b. Signs and Symptoms. Blood oozes from the nostrils. The blood may be
bright red if it comes from the anterior nose. Blood from the back of the throat may be
dark or bright red. The amount of blood may be great or small; there may or may not be
pain. Ninety percent of all nose bleeds occur at the anterior of the septum. Ten percent
occur in the posterior portion of the nose. A person having a moderate nose bleed may
feel light-headed, dizzy, and have slight respiratory difficulty. A person having a severe
hemorrhage may experience a sudden drop in blood pressure, rapid and bounding
pulse, dyspnea pallor, and other indications of progressive shock.
c. Evaluation. Begin by questioning the patient. Ask how long the bleeding
has been taking place and if he has a history of vascular disease. Then, estimate how
much blood the patient has lost. Check the patient's vital signs: temperature, pulse,
respiration, and blood pressure. Determine the location of the bleeding in this manner:
for anterior bleeding, inspect the nasal cavity closely. Clean the nasal cavity with clean
cotton tipped applicators dipped in sterile water. Use an otoscope or nasal speculum to
inspect the nasal cavity gently. For posterior bleeding, have the patient in a sitting
position. Be sure your light source is adequate. Have the patient hold his tongue or
you use a tongue depressor to hold his tongue down. Visually inspect. If the patient
has vomited, he may have swallowed large amounts of blood.
d. Treatment. Follow this procedure:
(1) Position the patient. A patient with no other signs or symptoms of
injuries should be in a seated position, leaning slightly forward. Then, blood and mucus
can drain well. If the patient cannot sit because of other injuries, have him lay back with
his head elevated slightly or have him turn his head to one side. For an unconscious or
possible spinal damage patient, immobilize the neck and spine before you position him.
If possible, all patients should have the head and upper torso elevated.
(2) Apply local pressure. Apply pressure to the affected nostril. For anterior
bleeding, pack the affected area with petrolatum strips sprayed with epinephrine. For
posterior bleeding, use nasogastric tubes to control the bleeding.
narrow the blood vessels).
Bleeding. Cauterize if the bleeding does not stop.
4-15. FRACTURE OF THE NOSE
a. Description. Fracture of the nose is a common injury, usually the result of a
blunt blow. The direction, type, and force of the blow to the nose determine the severity
of the fracture. Adequate and immediate treatment is necessary to prevent permanent
problems such as nasal displacement, septal deviation, or nasal obstruction.