Epistaxis
What is an anterior nosebleed?
Most nosebleeds or epistaxes begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. Nosebleed coming from the front of the nose or anterior nosebleeds often begin with a flow of blood out one nostril when the patient is sitting or standing.
Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).
我如何阻止前后流鼻血？
- Stay calm, or help a young child stay calm. A person who is agitated may bleed more profusely than someone who’s been reassured and supported.
- Keep head higher than the level of the heart. Sit up.
- Lean slightly forward so the blood won’t drain in the back of the throat.
- 用拇指和食指，捏住鼻子的所有柔软部分，或将棉球浸入鼻孔中，将棉球浸泡在鼻孔中，并施加压力。应施加压力的区域位于鼻子的末端和形成鼻子桥的坚硬的骨脊之间。不要用纱布或棉花包装鼻子的内部。
- Apply ice—crushed in a plastic bag or washcloth—to nose and cheeks.
- Hold the position for five minutes. If it’s still bleeding, hold it again for an additional 10 minutes.
什么是后鼻音？
更少的是，流鼻血可以从鼻子内开始高处，即使患者坐着或站立，鼻子和喉咙的后部也会流下。
Obviously, when lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow toward the back of the throat especially if coughing or blowing the nose. It is important to try to make the distinction between the anterior and posterior nosebleed, since posterior nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.
What are the causes of recurring nosebleeds?
- Allergies, infections, or dryness that cause itching and lead to picking of the nose.
- 隆起的鼻子破裂，使表面血管破裂。
- Clotting disorders that run in families or are due to medications.
- 药物（例如抗凝剂或抗炎药）。
- Fractures of the nose or the base of the skull. Head injuries that cause nosebleeds should be regarded seriously.
- Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.
- 必须考虑恶性和非恶性肿瘤，尤其是在老年患者或吸烟者中。
When should an otolaryngologist be consulted?
If frequent nosebleeds are a problem, it is important to consult an otolaryngologist. An ear, nose, and throat specialist will carefully examine the nose using an endoscope, a tube with a light for seeing inside the nose, prior to making a treatment recommendation. Two of the most common treatments are cautery and packing the nose. Cautery is a technique in which the blood vessel is burned with an electric current, silver nitrate, or a laser. Sometimes, a doctor may just pack the nose with a special gauze or an inflatable latex balloon to put pressure on the blood vessel.
防止流鼻血的提示
- Keep the lining of the nose moist by gently applying a light coating of petroleum jelly or an antibiotic ointment with a cotton swab three times daily, including at bedtime. Commonly used products include Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline.
- Keep children’s fingernails short to discourage nose picking.
- Counteract the effects of dry air by using a humidifier.
- 使用盐水鼻喷雾来润湿干燥的鼻膜。
- 戒烟。吸烟会干鼻子并刺激它。
Tips to prevent rebleeding after initial bleeding has stopped
- Do not pick or blow nose.
- 请勿紧张或弯曲以抬起重物。
- 保持比心脏高。
If rebleeding occurs:
- Attempt to clear nose of all blood clots.
- 用充血喷雾（例如Afrin或Neo-Synephrine）在流血的鼻孔中喷洒鼻子四次。
- 重复步骤，以阻止前后流鼻血。
- Call a doctor if bleeding persists after 30 minutes or if nosebleed occurs after an injury to the head.
Reprinted fromentnet.orgwith permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2009. All rights reserved.
