Epistaxis

EPISTAXIS (from Greek epistaso- meaning 'to drip strongly'), bleeding from the nose, occurs more frequently than from other organs due to the delicate structure of the mucous membrane and its richness in blood vessels. The bleeding can occur in any area of the mucous membrane, but in most cases it happens from the anterior part of the nasal septum (locus Kiesselbachii), where the vessels lie very superficially. The bleeding may depend on local causes or be associated with a number of general diseases; it can occur both in childhood and old age. In some cases, it occurs quite unexpectedly, sometimes during sleep, while in others patients note precursors: headache, dizziness, ringing in the ears. Local causes for nasal bleeding vary and include: traumatic injuries to the nose, introduction of foreign bodies, cauterization, vigorous blowing and sneezing, etc.; in addition, acute and chronic rhinitis, deviations of the nasal septum, adenoids in the nasopharynx, nasal polyps, benign and malignant tumors—especially cancers, sarcomas, angiomas, etc., ulcers due to diphtheria, syphilis, cartilage diseases in anterior dry rhinitis; finally, bleeding often occurs after surgical interventions, especially in areas with cavernous tissue (conchotomy). The most dangerous bleedings occur in cases of fracture of the base of the skull. - Nasal bleeding as a symptom is observed in those diseases in which there are changes in the walls of blood vessels and in the composition of the blood, with increased blood pressure, with various kinds of intoxications, infectious diseases, sepsis, etc. These include: blood diseases, hemophilia, scurvy, morbus maculosus Werlhofii, anemia, chlorosis, leukemia, malaria. Severe bleeding occurs in chronic nephritis, often before an attack of uremia, in liver diseases, heart defects, emphysema, whooping cough. Nasal bleeding is often a companion and sometimes a precursor to influenza, measles, scarlet fever, typhus, especially typhus, pneumonia, erysipelas, angina, as well as phosphorus poisoning. Furthermore, bleeding can be caused by all circumstances accompanied by increased pressure in the vascular system (e.g., after strenuous physical exercise, excessive consumption of alcohol), local congestion from stenosis of the respiratory tract, from pressure by tumors, goiter, tight collars. Sometimes menstrual and hemorrhoidal hemorrhages are replaced by so-called vicarious nasal ones. In boys and anemic girls, bleeding often occurs during puberty; it also occurs in masturbators. Finally, mention should be made of bleeding in elderly people in connection with arteriosclerotic changes in the vessels and varicose dilations. As an external causal factor for the development of bleeding, one can point to changes in air pressure when the barometer falls, when ascending mountains, in aviators, etc. - The outcome of bleeding is usually favorable due to spontaneous stopping, sometimes weakness, fainting, collapse occur; death from bleeding is rare. - In treatment, it is first necessary to determine the source point, which is not always easy to do due to the constant flow of blood and formation of clots. The best way to stop bleeding is tamponade with gauze or cotton after preliminary lubrication of the mucous membrane with cocaine and adrenaline and cauterization of the bleeding area with chromic acid; the tampon is removed after a day. In severe cases, when localization cannot be determined and it is not possible to compress the bleeding vessel, one has to resort to posterior Bellocovian tamponade. For diffuse parenchymal hemorrhages, in addition to local treatment, calcium salts, ergotin, Extract. Hydrastis canadensis, horse serum, gelatin, etc. are administered orally or subcutaneously. In other cases, action is taken to lower or raise blood pressure. Laxatives, rest, cold compresses. With significant blood loss, physiological solution of NaCl is administered intravenously. In exceptional cases, ligation of the carotid artery is permissible. Soaking tampons with any hemostatic agents (hydrogen peroxide, ferropyrin, stipticin, ferric chloride, etc.) is usually unnecessary.