Epistaxis is understood as any bleeding originating in the nasal passages. The name has its origins in Greek and means “to flow drop by drop.”
Nosebleeds are classified as anterior and posterior. In anterior epistaxis, which account for 90% of the total, the bleeding point is normally found in the mucosa of the anterior region of the nasal septum, in a region rich in vascularization due to an arterial plexus known as the Kiesselbach plexus. In the case of anterior nosebleeds, the most common sign is the emission of blood through one or both nostrils.
Posterior nosebleeds are less common and account for approximately 10 percent of the total. Bleeding through the nasal passages is less frequent and the fundamental sign is blood falling through the pharynx and swallowing it. This drop of blood is evidenced by asking the patient to open the mouth, leaving the tongue inside and observing active bleeding behind the uvula.
Usually it is a self-limiting process, that is, a process that remits spontaneously. In case of epistaxis, the first measure is to tilt the patient’s head forward and tell him to press his nose hard with two fingers for five timed minutes. This simple measure stops most bleeding. It is not advisable to tilt the patient’s head backwards, because although this measure stops bleeding through the nasal passages, it causes the blood to fall into the pharynx and be swallowed, irritating the digestive mucosa.
If, after five minutes of compression, bleeding persists, epistaxis should be evaluated by a doctor. Anterior epistaxis usually benefit from anterior packing with various materials: edged gauze, cotton wicks, self-expanding plugs, etc. Posterior epistaxis can be treated with posterior packings introduced through the mouth. Packings should be removed after 48 or 72 hours although, depending on the patient’s characteristics, the doctor may indicate that they remain for a longer or shorter time.
There are emergency measures to stop bleeding, such as one- or two-balloon probes that are introduced through a nostril or, in extreme cases, surgical treatment, which consists of embolization of the bleeding vessel.