Most nosebleeds are not life threatening, and although they may appear to be bleeding profusely they usually do not not result in a significant amount of blood loss. Patients will often present holding tissues or a cloth to the nose and appear very anxious. Nosebleeds can generally be managed by holding pressure to the nose and very few require any invasive packing treatment.
Most Common Cause
There are a number of reasons people get nosebleeds, but the most common cause is nose picking. In most cases, this type of nose bleed can be managed by keeping the patient in the upright position with the head tilted downward and the nostrils pinched. According to "Sheehy's Emergency Nursing Principles and Practice," simply pinching the nostrils for 5 to 10 minutes is usually sufficient to control bleeding.
Other Causes
Nosebleeds can result from other causes, such as trauma, infection and foreign bodies. Small children are known to stick objects such as crayons or pencils into the nose and this can result in nosebleeds. Patients who are on blood thinning medications or have high blood pressure may develop nosebleeds without any warning. Bleeding disorders, such as hemophilia, predispose patients to nosebleeds. As noted by "Current Diagnosis & Treatment Emergency Medicine," in cold seasons the dry conditions created by heated indoor air can dehydrate the airways, causing the nasal lining to crack and bleed. Repeated blowing and wiping of the nose because of cold symptoms may also injure the lining of the nose.
Treatment
Although most common nosebleeds can be controlled by holding pressure, some may require additional treatment. If the bleeding persists, it may require that the bleed be cauterized with a small silver nitrate stick or a nasal packing may need to be placed. The packing is usually left in place for 24 to 72 hours, according to "Sheehy's Emergency Nursing Principles and Practice."
Posterior Nasal Bleed
Bleeding that originates in the posterior area of the nose is usually caused by an arterial bleed and it may be more difficult to control. Treatment for this type of bleeding will require the use of a nasal balloon device. The balloon device is inserted into the nares and inflated to hold pressure and stop the bleeding. Patients requiring the balloon device will be admitted to a hospital for closer observation.
Complications
In cases where the patient requires a nasal packing, there are complications that need to be considered. Because the nose is packed, there is the potential the airway could become obstructed and the patient can have breathing problems. If bleeding is severe enough, the patient may need blood transfusions, intravenous fluids and antibiotics.
References
- "Sheehy's Emergency Nursing Principles and Practice": Mosby Elsevier; 2010
- "Current Diagnosis & Treatment Emergency Medicine"; McGraw Hill; 2010
