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- Nose Bleed (Epistaxis) - Level 2
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Dec 09
H4H Monographs
Nose Bleed (Epistaxis)
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What is a nose
bleed?
The inside of the nose
(particularly the anterior frontal part) is covered with moist,
delicate tissue (mucosa) that has a rich supply of blood
vessels/tissues.
These blood vessels or capillaries are quite
delicate and close to the surface
in order to maximise
their efficiency to moderate the temperature of each breath of air
so that it is just right for the head and the lungs.
When this
vascular tissue is injured or the cells are ruptured
as a result
of trauma, even as a result of something apparently minor,
the
capillary blood vessels bleed, sometimes heavily.
Occasionally
nose bleeds are spontaneous but
regardless of how they are
caused they can be embarrassing and distressful
even though life
threatening situations are extremely rare in the case of anterior
nose bleeds.
Are there
different types of nose bleed?
1. Anterior Nose
Bleeds,
These are from the
front of the nose and are most common representing about 90% of
epistaxic (nose bleed) situations. The most frequent location is the
nasal septum which is the wall between
the two nostrils. In most
cases, this type of nosebleed is not serious. It usually can be
stopped
with some local pressure and a little
patience.
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Reasons
for Anterior Nose Bleed
i)
Dry mucous membranes
This is the main cause for
anterior nose bleeds caused
by
- a hot climate
or
- hot stuffy
indoor atmosphere
ii) Infection and/or
Allergies
- Which results in nasal inflammation and congestion causing blood
vessels to widen (dilate),
thus making them more vulnerable to injury. Nosebleeds occur most
often in autumn/winter
when upper respiratory infections which leave noses crusty and dried
out are most common.
iii) Nose
picking
- which results in rupture of the mucosal
lining.
iv) Strenuous nose
blowing
-
producing ruptured vascular tissue as a result of a head
cold.
v) Medications &
Supplements
- Including aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or
warfarin (Coumadin).
Additionally some herbal remedies including Danshen, Dong quai,
Feverfew, Garlic,
Ginger, Ginko biloba, Ginseng, vitamin E and Omega 3 (fish
oil) all of which exhibit
blood
thinning characteristics.
If any these (or similar alternatives) have been prescribed
you need
to contact your physician and discuss the possibility of
stopping them at least
for a
short period.
vi) Exposure to Chemicals and/or
fumes
- which
damage the nasal lining. The principle culprit here is secondhand
cigarette smoke
but nosebleeds
can develop from on-the-job exposure to sulfuric
acid,
ammonia,
gasoline or other chemical irritants.
vii) Hot
Liquids &
Showers
- Drinking
hot soup and beverages as well as hot water showers to the head
can
also
result
in undesirable blood vessel dilation.
viii)
Constipation
- Resulting
in undue straining during bowel movements.
2. Posterior Nose
Bleeds
These come from deep at the rear of the
nose and are characterised by a blood flow down the
throat and
mouth even when the person is sitting. They occur usually in older
people over
60 years and are more severe and can be difficult to
control and stop. With age, arteries and blood vessels loose
their elasticity and flexibility. Atherosclerosis as a consequence
of high blood pressure damages arteries by scaring. These factors
can hamper the contracting and retracting of an artery causing
rupture and posterior nosebleed to persist.
A posterior nose
bleed can be life-threatening.
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Reasons for Posterior Nose
Bleed (in addition to those for Anterior
Bleeds)
i) Medical
Condition
-
Examples include kidney failure, thrombocytopenia (low platelet
levels needed
for
clotting),
haemophilia etc.
ii) Addictions
including
-
Alcohol, Tobacco and Recreational Drugs (particularly
cocaine) not only cause injury
and
bleeding
to superficial blood vessels as a consequence
of dilation but in addition interfere
with
normal blood
platelet activity increasing the time needed for
blood clot formation.
ii) Nose
Scaring
- as a
result of previous trauma to nose or nose breakage. A scar (or
cicatrix)
can
result
in weakened superficial blood tissue around its edges.
iv) High Blood
Pressure
- which
exerts a continual, abnormally high pressure on your circulatory
system.
v) Mental
Stress/Tension
-
Stress increases the metabolic rate causing hormone surges,
exhaustion, tension,
headaches, irritability, aggression and hypertension.
For a full list
of 260
causes of Nosebleed
click More below
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1st Aid for
Anterior (frontal) nose bleed
(this covers 90% of nose bleed situations)
1. Dont panic. Keep calm. It is
unlikely to be life threatening
2. Sit upright
3. Lean head slightly forward
(Not backwards as this can cause choking
or not
too forward as this can encourage flow)
4. Do not swallow blood
If blood
flows down the throat spit it out.
