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey. Medical Editor: William C. Shiel Jr., MD, FACP, FACR William C. Shiel Jr., MD, FACP, FACR Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame.

There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. Share Your Story The nose is a part of the body rich in blood vessels (vascular) and is located in a vulnerable position protruding on the face. As a result, trauma to the face can cause nasal injury and bleeding. The bleeding may be profuse, or simply a minor complication. Nosebleeds can occur spontaneously when the nasal membranes dry out and crack. This is common in dry climates, or during the winter months when the air is dry and warm from household heaters. People are more susceptible to a bloody nose if they take medications that prevent normal blood clotting ( warfarin [Coumadin, Jantoven], clopidogrel [ Plavix ], aspirin, or any anti-inflammatory medication). In this situation, even a minor trauma could result in significant bleeding. The incidence of nosebleeds is higher during the colder winter months when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically.

In addition, changes from a bitter cold outside environment to a warm, dry, heated home result in drying and changes in the nose which make it more susceptible to bleeding. Nosebleeds also occur in hot, dry climates with low humidity, or when there is a change in the seasons. The following risk factors predispose people to nosebleeds: Infection Prospective Pilot Study of Floseal for the Treatment of Anterior Epistaxis in Patients With (HHT) - Full Text View - ClinicalTrials.gov Prospective Pilot Study of Floseal for the Treatment of Anterior Epistaxis in Patients With (HHT) This study is currently recruiting participants. (see Contacts and Locations ) Verified October 2016 by St. Michael's Hospital, Toronto Sponsor: Information provided by (Responsible Party): St.

Michael's Hospital, Toronto First received: October 13, 2015 Last updated: October 14, 2016 Last verified: October 2016 How to Read a Study Record Purpose Current management strategies for severe and recurrent epistaxis secondary to Hereditary hemorrhagic telangiectasia (HHT) include surgical procedures, and uncomfortable nasal packing, both of which are often only short-term solutions. Floseal® may provide a non-invasive and less painful treatment option for epistaxis in HHT patients. This hemostatic agent has been shown to be an effective intraoperative hemostatic agent in a number of surgical procedures including endoscopic sinus surgery. It has also been shown to be favorable over nasal packing at controlling acute anterior epistaxis. Though the efficacy of using Floseal® for epistaxis in HHT patients has been proven anecdotally in the literature it has yet to be proven in a prospective clinical trial. The results of this pilot study will provide insight into the efficacy of using Floseal® in the management of severe epistaxis in HHT patients and to assist in the development of a full-scale prospective clinical trial.

Assigned Interventions Experimental: HHT - Floseal Once the bleeding has stopped following application of the Floseal® a 50 cc syringe with sterile saline will be used to irrigate the treated nasal cavity to remove any excess Floseal® product as per manufacturer recommendations. This is done with the patient's head tilted downwards at a 30 degree angle so that the irrigation and excess product is removed from the nasal cavity. Drug: Floseal Topical lidocaine spray (2%) is then administered using 1-2 sprays in the affected nasal cavity via the nostril that is to have Floseal® applied. Once the bleeding has stopped following application of the Floseal® a 50 cc syringe with sterile saline will be used to irrigate the treated nasal cavity to remove any excess Floseal® product as per manufacturer recommendations. This is done with the patient's head tilted downwards at a 30 degree angle so that the irrigation and excess product is removed from the nasal cavity. Once the irrigation is complete, the nasal cavity is inspected for evidence of continued bleeding.

Other Name: Floseal hemostatic matrix Active Comparator: HHT - Standard of Care If bleeding is not controlled after up to two Floseal applications, the gel and clots will be removed with suction, and the patient will be treated with a standard packing treatment (standard of care). Other: Packing If bleeding is not controlled after up to two Floseal applications, the gel and clots will be removed with suction, and the patient will be treated with a standard packing treatment (standard of care). Detailed Description: Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is an autosomal dominant disorder that is characterized by abnormal blood vessel development. This dysplasia manifests as mucocutaneous telangiectases and visceral arteriovenous malformations (AVM). The most common symptom is epistaxis occurring secondary to telangiectases in the nasal mucosa in more than 90% of HHT patients. Heterogeneity exists in the severity of epistaxis experienced by HHT patients; therefore, treatments and management strategies can vary.

For minor bleeding, conservative management may include preventing drying of the nasal mucosa with the use of ointments and humidification. In some cases, topical or systemic estrogen may also be used to improve the stability of the nasal mucosa, thereby reducing bleeding. Commonly, anterior nasal packing is used as a non-surgical management strategy to control major bleeding. When medical management strategies have failed, laser coagulation of the telangiectases or septodermoplasty may be considered however, these solutions are temporary as telangiectasia are known to recur. In the acute setting, embolization may be used to occlude the abnormal vasculature while maintaining blood flow to the surrounding tissue; however, this is also not an effective long-term solution. Severe and difficult to manage epistaxis has been effectively treated using the modified Young's procedure where closure of the nostril is achieved by suturing together circumferential skin and mucosa flaps. Floseal hemostatic matrix (Floseal®) is a hemostatic agent that consists of two major components. The first are gelatin granules that swell when they come into contact with blood or other wet surfaces creating a tamponade effect.

