Epistaxis for university exam very simple language with homeopathic medicine
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Epistaxis (Nosebleed) - University Exam Notes
What is Epistaxis?
Epistaxis = bleeding from the nose. The word comes from Greek: epi (above) + stazein (to drip). It is one of the most common ENT emergencies.
Anatomy You Must Know
Little's Area (Kiesselbach's Plexus)
- Located at the anteroinferior part of the nasal septum
- This is where 4 arteries meet:
- Anterior ethmoidal artery
- Posterior ethmoidal artery
- Sphenopalatine artery
- Greater palatine artery + septal branch of superior labial artery
- Most common site of epistaxis - especially in children and young adults
Types of Epistaxis
| Feature | Anterior | Posterior |
|---|---|---|
| Site | Little's area (septum) | Posterior nasal cavity |
| Who gets it | Children, young adults | Elderly, hypertensives |
| Severity | Usually mild, self-limiting | Heavier, more serious |
| Visibility | Easy to see and treat | Harder to access |
| Common cause | Nose picking, dry air | Hypertension, anticoagulants |
Causes (Easy to Remember)
LOCAL Causes
- Nose picking (most common in children)
- Nasal trauma / fracture
- Foreign body in nose
- Infections (rhinitis, sinusitis)
- Tumours (e.g. juvenile angiofibroma in adolescent boys - can cause massive bleeding)
- Granulomatous diseases (e.g. Wegener's granulomatosis)
- Septal deviation / perforation
SYSTEMIC Causes
- Hypertension (most common systemic cause in adults/elderly)
- Anticoagulants - Warfarin, Rivaroxaban
- Antiplatelet drugs - Aspirin, Clopidogrel
- Bleeding disorders - Haemophilia, von Willebrand's disease
- Blood cancers - Leukaemia
- Hereditary Haemorrhagic Telangiectasia (HHT / Osler's disease) - recurrent bleeds from thin-walled fragile vessels
- Liver disease, renal failure
ENVIRONMENTAL
- Dry air, low humidity
- High altitude
- Sudden temperature change
Clinical Features
- Blood coming from one or both nostrils
- Blood may flow backwards into the throat (posterior bleed) - causing swallowing, nausea, or vomiting
- Severe bleeding can cause anaemia or haemorrhagic shock
First Aid / Immediate Management
This is called the "Trotter's Method" or basic first aid:
- Sit the patient upright, lean head slightly FORWARD (not backward - prevents swallowing blood)
- Pinch the soft lower part of the nose for 10-15 minutes continuously
- Breathe through the mouth
- Apply ice pack or cold compress to the bridge of the nose
- Do NOT blow the nose, tilt head back, or swallow blood
Medical & Surgical Management (Step-by-Step)
Step 1 - First Line (Simple)
- Anterior bleeding: Silver nitrate cautery under local anaesthesia - very effective for Little's area bleeds
Step 2 - Nasal Packing
- Anterior nasal packing: Vaseline-impregnated ribbon gauze or absorbable haemostatic material
- Inflatable epistaxis balloon catheter: passed into nose, balloons inflated to compress bleeding point - effective but uncomfortable
Step 3 - Posterior Bleeding (Severe)
- Posterior nasal pack under general anaesthesia
- Endoscopic sphenopalatine artery clipping - very effective for bleeds not responding to packing/cautery
- Endoscopic electrocautery using nasal endoscope
Step 4 - Life-Threatening / Refractory Cases
- Vascular ligation: internal maxillary artery ligation, anterior/posterior ethmoidal artery ligation
- External carotid artery ligation
- Interventional radiology - Embolisation: Superselective embolisation of internal maxillary and facial arteries. Success rate 91-97%, complication rate 0-3%
General Measures
- Treat underlying cause (e.g. control blood pressure, adjust anticoagulants)
- Correct clotting abnormalities, platelet transfusion if needed
- Tranexamic acid to help clotting
- Humidify environment, saline nasal spray to keep mucosa moist
Special Conditions to Know
Juvenile Angiofibroma
- Occurs in adolescent boys
- Highly vascular benign tumour - can cause massive life-threatening epistaxis
- Diagnosed by contrast CT/MRI
- Classic sign: Holman-Miller sign (antral sign) - anterior bowing of posterior antral wall on imaging
- Do NOT biopsy (risk of uncontrollable haemorrhage)
- Treatment: surgical excision (usually endoscopic), preoperative embolisation to reduce bleeding
HHT (Osler's Disease / Hereditary Haemorrhagic Telangiectasia)
- Autosomal dominant
- Recurrent epistaxis from fragile thin-walled telangiectatic vessels on nasal mucosa
- No muscle or elastic tissue in vessel walls
Homeopathic Medicines for Epistaxis
These are the key remedies - remember the key indication for each:
| Medicine | Key Indication |
|---|---|
| Arnica montana | Epistaxis after trauma/injury, blow or fall on nose; also in typhoid fever; sore, bruised feeling |
| Ferrum phosphoricum | Epistaxis in children with frequent colds and fevers; first stage of inflammation; bright red blood; child picks/rubs nose constantly |
| Millefolium (Yarrow) | General epistaxis - bright red blood without any known cause; most commonly prescribed remedy |
| Phosphorus | Bright red blood in tall, thin individuals; bleeding from small wounds; tendency to easy bleeding |
| Lachesis | Dark, thick, offensive blood; blood may be acrid and irritating to nostrils/lips; black blood |
| Carbo vegetabilis | Epistaxis in debilitated, exhausted patients; air hunger; useful in elderly |
| Melilotus alba | Nosebleed relieves a congestive headache; bright red blood; throbbing headache with flushed face that disappears when bleeding starts |
| Hamamelis | Venous bleeding; dark blood; passive haemorrhage; weakness after blood loss |
| Crocus sativus | Stringy, dark blood forming threads from the nose; haemorrhage with alternate laughing and weeping |
Quick Potency Guide (commonly used):
- Millefolium 6C - general use
- Arnica 1M - after trauma (frequent doses)
- Ferrum Met 200C or 1M, Phosphorus 30C or 1M - without obvious cause
Summary Table for Quick Revision
| Point | Key Fact |
|---|---|
| Most common site | Little's area / Kiesselbach's plexus |
| Most common cause in children | Nose picking |
| Most common systemic cause | Hypertension |
| Most common type | Anterior epistaxis |
| Most dangerous tumour | Juvenile angiofibroma (adolescent boys) |
| Do NOT do | Tilt head back / biopsy juvenile angiofibroma |
| Best homeopathic for general use | Millefolium |
| Best homeopathic after trauma | Arnica |
| Best homeopathic for children with fever | Ferrum phos |
| Best homeopathic for dark/thick blood | Lachesis |
Sources
- Bailey and Love's Short Practice of Surgery, 28th Ed. (Ch. 51 - Nose)
- Cummings Otolaryngology Head and Neck Surgery
- Rosen's Emergency Medicine
- Boericke W. - Pocket Manual of Homoeopathic Materia Medica
- Dr. Bhatia's Homeopathy - Epistaxis Remedies
- International Journal of Homoeopathic Sciences - Epistaxis Article
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