Nosebleed
From Wikipedia, the free encyclopedia
- For other uses, see Nosebleed plant
 |
||
|---|---|---|
| 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 nosebleed or nosebleedage, 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 nausea and vomiting.
Contents |
[edit] Etiology
The cause of nosebleeds can generally be divided into two categories, local and systemic factors.
[edit] Local factors
- Anatomic deformities
- 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 endoscopic sinus surgery)
- Trauma
[edit] Systemic factors
- Drugs - aspirin, warfarin, clopidogrel, desmopressin and others
- 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
- Muscle tightness as caused by scoliosis (the tightened muscles cause blood vessels to be come constricted, resulting in nosebleeds from the same side as the tightened muscles).
[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. Tilting the head back is not advised, as it can lead to blood flowing into the respiratory system, and possibly resulting in vomiting or death. Petroleum jelly is sometimes applied to stop the blood from seeping out of and prohibit the loss of moisture in the nasal cavity. However, the jelly can drain into the lungs producing a buildup that leads to lipoid pneumonia. [1]
If other techniques do not work, an anterior packing is a possible remedy. An anterior pack works by applying pressure from the inside of the cavity, thus stopping the bleeding. This procedure can be performed at home for minor nosebleeds by gently packing tissue or gauze into the nasal cavity. Nasal sponges[2] are readily available at most drugstores and supermarkets.
If bleeding continues, seeking emergency medical attention is important. Continued bleeding is an indication of more serious underlying conditions.[3] First aid includes inserting either a balloon inflated nasal tampon or dry hydrophilic nasal tampon.[4]
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. A famous person who is reported to have died from a nosebleed was Atilla the Hun. 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. Embolization or ligation of the artery, risking damage to the facial nerves, may be the only solution.
Nevertheless, severe protracted nosebleeds may cause anemia due to iron deficiency.
[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. 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.[citation needed] 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.
Detective Conan involves a high school detective shrinking into a child from the ingestion of APTX-4869 from a crime syndicate. He currently lives with his "friend" Ran whom he actually loves, as so does she, but they refuse to admit it. She is unaware of his real identity, and often treats him like a kid. Because of this, there have been occurences when he has taken baths with her. When she mentions it, he gets a severe nosebleed. He also got a nosebleed when she mentioned her trip to a hotspring with him.
One more example is from the American show Beavis and Butt-head, where Beavis gets punched three times in the nose, resulting in a nosebleed; the lack of intelligence from both characters and Butt-head's insane ideas results in Beavis suffering great losses of blood before they purchase tampons to stem the blood flow.
In the show Everybody Loves Raymond episode "Mozart", Robert quit piano lessons given by his mother because it caused him to have nosebleeds. At the end of the show, Robert is shown playing the drums with his brother, Ray, beside him with tissues when his nose bleeds. He is shown tilting his head backwards, which is NOT advised but was the theory in previous times.
In the movie The Ring, victims get nosebleeds after having seen the videotape.
In Michael Frayn's three-act play Noises Off, Frederick Fellowes gets nosebleeds whenever he sees instances of violence.
In Aqua Teen Hunger Force episode "Antenna", Carl is paid to watch an alien TV show, which is really just a recording of two aliens stacking boxes, while he tilts his head back. This results in his head growing large and losing lots of blood by a nosebleed. In the end of the episode, the effect happens to Meatwad and Frylock as they watch a live recording of Master Shake doing stand-up comedy.
[edit] References
[edit] See also
[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
