Nasal tamponade is used in traumatology and otorhinolaryngology to stop nosebleeds of various etiologies. And if the anterior tamponade is a fairly common procedure, then the posterior tamponade is performed only by the “chosen ones”. Those whose blood does not want to stop under any pretext, or those whose damage is much more serious than it seems at first glance.
Nosebleed
Nasal bleeding is called bleeding from the nasal cavity, when fluid flows through the nostrils to the face, or through the choanae to 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 out through the orbit. This can be misleading to eyewitnesses of the phenomenon and first responders.
Fresh blood and blood clots can pass through the esophagus into the stomach, causing nausea or even vomiting. Very rarely, nosebleeds can be fatal. The literature mentions the leader Attila, who choked on his blood in a dream on his wedding night.
Nasal packing is needed to stop nosebleeds. Perhaps the loss of fluid in this case is small, but the presencecomplications makes this condition an emergency.
Reasons
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 provoke bleeding. They are divided into local and system.
Local includes:
- 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 also more exotic ones:
- anatomical deformities;
- drug inhalation;
- oncological processes in the nasal cavity;
- cold and dry air;
- abuse of cold drops;
- barotrauma and surgery.
Systemic factors include allergies, 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 clotting system, vitamin K and C deficiency, and systemic autoimmune diseases.
Pathophysiology
In order for bleeding to open, you need to damage the wall of the vessel. The nasal mucosa is very well vascularized, so even a small application of force is enough to bleed.
Most common nosebleedsoccur in children under ten years of age and in people over sixty, usually in men.
Against the background of high blood pressure, bleeding occurs spontaneously and can be quite prolonged if measures are not taken in time. In old age, the mucous membrane is so thin that even elementary hygiene procedures can provoke a rupture of the vessel.
In 95% of cases, the source of bleeding is the anteroinferior part of the 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 in the face, a ruptured aneurysm, or a decaying tumor.
Anterior nasal packing
Anterior nasal packing for bleeding is the most commonly used. Such "love" of physicians for this procedure is due to the fact that in the vast majority of cases the anterior 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 just 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 he alth and whether there is a reason to look to the doctor.
Etiology
Isolate traumatic causes of bleeding. They include injuries of any origin, including surgicalintervention. And there are also symptomatic causes that are associated with manifestations of systemic diseases in the anatomical integrity of the nose.
Women have concomitant (that is, going along with menstruation) and vicarious (that is, replacing the 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 to stop nosebleeds
Today, there are many ways to stop bleeding. The choice depends on the massiveness and the cause of this condition. It is not necessary that nasal tamponade should be used as the main method. The bleeding control algorithm consists of the following steps:
1. Detect bleeding.
2. Determine its cause.
3. Determine the damaged vessel.
4. Stop bleeding in the most convenient and fastest way.5. Monitor the patient's condition.
You can fix a slight nosebleed on your own in the following ways:
1. Nasal packing. The technique is simple: a cotton or gauze swab soaked in 3% hydrogen peroxide is inserted into the lumen of the turbinate.
2. Pre-moisten a cotton turunda in vasoconstrictor drops, and then insert it into the nasal passage from which blood flows.
3. Ask the patient to take a deep breath through the nose, exhale through the mouth and at the same time put ice on the bridge of the nose andnape.
During any of the procedures, the patient should sit or take a semi-sitting position, and lower his head forward. This is necessary so that blood does not flow down the back of the throat into the stomach.
Anterior Packing Technique
If all of the above methods are ineffective, anterior nasal tamponade is performed. Its technique is quite simple to perform. First of all, the doctor must do local anesthesia of the nasal cavity with a solution of lidocaine or novocaine (having previously performed allergy tests, of course). Then the doctor introduces sterile gauze moistened with a hemostatic preparation or vaseline ointment into the bleeding passage. The length of gauze can be about seventy centimeters, 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.
This tampon is left for almost three days, and after this period is removed. For particularly 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 posterior tamponade
Anterior nasal packing may not give the expected results. Or the source of the bleeding may be further away than originally thought. In such cases, resort to a more time-consuming, but effective method.
Posterior nasal packing is done to stop nosebleeds if:
1. The patient had a direct blow to the nose or a foreign body got into the nasal passage.
2. If bleeding is caused by long-term rhinitis or sinusitis.
3. In cases where high systemic blood pressure prevents the walls of the vessel from collapsing and prevents the formation of a blood clot.
4. The cause of the bleeding is a decaying tumor.5. The patient has blood disorders.
Nasal Packing Technique
Only a trained specialist can perform this manipulation, you should not try to self-medicate at home. In addition to the doctor, two or even three more people participate in this action. One of them is needed in order to maintain the correct position of the patient's head. The second feeds the swabs and helps to fix them, and the third prepares new sterile swabs if necessary.
Before starting the procedure, the patient is administered any sedative to relax him and reduce the gag reflex. Then a soft catheter lubricated with sterile vaseline oil is inserted into the oral cavity through the nose. A gauze swab of the appropriate size is tied to the end of this tube. There are three threads on the tampon: two fix it on the catheter, and one remains in the mouth, and then is attached to the cheek with a plaster. The next step is to remove the catheter through the nose. In this case, the tampon is pressed against the choanae and completely closes the nasopharynx. After that, an anterior tamponade is made and the remaining two threads are tied in front. The tampon is also removed after two or three days.
Complications
Tamponade of the nasal cavity, like any other manipulation, can cause complications. Among them are phenomena such as necrosisnasal mucosa. This is due to prolonged compression of blood vessels and nerves during the exposure of turunda. The second problem may be the exacerbation or development of purulent diseases of the sinuses (sinusitis, sinusitis), since blood and gauze are a good breeding ground for bacteria.
In difficult cases, posterior tamponade can lead to deformity 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 addition of a secondary infection.
