Sunday, January 15, 2006

epistaxis (nosebleeds)

In older adults nosebleeds are more often found to originate in the posterior part of the nose rather than in the anterior part as occurs in children and younger adults. The cause is usually spontaneous rupture of a hardened vessel. The bleeding is worse if the patient is hypertensive. Epistaxis is often an early warning sign in many blood diseases such as anemia, leukemia, and various coagulation defects. Treatment of nosebleeds first involves applying firm pressure on the nose for several minutes. A calm environment to reduce the level of anxiety is essential. If the bleeding does not stop quickly medical treatment should be obtained.
Control of bleeding from posterior epistaxis is complicated by the inaccessibility of the bleeding site. Hospitalization is not unusual. Postnasal packing is frequently necessary as is cauterization of the bleeding site. If lesser measures are not successful ligation of the vascular supply may be indicated. Probably the best treatment for nosebleeds is prevention. It is important to maintain adequate humidification, especially during the winter months, and use Vaseline or lanolin ointment to moisten the nasal membranes. The person should also refrain from traumatizing the nose with the finger or other objects, avoid forceful blowing of the nose, limit the use of aspirin, and control high blood pressure.
Ballenger, J. J. Diseases of the Nose, Throat, Ear, Head and Neck, 13th ed. Philadelphia; Lea & Febiger, 1985.

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