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 blood pressure.
Furthermore, if anticoagulants (anticoagulants) are being taken, the dosage should be checked if necessary. It is not uncommon for this to be a possible cause of sudden nosebleeds. However, it should be noted that one in five patients on anticoagulation complains of harmless bleeding such as nosebleeds, and the risk of severe bleeding occurring in the following six months is just as high for affected patients as for patients without such bleeding (OR: 1.04 after adjustment for the ATRIA bleeding score; p = 0.86).Conclusion: Remain vigilant and clarify the bleeding risk again if a new bleed occurs.
Basically, always treat the underlying disease.
General Measures
- Bend head slightly forward, possibly over a sink.
- Compression by squeezing the nostrils for 10-15 minutes with constant pressure; decongestant nasal drops may also promote hemostasis by vasoconstriction (narrowing of blood vessels).
- Applying a cold compress to the neck to vasoconstrict the nasal (belonging to the nose) blood vessels; however, sucking ice cubes is said to be more effective. This measure is to lead via a reflex arc to vasoconstriction of the mucosa-supplying vessels.
- Spit out any blood to avoid vomiting.
- After stopping bleeding, refrain from blowing the nose for several days; the same applies after conservative or surgical therapy.
Special measures
- Anterior epistaxis (localization: locus Kiesselbachi, a vascular plexus in the anterior third of the nasal septum): Sloughing by bipolar electrocoagulation (this is reported to be more effective than local application of silver nitrate), laser.
- Posterior epistaxis (localization: deeper nasal sections): insertion of nasal tamponades of various designs (e.g., choanal balloon tamponade).as primary therapy.
- After frustrated outpatient therapy: inpatient therapy;
- Conservative therapy attempt by tamponade (1-2 days) followed by intensive nasal care.
- In case of failure of conservative therapy and difficult to stop nosebleeds: Operative exploration of the nose by nasal endoscope (nasal cavity endoscopy) under anesthesia to determine a bleeding source.and care of the same; if necessary, also selective arteriography (targeted imaging of the affected arteries by contrast medium) and embolization (artificial closure of blood vessels by administration of fibrin sponges, for example, through a catheter).
Note: When treating patients with nosebleeds, avoid self-contamination (” self-contamination”; ). According to the literature, the risk of contamination via gloves is 55 to 70%; the risk for conjunctival transmission (“via the conjunctiva of the eye”) without protective goggles according to the literature is about 18%.
Measures to protect self-contamination:
- Put on protective clothing (goggles, gloves, gown).
- Apply mouthguard under the nose of the patient (counteracts the spraying of oropharyngeal in the blood).
- Work laterally or avoid frontal work