NOSE BLEED

HUMILARY BLEEDING - bleeding, the source of which is in the nasal cavity. It arises with arterial hypertension (hypertension, etc.), violations of the blood coagulation system and increased permeability of the vascular wall (hemorrhagic diathesis, leukemia , liver cirrhosis, hypovitaminosis, a number of infectious diseases, especially typhoid fever , brucellosis, scarlet fever , influenza, malaria) With septic conditions, intoxications, physical and mental stress, due to prolonged exposure to the sun. Often nosebleeds are associated with a sudden change in atmospheric pressure (in pilots and climbers), etc.

Local causes are nasal trauma, atrophy of the mucous membrane, especially in the anterior part of the septum, nose and paranasal sinuses, disintegration of tuberculous or syphilitic infiltration of the nasal mucosa, foreign bodies , etc. Predisposing factors may be rhinitis , adenoids , curvature of the septum , As well as strong smoky, coughing , sneezing.

Clinical picture . Usually, bleeding occurs immediately, for example, after a trauma to the nose or head, sometimes without apparent causes for the patient. In most cases, bleeding from one side of the nose is observed, and often the blood flows through the nasopharynx into the other half. Blood with nasal bleeding is usually bright red, not foamed. Minor bleeding occurs most often and is not life threatening. Sometimes it stops on its own, but in some cases it can continue for a long time, leading to the development of anemia . Nasal hemorrhage of moderate severity is characterized not only by local but also by common signs: blushing of the facial skin, increasing pulse to 90-100 beats per minute, sometimes lowering the systolic pressure (up to 90-100 mm Hg), decreasing the hematocrit. With massive bleeding, the general condition is severe, the pulse is accelerating to PO - 120 beats per 1 minute or more, the systolic pressure drops to 80 mm Hg. Art. And below. It should be noted that the hemoglobin content in the blood immediately after bleeding does not change, it decreases only after a day. A reliable indicator of the volume of blood loss is hematocrit.

A special clinical picture is observed with severe recurrent nasal bleeding after traumatic brain injuries, often with fractures of the base of the skull. After such an injury, bleeding is repeated in some patients after long periods of time (2 to 3 weeks), differs massive (up to 0.5-1.5 liters and more) and rapid blood loss. It starts suddenly and lasts for several minutes. If you do not take appropriate measures, with one of these bleedings the patient may die.

The diagnosis of special difficulties does not represent, complications arise only at definition of a place of a bleeding and in cases of the latent bleedings. With anterior rhinoscopy in front of the septum, you can see a bleeding place - the so-called Kisselbach field. This field has a rounded shape, a diameter of about 0.5-1.5 cm and is located about 1 cm from the entrance to the nose. It is determined by a thin mucous membrane and radiating through the epithelium of the network of blood vessels. Bleeding from the Kisselbach field, as a rule, is not abundant. Abundant (profuse) bleeding in most cases come from the back of the nose, which is explained by the large caliber of vessels located here.

Treatment includes local halting of bleeding and general measures aimed at replenishing the blood and fluid in the bloodstream, affecting the processes of blood clotting, maintaining the vital functions of the body, eliminating the causes of bleeding.

With a slight bleeding, the finger is pressed against the septum by the wing of the nose, but it is better to pre-insert into the vestibule of the nose dry or moistened with a 3% solution of hydrogen peroxide a wad of cotton wool. Cold weather is applied to the bridge of the nose or for 3 to 4 minutes with interruptions of the same duration until bleeding ceases. Do not throw back the patient's head, since in this position the blood can drip imperceptibly along the back wall of the pharynx.

With ineffectiveness of the described measures and severe bleeding, anterior tamponade of the nasal cavity is often produced. After preliminary lubrication of the mucous membrane with a mixture of 1% solution of dicaine and 0.1% solution of adrenaline, tamponade is produced by gauze tampons impregnated with iodoform or haemostatic paste Vasilieva (streptocid and calcium chloride 5.0, zinc oxide 10.0, gelatin 25.0, glycerin And distilled water at 50.0); Also used is a haemostatic emulsion (tannin 5.0, ephedrine 0.1, salicylic acid 1.0, lanolin 25.0, peach oil 40.0, lead acetate 10.0, distilled water 20.0), etc. The tampon is injected layer by layer , Starting from the bottom of the nasal cavity. You can use elastic tampons made from surgical rubber gloves and foam rubber (a rubber finger is put on the strip of foam rubber from the glove and sterilized). In one half of the nose, 2 to 5 such tampons are administered. Tampons from the nose are usually removed after 1 day. With delayed hemostasis, they are left for 2 -5 days (it is advisable to impregnate 40% aminocaproic acid solution by tampons daily).

In some cases, anterior tamponade may be ineffective, so often immediately proceed to the posterior tamponade of the nasal cavity. It is produced in advance by a prepared sterile swab (size for an adult of approximately 2x3 cm), tied with three strong silk threads 20 cm long. A rubber catheter (or tube) with a diameter of 2 to 3 mm is carried along the bottom of the bleeding half of the nose to the pharynx and, capturing its end with a forceps, Output through the mouth. Two threads from the tampon are attached to the oral end of the catheter, then the catheter, together with the two strings, is stretched in the opposite direction through the nose, and the index finger of the right hand leads a tampon for the palatine curtain into the corresponding hoan and lightly presses it down with two fingers at the same time nose. After this, the front tamponade of the same half of the nose is produced, at the end of the tamponade, these two strings are tying at the entrance to the nose over a dense gauze roller. The third thread of the tampon, coming out of the mouth, is glued with a stick plaster to the cheek or cut off at the level of the lower edge of the palatine curtain. Remove the rear swab with a corncang for this third thread. The tampon is in the nasopharynx, usually 2 days, in some cases up to 10 days. Sometimes, with severe bleeding from the back of the nose, when it is not possible to determine from which half (nose) of the nose bleeding occurs, produce a back tamponade of both halves of the nose or inject a large swab densely filling the entire nasopharynx. After the posterior tamponade, in order to prevent the development of tubo-otitis, acute otitis media, acute pharyngitis, antibacterial agents and preparations that reduce edema are prescribed.

In those cases when bleeding is stopped with the help of a tamponade of the nose fails, surgical treatment is indicated.

Of the general measures for mild nasal bleeding and moderate severity, 10 ml of 10% calcium chloride solution, 10-20 ml of a 5% gelatin solution, intravenous infusion are administered, vitamins are prescribed. Intravenous hydrocortisone was administered at 30 mg 2 to 3 times daily for

3 - 4 days, 5% aminocaproic acid solution per 100 ml for 3 -

4 days (under the control of a coagulogram), 5% sodium bicarbonate solution, 30 ml per day. Assign also inhalation of moistened oxygen. Transfusion of blood products is usually carried out only with relatively rapid blood loss.