Epistaxis

Epistaxis, nose bleeding is common in about 20% population, more common in children. A condition that’s considered harmless, easy to treat and simple can turn critical. There is a need for good clinician to understand the problem and then to handle accordingly. Wrong diagnosis or treatment or surgical procedures can be detrimental and patients condition can turn critical. Given below is account of my recent experience. There might be some dramatization due to selection of certain words. Those who do not like to read about medical conditions should not read further. In this first part I am giving the preoperative situation that was experienced. Next part will offer some description of operative procedure, post operative complications, and recovery. The write up on hospital stay and the services offered can be a good material for management students to understand gap analysis. Those in service industry can have some value addition. If you are comfortable then read further, the first part of Epistaxis.

For the third time in my life on April 10^th 2013, I was admitted to the hospital for an emergency. The first admission was on Oct 18^th 1955, when I had a fall from tree resulting in multiple fractures. Second one was on April 9^th 1984, when the scooter that I was riding was knocked down by a speeding car resulting in injuries and multiple fractures. These events were cyclic and took place in cycle of 29 years. I know the astrological reasons and planetary positions of those days, but it’s not the scope of this article. It all started on April 3^rd 2013. I shut down the desktop by 10 in the night and decided to retire. As I was changing I noticed trickle of blood through my nostril. I dismissed it as minor incidence and attributed the same to hot climatic conditions. In few minutes the trickle turned into a gush and there was blood everywhere from bed to bathroom. I packed my nose with cotton gauze, placed crushed ice over the nose and waited for a while for bleeding to stop. My wife in the meantime checked my blood pressure and it was absolutely normal. I called my cardiologist brother and a surgeon friend but no one could figure out the cause. The common cause at my age can be high blood pressure, but I always had normal blood pressure and there were no issues, physical or emotional that would surge the blood pressure. Bleeding stopped in short while. My throat was experiencing irritation due to trickling down of clotted blood. I involuntarily coughed and this time gush of blood started. When looked at myself in the mirror over the wash basin, I couldn’t believe, I was looking like a vampire without protruding canines.  I repacked the nostrils and decided to held the head straight above the level of heart to reduce the blood supply towards the nose. It worked and the bleeding stopped. I spent a restless night. Next noon I had an appointment with the ENT surgeon. I explained to him what all had happened. He was shocked. He suggested not to remove the pack and prescribed vitamin K injections, some coagulants and nasal drops.  He thought it was posterior bleeding, I thought it was anterior. I volunteered to remove the pack so that he could examine. He was unwilling, yet I removed and asked him examine the septum and internal parts of the nose. Everything looked normal except the raw areas which were bleeding last night. I also got my bleeding time, clotting time and prothrombin time tests done. They all were normal. No injury to nose, no high blood pressure, no headache or dizziness, no infection, no alcohol consumption yet nose was bleeding. 

A day went by with sporadic bleeding. The medications were on.  Next day I decided to have second opinion and went to another ENT surgeon. She was more bold than earlier doctor. She prescribed me an antibiotic and for some unknown reasons asked to stop the medications prescribed by first ENT surgeon. I followed her advice. Due to the blood that had gone down the throat, I had dark tarry stools. This was on  April 5^th 2013. Next twenty four hours were ok, but from subsequent day my nose started bleeding again. I was confined to indoors as the bleeding would start anytime without any forewarning. I was feeling weak with loss of blood. Each episode would result in minimum half a cup of blood loss. It was frightening for family members. My wife being bold handled every episode with care and utmost courage. The female ENT surgeon was repeatedly assuring that the bleeding will stop and we need not worry. On 9^th night I again had a profuse bleeding, just like the one I had on 3^rd. There was blood everywhere, the pillows, the bed sheets, the floor. I packed the nose and kept crushed ice over the face. It stopped in while, but I had a premonition. I could not sleep, I was very restless. There was a constant feeling that something serious is on the cards. Midnight passed by, I was tossing in the bed. By 3.30 early morning I could sense the bleeding and before I could act there was a gush as if tap has been opened. I woke up my wife, she was aghast to see the way blood was pouring out of my nose. I struggled to pack my nostrils, kept my head under the cold shower. It took about 10 to 15 minutes to get the situation under control. I asked my daughter in law to call my cardiologist brother, surgeon friend and the ENT surgeon. They were explained the gravity of situation and we decided to get admitted in hospital. My surgeon friend drove me to the hospital, my brother was already waiting there for me and the ENT surgeon had given instructions to the casualty staff. It was about 4.30 in the morning of April 10^th, the Amavasya day, I was admitted. The procedure was scheduled for 10 am same day. Operation theater was booked; it was available as there were no planned surgeries being Amavasya on that day. From casualty I was moved to the room and the preoperative check up were initiated.