foreign [Applause] [Music] ers.com in this video I'm going to be going through nosebleeds and you can find written notes on this topic at xerodofinos.com nosebleeds or in the ear nose and throat section of the zero to finals surgery book so let's jump straight in nosebleeds are also known as epistaxis bleeding usually originates from Kiesel backs plexus which is located in Little's area on the inside of the nose this is an area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels when the mucosa is disrupted and the blood vessels are exposed they can become more prone to bleeding attempt it for you Little's area which is the area most affected by little fingers picking noses is a popular exam topic it's worth remembering Little's area as examiners like to ask what is the most likely location of the bleeding let's talk about the presentation nosebleeds are common in young children and older adults they can be triggered by nose picking colds or viral upper respiratory tract infections sinusitis vigorous nose-blowing trauma to the nose changes in the weather coagulation disorders for example thrombocytopenia which is a low platelet count or Von Willebrand disease anticoagulant medications which may be found in older people for example aspirin direct acting anticoagulants or doax or Warfarin people who snort cocaine and tumors inside the nose for example squamous cell carcinoma patients may present reporting that they vomited up blood when in fact they swallowed blood during a nosebleed usually the bleeding is unilateral from only one nostril bleeding from both nostrils May indicate bleeding posteriorly in the nose and posterior bleeding presents a higher risk of aspiration of the blood taking the blood down into the lungs Let's Talk About Management of nosebleeds nosebleeds will usually resolve without needing any medical assistance recurrent or significant nosebleeds might require further investigation to look for the underlying cause for example thrombocytopenia or a low platelet count or clotting disorders you may have to advise patients on how to manage a nosebleed in an ASCII scenario or in an exam the way to manage a nosebleed is to sit up and tilt the head forward so that the blood runs forward rather than backwards into the throat and towards the airway squeeze the soft part of the nostrils together for 10 to 15 minutes and if any blood enters the mouth spit it out rather than swallowing it patients may require a trip to hospital or admission if the nose bleeding does not stop after 10 to 15 minutes the nosebleed is severe with lots of bleeding there's bleeding from both nostrils or the patient is hemodynamically unstable treatment options in this case are nasal packing using nasal tampons or inflatable packs and nasal cautery using silver nitrate sticks after treating an acute nosebleed once the bleeding is stopped consider prescribing naseptin nasal cream which contains chlorhexidine and neomycin which is an antibiotic and this can be used four times daily for 10 days in order to reduce any crusting inflammation and infection inside the nostrils May septum cream is contraindicated in peanuts or soya allergy which is worth remembering if you like this video consider joining the zero to finals patreon account where you get early access to these videos before they appear on YouTube you also get access to my comprehensive course on how to learn medicine and do well in medical exams digital flash cards for rapidly testing the key facts you need for medical exams early access to the zero to finals podcast episodes and question podcasts which you can use to test your knowledge on the go thanks for watching and I'll see you in the next video