Definition of Nosebleeds also the incidence.
The neonatal runny nose is caused by ruptured capillaries in the nasal cavity, causes bleeding from one or both sides, can flow from the front, or the back of the nose is found in both men and women.
Nasal congestion is common in children and young adults. Bleeding from the back of the nose is more common in the elderly. Which is often caused by high blood pressure.
Epistaxis means bleeding from the nasal cavity to the front or back of the nasal cavity. It can be found on one side or on both sides can be found in all genders and ages, which are often found in men more than women. This condition is more common in cold weather than in other seasons.
This is because it is difficult to estimate the incidence of runny nose in the general population in winter with low humidity and cold or upper respiratory tract inflammation.
Because the condition can go away on its own or can be improved with psychiatric care without seeing a doctor. Neonates themselves can be caused by nasal or bone diseases or other diseases. Patients who come to the doctor with this problem can be divided into 2 major groups.
A group of small amounts of bleeding can stop on its own but it has happened many times in children, adolescents, or young people. Bleeding from the back of the nose (previous version).
A group of nosebleeds but has a lot of blood and can’t stop itself. They are patients who have a medical condition such as hypertension and bleeding, which often occurs from the penis.
Anatomy of the blood vessels that feed the nasal cavity, The nasal cavity is the area where most of the blood is supplied, both the posterior nasal wall and the nasal septum.
Where the nuclei are distributed.
Bleeding from the front of the nasal cavity, which occurs in 90% of all newborn parts of the nose, is most common in children and adolescents who have a history of nasal congestion or most bleeding with the nasal mucosa. Comes from the nose. Which is a region in which more than one blood vessel is paired with a nasal cavity examination at the front
Bleeding from the back of the nasal cavity Bleeding from the neck which often has severe symptoms and can be found in elderly patients with hypertension with arteriosclerosis or in patients with tumors in the nasopharynx which There is too much blood to feed (nasopharyngeal angiofibroma),
For example, blood often comes from an aorta behind the nasal cavity. This location can be seen through an endoscope examination of the nasal cavity.
Bleeding from the top of the nasal cavity Bleeding from this position is usually less than the first 2 types, which may be due to bone surgery, head injury, or certain types of tumors.
Because of the nose
1. Specific reasons
1.1) Irritation or injury to the nose, such as picking the nose, which is often done to get into the habit. People who have a habit of blowing their nose have a tendency to dry their nose. When choosing, it creates friction.
And there can be chronic sores, especially in the front of the nose, nasal congestion (which may or may not break the nasal bone), surgery in the nasal cavity, such as nasal separation surgery, separation from the nose Surgery, bone marrow surgery, endotracheal intubation, nasal spray steroid medications or inhaling cocaine incorrectly for a long period of time, nasal discharge or rapid change in air pressure, such as when boarding an airplane.
The time or while diving, e.g. Bleeding from the nose will cause the nasal cavity to rupture, the amount of bleeding is usually less. And went out for a short time and may bleed repeatedly during the rehabilitation phase. Severe injury to the head and face (which can directly hit the nose or bone cavity) Excessive bleeding from the nose in the early stages Is.
But if you are bleeding from your nose after an injury this week, you should also think about the brain damage caused by an accident, as far as cold weather is concerned, low humidity will dry out the nasal brain and cause irritation. Will become And bleeding easily.
1.2) Inflammation of the nasal cavity such as viral infections, allergic rhinitis, sinusitis, foreign substances in the nose, various itching such as saline cocaine inhalation to treat sleep apnea to an air compressor [nose constant positive airway pressure (CPAP).
Or providing oxygen with low humidity which is why it will cause congestion in the lining of the nose and/or more than normal bone mucosa and blood vessels to break easily so blood is often mixed in the mucus Is. But if the inflammation gets worse or the patient flies too much, he will be able to bleed a lot
1.3) Physical abnormalities such as a crooked nasal wall or bone that grows or has a hole in it that causes an imbalance of air that passes through it. Patients often have a runny nose that has a nasal wall.
Or the narrow side because the narrow side is breathing or the air is passing out. More and more sharp nasal mucosa becomes dry, flaky, and delicate, bleeding easily. The point that often causes bleeding is usually It is positioned in front of a crooked or bent bone.
1.4) Tumors, such as cancer in the nose, sinuses or nasopharynx, or benign tumors with high blood vessels can cause nosebleeds. Therefore, patients with nosebleeds are disappearing. Or there is a large amount of bleeding from the nose. There should be an endoscope in the nasal cavity or get an X-ray examination. Is there a tumor that is causing it?
1.5) Damage to the blood vessels that reach the nose, such as an aneurysm due to an accident or abnormal arteries and blackness that was accumulated by accident, etc.
2. Due to other systemic diseases
2.1) Various blood diseases including various blood clotting diseases such as hemophilia, cirrhosis, anticoagulant drugs, vitamin K deficiency, thrombocytopenia. Or impaired function, such as aspirin or NSAIDs
2.2) Patients with vascular diseases such as hereditary hemorrhagic telangiectasia with certain genetic disorders or atherosclerosis which is common in hypertension etc.
