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A '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. It only accounts for 1/100000th of all deaths in the U.S.

Contents

Etiology

Local factors

Systemic factors

Pathophysiology

Treatment

Famous nosebleeds

Nosebleeds in fiction

References

See also

External links

Etiology

The cause of nosebleeds can generally be divided into two categories, ''local'' and '' factors.

Local factors

★ Anatomic deformities

★ Chemical inhalant

★ Inflammatory reaction (eg. acute respiratory tract infections, chronic sinusitis, allergic rhinitis and environmental irritants)

★ Foreign bodies

★ Intranasal tumors (Nasopharyngeal carcinoma in adult, and nasopharyngeal angiofibroma in adolescent males)

★ Nasal prong O₂

★ Nasal spray

★ Surgery (such as septoplasty and endoscopic sinus surgery)

★ Trauma

Systemic factors

★ Drugs - Aspirin, Fexofenadine/Allegra/Telfast, warfarin, ibuprofen, clopidogrel, isotretinoin, desmopressin and others

★ Alcohol (due to vasodilation)

★ Allergies

★ Blood dyscrasias

★ Heart failure (due to an increase in venous pressure)

★ Hematological malignancy

★ Hypertension

★ Infectious diseases

★ Malnutrition (especially anemia)

★ Narcotics

★ Vascular disorders

★ Nose-picking (especially in children)

★ Muscle tightness as caused by scoliosis (the tightened muscles cause blood vessels to become constricted, resulting in nosebleeds from the same side as the tightened muscles).

Pathophysiology

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury harder to repair.

Treatment

The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure and reducing the blood pressure in the head by sitting upright with the head tilted forward for about 10 minutes. Tilting the head back is not advised, as it can lead to blood flowing into the respiratory system, and possibly resulting in vomiting or death.
Petroleum jelly is sometimes applied to stop the blood from seeping out of and prohibit the loss of moisture in the nasal cavity. However, the jelly can drain into the lungs producing a buildup that leads to lipid pneumonia. ^[1]
If other techniques do not work, an anterior packing is a possible remedy. An anterior pack works by applying pressure from the inside of the cavity, thus stopping the bleeding. This procedure can be performed at home for minor nosebleeds by gently packing tissue or gauze into the nasal cavity. Nasal sponges^[2] are readily available at most drugstores and supermarkets.
If bleeding continues, seeking emergency medical attention is important. Continued bleeding is an indication of more serious underlying conditions.^[3]
Chronic epistaxis resulting from a dry nasal mucosa is often treated by spraying saline in the nose up to three times per day. There are also non-petroleum based gels that can be used.
Persistent epistaxis is an indication for urgent medical consultation. Nasal packing, cryosurgery, electrocautery or application of trichloroacetic acid are options that may be used in severe epistaxis.
It is uncommon to die from bleeding through nosebleeds. A famous person who is reported to have died from a nosebleed was Attila the Hun. However, damage to the maxillary artery can lead to rapid blood loss via the nose and presents difficulty in treatment; pressure, vasoconstrictor and rhinocort occasionally proving ineffective. Embolization or of the artery, risking damage to the facial nerves, may be the only solution.
Another technique to stop nose bleeds is to by taking a small ball of cotton, place under a tap of running water, squeeze the water out and place the ball in the nostril that is bleeding. The cotton ball helps the blood to clot faster
Severe protracted nosebleeds may cause anemia due to iron deficiency.

Famous nosebleeds

Attila the Hun, a legendary commander and the founder of an empire, is reputed by the contemporary historian Priscus to have died of a nosebleed after his wedding. However, the nosebleed only proved to be fatal as the blood ran down Attila’s throat causing him to choke to death. This occurred as a result of Attila being intoxicated and walking into a beam. The impact knocked the famous leader unconscious, and caused his nose to bleed. Ironically, his new wife watched him die, too terrified to call for help.
Andrew W.K.'s album ''I Get Wet'' depicts himself with a bloody nose on the cover. Many music retailers covered the image with a black sticker. Nosebleeds feature on the Icelandic band Sigur Rós's 2005 album, ''Takk''.

