Epistaxis

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EpistaxisEpistaxisNasal hemorrhage (epistaxis) is also called epistaxis, is one of the most common clinical symptoms, mostly caused by nasal

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Epistaxis

Epistaxis

Nasal hemorrhage (epistaxis) is also called epistaxis, is one of the most common clinical symptoms, mostly caused by nasal lesions can also be caused by systemic disease, sometimes due to nasal nasal bleeding lesions adjacent outflow. Epistaxis is unilateral, bilateral or intermittent; repeated hemorrhage, or continuous hemorrhage; bleeding amount is not a light, only blood in the nose, they can cause hemorrhagic shock; repeated hemorrhage can lead to anemia. Most bleeding can be stopped.

Pathogeny

Overview of etiology etiology can be divided into local and systemic reasons why. Local reasons: nasal trauma or nose deep impact

Recurrent epistaxis for prevention of cerebral hemorrhage

Heavy nose. The deviation of nasal septum or ridge, distance of condyle, because local mucosa thick, easy bleeding after stimulation by air. Patients suffering from acute rhinitis, atrophic rhinitis easy bleeding. In a few cases are caused by nasal cavity and paranasal sinus or nasopharynx tumor bleeding, such as hemangioma and malignant tumor. Systemic causes: arterial pressure is too high, such as high blood pressure, arteriosclerosis. Increased venous pressure, such as mitral stenosis, pulmonary edema, etc.. Acute febrile infectious diseases, such as respiratory infections, influenza, etc.. The blood diseases, such as leukemia, hemophilia, purpura. The liver and spleen diseases and rheumatism. The phosphorus, arsenic, benzene poisoning can damage the hematopoietic function caused by bleeding. The vicarious menstruation.

Nasal bleeding mainly occurred in nasal septum before the site, there are dilated blood vessels formed vascular plexus, called septum easy bleeding area for nasal bleeding, a few cases behind the nasal cavity or other parts. Most of the nasal bleeding is unilateral, the amount of bleeding can be very small, can also be a large number of arterial bleeding, or even shock.

Local cause

Food for preventing epistaxis

1 trauma.

2 air pressure injury.

3 deviation of nasal septum. Perforation of nasal septum often have symptoms of epistaxis.

4: the inflammation of nonspecific inflammation: dry rhinitis, atrophic rhinitis, acute rhinitis, acute maxillary sinusitis, often cause nasal bleeding. The specific infection: nasal tuberculosis, diphtheria, syphilis and other nasal nasal mucosa, nasal bleeding due to ulcers, prone to cause.

5 tumor.

6 other: nasal foreign body, nasal leech, can cause recurrent massive hemorrhage. In the plateau region, because of the relative humidity is too low, and more suffering from dry rhinitis, for the important causes of regional epistaxis.

Systemic causes

hemostasis

1 hematologic disorders: abnormal platelet volume or quality. Abnormal coagulation mechanism.

2 acute infectious diseases.

3 cardiovascular disease: arterial pressure is too high: such as high blood pressure, arteriosclerosis, nephritis, hypertension and eclampsia. Increased venous pressure: such as mitral stenosis, chest or mediastinal and neck mass, emphysema, pulmonary edema and bronchial pneumonia.

4 vitamin deficiency: vitamin C, K, P and trace elements such as calcium deficiency, are prone to nasal bleeding.

5 chemical drugs and drug poisoning: phosphorus, mercury, arsenic, benzene poisoning, can cause damage to the hematopoietic system function caused by epistaxis. Long term use of salicylic acid drugs, can lead to reduced prothrombin and easy bleeding.

6 endocrine disorders: compensatory menstruation, threatened nasal hemorrhage often occurs in puberty, due to the reduction of estrogen content in blood and nasal mucosa caused by vascular dilatation.

7 hereditary hemorrhagic telangiectasia, liver, kidney and chronic diseases such as rheumatic fever, can also be associated with nasal bleeding.

