#Epistaxis – Nosebleeds
–Pathophysiology and causes reviewed.
Acute treatment
-Position patient leaning forward. This Keeps blood from collecting posteriorly. Prevents Nausea and airway obstruction
-Pinch the nose for 10-20 minutes.
-Oxymetazoline (Afrin) spray. Consider using it to cause vasoconstriction and reduce bleeding.
-Cauterize with silver nitrate. It’s as good as electrical cautery. Don’t use silver nitrate cautery on both sides of the septum. That increases the risk of perforation.
-Nasal packing – Many different types of packings are available, ranging from petroleum (Vaseline) gauze to balloon packs to synthetic sponge packs that expand when moistened. The decision as to which one to use is usually made by the doctor.
-Ice.
Preventing Nosebleeds
Most nosebleeds occur during the winter in cold, dry climates. If you are prone to nosebleeds,
– Humidifier: Use a warm or cold humidifier containing water without additives in the child’s bedroom at night is helpful. May be contraindicated in a child with severe allergies or pulmonary problems.
-Saline Nose Spray: Instead of a humidifier, you may use a saline nasal spray to keep the nasal passages moist. Apply two to four times per day. Can get OTC in most drug stores.
– Put ointment in the nose: Put ointment in the child’s nose (on a nightly basis if the child is having frequent nose bleeds). Use a q-tip to but vaseline (petroleum jelly) or another over-the-counter nasal lubricant into the nose. Then gently squeeze the nose to remove some of it and leave the rest. You may use an antibiotic ointment sometimes if an infection is thought to be the cause of the dryness. But vaseline or preferably, a water-based ointment is best.
–Avoid picking the nose or blowing your nose too vigorously. Keep fingernails short and use protective face gear, as indicated, during sports.
-Control Medical condition: If the nosebleed is due to a medical condition, such as liver disease, nasal allergies, or a chronic sinus condition, follow your doctor’s instructions to keep that problem under control.
-Stop smoking: Smoking contributes to nasal dryness and irritation.
**If it’s posterior bleeding, you will admit and consult ENT. They will do packing other tx.