Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification. Endoscopy of the nose: Anterior rhinoscopy (anterior nasal endoscopy) with nasal speculum and headlamp or magnifying microscope. Rigid endoscopy of the nasal cavity – if bleeding of the posterior … Nosebleeds (Epistaxis): Diagnostic Tests
Prior therapeutic trial with local application of a vasoconstrictor (agent for vasoconstriction) and a local anesthetic (agent for local anesthesia). Further procedure as follows: Easily visible bleeding from the anterior region of the nose can be treated with silver nitrate or electrocoagulation (cauterization).Note: In children, chemical cauterization should be preferred to electrical cauterization if the … Nosebleeds (Epistaxis): Surgical Therapy
To prevent epistaxis (nosebleeds), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet: Vitamin deficiency (vitamin C and E) Mechanical manipulation as in “nose picking”. Heavy snowing and sneezing Environmental pollution – intoxications (poisoning). Climatic influences such as dry indoor air (low humidity) due tooverheated rooms, underfloor heating, air conditioning. Preventive … Nosebleeds (Epistaxis): Prevention
The following symptoms and complaints may indicate epistaxis (nosebleed): Pathognomonic (indicative of a disease). Bleeding from the nose Warning signs (red flags) Recurrent nosebleeds + petechiae (minute skin/mucosal bleeding; flea-like), often first on hocks, lower legs → think of: Werlhof’s disease Unilateral bloody discharge + middle and old age → think of: Carcinoma of the … Nosebleeds (Epistaxis): Symptoms, Complaints, Signs
In cases of severe bleeding (rare!), the first step should be an evaluation of airway safety (“Airways”), breathing (“Breathing”), and cardiovascular stability (“Circulation“) according to the ABC scheme. If blood pressure is above 180/120 mmHg after multiple blood pressure measurements, the European Hypertension Society and the European Society of Cardiology recommend oral medication to lower … Nosebleeds (Epistaxis): Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing) of the skin, mucous membranes and sclerae (white part of the eye). ENT medical examination – including anterior and posterior rhinoscopy (reflection of the nasal cavity from the nostril … Nosebleeds (Epistaxis): Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Small blood count Differential blood count Fasting glucose (fasting blood glucose), oral glucose tolerance test (oGTT) if necessary. Liver parameters – alanine aminotransferase(ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and … Nosebleeds (Epistaxis): Test and Diagnosis
Therapeutic target Hemostasis Therapy recommendations Apply antifibrinolytic tranexamic acid (→ complex formation with plasminogen, inhibiting its binding to the fibrin surface/inhibiting clot dissolution) to absorbent cotton (500 mg in 5 ml) and apply to anterior source of bleeding Possibly cauterize (destroy tissue) with silver nitrate (note: electrocauterization is reported to be more effective than silver … Nosebleeds (Epistaxis): Drug Therapy
Medical history (history of illness) represents an important component in the diagnosis of epistaxis (nosebleeds). Family history What is the general health of your family members? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Current medical history/systemic history (somatic … Nosebleeds (Epistaxis): Medical History
Respiratory System (J00-J99) Allergic rhinitis (AR) (inflammation of the nasal mucosa). Atrophic rhinitis – loss of mucus-forming goblet cells and ciliated epithelium with the consequences of desiccation and verborkung. Granulomas (usually benign, nodular tissue neoplasms) and perforations (piercing) of the nasal septum (nasal septum). Nasal septum deviation (nasal septum curvature). Polyposis nasi – formation of … Nosebleeds (Epistaxis): Or something else? Differential Diagnosis
Epistaxis rarely leads to sequelae or complications. Blood, blood-forming organs – immune system (D50-D90). Anemia (anemia) – very rare. Infectious and parasitic diseases (A00-B99). Toxic shock syndrome – very rare complication that can occur after nasal tamponade insertion. More Necrosis (tissue destruction) of the nasal framework due to coagulation, nasal tamponade, etc.
