Nosebleeds: how to stop bleeding correctly and when you need a doctor - in Tashkent

Where does blood usually come from?

The nasal mucosa is supplied with blood very abundantly: its task is to warm and moisturize the inhaled air, and this requires powerful blood flow. In the anterior inferior part of the nasal septum, vessels from different basins form a dense plexus, lying directly under a thin layer of mucous membrane, almost without a protective layer. This area is called the Kisselbach area, and it is responsible for up to 90 percent of all nosebleeds. A small injury, dry air or a sudden change in pressure is enough for the vessel wall to tear.

Anterior bleeding is easy to recognize: blood flows outward from the nostril, usually on one side, the flow is moderate, and it responds well to simple pressure. Posterior bleeding is much less common - from larger vessels deep in the nasal cavity. It is more dangerous: blood flows abundantly into the throat, the person swallows it or coughs it up, and almost nothing may appear outside. This bleeding does not stop on its own and requires medical attention, so it is important to distinguish between these two scenarios.

• Anterior bleeding - up to 90 percent of cases, the source is visible during normal examination, stops with pressure
• Posterior bleeding - less common, more common in older people and with high blood pressure, blood goes mainly into the throat, requires the help of a doctor
• Unilateral bleeding is typical for a local cause: vessel, crust, injury
• Bilateral is more often associated with general causes - pressure, clotting disorders, taking medications
• Repeated bleeding from only one nostril in a teenager requires mandatory examination with endoscopy

How to stop correctly - step by step

The correct sequence of actions is simple, but each point is important, and violation of any one reduces the effect to zero. The main thing to understand is that a vessel stops bleeding when its walls are pressed against each other long enough to form a strong clot. Intermittent pressing resets this process every time.

1. Сядьте прямо и слегка наклоните голову и корпус вперёд, чтобы кровь вытекала наружу, а не в горло. Не ложитесь и не запрокидывайте голову.
2. Двумя пальцами плотно зажмите мягкую часть носа — крылья ниже костной спинки, там, где нос легко сдавливается. Прижимать нужно именно мягкую часть, а не переносицу: на переносице давить бесполезно, там кость.
3. Держите непрерывно 10-15 минут по часам. Не отпускайте каждую минуту, чтобы посмотреть, идёт ли кровь, — это самая частая ошибка, которая разрушает формирующийся сгусток.
4. Дышите ртом. Кровь, попавшую в рот, сплёвывайте, а не глотайте: проглоченная кровь раздражает желудок и вызывает тошноту и рвоту, что затрудняет оценку ситуации.
5. Можно приложить холод на переносицу или на затылок и подержать во рту кусочек льда — это сужает сосуды, но не заменяет прижатие.
6. Через 15 минут медленно отпустите. Если кровь идёт, повторите прижатие ещё на 15 минут. Если и после этого не остановилась — обращайтесь за медицинской помощью.
7. После остановки не сморкайтесь и не трогайте нос минимум несколько часов, не наклоняйтесь и не поднимайте тяжести до конца дня, не пейте горячее и не принимайте горячую ванну.

Why can't you throw your head back?

The advice to tilt your head back has been passed down from generation to generation and is convincing because the blood actually stops dripping out. But this is an illusion of stopping: the vessel continues to bleed, but the blood now flows down the back wall of the throat. Several problems follow from this, and all of them are real.

• Control is lost: it is impossible to understand whether the bleeding has stopped or continues, and the person considers the problem solved, wasting time
• Swallowed blood irritates the gastric mucosa and almost always causes nausea, and then vomiting of dark contents, which frightens both the person himself and those around him.
• Vomiting sharply increases the pressure in the vessels of the head and provokes new, more severe bleeding.
• In a child, elderly person or unconscious patient, blood may enter the respiratory tract - this is a direct threat
• Assessing blood loss becomes impossible: the doctor does not see how much blood has gone into the stomach

The same applies to the advice to lie down. In a horizontal position, the blood also goes into the pharynx, and the venous pressure in the head increases, which does not help stop. The correct posture is sitting, slightly leaning forward; in this case, the head does not need to be lowered too low, a slight tilt is enough. If a person feels weak and is about to lose consciousness, they are placed on their side rather than on their back to prevent blood from flowing into the airways.

