In order to stop nosebleeds, usually quite well known household remedies are used in advance. If a nosebleed has started, the patient should keep his head bent forward and let the blood flow off unhindered. If possible, the blood should be collected, otherwise it is impossible to get an idea of the amount of bleeding.
This information is of particular interest during subsequent medical treatment. Contrary to what is still occasionally believed, the head should not be taken in the neck, as otherwise most of the blood on the back of the throat will flow towards the stomach and cause nausea when a certain amount is reached. Depending on the general condition of the patient, this can be undesirable or even dangerous.
As a further first measure, a wet and cool towel or a cold compress is placed in the patient’s neck, which causes the vessels to contract and thus reduces the nosebleed. Nosebleeds often stop spontaneously, unless there is a more serious cause, but if it lasts longer, a doctor should be consulted to stop the nosebleed. A maximum of thirty minutes is recommended for adults, and twenty minutes for children.
If it is necessary to see a doctor, a hospital outpatient clinic or a general practitioner will be able to help, in addition to the ear, nose and throat doctor who should ideally be consulted. The otorhinolaryngologist often first attempts to coagulate the affected vessel by means of electricity or a laser, but this is only possible if the source of bleeding is located in the anterior nasal region in the so-called locus Kiesselbachi. As an alternative for ‘anterior’ bleeding, an anterior nasal tamponade is also an option, in which ointment-soaked gauze strips are inserted into both nasal cavities, regardless of the affected half of the nose.
The nose is filled up as completely as possible, which leads to compression of the bleeding source, similar to a pressure bandage. If the source of bleeding is located in the posterior nasal region, a posterior nasal tamponade is applied immediately, in which the posterior nasal opening is first blocked in the direction of the throat and then the same procedure is followed as for the anterior nasal tamponade. Either way, the tamponade remains in place for about 2-3 days and after its removal, one makes sure that there is no further bleeding.
Posterior nosebleeds originate from another vascular area that is close to the supply of the base of the skull. If a posterior tamponade cannot stop the bleeding, surgical hemostasis is necessary. A method frequently used in this case today is neuroradiological vascular sclerotherapy, in which a catheter is inserted through the inguinal artery, as is also the case with heart catheters, and the catheter is then advanced to the beginning of the artery causing the bleeding.
Now the vessel is sclerosed by a drug injected through the catheter, thereby stopping the bleeding. A minimal-surgical obliteration of the vessel is also possible and was mainly performed before the neuroradiological treatment option was available. It is still a good alternative if the neuroradiological method is not applicable in a patient for various reasons.
In addition to the direct treatment strategies, the physician naturally also takes care of the clarification of a responsible underlying disease. In most cases, however, it is a spontaneous nosebleed, which should be clarified all the more thoroughly the more frequently it is repeated in a short period of time. For the duration of treatment, it may be advisable to temporarily discontinue blood-thinning medication.
In particularly severe cases, a patient may lose such an amount of blood that it affects the circulation, a volume deficiency shock occurs, up to and including collapse or loss of consciousness. In all these cases, in-patient observation or further treatment is unavoidable, where, for example, the administration of erythrocyte concentrates counteracts the blood loss that has occurred.