The second is a high concentration of human thrombin that promotes natural clot formation by converting fibrinogen to fibrin. Floseal® is hydrophilic and therefore adheres well to wet tissues. It is indicated for use as an adjunct surgical hemostat and it has recently been demonstrated to be an effective treatment for epistaxis. A prospective, randomized, controlled trial compared Floseal® to nasal packing in the treatment of acute anterior epistaxis. The results showed Floseal® to be better at initially controlling epistaxis and resulted in fewer rebleed events within a seven day follow-up period. Patients also reported less pain and greater overall satisfaction with Floseal® as compared with nasal packing. Similarly, two prospective studies have evaluated the use of Floseal® for the treatment of posterior epistaxis. These trials also showed Floseal® treatment to be an effective treatment for posterior epistaxis. Furthermore, the use of Floseal® was associated with substantial institutional cost savings. In summary, Floseal® has been demonstrated to be an effective treatment for posterior epistaxis, regardless of origin within the nose. Recently, Floseal® has been used in patients with HHT.

This case series showed that patients with anterior epistaxis due to HHT could self-administer Floseal® to treat recurrent anterior epistaxis at their home without a contact with the medical system, as would customarily occur. This directly leads to an improvement in the quality of life of the patients in this study. Impairment of the quality of life for patients with HHT is a significant concern. Compared to the normative population, all subscales of SF36, but bodily pain, have been shown to be significantly poorer in the HHT patients. Studies of HHT substantiate that disease severity is associated with poorer QoL in these patients. Treatments for epistaxis that can improve the quality of life for patients with HHT are needed. Eligibility Active anterior epistaxis Exclusion Criteria: A known sensitivity to any of the materials of Floseal® or the topical medications administered as part of the evaluation and treatment of epistaxis (lidocaine, xylometazoline hydrochloride) Pregnant and/or breast feeding woman Contacts and Locations Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.

To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies. Please refer to this study by its ClinicalTrials.gov identifier: NCT02638012 Contacts Nosebleed (Epistaxis) - Harvard Health Nosebleed (Epistaxis) What Is It? The inside of the nose is covered with moist, delicate tissue (mucosa) that has a rich supply of blood vessels near the surface. When this tissue is injured, even from a minor nick or scratch, these blood vessels tend to bleed, sometimes heavily. Nosebleeds near the front of the nose, called anterior nosebleeds, are very common since this is the most accessible area to injury. The most frequent location is the nasal septum, the wall between the two sides of the nose. In most cases, this type of nosebleed is not serious. It usually can be stopped with some local pressure and a little patience. Only rarely is a nosebleed life threatening or fatal. In these cases, the hemorrhage (severe bleeding) is usually from an artery in a posterior location, higher and deeper in the nose.

Posterior bleeds usually drain down the back of the throat, but can also bleed out of both nostrils. Also, in most cases of severe nosebleeds, the person has another health problem, such as high blood pressure or a bleeding disorder, or the person takes a blood-thinning medication that slows down the blood-clotting process. To continue reading this article, you must login . Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Research health conditions Prepare for a doctor's visit or test Find the best treatments and procedures for you Explore options for better nutrition and exercise I'd like to receive access to Harvard Health Online for only $4.99 a month. Sign Me Up » Nosebleed (Epistaxis) Guide: Causes, Symptoms and Treatment Options Nosebleed (Epistaxis) What Is It? The inside of the nose is covered with moist, delicate tissue (mucosa) that has a rich supply of blood vessels near the surface. When this tissue is injured, even from a minor nick or scratch, these blood vessels tend to bleed, sometimes heavily.

Nosebleeds near the front of the nose, called anterior nosebleeds, are very common since this is the most accessible area to injury. The most frequent location is the nasal septum, the wall between the two sides of the nose. In most cases, this type of nosebleed is not serious. It usually can be stopped with some local pressure and a little patience. Only rarely is a nosebleed life threatening or fatal. In these cases, the hemorrhage (severe bleeding) is usually from an artery in a posterior location, higher and deeper in the nose. Posterior bleeds usually drain down the back of the throat, but can also bleed out of both nostrils. Also, in most cases of severe nosebleeds, the person has another health problem, such as high blood pressure or a bleeding disorder, or the person takes a blood-thinning medication that slows down the blood-clotting process. Certain people are more likely to get nosebleeds because of their environment, work history, health problems or use of medications that increase the tendency to bleed.

Common risk factors for nosebleeds include: A hot, dry indoor climate - This is a trigger for nosebleeds in parts of the United States where heat (especially forced hot air) is used during the winter. The hot, dry indoor air causes the delicate nasal skin to crack and bleed. Nosebleeds are more frequent during changes of seasons before the tissues have become accustomed to the change in humidity. A deviated septum - If the wall between the two nostrils is shifted to one side (deviated), air flow in the nostrils is uneven. The altered airflow pattern causes the skin of the nasal septum, on the narrower side, to become dry and cracked, increasing the risk of bleeding. Colds and allergies - Upper respiratory tract infections and allergies cause inflammation in the nose, which can increase the risk of bleeding. More congestion can cause blood vessels to widen (dilate), which makes them more vulnerable to injury. Strenuous nose blowing to clear the nose also can cause a nose to bleed or to start bleeding again after a nosebleed has been controlled. Exposure to irritating chemicals - The primary culprit is cigarette smoke, even secondhand cigarette smoke.