2.3) The reason for which is not yet known. About 10% found
1. Assess the severity and correct the condition caused by anemia and find out the cause, the first thing to consider is the respiratory diagnosis and correct the basic circulatory system and timely like air.
Pave the way for anesthesia fluid administration, blood reservation together with hemostasis, and then detect the cause of the nose
In general, the severity of nuclei can be divided
1.1) Low level means a small amount of blood. Can’t measure the amount clearly, such as contaminated handkerchiefs or toilet paper, and often stops by itself.
1.2) Medium means more bleeding and can explain this amount, such as more than 100 ml or a glass of drinking water. Significant symptoms are still common.
1.3) Severe level means heavy bleeding unless there is a sign of low-level fluid in the arteries or convulsions, such as high pulse, low blood pressure, or fainting. Close even after being blocked by gauze in the nasal cavity in the front and back.
It will be important for doctors to diagnose patients with a history or nearby causes, but if the patient is bleeding at the moment, the doctor will treat you by taking a date with you, such as dose, severity, duration, and bleeding.
Frequent frequency and bleeding from the side of the nose (left-right), nose, runny nose, history of nasal trauma. Overall health history Family history of illness, medication, smoking or alcoholism
After that, the doctor will perform a general physical examination, examine the head and neck, and examine the nasal cavity using an endoscope.
Check both first and sign up in the nasal cavity after using vasoconstrictor drugs or other special tests such as blood clotting level, volume and platelet function in case of a desire to evaluate the anatomy in the nasal cavity or suspected The patient may have a tumor or cancer, may have a radiological examination such as a CT scan or MRI
The patient with the front bleeding position should be in a sitting position and there is enough light to illuminate the examination area. The doctor will prepare an anesthetic.
Blood suction and sphincter machine Use material to stop bleeding or pendant to bleed the area then the doctor will start examining the nose and then use the nose to suck the blood clots in the nasal cavity. Cotton sleeping cotton bush to enter the cavity. Stop bleeding.
Patients with a bleeding position in the back will begin with hemostasis in front of the doctor. And using gauze behind the nasal cavity can block the arteries behind the nasal cavity if you can’t stop the bleeding or consider the presence of a vascular filling agent using a nasal cavity using a camera.
This is becoming increasingly popular as the bleeding position can be clearly seen, especially the back of the nasal cavity, and can be used in conjunction with bleeding points.
Hemostasis by different methods, according to the degree of increasing severity and according to the status of bleeding
2.1 Stress is a first aid kit. In which the patient is seen up or down and allows the patient to use the finger and thumb, instead of breathing through the mouth, squeeze firmly for 5-10 minutes.
Use ice to press the front of the nasal partition wall where the most bleeding is, or a cold cloth to press the outside nose. If there is bleeding from the neck, spit in a container to estimate the amount of blood. Give And prevents vomiting from swallowing too much blood
Within the first 24-48 hours after nasal congestion, if the bleeding stops, you should rest, raise your head, and bring ice or cold packs to compress your forehead or neck.
And avoid ordering strong notes, nasal congestion, nasal trauma, extreme physical activity, strenuous sports or lifting heavy objects as this can cause bleeding if the bleeding does not stop or stops abnormally. Patients should go to the hospital immediately to consult a doctor.
2.2 For small amounts of bleeding, topical detergents can use the blood vessels to narrow the nose, which causes the blood vessels in the nasal mucosa to contract. Or the doctor may use a cotton ball moistened with the medicine to narrow the blood vessels in the nose and squeeze the patient.
Examples of drugs in this group include 1–3% ephedrine or 0.025–0.05% oxymetazoline, etc. The use of nasal drops in this group. Should not be used permanently for more than 7 days as rhinitis may be medisominotus.
2.3 Cauterization, doctors will choose to use small amounts of blood in cases. Or hijacking this hemostatic with frequent bleeding and hemorrhage can be done using chemical stimulants such as 20% silver nitrate or 50% (or 85%) trichlor acid which is suitable for spot bleeding.
In front of the nasal partition wall or using electric (electric cartilage) and in some cases after the pendant is removed, the doctor may choose to use a laser (laser verticalization). (Such as chloramphenicol ointment) where bleeding used to occur. For 7-10 consecutive days
2.4 Hemorrhage cannot be prevented by using back nasal packaging for nasal bleeding and by pressing or hijacking, or in cases where the bleeding position is not clearly visible
To prevent bleeding, this method can use many substances such as Merocel (hemostatic substance spread after contact with blood or water), use of balloons in the nose to prevent bleeding, Vaseline Goose, rubber gloves using gloves, filled with sponge (nose sponge) and can choose to use materials that dissolve without stretching themselves, such as gel foam or Surgical ox (oxidized cellulose), which is suitable for patients with blood diseases. (Like easy bleeding but hard to stop)
Vaseline-colored goosebumps in the frontal nasal cavity begin with colored Vaseline, about 3 inches wide, coated with antimicrobial ointment. Enter the nasal cavity and lay the gases arranged in layers from bottom to top.
