Emergency Timely Nosebleeds
Nosebleeds are a very common occurrence, it is not a disease but a symptom of many diseases caused by many causes.
Why nosebleed?
Nasal mucosa is easy to bleed because there are many blood vessels and dense capillary network. Although nosebleeds can be encountered at any age, but most commonly in people over 40 (64%), because blood vessel walls at this age have less flexibility, poor elasticity.
Especially nosebleeds are common in the cold dry season due to reduced air humidity, causing cracked nasal mucosa. When the weather and climate change erratically, affecting many diseases such as: hypertension, allergies, dryness cracked nasal mucosa causing bleeding
Most nosebleeds are not easily identified. However, there are some easy-to-understand reasons such as trauma, being hit in the nose, and picking the nose, noting that cold air constantly stimulating the nasal mucosa also causes bleeding.
Less common causes of nosebleeds include: blood clotting, usually due to blood thinners such as warfarin and aspirin
Liver disease can also make blood difficult to clot.
Hypertension can also cause bleeding but is never the only cause of nosebleeds.
Acute sinusitis, ulcerative diseases in the nose, polyps, cancer, influenza, dengue fever, leukemia, thrombocytopenic purpura, coagulopathy ... surgery in the nasal cavity and maxillofacial.
A Vietnamese study found that about 70% of patients with nosebleeds did not find the cause.
Need to distinguish nosebleeds from diseases elsewhere bleeding to the nostrils such as due to benign or malignant tumors causing bleeding, blood flowing from the throat, choking larynx to the nose, bleeding from tuberculosis, hemangiomas, rupture esophageal veins cause vomiting, choke on the nose in cirrhosis, hypertension of portal vein pressure, rupture of arteries in middle layer of skull base, middle ear injury
.
Nasal mucosa is easy to bleed because there are many blood vessels and dense capillary network
Treatment of nosebleeds
Emergency patients with a nose bleed, must stop bleeding quickly and then find the cause. In case of heavy bleeding, attention should be paid to the patient's whole body condition by close monitoring of blood vessels and blood pressure. The patient should rest quietly, sit or rest their head high, open their mouth to breathe and spit blood. Infusion if patient has vascular collapse and hypotension.
Transfusion if Hb is lower than 50%, especially in severe bleeding, it is best to give small fresh blood transfusions (100ml) several times.
In the case of heavy bleeding it is best to give small fresh blood transfusions (100ml) several times
Corticosteroids such as intravenous depersolone used in bleeding are necessary, if there are no contraindications. Use antibiotics to prevent infections.
Use coagulants to strengthen the walls, reduce bleeding time such as adrenoxyl, premarin, tranesamic acid ... or directly coagulate as vitamin K, sulfate de protamine. Hemostasis in place is performed from simple to complex following the steps:
Use two fingers to gently squeeze the nose of the nose to press into the septum corresponding to Kisselbach's pulse point for a few minutes, applied in cases of small bleeding, bleeding at the Kisselbach pulse point.
Using cotton soaked in hemostatic solution such as 12-volume hydrogen peroxide, 1-3% ephedrine tucked into the nostril, pressing on the bleeding.
Stuffing the nose first: after anesthetizing the nasal cavity, use a meche roll with a width of 1 - 1.5cm, a length of 50cm soaked with antibiotic ointment into the nose, pay attention to stuffing the meche with a hammock-shaped bottom so that the meche does not fall down into behind the throat, tuck from back to front until it reaches the front of the nose.
Squeeze the tongue to check if blood is draining down the back of the throat, if it's okay not to run down. Time saved mechè from 24 - 48 hours.
In case of heavy bleeding due to trauma, hypertension ... if you have to insert the nose first but not stop the bleeding, you must insert the next nose.
Insert the back of the nose: use a gauze to seal the back of the nose to prevent blood from flowing down the back of the throat, the diameter of the gauze is about 2 - 2.5cm, 2.
5cm height with rope tied in the middle, each end is about 30cm. After sealing the rear nostril, the nose must be inserted first.
In cases of capillary bleeding, especially in children, autonomic proteins such as spongel can be used to stop bleeding.
In many countries with advanced medicine, people use Merocel is a kind of foam shaped like a nostril, placed in the nose, watered, it swells tightly to the heart of the nasal cavity, blood stops immediately without pain. Or use a rubber bubble for the nose and then inflate, when taking out just deflated, very convenient.
Merocel is a type of foam shaped like a nostril, placed into the nose to tightly fit the nostril
Currently in our country has used coagulation under the guidance of endoscopy to stop bleeding is widely applied.
Complicated cases require surgical treatment: angioplasty, artery constriction, treatment of etiology..
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