Dr Jitendra Kumar Srivastava
A bleeding through nose, medically known as epistaxis, is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the sinus and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause upset stomachs and vomiting.
The etiology of epistaxis is not always straightforward. Multiple disease processes can result in bleeding from the nose. In order to properly diagnose the patient, it is important that the clinician be aware of underlying abnormalities that can result in the clinical picture. The multiple causes of epistaxis can be divided into two broad categories—local and systemic disease states. Local factors leading to epistaxis include vascular anomalies , infectious/inflammatory states, trauma, iatrogenic injuries, neoplasm, desiccation and foreign bodies. Systemic factors leading to epistaxis include hypertension, atherosclerosis, infectious/inflammatory diseases, blood dyscrasias, platelet deficiencies or dysfunction, coagulopathies, as well as kidney and liver disease. Elucidation of a good medical history as well as a thorough physical exam should allow the physician to significantly narrow his differential.
Hypertension, though not conclusively tied to epistaxis, is a factor in the development of atherosclerosis. Accumulation of the atherosclerotic plaques in the arterial walls with fibrous replacement of the muscular vessel wall layers lead to decreased hemostatic abilities and more fragile vessels. This is thought to be the reason that posterior nose bleeds are seen more often in older persons.
EVALUATION OF EPISTAXIS
When evaluating a patient with epistaxis it is important to pursue an extensive medical history and physical examination. Initial management should always begin with evaluation of the “ABC’s” of ATLS initial resuscitation. This should include evaluation of the patient’s blood pressure and heart rate. Fluid resuscitation may be necessary in the epistaxis patient. Replacement with Lactated Ringers or Normal Saline is usually sufficient. If the patient is estimated to have lost more than 30% of his/her blood volume (1.5 liters in a normal adult), or if he/she shows signs of severe blood loss (tachycardia, low blood pressure, tachypnea) blood products should be transfused. Once the patient is stable, a full history and physical examination can be pursued. In most situations, the specialist will not be involved until after the patient is stabilized.
TREATMENT OF EPISTAXIS
Most of the time bleeding occurs from the little`s area and can be easily controlled by pinching the nose with thumb and index finger for about 5 min. this compresses the vessels of the little`s area .in TROTTER`S METHOD method patient is made to sit leaning a little forward over a basin to spit any blood and breathe quietly from mouth .cold compresses should be applied to the nose to cause reflex vasoconstriction.
Epistaxis is the manifestation of many different disease processes. Its treatment is as varied as its etiologies. Treatment will be most effective when underlying medical problems are understood, nasal anatomy is appreciated, and the patient’s response to treatment and general medical status are taken into account. The otolaryngologist should be familiar with treatment options and be able to offer surgical intervention, if necessary.
HOMOEOPATHIC TREATMENT AND MANAGEMENT PRESCRIBED BY DR CFS HAHNEMANN IN HIS ORGANON OF MEDICINE FOR ACUTE AND CHRONIC AILMENTS
We know that the first step towards achieving proper Homoeopathic interpretation of a case is to record every detail faithfully with all symptoms complete as to location, sensation, modalities, possible causation and concomitants, as well as past history, family history, personal history including mental and physical generals, and a history of various treatments pursued. All this must then be interpreted in terms of the evolution of the symptoms with respect to time.
- Ambra grasia—tearing pain in the upper half of brain, snile dizziness with rush of blood to head when listening to music, epistaxis especially in the morning , the presence of others is unbearable ,after business embarassement , sensation of coldness in abdomen , time passes too slowly ,music is intolerable
- Ammo.carb—epistaxis when washig the face in the morning or after eating especially from left nostril althoug it is right sided remedy ,stoping of nose in the night must breath throgh mouth ,patient dislikes washing, ozaena with snuffles of nose ,cholera like symptoms at the commencement of menses
- Ambrosia—watery coryza sneezing watery discharge with epistaxis.
- Bar.carb—sensation of smoke in nose ,coryza with swelling of upper lip and nose ,patient is mentally and physically dwarf ,sits at the corners of the rooms or street doing nothing or doing some foolish things like throwing stones to the strangers
- Bufo—epistaxis with flushed face ,sensation as if hot vapor rose to top of head ,desire to solitude in order to perform masturbation ,disposition to hold genitals ,epilepsy during night
- Bryonia—epistaxis when menses should appear. Vicarious mensturation ,dryness of the all mucous membrane with unquenchable thirst for large quantity of cold water at large interwal ,all complaints are ameleorated at rest and aggravated in motion
- Calc.carb—fair fatty flabby people which catches cold easily ,constipated ,nose with polyp and epistaxis
- Camph—persistent epistaxis with goose flesh state of skin,skin is cold to touch but can not bear to cover
- Carb.veg—epistaxis in daily attacks with pale face ,surface of body cold to touch ,simple food disagrees,wants to be fanned rapidly from a closed distance ,complaints relief from erructation and flatus
- Convalaria majalis—epistaxis sees imaginiary gray spots about three inches square , associated with cardiac symptoms and anasarca with female symptoms
- Corallium—odors of smoke onions etc. With epistaxis ,post nasal drip
- Croc sat—epistaxis dark stringy clotted strings of dark blood hanging down the nose,sensation of something alive moving in abdomen,spasmodic twitch of single muscle
- Crot hor—epistaxis blood black and stringy ozaena after exanthemata or syphilis
- Diptherinum—epistaxis associated with diptheria
- Erechthitis—-epistaxis of bright red color
- Ferrmet—-mucous membrane relaxed boggy anaemic and pale with false plethora
- Ferrphos—epistaxis of bright red blood
- Ferrpic—epistaxis associated with senile hypertrophy of prostate and friquent micturation at night
- Hammemelis—epistaxis of blood with fullness feeling, intense soreness of the affected part,vicarious menses
- Ipecac—epistaxis with persistent feeling of nousea and vomiting even not relieved by vomiting , tongue is clean
- Melifolium—-profuse epistaxis , headache relieved by epistaxis
- Natsulf—epistaxis due to humid environment, salty mucous
- Nat sali—-epistaxis after influenza
- Phos—epistaxis instead of menses , vicarious menses, fan like motion of alae nasi ,patient is chilly but desires cold things
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Dr Jitendra Kumar Srivastava