Editing Nosebleed (section)

{{short description|Bleeding from the nose}}
{{Other uses}}
{{Infobox medical condition (new)
| name            =
| image           = Young_child_with_nosebleed,_smiling_cropped.jpg
| synonyms        = Epistaxis, bloody nose, nasal hemorrhage<ref name=Fer2013/>
| caption         = A three-year-old child with a minor nosebleed from falling and hitting his face on the floor
| pronounce       = Epistaxis {{IPAc-en|ˌ|ɛ|p|ᵻ|ˈ|s|t|æ|k|s|ᵻ|s}} {{respell|EP|ih|STAK|sis}}
| field           = [[Otorhinolaryngology]]
| symptoms        = Bleeding from the nose<ref name=Fer2013/>
| complications   =
| onset           = Less than 10 and over 50 years old<ref name=AFP2005/>
| duration        =
| types           =
| causes          =
| risks           = Trauma, excessive [[nose picking]], certain [[infection]]s, [[anticoagulants|blood thinners]], [[high blood pressure]], [[alcoholism]], [[seasonal allergies]], dry weather<ref name=Stat2019/>
| diagnosis       = Direct observation<ref name=Fer2013/>
| differential    = [[Hemoptysis|Bleeding from the lungs]], [[esophageal varices]],<ref name=Fer2013/> [[vomiting blood]]
| prevention      = [[Petroleum jelly]] in the nose<ref name=Kell2014/>
| treatment       = Pressure over the lower half of the nose, [[nasal packing]], [[endoscopy]]<ref name=Tun2020/>
| medication      = [[Tranexamic acid]]<ref name=Jos2018/>
| prognosis       =
| frequency       = 60% at some point in time<ref name=Wac2009/>
| deaths          = Rare<ref name=Stat2019/>
}}
<!-- Definition and symptoms -->
A '''nosebleed''', also known as '''epistaxis''', is an instance of [[bleeding]] from the [[nose]].<ref name=Fer2013>{{cite book |last1=Ferri |first1=Fred F. |title=Ferri's Clinical Advisor 2014 E-Book: 5 Books in 1 |date=2013 |publisher=Elsevier Health Sciences |isbn=978-0-323-08431-4 |page=399 |url=https://books.google.com/books?id=H63KViNwsdcC&pg=PA399 |language=en}}</ref> [[Blood]] can flow down into the stomach, and cause [[nausea]] and [[vomiting]].<ref>{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK411/|title=Clinical Methods: The History, Physical, and Laboratory Examinations|last=Wilson|first=I. Dodd|date=1990|publisher=Butterworths|isbn=978-0409900774|editor-last=Walker|editor-first=H. Kenneth|edition=3rd|location=Boston|pmid=21250251|editor-last2=Hall|editor-first2=W. Dallas|editor-last3=Hurst|editor-first3=J. Willis}}</ref> In more severe cases, blood may come out of both [[nostrils]].<ref>{{cite journal |last1=Krulewitz |first1=NA |last2=Fix |first2=ML |title=Epistaxis. |journal=Emergency Medicine Clinics of North America |date=February 2019 |volume=37 |issue=1 |pages=29–39 |doi=10.1016/j.emc.2018.09.005 |pmid=30454778|s2cid=242676103 }}</ref> Rarely, bleeding may be so significant that [[low blood pressure]] occurs.<ref name=Fer2013/> Blood may also be forced to flow up and through the [[nasolacrimal duct]] and out of the eye, producing [[haemolacria|bloody tears]].<ref>{{cite book |last1=Riordan-Eva |first1=Paul |title=Vaughan and Asbury's General Ophthalmology |date=2000 |publisher=McGraw Hill Professional |isbn=978-0-07-137831-4 |page=92 |language=en}}</ref>

<!-- Cause and diagnosis -->
Risk factors include trauma, including putting the finger in the nose, [[anticoagulants|blood thinners]], [[high blood pressure]], [[alcoholism]], [[seasonal allergies]], dry weather, and [[inhaled corticosteroid]]s.<ref name=Stat2019/> There are two types: anterior, which is more common; and posterior, which is less common but more serious.<ref name=Stat2019>{{cite journal |last1=Tabassom |first1=A |last2=Cho |first2=JJ |title=Epistaxis (Nose Bleed) |journal=StatPearls |date=January 2020 |pmid=28613768}}</ref> Anterior nosebleeds generally occur from [[Kiesselbach's plexus]] while posterior bleeds generally occur from the [[sphenopalatine artery]] or [[Woodruff's plexus]].<ref name=Stat2019/> The diagnosis is by direct observation.<ref name=Fer2013/>

