what to do in case of nosebleed

nose bleed It is something very common in some people and very rare in others. Nosebleeds can manifest as a small thread or a large flow of blood.

Generally, this is a benign situation, which does not involve major problems. In any case, it is essential to know what to do whenever you have a nosebleed, as well as to understand when it makes sense to see a doctor.

Bleeding from the nose: main causes and treatments

There are two main types of nosebleeds.

anterior nosebleed

This is the most common typology and originates in the front of the nose, that is, in the small blood vessels located in the cartilage (nasal septum) that separates the two nostrils. The nasal septum is a highly irrigated area and, therefore, it is normal for bleeding from this region to be abundant, although, normally, they do not pose many risks.

posterior nosebleed

This hemorrhage originates from larger blood vessels located at the back of the nose. Although more uncommon, this type of bleeding is more dangerous and difficult to treat.

This hemorrhage usually affects people with atherosclerosis (a disease that impairs the flow of blood in the arteries); with bleeding disorders; who take medications that interfere with clotting; and/or who have undergone nasal or sinus surgery.

Causes possible for nose bleed

Nosebleeds are caused by an irritation of the moist inner lining of the nose or a ruptured blood vessel.

The causes can be very diverse, from the regular intake of anticoagulants, to coagulation disorders and hardening of the arteries, associated with atherosclerosis. Although not a cause of nosebleeds, hypertension can favor its duration. Here are some of the more and less frequent causes.

common causes

• Trauma, which may be due to a bump on the nose or the simple act of blowing your nose.
• Dryness of the inner lining of the nose, which is more frequent in the cold months.

Less common causes

• nasal infections
• foreign bodies
• Rendu-Osler-Weber Syndrome
• Tumors of the nose or sinuses
• Bleeding disorders (coagulopathies)
• Body/systemic disorders

Diagnosis

As we said, usually, a nosebleed is not a cause for concern, as it is a benign and transient situation. However, there are cases where a nose bleed can be a symptom of a more serious problem, and in these situations it is necessary to consult a doctor.

Therefore, you should be subject to clinical evaluation if you are unable to stop the bleeding or if you have a nosebleed and:

• lose a lot of blood, starting to feel weak, faint or dizzy when standing up;
• taking drugs that interfere with clotting, such as aspirinclopidogrel, warfarin, rivaroxiban and apixaban;
• have bleeding disorders such as haemophilia;
• this is a very recurrent episode, with no known cause.

If you visit a doctor, he will review your medical history; evaluate the manifested symptoms; and have a physical exam, where you measure your heart rate and blood pressure. This can especially help you understand why your nose bleeds.

In order to carry out a detailed and complete anamnesis, the physician must take into account:

• obvious triggers, that is, if the person sneezed; if you blew your nose; if you have suffered any trauma; or if you have had an upper respiratory tract infection;
• the duration and number of nosebleed episodes;
• whether there are bleeding disorders or blood clotting problems in the family;
• whether the person takes medication that interferes with blood clotting;
• if the individual suffers from cancer or serious liver disease such as cirrhosis or hepatitis.

Then the doctor will try to locate the source of the bleeding and evaluate the person’s skin to check for symptoms of bleeding disorders, such as petechiae, bruising, or dilated blood vessels.

In some cases, it may still be necessary to make some blood tests and/or a CT scan if a foreign body, tumor, or sinusitis is suspected.

Treatment

As a first approach, bleeding from the nose is associated with an anterior nosebleed. Only if there is a great deal of blood loss are intravenous fluids and blood transfusions given.

The doctor also usually puts cotton soaked in lidocaine (anesthetic drug) and phenylephrine (a drug that “closes” the blood vessels of the nose) or a special spongy plug (nasal plug) in the patient’s nostrils.

In more severe nosebleeds, the doctor may decide to cauterize the bleeding spot with a chemical (silver nitrate) or electrocautery (electric current).

posterior nosebleed

If it turns out that the reason for the nosebleed has its origin in the blood vessels at the back of the nose, then the intervention is more difficult and complex. In this case, squeezing the nose can have the opposite effect, as it can cause blood to drain into the throat.

In this situation, the doctor has to place a specially shaped balloon in the patient’s nose and inflate it to compress the bleeding site. This type of procedure usually involves hospitalization, sedation, oxygen and antibiotics.

If this intervention is unsuccessful, then surgery may be required to close the ruptured blood vessel. For this, a fiber optic endoscope is used. Another technique consists of introducing a small catheter into the nose, which will inject a product to block the blood vessel that is causing the nose to bleed.

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Bleeding from the nose: the what to do?

In most situations, to control nosebleeds, Both sides of the nose should be squeezed simultaneously for 10 minutes while the person is sitting upright.

If, after 10 minutes, the bleeding persists, the procedure can be repeated another time. Only then should medical help be sought if the bleeding does not stop.

Bleeding from the nose: the what not to do?

• Lean the torso backwards: this position will help blood to flow down the back of the throat, possibly going into the trachea and lungs, which can lead to breathing problems. Also, when swallowing the blood, you may experience abdominal pain, vomiting, diarrhea or other uncomfortable symptoms.
• Pinch the nose at the top, on the bone, between the eyes: to stop the bleeding you must compress the region of the nose that has veins and not the bone area.
• Squeeze only one side of the nose: pressure is only effective if applied on both sides of the nose.
• Placing objects inside the nose: it is not advisable to put paper, cotton or other elements in the nostrils. In addition to having no effect, it can lead to other problems.