Epistaxis overview: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
In past centuries, people thought [[epistaxis]] happened due to internal diseases. As the medical knowledge advanced, people found out that nasal compression can stop [[bleeding]]. [[Hippocrates]] was the first one who used some instruments to stop nasal [[bleeding]]. The term epistaxis was originally derived from the Greek word ''epistazein'' (epi – above, over; stazein – to drip). | In past centuries, people thought [[epistaxis]] happened due to internal diseases. As the medical knowledge advanced, people found out that nasal compression can stop [[bleeding]]. [[Hippocrates]] was the first one who used some instruments to stop nasal [[bleeding]]. The term epistaxis was originally derived from the Greek word ''epistazein'' (epi – above, over; stazein – to drip). | ||
==Causes== | |||
The [[causes]] of [[epistaxis]] can be divided into [[idiopathic]] and [[non-idiopathic]] ones. There are many [[diseases]] can cause [[epistaxis]], it can start spontaneous either. Usually [[epistaxis]] is not dangerous but in some cases it can become [[life threatening]]. [[Trauma]] is the most common [[Causes|cause]] of epistaxis. besides it, [[medications]] and [[idiopathic]] [[epistaxis]] are other common causes of [[epistaxis]]. | |||
==Pathophysiology== | ==Pathophysiology== |
Revision as of 23:04, 29 October 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D., Liudvikas Jagminas, M.D., FACEP [2]
Overview
Epistaxis is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.
Historical Perspective
In past centuries, people thought epistaxis happened due to internal diseases. As the medical knowledge advanced, people found out that nasal compression can stop bleeding. Hippocrates was the first one who used some instruments to stop nasal bleeding. The term epistaxis was originally derived from the Greek word epistazein (epi – above, over; stazein – to drip).
Causes
The causes of epistaxis can be divided into idiopathic and non-idiopathic ones. There are many diseases can cause epistaxis, it can start spontaneous either. Usually epistaxis is not dangerous but in some cases it can become life threatening. Trauma is the most common cause of epistaxis. besides it, medications and idiopathic epistaxis are other common causes of epistaxis.
Pathophysiology
All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause tears, while inflammation, coagulation problems, and other disorders may make the injury harder to repair...[1]
Risk Factors
- Vascular abnormalities:.[1] [2]
- Hereditary Hemorrhagic Telangiectasia
- Congestive hearth failure
- Granulomatosis with polyangitis
- Trauma
- Infections
- Coagulopathies:
There is not enough evidence that hypertension is a risk factor for epistaxis. The role of lowering blood pressure to control and prevent epistaxis remains controversial.
Diagnosis
Epistaxis has different causes and based on medical history, family history, and physical examination we can find the cause Rhinoscopy is the first option to find the location of bleeding..[1] [3] [4]
- Trauma is the most cause of epistaxis.
Treatment
- Nasal compression for more than 5 minutes is the first action to stop active nose bleeding.[1] [3] [4] [5] [6]
- Rhinoscopy should be performed to find the bleeding site. Lubricants, Topical vasoconstrictors, Nasal cautery are options after finding the bleeding site.
- Nasal packing is used when we couldn't find the bleeding site or when we couldn't stop bleeding with other actions:
- Absorbale packing is preferred in patients with HTT or on anticoagulants and in children.
- Non-absorbable packing is the other option that can be used for other patients.
- In patients on anticoagulant medications, we should evaluate the need for or risk of discontinuation Anti-Coag/Anti-Platelet medications.
Surgery
Embolization and surgical arterial ligation are the last options to stop epistaxis in patients which other actions didn't work.[1] [4]
Primary Prevention
Avoid Nose-picking and using lubricants and nasal saline spray can decrease possibility of epistaxis.[1] [5]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
- ↑ Douglas, Richard; Wormald, Peter-John (2007). "Update on epistaxis". Current Opinion in Otolaryngology & Head and Neck Surgery. 15 (3): 180–183. doi:10.1097/MOO.0b013e32814b06ed. ISSN 1068-9508.
- ↑ 3.0 3.1 Tunkel, David E.; Anne, Samantha; Payne, Spencer C.; Ishman, Stacey L.; Rosenfeld, Richard M.; Abramson, Peter J.; Alikhaani, Jacqueline D.; Benoit, Margo McKenna; Bercovitz, Rachel S.; Brown, Michael D.; Chernobilsky, Boris; Feldstein, David A.; Hackell, Jesse M.; Holbrook, Eric H.; Holdsworth, Sarah M.; Lin, Kenneth W.; Lind, Meredith Merz; Poetker, David M.; Riley, Charles A.; Schneider, John S.; Seidman, Michael D.; Vadlamudi, Venu; Valdez, Tulio A.; Nnacheta, Lorraine C.; Monjur, Taskin M. (2020). "Clinical Practice Guideline: Nosebleed (Epistaxis)". Otolaryngology–Head and Neck Surgery. 162 (1_suppl): S1–S38. doi:10.1177/0194599819890327. ISSN 0194-5998.
- ↑ 4.0 4.1 4.2 Thornton, M A.; Mahesh, B N.; Lang, J (2005). "Posterior Epistaxis: Identification of Common Bleeding Sites". The Laryngoscope. 115 (4): 588–590. doi:10.1097/01.mlg.0000161365.96685.6c. ISSN 0023-852X.
- ↑ 5.0 5.1 Chaaban, Mohamad R.; Zhang, Dong; Resto, Vicente; Goodwin, James S. (2016). "Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis". Otolaryngology–Head and Neck Surgery. 156 (1): 81–86. doi:10.1177/0194599816667295. ISSN 0194-5998.
- ↑ Viehweg, Tate L.; Roberson, John B.; Hudson, J.W. (2006). "Epistaxis: Diagnosis and Treatment". Journal of Oral and Maxillofacial Surgery. 64 (3): 511–518. doi:10.1016/j.joms.2005.11.031. ISSN 0278-2391.