Reasons: local and general

The cause of nosebleeds is sought in two directions. Local causes are associated with the mucous membrane itself and are much more common, especially in children and young people. General ones are associated with the condition of blood vessels and the coagulation system, and their likelihood increases with age.

• Dry air is the main and most underestimated reason; with heating in winter and air conditioning in summer, humidity drops to 20-25 percent, the mucous membrane dries out, crusts form, and the vessel tears
• Nose picking and removing dried crusts is a common cause in children and, contrary to popular belief, in many adults
• Nasal trauma, including minor blows, and foreign body impaction in young children
• Abuse of vasoconstrictor drops: they thin the mucous membrane and make blood vessels brittle
• Inhaled hormonal sprays for allergic rhinitis, if the stream is directed to the septum and not to the side wall of the nose
• Deviation of the nasal septum: in protruding areas, air passes faster, the mucous membrane dries more strongly
• Arterial hypertension is the most important common cause in people over 50 years of age
• Taking blood thinners, including low-dose regular aspirin
• Bleeding disorders, liver disease, vitamin K deficiency
• Hormonal changes during pregnancy, when the mucous membrane becomes congested and loose

Sometimes the cause of a nosebleed appears completely unexpected and lies outside the nose. For example, repeated episodes in a person who has recently started taking blood thinners do not require cauterization, but rather a discussion of the dose with the cardiologist. In a male teenager, repeated heavy bleeding strictly from one half of the nose in combination with increasing congestion must be checked by endoscopy and tomography - this rare, but typical for this age, situation requires the exclusion of a vascular tumor of the nasopharynx.

What does a doctor do and when is cauterization necessary?

1. Осмотр полости носа, при необходимости с эндоскопом: врач находит источник кровотечения, что при передней локализации удаётся почти всегда.
2. Остановка кровотечения местными средствами: гемостатические губки и рассасывающиеся материалы, которые не нужно извлекать и которые не травмируют слизистую.
3. Прижигание кровоточащего сосуда — химическое или электрокоагуляцией, под местным обезболиванием; процедура занимает несколько минут и решает проблему повторных кровотечений of зоны Киссельбаха.
4. Передняя тампонада — при продолжающемся кровотечении; современные тампоны раскрываются при смачивании и удаляются менее травматично, чем марлевые.
5. Задняя тампонада или эндоскопическая коагуляция глубоких сосудов — при заднем кровотечении, в условиях стационара.
6. Обследование при повторных эпизодах: общий анализ крови, коагулограмма, измерение артериального давления, при необходимости консультация терапевта или гематолога.
7. Компьютерная томография околоносовых пазух и эндоскопия — при односторонних повторяющихся кровотечениях, чтобы исключить новообразование.

Children and prevention of recurrent episodes

Nosebleeds are common in children, especially between the ages of three and ten years. A child’s mucous membrane is thin, the vessels are close, and almost everyone has the habit of examining the nose with a finger. The heating season plays a special role: in an apartment with radiators, the humidity drops to desert levels, the mucous membrane dries out, crusts form, the child removes them - and bleeding results. This is why most children have episodes in the winter and in the morning.

• Maintain bedroom humidity at 40-60 percent, especially during the heating season
• Regularly moisturize the mucous membranes with saline solutions; if you are prone to crusting, your doctor may recommend emollient ointments
• Cut your child's nails short and calmly explain why he shouldn't pick his nose - punishments don't work here.
• Do not use vasoconstrictor drops for longer than 5-7 days
• When using a hormonal spray, direct the spray towards the outer wall of the nose, not into the septum.
• Treat allergic rhinitis: constant itching causes the child to rub his nose and injure the mucous membrane
• Monitor blood pressure if episodes begin in adulthood or old age
• Discuss medications that affect clotting with your doctor; you cannot stop them on your own.