Most common nosebleeds will stop after the application of first aid by the patient.
- When your nose starts bleeding, sit up and lean forward to prevent blood from passing into your throat, which may cause choking.
- Pinch the nose firmly together between the thumb and index finger, just below the nasal bones, and hold it for 10 minutes.
- Moisten a cotton ball or pad with a saline nasal spray and press it against the bleeding part of the nose if possible.
- Continue to sit quietly and press on your nose.
- After the bleeding stops, apply zinc oxide to the septum to prevent drying and abrasions. Also, use a saline nasal spray to keep the nose moist.
If a nosebleed does not respond to first aid or lasts more than 20 minutes, however, it is necessary to see a physician.
The physician will remove all packings, and may apply a topical anesthetic and vasoconstrictor via an aerosol spray or cotton applicators. Clots may be suctioned out to permit view of the site. Anterior rhinoscopy may be performed (DESCRIBE) before and after the administration of medication. The physician may use a fiberoptic endoscope to examine the entire nasal cavity, including the nasopharynx. Rigid endoscopes are superior to flexible endoscopes in this case, because they provide better optics and also permit endoscopic suction and cauterization. If underlying medical conditions are suspected, a range of laboratory tests may be recommended. Imaging studies (such as CT scan or MRI) may be recommended to determine the presence or extent of rhinosinusitis, foreign bodies, or abnormal growths.
Cauterization is a procedure used to force the blood to clot (coagulate) at the site of the bleeding. Cautery may be done with silver nitrate or with an electrocautery instrument. Electocautery is usually reserved for more severe bleeding and posterior nosebleeds, and usually requires the use of local anesthesia.
Nasal packing may be used to treat nosebleeds not responsive to cautery. Packing for anterior nosebleeds (near the front of the nose) is relatively simple. Packing for posterior nosebleeds (in the back of the nose) can be more difficult and uncomfortable. Your physician will use anesthetics to numb the site and vasoconstrictive agents to reduce the blood flow to the area. Several packing materials are commonly used, including petroleum jelly gauze impregnated with antibiotic ointment, absorbable materials (such as Gelfoam, Surgicel, Avitene), and Merocel sponges. For posterior nosebleeds, rolled gauze or recently developed inflatable balloon devices may be used. If a posterior pack is placed, an anterior pack will also be used as well. Patients will receive antibiotics to prevent infection.
Patients should never remove their packing; severe bleeding and improperly handled packing can be fatal.
For a week after packing, patients should avoid physical strain and injury to the nasal mucosa by picking, rubbing, or forcefully blowing the nose.
While most nosebleeds stop with cautery and/or packing, severe or recurrent bleeding may require surgical treatment. Procedures may include:
Packing may fail because of lack of cooperation (especially among children) or from anatomic problems such as a deviated septum. An endoscopic exam under general anesthesia may be performed, bleeding sites may be cauterized, deviated septum may be straightened, spurs may be removed, packing may be replaced, and arterial ligation may be performed during the same procedure, if necessary.
Arterial ligation involves constricting specific blood vessels in order to stop bleeding. Procedures may require local or general anesthesia. Ligation may be performed on the external carotid artery, the internal maxillary artery, the ethmoid artery (anterior and/or posterior). Depending on the procedure and the site of ligation, arteries may be cauterized or clipped. [CAN YOU PLEASE ADD MORE HERE - SAY WHAT THE EFFECTS, SUCCESS RATE, PROBLEMS, ETC ARE WITH ARTERIAL LIGATION]
Embolization (sometimes called embolotherapy) entails the introduction of a substance into a blood vessel in order to close it and prevent bleeding. See http://www.entcolumbia.org/embol.htm for information on this procedure.
Information about nosebleeds