ear, nose, and throat disorders
Nosebleeds
Evaluation of Nosebleeds
The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with a nosebleed, certain symptoms and characteristics are cause for concern. They include Signs of excessive blood loss (such as weakness, fainting, or dizziness when standing up) Use of medications that interfere with blood clotting Signs of a bleeding disorder or a known bleeding disorder (such as Hemophilia ) Bleeding that is not easily stopped—for example by direct pressure Several recent episodes of nosebleeds, particularly with no clear cause The most common medications that interfere with blood clotting includeaspirin,clopidogrel,warfarin, and newer medications taken by mouth (called novel oral anticoagulants), such asrivaroxabanandapixaban. Signs of a bleeding disorder include Numerous small, red or purplish spots on the skin (petechiae) Many large bruises Easily bleeding gums Bloody or tarry stools Coughing up blood Blood in the urine Excess bleeding while brushing the teeth, having blood tests, or getting minor cuts Heavy menstrual periods in women People who cannot get the nosebleed to stop by Anterior nosebleed should go to the hospital right away. Even if the bleeding has stopped, people who have Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a Some Causes and Features of Nosebleeds and the tests that may need to be done. During the medical history, doctors ask about the following: Obvious triggers (such as sneezing, nose blowing or picking, and recent upper respiratory infections) The time and number of previous nose-bleeding episodes and how they were stopped Whether the person (or a family member) has a bleeding disorder or other disorders that sometimes cause problems with blood clotting Whether the person takes any medications that interfere with blood clotting Disorders that can cause problems with clotting include severe liver disease (such as cirrhosis or hepatitis) and certain cancers. During the physical examination, doctors first look for signs of extensive blood loss (such as a fast heart rate and low blood pressure) and for markedly high blood pressure. Doctors then focus on the nose, looking for the bleeding site. They also check the person's skin for signs of bleeding disorders, including petechiae, large bruises, and dilated small blood vessels in and around the mouth and on the tips of the fingers and toes. An anterior bleeding site is usually easy for the doctor to see with a handheld light and an instrument used to hold the nostrils open. Sometimes the doctor uses a headlamp or head mirror to reflect light into the nose, To see a posterior bleeding site, doctors need to use a flexible viewing scope (nasal endoscope). However, an actively bleeding posterior site produces too much blood for the doctor to see anything, even with a viewing scope. Laboratory testing is not usually required. If people have symptoms of a bleeding disorder and/or signs of significant blood loss or severe or recurring nosebleeds, blood tests are done. Computed Tomography (CT) (CT) may be done if a foreign object, a tumor, or sinusitis is suspected. 