To be narrow enough to stop the blood and gas can enter the finger part of the rubber glove to stop the flow of gas in the back of the nasal cavity and gossip. It helps to stick to the nasal mucosa.
No bleeding due to this hemostatic substance. When removing this hemostatic substance, in general, but the insoluble hemostatic substance in the nose for at least 24 – 48 hours and then consider removing it. To do
Complications of this hemostasis are open science thrombosis. Can cause sinusitis, sharp tears, nasal mucosa clogging, wall-to-wall spasm or hypoxia, especially in patients with obstruction of the airways when sleeping pos.
The use of nasal packaging for nasal packaging is used in cases of severe nasal congestion from the back or after the use of substances to prevent bleeding into the nasal cavity if bleeding does not stop.
2.5 How to do it: You can choose to use a balloon with a hemostatic catheter or use a Vaseline roll. Local anesthesia, nasal and throat spray, or general anesthesia. Blue urine enters the nose through the catheter with a bleeding aspect.
When the tip is in the nasopharynx, the doctor will moderately inject air or water into the balloon. Then, use colored gauze with Vaseline to stop bleeding in the nasal cavity.
In the case of a Vaseline goose wrapped in a hemostatic sinusoidal goose, the doctor will start by attaching the Vaseline to a 4 X 4-inch goose and then twisting it into a knot.
The gauze roll has 2 silk threads on one side and only one silk thread on the other side. And use a small hose into the nose that is bleeding profusely, down the throat, through the nasopharynx, then let the patient open his mouth. And bring the end of the hose out through the mouth to tie the end of the silk thread which has 2 strings of the finished coil and pull the hose back to the nose to take the gas to the back of the nasal cavity.
And use goose-colored Vaseline to stop bleeding into the nasal cavity. When finished, the doctor will tie the two threads using small pieces of gauze. Attach it to the fistula. So that the gossip is not below the neck, the remaining 1 line is coming out of the mouth. The doctor will use sticky tape to put on the cheeks. Later to be used to extract the gas coil.
The doctor will allow the patient to stay in the hospital. Raise your head about 30-40 degrees, give oxygen, including pain medication and antimicrobial. Typically, the hemostatic substance is pressed against the front of the nasal cavity and the goose is attached to the nasal passages. There is always bleeding in the nasopharynx.
And consider removing the hemostatic substance or removing gauze-colored Vaseline. Bleeding or replacement within 3-5 days. Possible complications include suffocation, difficulty swallowing, obstruction of the eustachian tube, congestion in the middle ear.
If you don’t care, there may be pressure ulcers on the wings of the nose or gauze silk affected by Vaseline curling can cause sores on the soft palate and corners of the mouth. Stop bleeding in the nasal cavity.
2.6 Arterial injection
Hemostasis is a very effective method. Both are diagnostic and are therefore effective in locating blood vessels, and vascular fillers such as polyvinyl alcohol, gel foam, and especially injectable treatment are used in patients with severe bleeding.
Does not stop after the use of hemostasis in the nasal cavity from the back of the nose and still in the front and is used in patients with nasopharyngeal glands, or abnormal vascular disease, or having a tumor that has a lot of blood vessels Am
Contraindications to using this method include patients with atherosclerosis, patients who are allergic to radiotherapy, and who should not use it in case of bleeding from the top of the nasal cavity, which may increase the risk of brain complications.
The advantage of this method is that bleeding can be clearly detected, especially in areas where the veins are deep, and surgery is not accessible. It can also be repeated if there is another bleeding and there may be no need for anesthesia.
The disadvantage is that expensive instruments are needed and radiologists who specialize in vascular injections. Therefore, this can only happen in institutions that are ready. Are
Problems that may occur with this procedure include hemostasis, ischemic brain, facial nerve paralysis, blindness from clogged blood vessels in the eyes, discomfort in the face and jaw, bleeding in the affected area, and clotting. Is. Lines for injecting blood vessels, etc., which are rare.
2.7 Artery binding
It is often used in cases of a severe runny nose when using a hemostatic substance to press into the anterior cavity and the nasopharyngeal cavity and ineffective, which will choose which blood vessel to tie depends on the idea that the nose Exits Coming out of any position and blood vessels that eat this position What is a blood vessel?
Use a camera to look at arteries that may be blocked, such as through a surgical incision in the neck, near the head of the eye, or inside the nose, then use a device to squeeze the veins.
Provide treatment and repair the epithelium such as surgery to find the cause and remove the tumor, surgery to remove the lesions, correct the hemorrhage disorder or perform crooked septum surgery or cut the bone that has crooked nasal walls Or it grows in patients with bone regeneration, which causes bleeding from the nose and so on.
In short, nose to nose or bleeding. It is a common condition and an ENT emergency that patients should be able to treat as soon as possible. The most common cause is a runny nose or rhinitis, especially in young patients.
Rehabilitation that should be done in a timely manner Check the amount of bleeding and lost blood so that a suitable alternative can be made and see a doctor find out the cause and treat according to the causes