Nosebleed

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Nosebleed
Classifications and external resources

Nosebleed as a result of fracture through a rugby impact.
ICD-10	R04.0
ICD-9	784.7
DiseasesDB	18327
eMedicine	emerg/806  ent/701, ped/1618
MeSH	C08.460.261

A nosebleedage or nose bleed, medically known as epistaxis, is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the sinus and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause upset stomachs and vomiting.

[edit] Etiology

The cause of nosebleeds can generally be divided into two broad categories, local and systematic factors.

Local factors

• Anatomic deformitis
  
• Chemical inhalant
  
• Inflammatory reaction (eg. acute respiratory tract infections, chronic sinusitis, allergic rhinitis and environmental irritants
  
• Foreign bodies
  
• Intranasal tumors (Nasopharyngeal carcinoma in adult and juvenile angiofibroma in adolescent males)
  
• Nasal prong O2 ，continuous positive airway pressure therapy
  
• Nasal spray
  
• Surgery (such as septoplasty and endoscpoic sinus surgery)
  
• Trauma
  

Systemic factors

• Alcohol (due to vasodilation)
  
• Allergies
  
• Blood dyscrasias
  
• Heart failure (due to an increase in venous pressure)
  
• Hematological malignancy
  
• Hypertension
  
• Infectious diseases
  
• Malnutrition (especially anemia)
  
• Narcotics
  
• Vascular disorders
  

[edit] Pathophysiology

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury harder to repair.

[edit] Treatment

The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure and reducing the blood pressure in the head by sitting upright with the head tilted forward for about 10 minutes.

Petroleum jelly is sometimes applied to stop the blood from seeping out, but should not be used^{[citation needed]}; as it is petroleum based, it actually further dries out the nasal cavity. Furthermore, it can seep into the lungs and cause a very serious condition known as lipoid pneumonia^{[citation needed]}.

If pressure, ice on the bridge of the nose, application of a vasoconstrictor, or other techniques do not work, a nasal tampon is usually the next step. The nasal tampon stops the bleeding by applying pressure from inside of the nose and is usually kept in for 1-3 days.

Chronic epistaxis resulting from a dry nasal mucosa is often treated by spraying saline in the nose up to three times per day. There are also non-petroleum based gels that can be used.

Persistent epistaxis is an indication for urgent medical consultation. Nasal packing, cryosurgery, electrocautery or application of trichloroacetic acid are options that may be used in severe epistaxis.

It is uncommon to die from bleeding through nosebleeds. However, damage to the maxillary artery can lead to rapid blood loss via the nose and present difficulty in treatment, pressure, vasoconstrictor and rhinocort occasionally proving ineffective. Ligation of the artery, risking damage to the facial nerves, may be the only solution.

A simple treatment for those who have nosebleed on a regular basis is to increase your daily dietary fiber intake. This would make the blood coagulation faster and help quickly stop the hemorrhage.

Nevertheless, severe protracted nosebleeds may cause anemia due to iron deficiency.

If a nosebleed lasts for more than 15 minutes, occurs following a serious injury, or is accompanied by severe blood loss, you should call your doctor or go to the emergency room.

[edit] Famous nosebleeds

Attila the Hun, a legendary commander and the founder of an empire, is reputed by the contemporary historian Priscus to have died of a nosebleed after his wedding. However, the nosebleed only proved to be fatal as the blood ran down Attila’s throat causing him to choke to death. This occurred as a result of Attila the Hun being intoxicated and horizontal during the onset of the nosebleed.

Andrew W.K.'s album I Get Wet depicts himself with a bloody nose on the cover. Many music retailers covered the image with a black sticker.

Nosebleeds feature on the Icelandic band Sigur Rós's 2005 album, Takk.

[edit] Nosebleeds in fiction

In anime and manga (Japanese-originating animation style), it is very common to see sexually/romantically-aroused characters suffering nosebleeds, sometimes intense ones. This happens often in the Anime Naruto whenever the main character Naruto uses his "Sexy no Jutsu" in which he transforms into a very beautiful and naked girl. Sometimes referred as the Japanese Slapstick. This rarely occurs in real life, but is based on a Japanese "old wives' tale", which states that becoming sexually excited can cause nosebleeds. Such occurrences are generally played for laughs and signify "loserhood" and/or virginity. This conception regarding nosebleeds also exists in Chinese culture. The English trip-hop musician Tricky makes a reference to sexual arousal causing nosebleeds in the song Abbaon Fat Tracks in his 1995 record Maxinquaye.

[edit] References

[edit] See also

• Kiesselbach's plexus
• Nosebleed section

[edit] External links

• National Library of Medicine - Describes causes, solutions, and prevention of nosebleeds
• stop-nosebleeds.org - describes the Thumbs Up alternate method of stopping nose bleeds