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common cause of Epistaxis

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epistaxis AND causes

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epistaxis common causes patient information

The most common causes of epistaxis (nosebleed) are:
  • Local trauma: nose picking, forceful nose blowing, minor injury
  • Dry nasal mucosa: dry weather, air-conditioning, heated rooms
  • Inflammation/infection: rhinitis, common cold, sinusitis, allergies
Most arise from fragile vessels in Little's area (Kiesselbach plexus) on the anterior nasal septum.
Other important causes include nasal foreign body or trauma, use of anticoagulants/aspirin, bleeding disorders, intranasal drug use, and rarely a nasal tumor. High blood pressure usually does not initiate a nosebleed but can make bleeding more persistent, as summarized by the Merck Manual.
Seek urgent care if bleeding is heavy, follows significant injury, causes faintness/breathlessness, or continues after 15-20 minutes of firm nasal pressure.

When does a nosebleed require urgent medical care? days but no bleeding trace. after sometimes, he developed profuse nasal bleeding, wgat can be the probable causes?

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epistaxis AND management

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epistaxis emergency warning signs persistent bleeding first aid official health advice

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Profuse bleeding after several symptom-free days needs urgent assessment today, especially if there was recent nose, facial, or head trauma. Go to the emergency department now if bleeding is ongoing or recurring heavily.

Seek emergency care immediately if

  • Bleeding continues after 15-20 minutes of uninterrupted correct pressure
  • Blood is pouring from the nose, running into the throat, or coming from both nostrils
  • There is dizziness, fainting, weakness, pale/clammy skin, shortness of breath, chest pain, or confusion
  • There was a head/facial injury, suspected nasal fracture, or recent nasal/sinus surgery
  • The person takes a blood thinner or antiplatelet drug, such as warfarin, apixaban, rivaroxaban, aspirin, or clopidogrel
  • There is known liver disease, low platelets, a bleeding disorder, or easy bruising
  • It is recurrent without an obvious trigger, especially with nasal blockage or a mass
The emergency concern is a posterior nosebleed, which can be heavier and more difficult to control than the common anterior bleed. It can compromise the airway or cause substantial blood loss. Textbook of Family Medicine, p. 174; Tintinalli's Emergency Medicine, p. 949.

What to do now

  1. Sit upright and lean forward. Do not lie down or tilt the head back.
  2. Spit out blood rather than swallowing it.
  3. Pinch the soft part of the nose, just below the bony bridge, firmly and continuously for 15-20 minutes. Do not check repeatedly.
  4. Apply a cold pack to the nose/cheeks.
  5. Do not blow, pick, pack with tissue/cotton, or take aspirin/ibuprofen for the bleeding unless a clinician has advised it.
  6. If bleeding is profuse, call local emergency services rather than driving yourself. The Merck warning signs include shock symptoms, failure of pressure to stop bleeding, and repeated unexplained episodes.

Possible causes of severe delayed bleeding

If you mean there was an injury, then no bleeding for days followed by a heavy bleed can occur from:
  • A damaged nasal lining or vessel that initially clotted, then reopened due to nose blowing, picking, coughing, exertion, dry air, or infection
  • An unrecognized nasal fracture or deeper posterior nasal injury
  • A medication or condition that impairs clotting: blood thinners, aspirin/clopidogrel, low platelet count, liver disease, leukemia, or inherited bleeding disorders
  • Nasal infection/inflammation, a foreign body in children, or less commonly a nasal growth
  • Rarely after significant facial/head trauma or surgery, an injured artery can form a pseudoaneurysm and bleed later, often profusely. This requires emergency ENT and sometimes radiology treatment.
High blood pressure can be elevated during a nosebleed from stress and may contribute to persistent bleeding, but it should not be assumed to be the sole cause. Rosen's Emergency Medicine, p. 1008.
Do not stop prescribed anticoagulants on your own, but bring the medication list to the emergency department.
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