Strolling along a snowy path in the middle of winter conjures up an idyllic setting memorialized in popular media. The surrounding woods smell fresh, with an effervescent, tingling sensation upon your skin. Feeling something dribble down your nose, you absentmindedly brush your hand across your nose, without giving a second thought. As you pull your hand back, however, you stare in horror as a bright red streak of blood paints the side of your hand. The cold blooded epistaxis has come to turn your happily-ever-after into your current nightmare.
Image Source: Henrik Sorensen
Epistaxis, more commonly known as a nosebleed, is a relatively common medical condition in which blood hemorrhages from the nose and is noticed when it drains out through the nostrils. Nosebleeds are usually unilateral and consist of two types, anterior or posterior, which identifies where the bleed site is in the nasal cavity. The vast majority of nose bleeds occur in the anterior part of the nose from the nasal septum, with blood coming from the Kiesselbach’s plexus. Posterior bleeding occurs at the posterior part of the inferior meatus, with Woodruff’s plexus supplying venous blood. Posterior bleeds are often prolonged and may require medical attention to control. Although the seemingly copious amounts of blood streaming from the nose may be alarming and warrant medical attention, epistaxis cases are rarely fatal. According to the Center for Disease Control, in 1999, epistaxis accounted for only 4 out of the 2.4 million deaths in the U.S. To put that into perspective, you have a much greater chance of getting hit by lightning (1 in every 12,000 people).
Various factors influence the frequency of epistaxis, including, but not limited to: nasal trauma (which includes picking your nose), allergies, chronic inflammation, certain types of medication, and environmental factors such as low humidity and temperature. Vasodilators and anticoagulation medications such as aspirin and Warfarin also contribute to the length of epistaxis episodes as they prevent the body from naturally clotting the blood. For short episodes that last less than 5 minutes, the following steps may be used to promote blood clotting.
- Blow all the clots out of the nose
- Sit up and lean forward. This way you can see the blood flow out of the nose, and you will avoid choking on blood flowing down the throat.
- Pinch the soft parts of the nose together, push firmly in towards the face until the flow stops. Hold this position for five minutes before releasing the pressure. It is helpful to time this by a clock.
For more complicated posterior bleeding or chronic epistaxis, a visit to an otolaryngologist may be needed as a nasal endoscopy may be performed to locate any deep or active bleed sites. Once these sites have been identified, topical anesthesia is applied and silver nitrate is used to chemically cauterize the blood vessel, resulting in a chemical reaction that seals the blood vessel.
To save yourself from this hassle, there are easy preventative measures that can ward off frequent epistaxis. During dry, winter months, maintaining nasal humidity is of utmost importance. Use a saline solution (available at drugstores under names such as Ocean or Ayr, or easily made at home by adding 1/4 teaspoon salt to a cup of water) to irrigate the nose several times a day. A small amount of lubricating cream such as Vaseline can be placed inside the nose morning and night, and general measures to increase the humidity at home or at the workplace are also helpful. Avoid frequent rubbing or picking the nose, and trim the fingernails of small children to prevent trauma.
All of these measures will hopefully keep you safe from the cold-blooded epistaxis!
Feature Image Source: Justin Chin
