What
are the common causes of epistaxis?
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The most common cause is what we called idiopathic
due to rupture of blood vessels in the nose as a result of minor trauma during
nose blowing, rubbing, pricking and sneezing.
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Other more definite trauma
to the nose such as a blow or a fall with nose hitting against object can
obviously results in epistaxis.
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Tumour
of the nose or nasopharynx is also a common cause.
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Epistaxis is also commonly seen in patient with
bleeding tendency e.g. platelet
insufficiency.
What
should we do when epistaxis happens?
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Since most of the epistatic episodes are
idiopathic and occur over the anterior part of the nose, the bleeding can often
be stopped by ¡¥digital pressure¡¦ i.e. by pressing on the nose with fingers.
However, most patients do it wrong.
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Do not insert materials such as toilet tissue
paper inside the nose because the pressure on the blood vessel is usually not
enough and you may cause further damage to the nose if not done properly. Some
part may also be left inside the nose.
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If bleeding cannot be stopped by digital
pressure, go to the nearest emergency department or consult a registered ENT
specialist. There are some materials which can be inserted into the nose to stop
the bleeding. These include: vaseline gauze, gel foam, Merocel pack and various
rubber catheter that can be inflated after insertion.
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After the bleeding has stopped, the nose should
be examined thoroughly by an ENT specialist who will determine the cause of the
epistaxis and then treat accordingly to prevent further bleeding.
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The
correct way is to use two or three fingers to pinch the soft cartilaginous part (the tip) of the nose. Try to cover the entire soft part including the nostril. Do not release it every now and then to check the bleeding. Keep the pressure for at least five minutes and breath through the mouth. The patient should be sitting with the head in
the horizontal position. |
What can be done to prevent epistaxis?
- Avoid pricking and rubbing nose. Get appropriate treatment for cold and nasal allergy so that sneezing and nose blowing can be avoided.
- For those with repeated epistaxis of the idiopathic type, an ENT specialist can cauterize the vessels of the bleeding site by applying some chemicals (such as trichloroacetic acid and silver
nitrate) or by means of an electrode.
- Other causes such as bleeding tendency and tumour should be treated accordingly.
¡@ |
by Dr. Lo Kwok Fai, Godfrey
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