Workers also may develop nosebleeds from on-the-job exposure to sulfuric acid, ammonia, gasoline or other chemical irritants. Medical conditions - Examples include kidney failure, thrombocytopenia (low levels of the blood platelets needed for clotting), high blood pressure and hereditary bleeding disorders, such as hemophilia. Heavy alcohol use - Alcohol interferes with the normal activity of platelets in the blood, and this increases the time needed for blood clots to form. It also makes superficial blood vessels dilate (enlarge), making them more likely to be injured and bleed. Medications that interfere with blood clotting - These include prescription blood-thinners (anticoagulants) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen ( Aleve , Motrin and others). Homeopathic medications and dietary supplements - Some dietary supplements contain chemicals that prolong bleeding similar to prescription blood thinners. Danshen, dong quai , feverfew , garlic , ginger , ginko biloba, ginseng and vitamin E are some of them.

Nosebleeds also commonly are caused by trauma, such as nose picking, forceful blowing of the nose or severe facial trauma from an automobile accident or contact sports. Symptoms Nosebleeds usually involve one nostril, but occasionally both nostrils are involved. If one nostril becomes partially blocked with a blood clot, the blood might flow out the other nostril or down the back of the throat. In a posterior nosebleed (higher up in the nose), large amounts of blood typically flow down the back of the throat. The amount of bleeding from a nosebleed can vary with posterior bleeds usually bleeding significantly more. Diagnosis In otherwise healthy people, most mild anterior nosebleeds can be self-diagnosed and treated at home. If your nosebleed is severe and does not respond to first-aid measures, you will need to see a doctor immediately. The doctor will review your health history and current medications. He or she also will ask you to estimate the amount of blood you've lost, which usually is based on how long you've been bleeding and the number of soaked towels or tissues you've used. Next, the doctor will examine your nose to determine where the bleeding is located.

If necessary, he or she may insert a lighted, tube-like instrument called an endoscope into your nose to see the site of bleeding. Blood tests may be done to check for any bleeding abnormalities. Expected Duration When done correctly, simple first-aid measures usually will stop an uncomplicated anterior nosebleed within minutes. Prevention You can help to prevent nosebleeds by: Not picking your nose Being gentle whenever you blow your nose Not smoking Using a humidifier if your indoor climate is dry during the winter months Using a nonprescription saline nasal spray to moisturize the inside of your nose Applying a dab of nasal gel or petroleum jelly to the inside of your nostrils before bedtime Avoiding facial trauma by wearing a seatbelt and shoulder harness in the car and by using well-fitting headgear to protect your face during contact sports, such as football or karate Using protective equipment to avoid breathing irritating chemicals at work Treatment If you are bleeding from the front of your nose, begin by trying the following first-aid measures: Sit up (so your head is above the level of your heart), lean forward slightly and breathe through your mouth.

With your thumb and index finger, pinch the entire front of your nose (just above your nostrils and below the hard, bony base) and hold for five minutes. At the same time, use your other hand to apply an ice pack or a plastic bag of crushed ice to the bridge of your nose to slow blood flow. After you have pinched your nose for five minutes, release it to see if your nose is still bleeding. Keep the ice pack on for another 10 to 15 minutes. If your nose is still bleeding, pinch it for an additional 10 minutes. Release your nose again. If you are still bleeding, seek emergency medical help.

When simple first aid does not stop a nosebleed, your doctor may treat the problem by: Applying medication directly to the inside of your nose to stop the bleeding Sealing off (cauterizing) the injured blood vessel with a chemical, such as silver nitrate, or with an electric probe Packing your nose with gauze or a sponge Using other methods, such as: Laser therapy - A laser beam seals the bleeding blood vessel Embolization - A special plug inserted into the bleeding vessel blocks blood flow Surgery - Ties off a selection of blood vessels When To Call a Professional If you cannot stop a nosebleed by using the first-aid measures, call your doctor immediately or go to an emergency room. Also, contact your doctor if blood continues to ooze from your nose, especially if you also have persistent nasal stuffiness or a foul-smelling nasal discharge. In older people, especially smokers, these can be symptoms of a tumor inside the nose or sinuses. In a young child, these may be signs that a foreign object is lodged in a nostril. Prognosis With a little patience and pressure, almost all uncomplicated anterior nosebleeds respond to simple first-aid measures.

Even the rare nosebleed that requires a doctor's care usually can be treated successfully with cauterization, packing or other options. Even severe posterior nosebleeds can be controlled with appropriate first-aid measures at home. Some people who have excessive bleeding, multiple medical problems or who are taking anticoagulant medications may need to be hospitalized for treatment of a nosebleed. External resources American Academy of Otolaryngology - Head and Neck Surgery One Prince St.

Question: What is the human ailment epistaxis better known as?
Answer: Nosebleed