TCM explanation

hemostasis

"All" Lingshu born Yang said: "the injury of collateral blood overflow, blood overflow is nvxue." Epistaxis is the production of various causes of nasal Yang collaterals injury results. Clinically, epistaxis and lung, stomach, liver, kidney and spleen is closely related, are as follows:

1 lung heat or hot wind heat evil attacking the lung first, followed by the evil heat, on the back of nose, thermal injury vein, blood folly, overflow in the nose, so for epistaxis. "Surgical authentic" book said: "nasal bleeding, but the lung fire, forcing blood Wang Xing, from the nose out. "

2 moss known as stomach heat accumulation, or because of binge eating spirits, acrid, that moss, fiery, burnt, on the inflammation, injury of nasal Zhongyang collaterals, blood heat with Chung, folly on the pulse, and epistaxis. "Shou Shi Bao Yuan" book said: "epistaxis, nasal bleeding, boiling Yang Yu, actuation of the stomach, stomach fire burning, blood folly, is also bleeding." Because of a very "three disease andsyndrome theory" volume nine also said: "the patient to drink too much, and eat fried Bo five hot food, to the blood, with blood gas overflow, for epistaxis, wine food addiction."

3 fire inverse emotional upset, liver qi stagnation, long stagnation of fire, or the fury of liver injury, liver blood inverse, with fire, steam forced nose, vein damage, blood overflow, for epistaxis. "Experience in oncology," said: "there are injured because of seven emotions, moving within the blood, with gas overflow."

4 liver kidney yin deficiency and excessive labor room, Haoshang kidney, prolonged illness or injury of yin deficiency of liver and kidney, water does not contain wood, not liver Tibet blood, xuhuo phlogistic, blood rising, overflow in Qingqiao, and epistaxis. "2" certificate for Mai Zhi said: "the real strain or kidney yin deficiency in water, fire, or angry liver injury, liver, yin and blood with the fire rose by more absurd is wrong, the disease take traumatic epistaxis." "Jing Yue book" volume thirty also said: "although the number of epistaxis by fire, but only from the deficiency is especially much, is a strain of yin and water is not for fire, the most active Chongren Yin blood".

5 Spleen Failing blood after a long illness, with sorrow, improper diet, injury of temper, temper weak, blood loss, blood gas, blood does not follow through, from the veins, seep in the nose, and epistaxis.

Symptom

Nasal bleeding

Bleeding can occur in any part of the nasal cavity, but the most common in the anterior inferior nasal septum, sometimes visible ejection or pulsatile arteriolar hemorrhage. The hemorrhage in the posterior part of the nose often flows rapidly into the pharynx and spits out of the mouth. In general, local diseases caused by nasal bleeding, mostly confined to one side of the nasal cavity, and systemic disease caused by the possibility of both sides of the nasal cavity alternately or simultaneously bleeding.

Check through the anterior rhinoscopy can not find the bleeding site, if bleeding is not feasible after the play, nose or fiber nasopharyngoscopy. Hemorrhage from the nasal cavity, often from the nasal or olfactory cleft. Except for the bleeding point, and make the necessary systemic examination (blood pressure, blood routine examination, bleeding time and coagulation time test, platelet count and capillary fragility test etc.). Sometimes, it is necessary to consult with the relevant departments to find the cause.

Diagnosis

Internal structure of nasal cavity

For patients with nasal bleeding, should be carried out a comprehensive, accurate examination, which is related to the future therapeutic effect.

1 access to the history of nasal bleeding patients who are often bilateral blood, through the medical history to inquire about the first side of the bleeding, the side that is bleeding nasal cavity, the understanding of the past the main disease is also necessary.

2 quickly find the location of bleeding in order to contain 0.1% pieces of adrenaline into the bleeding in the nasal cavity, one minute after the removal of the nasal cavity to find the bleeding site.

(1) below the nasal septum before the nasal mucosa in the branch from the anterior ethmoidal artery, nasopalatine artery, superior labial artery, superficial mucosal anastomosis in mesh with each other. The site is called Kiesselbach or Little, and is a common site of bleeding.

(2) where the bottom of the front end of the nasal septum were bleeding, fingers can press the side of the upper lip. If bleeding is reduced or stopped, said nasal septum branch of superior labial artery rupture, the treatment must be considered when the upper lip artery ligation.

(3) attention should be paid to the top of the nasal cavity when the head and face of the nasal cavity is damaged. The blood is from the top of the nasal cavity. Anterior ethmoidal artery in the ethmoid gas room, ethmoid fracture may serious bleeding.

Epistaxis

(4) the occurrence of serious epistaxis such as head trauma after several days, should check the visual acuity, eye muscle function, vigilance in the middle cranial fossa fracture, internal carotid artery pseudoaneurysm rupture.

The diagnosis of internal carotid artery pseudoaneurysm: a history of head trauma. Vision loss or blindness. The oculomotor nerve palsy. After the incubation period after a large number of epistaxis. The intracranial vascular murmur. The intracranial angiography.

