Nosebleeds

Nosebleeds are also known as epistaxis. They originate from Kiesselbach’s plexus, which is also known as Little’s area. This is an area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels. When the mucosa is disrupted in this area and the blood vessels are exposed, for example due to trauma from a child picking their nose, they are prone to bleeding.

TOM TIP: Little’s area (the area most affected by Little fingers) is a popular topic in exams. Remember the name of this area as examiners like to ask “what is the most likely location of the bleeding?”

 

Presentation

Nosebleeds are common in otherwise healthy children. They can be triggered by nose picking, colds, vigorous nose blowing, trauma and changes in the weather. If children swallow blood during a nosebleed, they may present with vomiting blood. Bleeding is usually unilateral. Bleeding from both nostrils may indicated bleeding posteriorly in the nose.

 

Management

Nosebleeds will usually resolve without needing any medical assistance. Recurrent and significant nosebleeds might require investigations to look for an underlying cause, such as thrombocytopenia or clotting disorders.

You may have to advise patients and parents on how to manage a nosebleed:

  • Sit up and tilt the head forwards. Tilting the head backwards is not advised as blood will flow towards the airway.
  • Squeeze the soft part of the nostrils together for 10 – 15 minutes
  • Spit any blood in the mouth out rather than swallowing

When bleeding does not stop after 10 – 15 minutes, the nosebleed is severe, from both nostrils or they are unstable, patients may require admission to hospital. Treatment options are:

  • Nasal packing using nasal tampons or inflatable packs
  • Nasal cautery using a silver nitrate stick

After treating a nosebleed consider prescribing naseptin (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection. This is contraindicated in peanut or soya allergy.

 

Last updated January 2020
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