<!-- Prevention and treatment -->
Prevention may include the use of [[petroleum jelly]] in the nose.<ref name=Kell2014>{{Cite journal|last1=Morgan|first1=Daniel J.|last2=Kellerman|first2=Rick|date=March 2014|title=Epistaxis|journal=Primary Care: Clinics in Office Practice|volume=41|issue=1|pages=63–73|doi=10.1016/j.pop.2013.10.007|pmid=24439881|issn=0095-4543|doi-access=free}}</ref> Initially, treatment is generally the application of pressure for at least five minutes over the lower half of the nose.<ref name=Tun2020>{{cite journal |last1=Tunkel |first1=David E. |last2=Anne |first2=Samantha |last3=Payne |first3=Spencer C. |last4=Ishman |first4=Stacey L. |last5=Rosenfeld |first5=Richard M. |last6=Abramson |first6=Peter J. |last7=Alikhaani |first7=Jacqueline D. |last8=Benoit |first8=Margo McKenna |last9=Bercovitz |first9=Rachel S. |last10=Brown |first10=Michael D. |last11=Chernobilsky |first11=Boris |last12=Feldstein |first12=David A. |last13=Hackell |first13=Jesse M. |last14=Holbrook |first14=Eric H. |last15=Holdsworth |first15=Sarah M. |last16=Lin |first16=Kenneth W. |last17=Lind |first17=Meredith Merz |last18=Poetker |first18=David M. |last19=Riley |first19=Charles A. |last20=Schneider |first20=John S. |last21=Seidman |first21=Michael D. |last22=Vadlamudi |first22=Venu |last23=Valdez |first23=Tulio A. |last24=Nnacheta |first24=Lorraine C. |last25=Monjur |first25=Taskin M. |title=Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary |journal=Otolaryngology–Head and Neck Surgery |date=7 January 2020 |volume=162 |issue=1 |pages=8–25 |doi=10.1177/0194599819889955|pmid=31910122 |s2cid=210072386 |doi-access= }}</ref> If this is not sufficient, [[nasal packing]] may be used.<ref name=Tun2020/> [[Tranexamic acid]] may also be helpful.<ref name=Jos2018>{{Cite journal|last1=Joseph|first1=Jonathan|last2=Martinez-Devesa|first2=Pablo|last3=Bellorini|first3=Jenny|last4=Burton|first4=Martin J|date=2018-12-31|editor-last=Cochrane ENT Group|title=Tranexamic acid for patients with nasal haemorrhage (epistaxis)|journal=Cochrane Database of Systematic Reviews|volume=2018|issue=12|pages=CD004328|language=en|doi=10.1002/14651858.CD004328.pub3|pmc=6517002|pmid=30596479}}</ref> If bleeding episodes continue, [[endoscopy]] is recommended.<ref name=Tun2020/>

<!-- Epidemiology -->
About 60% of people have a nosebleed at some point in their life.<ref name=Wac2009>{{cite book|url=https://books.google.com/books?id=sGhzMnst1j8C&pg=PA551|title=Ballenger's otorhinolaryngology : head and neck surgery.|last1=Wackym|first1=James B. Snow,... P. Ashley|date=2009|publisher=People's Medical Pub. House/B C Decker|isbn=9781550093377|edition=17th|location=Shelton, Conn.|page=551}}</ref> About 10% of nosebleeds are serious.<ref name=Wac2009/> Nosebleeds are rarely fatal, accounting for only 4 of the 2.4 million deaths in the U.S. in 1999.<ref>{{cite web |title=Work Table I. Deaths from each cause by 5-year age groups, race and sex: US, 1999 |url=https://www.cdc.gov/nchs/data/statab/vs00199wktbli.pdf |website=CDC |access-date=13 April 2020 |page=1922 |date=2011}}</ref> Nosebleeds most commonly affect those younger than 10 and older than 50.<ref name=AFP2005>{{Cite journal|last1=Kucik|first1=Corry J.|last2=Clenney|first2=Timothy|date=2005-01-15|title=Management of epistaxis|journal=American Family Physician|volume=71|issue=2|pages=305–311|issn=0002-838X|pmid=15686301}}</ref>
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