(5) endoscopic sinus examination such as bleeding occurred in the nasal septum, nasal septum, posterior posterior middle turbinate, inferior turbinate front end and the rear floor of nose, nasal wall with nasal endoscope found the bleeding site exactly.

3 if time permits, should be performed in the paranasal sinuses X wire.

4 severe epistaxis, should quickly understand their body condition.

(1) the body temperature, pulse, blood pressure, heart and blood tests.

(2) to observe the body skin, conjunctiva and oral mucosa with no bleeding or bruising, clear the blood disease.

(3) for patients with nasal bleeding who are not aware of it, it is necessary to observe whether or not there is frequent swallowing action. It is necessary to perform a pharyngeal examination to determine whether or not the epistaxis continues to flow through the pharynx to the stomach.

Treatment

General principles 1 patients should be multi comfort.

2 severe nasal bleeding can make the cerebral cortex insufficiency, the patient often appear irritability, can be injected sedatives, general use of barbiturates, but for the elderly with diazepam or promethazine is appropriate. In patients with heart failure and pulmonary heart disease patients with nasal bleeding, avoid morphine in order to avoid breathing.

3 patients with symptoms of shock should pay attention to the respiratory tract, and those with respiratory obstruction should be relieved first, and effective anti shock therapy should be carried out at the same time.

Local hemostatic methods differ according to etiology and disease.

1 acupressure.

2 convergence method.

3 cauterization.

4 frozen hemostasis.

Injection of 5 pterygopalatine tube (large palatine foramen injection).

6 pack method.

Systemic treatment of 1 half sitting rest. Pay attention to nutrition, give high calorie digestible diet. For the elderly or bleeding more attention without hemorrhagic shock, anemia, heart damage, and timely treatment. Blood loss, blood transfusion, infusion.

2 to find the cause of bleeding, etiology treatment.

3 to give adequate vitamin C, K, P, etc., and given a moderate amount of sedatives.

4 intravenous injection of 50% glucose, calcium chloride or coagulation of 5% (~ 4ml, intramuscular injection, 2 times a day), in order to promote coagulation. The proper application of hemostatic agents, such as p-aminomethylbenzoic acid, amino acid, 6- has dicynone or Yunnan Baiyao etc..

5 repeated nasal packing time than the elderly, should be added with antibiotics to prevent infection.

Surgical treatment may be used as appropriate.

In front of the nasal septum bleeding for nasal or nasal filling cold sterilized cotton dipped with 1% ephedrine or tampon hemostatic, can also be a variety of hemostatic sponge, thromboplastin, thrombin etc.. The blood loss was more by the doctor, finding the bleeding site. Hemostatic method commonly used drugs, hemostasis and cauterization of frozen with vaseline gauze before or after nasal nasal filling filling method. A very small amount of severe bleeding need ligation or embolization of blood vessels to stop bleeding. In addition to the above part of the treatment, the use of hemostatic drugs, blood transfusion when necessary, and to find the cause for the treatment of the cause.

Point treatment symptoms: due to excessive heat, nasal dryness or other causes of nasal bleeding caused by stimulation, with the effect of acupuncture therapy is good. However, due to trauma or disease caused by nasal bleeding should first treat injury or disease.

Point: juliao, Tianzhu, Wen, hegu.

Methods: nasal bleeding should be quiet to sit down or lie down, if the activity bleeding also increased. Then with cotton nostrils, and unlock clothes collar to relax with cold water in the cold towel nose, to calm down and then slowly massage juliao, Tianzhu, Wen, Hegu acupoint.

With the index finger or middle finger next to a nostril oppression Ju Liao, and then hands behind the head of the Tianzhu on the thumb of oppression. Then the oppression of Wen LI4, later will be stopped.

If you are walking in when suddenly flow nosebleed, then do not panic. Panic can cause the blood vessels to dilate, causing blood flow. First, use a clean toilet paper to block the nostrils, and then try to find a nearby department store and other places, quickly go there by Restroom, soaked in cold water cold wet nose. It is best to find a quiet place to sit down, unlock the collar button, then press juliao, Tianzhu, Wen, Hegu and these 4 points, will gradually stop nosebleed.

Note that the nosebleed not drinking, bathing, so as not to stimulate the expansion of blood vessels bleeding again.

