Nasal tamponade is used in traumatology and otorhinolaryngology to stop nosebleeds of various etiologies. And if the front tamponade is a fairly common procedure, then the back is made only by the “chosen one”. Those whose blood does not want to stop under any pretext, or those whose injuries are much more serious than it seems at first glance.
Nose bleed
Nasal bleeding is called bleeding from the nasal cavity when fluid drains through the nostrils onto the face, or through the choan into the back of the throat. There are two types of bleeding: anterior and posterior. In some cases, blood enters the nasolacrimal canal (due to the suction effect) and flows through the orbit. This may mislead eyewitnesses to this phenomenon and first aid doctors.
Fresh blood and blood clots can enter the stomach through the esophagus, causing nausea or even vomiting. Very rarely, nosebleeds can be fatal. The literature mentions the leader Attila, who was choked with his blood in a dream on his wedding night.
Nasal tamponade is necessary to stop nosebleeds. It is possible that fluid loss is small, but the presence of complications makes this condition urgent.
Causes
The choice of procedure (anterior or posterior nasal tamponade is required by the patient) depends on which vessels are damaged. This is the only criterion. But there are a lot of factors that can trigger bleeding. They are divided into local and system.
Local include:
- injuries to the nose;
- foreign bodies;
- inflammation and swelling of the nasal mucosa.
These are the three most common factors that cause nosebleeds. There are more exotic ones:
- anatomical deformities;
- inhalation of drugs;
- oncological processes in the nasal cavity;
- cold and dry air;
- abuse of drops from a cold;
- barotrauma and surgery.
Systemic factors include allergies, a constant increase in blood pressure, the presence of colds. In addition, nosebleeds are possible as a result of taking non-steroidal anti-inflammatory drugs, drinking alcohol, having problems with the coagulation system, deficiency of vitamins K and C, systemic autoimmune diseases.
Pathophysiology
In order for bleeding to open, you need to damage the vessel wall. The nasal mucosa is very well vascularized, so even a small application of force is enough to spill blood.
Most often, nosebleeds occur in children under ten years of age and in people over sixty, usually in men.
Against the background of increased pressure, bleeding occurs spontaneously and can be quite prolonged if measures are not taken in time. In old age, the mucosa is so thin that even basic hygiene procedures can provoke a rupture of the vessel.
In 95% of cases, the source of bleeding is the anteroposterior nasal septum. There is the so-called Kisselbach plexus. There are also "signal" bleeding. They are characterized by spontaneity, short duration and abundance. These episodes may be due to damage to a large vessel on the face, rupture of an aneurysm, or a decaying tumor.
Anterior Tamponade
Anterior tamponade of the nose with bleeding is used most often. This "love" of doctors for this procedure is due to the fact that in the vast majority of cases, the front vessels of the nasal cavity are damaged, and there is no need for other methods.
As a rule, such bleeding is not an independent disease. They are only symptoms of more global changes in the body. Therefore, with frequent recurrent bleeding, you need to think about what other changes have occurred in your health and whether there is a reason to go to the doctor.
Etiology
Allocate the traumatic causes of bleeding. They include injuries of any genesis, including surgical interventions. And also there are symptomatic causes that are associated with manifestations of systemic diseases with the anatomical integrity of the nose.
In women, there are concomitant (that is, going along with menstruation) and vicarious (that is, replacing menstrual function) bleeding. The mechanism of their formation has not yet been sufficiently studied.
One way or another, whatever the reasons for the appearance of blood from the nasal passages, it is necessary to stop its flow.
Methods for stopping nosebleeds
Today, there are many ways to stop bleeding. The choice depends on the massiveness and cause of this condition. Not necessarily as the main method should be used nasal tamponade. The algorithm for stopping bleeding consists of the following steps:
1. Detect bleeding.
2. Determine its cause.
3. Identify a damaged vessel.
4. Stop the bleeding in the most convenient and quick way.
5. Monitor the patient's condition.
Independently eliminate mild nosebleeds in the following ways:
1. Tamponade of the nose. The technique is simple: a cotton or gauze swab soaked in 3% hydrogen peroxide is inserted into the lumen of the nasal concha .
2. Pre-moisten cotton wool in vasoconstrictor drops, and then inject into the nasal passage from which blood flows.
3. Ask the patient to take a deep breath with his nose, exhale through his mouth and at the same time put ice on the nose and neck.
During any of the procedures, the patient should sit or take a half-sitting position, and lower his head forward. This is necessary so that blood does not flow along the back wall of the pharynx into the stomach.
Front Swab Technique
If all of the above methods are ineffective, anterior nose tamponade is performed. Her technique is quite simple to perform. First of all, the doctor should make local anesthesia of the nasal cavity with a solution of lidocaine or novocaine (after conducting an allergy test, of course). Then the doctor introduces a sterile gauze into the bleeding passage moistened with a hemostatic drug or liquid paraffin. The gauze can be about seventy centimeters long, but the width is only one and a half. Turunda is placed in the form of an accordion so as to completely fill the nasal cavity.
Such a tampon is left for almost three days, and after this period is removed. With especially severe bleeding, gauze can be left for seven days, but in this case it must be moistened with solutions of antibiotics and aminocaproic acid.
Reasons for back tamponade
Anterior tamponade of the nose may not give the expected results. Or the source of the bleeding may be farther than originally thought. In such cases, they resort to a more laborious, but effective method.
Rear nasal tamponade is performed to stop nosebleeds if:
1. The patient had a direct blow to the nose or a foreign body fell into the nasal passage.
2. If bleeding is caused by prolonged rhinitis or sinusitis.
3. In cases where high systemic blood pressure prevents the walls of the vessel from falling off and interferes with the formation of a blood clot.
4. The cause of bleeding is a decaying tumor.
5. The patient has a blood disease.
Technique for performing nasal swabs
Only a trained specialist is able to perform this manipulation, do not try to self-medicate at home. In addition to the doctor, two or even three people participate in this action. One of them is needed in order to maintain the correct position of the patient’s head. The second delivers tampons and helps to fix them, and the third prepares new sterile tampons if necessary.
Before starting the procedure, the patient is injected with any sedative to relax him and reduce the vomiting reflex. Then, a soft catheter lubricated with sterile paraffin oil is inserted through the nose into the oral cavity. A gauze swab of the appropriate size is attached to the end of this tube. There are three threads on the swab: two fix it on the catheter, and one stays in the mouth, and then is attached to the cheek with a band-aid. The next step is the removal of the catheter through the nose. In this case, the tampon is pressed against the choan and completely closes the nasopharynx. After that, make the front tamponade and tie the remaining two threads in front. The swab is also removed after two to three days.
Complications
Tamponade of the nasal cavity, like any other manipulation, can cause complications. Among them are phenomena such as necrosis of the nasal mucosa. This is due to prolonged compression of the vessels and nerves during the exposure of turunda. The second problem may be the aggravation or development of purulent diseases of the sinuses of the nose (sinusitis, sinusitis), since blood and gauze are a good environment for the growth of bacteria.
In difficult cases, posterior tamponade can lead to deformation of the nose and nasal septum. In addition, therapy may result in the formation of a hematoma or septic fusion of the septum due to the attachment of a secondary infection.