(Swallowing
blood will make you feel nauseous and
will later
induce a bout of vomiting resulting in
straining.)
5. Breath
through the mouth
6. Remove
any dentures.
7. Pinch the
soft part of the nose
continuously for 10 mins.
(between the tip and the bridge)
8. Apply a cold compress to the back
of the neck.
This will also reinforce the slight forward tilt of
the head.
(Not the forehead as the head tends to
tilt backwards
in an effort to maintain the compress in
position
or the nose itself as it will be more difficult
to
maintain nasal pressure with a compress in place)
9. Repeat the above twice more
and
if the bleeding has not ceased
seek medical advice
(ie a total time duration of 30
mins)
10. Do not pack the nostrils with
cotton wool or similar
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Homeopathics for Nose Bleed
During
Bleeding
Take 2 pills of
Ferrum phosphate
(Ferrum-phos) 12X or 6X
every 5 mins until bleeding
stops.
(Max 6 doses over 30 mins)
After Bleeding
Stops
Continue to take 2 pills of
Ferrum phosphate
(Ferrum-phos) 12X or 6X
every 1 hr for 4 hrs (ie 4
doses)
Thereafter take AM and PM for the next 14 days.
When to Call the Emergency
Services
When the bleeding has not ceased in 30
mins
When a Posterior Nose bleed is
suspected
Recognising a
Posterior Nose Bleed
1. The patient is
elderly
2. When blood flows continually down
the throat
3. When bleeding is of a
gushing/pulsating/rapid nature
4. When bleeding continues for more
than 30 mins
5. When
bleeding stops but restarts
6. When there is an accompanying
headache
(sign of tension/high blood
pressure)
7. When
there has been a high loss of blood
(often difficult
to tell when the flow goes down the throat)
8. When the patient feels weak or
faint,
(presumably from blood
loss.)
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Nasal Cautery at A &
E
Cautery will seal the bleeding point in the
nose
This involves using as silver nitrate stick
which has
the appearance of a match stick.
The procedure can be performed
in the Accident & Emergency Centre
should further attempts
at first aid fail.
Precautions to
Take
after Nose Bleed has
Ceased
Over the next 3
Days
# Keep cool. No undue
excitement
# Sneeze through
the mouth
(ie with the mouth open)
# No hot showers
#
No facial hot water applications
# No hot drinks or hot soups
# Review your medication programme
(particularly if you are on blood manipulating
drugs/supplements)
Over the next
14 Days
# Sit
upright
# Sleep in a semi
erect position with the head raised well above heart level
# No alcohol
# Do not strain or bend down to lift
anything heavy or
engage in other strenuous activities.
(This can produce momentary surges in blood
pressure
which can cause the nose to bleed
again.)
# Do not
strain during bowel movements
(If necessary use
Super Shield Probiotic to maintain proper metabolic
function)
# Evaluate
a Homeopathic/Supplement rgime
to raise the level of natural
immunity against cold/cough/dry nose.
Permanently
# Blow
your nose gently
# Stop nose
picking
# Keep your
childrens nails (and yours) clipped short
# Use a
humidifier
(if your indoor climate is dry during the
winter months)
#
Avoid facial trauma by wearing a seatbelt and
shoulder harness in the car and use
well-fitting headgear to
protect your face during contact sports,
such as football or
karate
# Use protective
equipment to avoid breathing irritating chemicals at work
# Moisturise the inside of your nose
with Calendula cream twice daily
(Not petroleum
based jells or Vaseline as these contain alcohol and will dry the
skin)
# Abstain from
all Recreational Drug taking particularly cocaine
# Quit smoking
Homeopathics &
Supplements
Apply Calendula cream inside nostrils
twice daily to moisturise.
Take Homeopathic for hightened
immunity against colds/cough/dry nose.
1 cap/day Super Shield
Probiotic for metabolic function.
If Nose Bleeds
Reoccur
If nosebleeds continue to reoccur
or
if in the past you have suffered from
a pattern of nose
bleeds
you may have an underlying medical condition.
For further information
in order to make a fully informed choice contact
Dr. Peter
Darashah
Ph.D.,M.Sc
(Lond), B.Sc., DIHom (Pract),FBIH,
MARH
Nutrition
Consultant & Homeopathic
Physician
(087)
2621943
Consultations held at
:-
The
Natural Health Centre, 34 Princes Str.,Cork.
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