This document defines nosebleed (epistaxis) as bleeding from the nose caused by rupture of small blood vessels in the nasal cavity. The most common site is the anterior septum where three major arteries enter. Causes include trauma, dry air, infections, cancers, blood disorders, and certain drugs. There are two main types - spontaneous nosebleeds common in children and hypertensive nosebleeds more common in older adults. Symptoms are nose bleeding, dizziness, and confusion. Diagnosis involves tests like CBC, PT, and imaging. Management includes direct pressure, vasoconstrictors, cauterization, packing, supplements/medications, and potentially surgery.

1. Mr. Manikandan.T,
RN., RM., M.Sc(N)., D.C.A .,(Ph.D)
Assistant Professor,
Dept. of Medical Surgical Nursing,
VMCON, Puducherry.

2. DEFINITION
• hemorrhage from the nose, is caused by the rupture of
tiny, distended vessels in the mucous membrane of any
area of the nose.
• Most commonly, the site is the anterior septum, where
three major blood vessels enter the nasal cavity:
(1) the anterior ethmoidal artery on the forward part of
the roof (Kiesselbach’s plexus)
(2) the sphenopalatine artery in the posterosuperior
region
(3) the internal maxillary branches (the plexus of veins
located the back of the lateral wall)

3. CAUSES
• Trauma: physical trauma such as blows or accidents,
operative trauma
• Exposure to dry air for prolonged period
• High altitude
• Infection: influenza, typhoid, measles
• Rhinitis , sinusitis, adenoiditis
• Cancer of nose
• DNS
• Blood disorder : severe anemia, leukemia, hemophilia,
HTN, Redu-Osler-Weber syndrome (hereditary hemorrhagic
telangiectasia), vitamin k deficiency
• Drugs: aspirin, quinine

4. TYPES
• SPONTANEOUS:
it is common in children. It arises from littles
area. It may be precipated by infection or
minor trauma
Hypertensive : it affects older people. It arises
far back or high up in nose, its often difficult
to stop

5. SYMPTOMS
• Bleeding
• Dizziness
• Confusion
• Bleeding from teeth, gums, nostrils

6. DIAGNOSIS
• CBC
• PT
• CT
• X-RAY

7. MANAGEMENT
• A nasal speculum, penlight, or headlight may
be used to identify the site of bleeding in the
nasal cavity.
• Pinch the nostrils
• Apply : ice cold water
• Trotte’s method: make the patient to sit with
open mouth till the pressure decreases by
bleeding

8. management
• Most nosebleeds originate from the anterior portion of the nose. Initial
treatment may include applying direct pressure. The patient sits upright
with the head tilted forward to prevent swallowing and aspiration of blood
and is directed to pinch the soft outer portion of the nose against the
midline septum for 5 or 10 minutes continuously.
• Application of nasal decongestants (phenylephrine, one or two sprays) to
act as vasoconstrictors may be necessary.
• the nose must be examined using good illumination and suction to
determine the site of bleeding.
• Topical cocaine (4%) may be applied using an applicator or spray. It serves
as both an anesthetic and a vasoconstrictor.
• If cocaine is not available, oxymetazoline (topical decongestant) and
tetracaine (Pontocaine; topical anesthetic) can be substituted with equal
results.
• Visible bleeding sites may be cauterized with silver nitrate or
electrocautery (high-frequency electrical current).

9. • Sedation: 50-100 mg pethidine injection to
treat fear, anxiety
• Anterior nasal packing : nose should be
packed with ribbon gauze, soaked in
neosporin antiseptic cream for 24 hours- 48
hours
• Posterior nasal packing: a sponge pad of gauze
approximately palm size

10. • Vitamin C 500 mg 2-3 times a day
• Injection vitamin k
• Coagulants such as chromostat, ethamsylate
• Blood transfusion

11. SURGICAL MANAGEMENT
• Submucous resection
• Ligation of ethmoid artery
• Angiography