Epistaxis

A nosebleed, also known medically as epistaxis, is bleeding from the nasal cavity caused by rupture of small blood vessels in the nasal mucosa. Most cases are minor and stop spontaneously with simple first-aid or medical care. In some cases, blood may flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blood pressure occurs. Blood may also be forced to flow up and through the nasolacrimal duct and out of the eye, producing bloody tears.
Risk factors include trauma; especially from nosepicking, blood thinners, high blood pressure, alcoholism, seasonal allergies, dry weather, and inhaled corticosteroids. There are two types: anterior, which is more common; and posterior, which is less common but more serious. Anterior nosebleeds generally occur from Kiesselbach's plexus while posterior bleeds generally occur from the sphenopalatine artery or Woodruff's plexus. The diagnosis is by direct observation.
Although nosebleeds can appear dramatic, they are rarely life-threatening; most resolve without medical intervention, but posterior or severe bleeds may require urgent care. Prevention may include the use of petroleum jelly in the nose. Initially, treatment is generally the application of pressure for at least thirty minutes over the lower half of the nose. If this is not sufficient, nasal packing may be used. Tranexamic acid may also be helpful. If bleeding episodes continue, endoscopy is recommended.
About 60% of people have a nosebleed at some point in their life. About 10% of nosebleeds are serious. Approximately 6% of patients will seek medical attention for epistaxis. Nosebleeds are rarely fatal, accounting for only 4 of the 2.4 million deaths in the U.S. in 1999. Nosebleeds most commonly affect those younger than 10 and older than 50.