Nosebleeds in fiction

In an episode of the television series ''Monk'', Adrian has a nosebleed that just won't stop. This is apparently stress related, but causes him to remain around the hospital premises where he solves a case.
In anime and manga (Japanese-originating animation style), it is very common to see sexually aroused characters suffering nosebleeds, sometimes intense ones. Sometimes referred as the Japanese Slapstick, this rarely occurs in real life, but is based on a Japanese "old wives' tale", which states that becoming sexually excited can cause nosebleeds. Such occurrences are generally played for laughs and signify "hood" and/or virginity. This conception regarding nosebleeds also exists in Chinese culture.
The English trip-hop musician Tricky makes a reference to sexual arousal causing nosebleeds in the song "Abbaon Fat Tracks" in his 1995 record ''Maxinquaye''.
One more example is from the American show Beavis and Butt-head, where Beavis gets punched three times in the nose, resulting in a nosebleed; the lack of intelligence from both characters and Butt-head's insane ideas results in Beavis suffering great losses of blood before they purchase tampons to stem the blood flow.
In the show Everybody Loves Raymond episode "Mozart", Robert quit piano lessons given by his mother because it caused him to have nosebleeds. At the end of the show, Robert is shown playing the drums with his brother, Ray, beside him with tissues when his nose bleeds. He is shown tilting his head backwards, which is NOT advised but was the theory in previous times.
In the movie ''The Ring'', victims get nosebleeds after having seen the videotape.
In Michael Frayn's three-act play ''Noises Off'', Frederick Fellowes gets nosebleeds whenever he sees instances of violence.
In Aqua Teen Hunger Force episode "Antenna", Carl is paid to watch an alien TV show, which is really just a recording of two aliens stacking boxes, while he tilts his head back. This results in his head growing large and losing lots of blood by a nosebleed. Despite this, he continues after he gets yelled at by the aliens on the TV to "Tilt your head back!" In the end of the episode, the effect happens to Meatwad and Frylock as they watch a live recording of Master Shake doing stand-up comedy.
In the second series of UK sitcom "The League of Gentlemen," the entire town of Royston Vasey suffers from chronic nosebleeds as a result of eating "the special stuff" from Hilary Briss' Butchers shop. The "special stuff" is actually human flesh.
In the 2004 film ''The Butterfly Effect'', the main character (played by Ashton Kutcher) suffers increasingly powerful nose bleeding after each alteration of the past.
In the Sherlock Holmes story ''A Study in Scarlet'' by Sir Arthur Conan Doyle, the murderer Jefferson Hope suffers a nosebleed as he faced-off with one of his victims. This resulted from savage excitement coupled with a bad heart condition.
In Filipino humour, nosebleeding is associated when someone speaks in English with a notable accent (particularly those of UK or Scottish decent)and the other one who listens to the speech or conversation doesn't understand it.
In season 3 of ''24'', former MI6 agent Stephen Saunders threatens to release a deadly, weaponized virus called the Cordilla virus on twelve major cities in the United States unless President David Palmer gives in to his demands. When Saunders releases the virus in the Chandler Plaza Hotel in Los Angeles, almost everyone in the hotel is infected as a result, including CTU agent Gael Ortega. The first symptom of infection from the Cordilla virus is an uncontrollable nosebleed. Once symptoms start, death is inevitable. In the end, over one thousand people are infected by the virus until CTU can finally contain and destroy it.

References

1. http://www.mayoclinic.com/health/petroleum-jelly/AN00947
2. http://www.seal-on.com
3. http://www.nlm.nih.gov/medlineplus/ency/article/003106.htm


4.Laghzaoui O, Laghzaoui MJ. [Nasal endometriosis: apropos of 1 case.] [Article in French]. Gynecol Obstet Biol Reprod (Paris). 2001;30:786-788

See also

★ Kiesselbach's plexus

★ Nosebleed section

External links

★ National Library of Medicine - Describes causes, solutions, and prevention of nosebleeds

★ stop-nosebleeds.org - describes the Thumbs Up alternate method of stopping nose bleeds

★ drtbalu otolaryngology online

★ Natural Remedies for Nosebleeds