How to treat a method, the pressure to stop bleeding nose bleeding: a small amount of bleeding, can let the children sit on both sides of the nose pressed with the thumb and forefinger pressed to the nasal septum, pls let children breathe with the mouth. At the same time in the case of forehead covered with cold towels, general compression 5~10 minutes, you can stop the bleeding. A

Two, compression packing method: if the amount of bleeding, or with the method can not stop bleeding, you can use the method of compression hemostasis. The specific approach is: use absorbent cotton as the thickness of the strip to the nose, nasal cavity filling. Don't loose packing, because the packing is too loose, to reach the purpose of hemostasis. Note: pinch the nose bleeding blood, don't comfort children crying, mouth breathing, don't head back, so as to avoid the blood flow in the throat. After the above treatment, the general nasal bleeding can be stopped. If still bleeding, need to be sent to the hospital in time, in addition to continue to stop bleeding in the hospital, but also to identify the cause of bleeding [1].

According to the analysis of clinical data, the proportion of children with nasal bleeding in spring is much higher than that in other seasons. Nose bleeding is a sudden, often make the children feel at a loss, if the treatment is not timely, bleeding too much impact on health.

In children prone to nosebleed reason first, in the spring, the rapid rise of children body Yang, blood with gas Chung, rushed to the nasopharynx and easy bleeding.

Second, the winter to spring, take off heavy clothing heavy cap children, suddenly get the opportunity to outdoor activities, particularly excited, easy to cause nasal bleeding.

Third, the spring is warm, the winter is too long nasal vascular dilatation and contraction of the nose, in dry, itchy discomfort, a slightly dig, will be bleeding.

Fourth, spring is the flu, measles and other sexually transmitted diseases, the epidemic period, after a fever can be secondary to nasal and sinus infections, causing epistaxis.

Because the spring children prone to bleeding from the nose, therefore, fewer children participate in violent activities, avoid nasal trauma; we should pay attention to light diet, eat less fried food; to prevent colds and other febrile diseases; if there is a spring nasal bleeding history, can use honeysuckle, chrysanthemum, ophiopogon root etc. to prevent.

Diet is one of the most common symptoms of nasal hemorrhage in children. The causes include local and systemic bleeding in two categories, mostly in the anterior nasal septum below the Lai District, where a collection network of blood vessels, the surface of mucosa is thin, it is easy because of fatigue, mood swings, nose hole, fever, upper respiratory tract infection causes the expansion of capillary congestion, bleeding injury. In addition, most children with anorexia, unhealthy eating habit, if vitamin A, C and PP intake, can make the capillary fragility and permeability increase induced bleeding. Recent studies have shown that zinc deficiency can also be an important cause of epistaxis. Children suffering from leukemia, hemophilia, aplastic anemia and other blood diseases, in addition to systemic signs of bleeding, nasal bleeding often occurs.

Nose bleeding, parents can let their sit, head slightly upward, with the thumb and forefinger hold the bilateral ear wing, which is just as in Lai's area, generally 5 - 10 minutes most bleeding can be stopped, and the available cold towel around the nose and head. If this time is still not stop bleeding, can be ephedrine or 1 per 1000 epinephrine solution drops on the cotton ball into the nasal cavity, hemostatic effect.

The prevention of child nasal bleeding, parents should first help correct the child nose the bad habits, active prevention and treatment of rhinitis, sinusitis and other diseases. I shall ensure that the child's normal rest, eat more fresh fruits and vegetables, such as tomatoes, celery, radish, lotus root and water chestnut, watermelon, pear, loquat, orange, orange, hawthorn, do not eat lead to "get angry" acrid, fried food.

Easy to occur in children with nasal bleeding, but also can choose the following therapeutic side of Chinese medicine, in order to promote recovery and consolidate the efficacy:

The carp: carp 1 treaty gypsum pot tofu tofu 200 grams, 150 grams, 30 grams of gypsum; the fish slaughtered a good wash, with gypsum and tofu, into the pot, add appropriate amount of water boil for 1 hours, seasoning with salt can be eaten; children can only drink soup do not eat slag, to prevent choking fish. A drop of clearing lung heat, stomach, stop nosebleed effect.

The two students to drink: fresh rehmannia root, fresh rhizome 30 grams, fresh reed rhizome 50 grams, Shuijianbi, daily 1 agent, on behalf of the tea, for 7 - 10 days, can heat and cooling blood and hemostasis.

The fresh lotus root juice drink: xianou 300 grams abluent, grind rotten squeeze juice about 50 - 100 ml; 50 ml each time, with a small amount of sugar and mix thoroughly, stew boil. Can heat, cooling blood to stop bleeding.

The lily meat soup: Lily 30 grams (dried, soak wash), thin pork 100 grams, jujube 2 pieces, into the pot, add water simmer for 1 hours, after seasoning food with salt. There is heat, Pinggan Runzao, nosebleeds.

The donkey stew meat: gelatin 6 grams, 30 grams of lean meat (sliced), into bowl, add appropriate amount of boiling water, with water for 1 hours, with a little seasoning salt. There are nourishing Yin, nosebleeds function.

1, local hemostasis hemostasis: the head should keep normal erect or slightly forward. With the fingers from the nose outside the oppression of the nose side of the nose (soft nose), like the general hand to pinch the nose, direct compression of about five to ten minutes. Most of the patients can simply stop bleeding in this way. If the pressure is more than ten minutes after the blood has not yet stopped, it may represent a serious bleeding, or there are other problems exist, this time you need to send to the hospital for further treatment.

In 2, stop flow before the blood clot blow out, lest because the wound can not be closed to stop bleeding.

3, to wet cotton or nasal decongestant spray into the nose, can also help to stop the bleeding, white vinegar.

4, smear ointment: when nosebleed was controlled, in the nasal smear some vitamin E ointment. If you do not have vitamin E, you can use a small amount of antibiotics or steroid ointment instead, 2 ~ 3 times a day. Vitamin II ointment can promote wound healing, and antibiotics or intranasal steroid ointment can destroy Staphylococcus aureus, not only itching, prevent dry mucus (so as not to cause the nose impulse). If the nasal mucosa is dry due to pain, can use aloe or grass ointment in treating dysentery.

5, with ice cold: cold can cause dilation of blood vessels and reduce bleeding. You can use ice or ice cold towel nose, neck and cheeks, the dilation of blood vessels, reducing bleeding.

6, apply antibiotics or steroid ointment, can also prevent itching dry mucus.

7, left (right) nostril bleeding, raised the right (left) arm, a few minutes after the bleeding.

8, the patient's left (right) nostril bleeding, another person with the middle finger to hook the patient's right (left) in the hands of the root and forced bending, generally a few seconds to stop bleeding;

9, or cloth tied with the finger, left (right) with the right nostril bleed (left) hands, bleeding stopped, untied the cloth.

10, take the amount of garlic, peeled Daocheng mashed garlic, deposited in the soles, with gauze wrapped, can rapidly stop bleeding.

11, let the patient sit on the chair, put your feet soak in hot water, you can stop nosebleed.

12, acupoint massage Jianjing acupoints: (located in the midpoint of the cone and the acromion) treatment: the patient was sitting, patients with food, thumb pinch, squeeze the central point, the shoulder muscles to lift 3 - 5 seconds, repeated 3 to 1 times, each time interval of two min, 3 times the connection attack. 5 days for a course of 1. Each treatment interval of 3 days, pregnant women avoid using this method.

More than 13, such as nosebleeds, we must promptly to the hospital.

Children nosebleed six note 1 in the dry season, the nasal bleeding history of children, the family should be equipped with aureomycin eye ointment, evenly spread in the nasal cavity in every day, to moisten the nasal mucosa.

2 children correct eating habits, drink plenty of water, eat more vegetables, reasonable arrangements for the child's diet scientifically.

3 evening children nasal breathing, furosemide available liquid embellish nose, and do not pull the nose digging.

4 case of nasal bleeding, can use a clean cotton filling nasal bleeding, such as no cotton finger pressure on both sides of the nose for 5 minutes.

5 let nose bleeding in children down (note not upward) and raised his arm to increase the venous return to the heart, thereby reducing the blood supply to the nasal cavity to achieve the purpose of hemostasis.

6 with cold towel and nasal nasal vasoconstriction.

The unique "nosebleed" three method 1, hook finger fast check nasal bleeding:

Nose bleeding, as long as their hands in the middle finger of a hook, you can stop bleeding in tens of seconds. Children do not use the middle finger of each hand hook, adults can use their own two middle finger around the middle finger of the child, the same can stop bleeding.

2, thorn root can stop nosebleed:

Will a thorn root with white cloth wrapped to squeeze the water out, drink, nose bleeding stopped immediately. And it's not easy. (cold water can also be used to clean the nasal cavity), continued for 1 - 3 minutes, after washing the face, and then use the middle finger of the nose and then massage up and down about 20 times a day, 1 - 2 times, after a period of time, can receive significant results.

3, sesame oil control nosebleeds:

Every night before going to bed, with a cotton swab dipped in sesame oil, apply to the nostrils, Tu is best after the nose slowly to the site, especially the nasal septum department must be painted, so rich in blood vessels at mucosal thin and easy bleeding.

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