Question

A 20-year-old male comes to the casualty with complaints of bleeding from nose for the last one hour.
Discuss clinical features and examination findings in this patient.

Hint:

Examine the nasal cavity carefully with a speculum to differentiate between anterior and posterior nasal bleeding, as the management strategies differ. Severe blood loss may require volume resuscitation.

Answer 1

Step 1: Clinical Features.
- Active Bleeding: The most obvious feature is the bleeding from the nose, which can be mild to moderate or severe. Blood may be seen coming from one or both nostrils.
- Nasal Obstruction: The patient may experience difficulty breathing through the nose due to the accumulation of blood in the nasal cavity.
- Associated Symptoms: In severe cases, the patient may complain of dizziness, weakness, or palpitations due to blood loss, and may exhibit symptoms of hypovolemia such as low blood pressure or tachycardia.

Step 2: Examination Findings.
- Visible Blood in Nasal Cavity: During examination, blood may be seen in the anterior part of the nasal cavity, particularly if the bleeding is from Kiesselbach's plexus.
- Signs of Hypovolemia: If the patient is losing a significant amount of blood, signs of hypovolemia such as tachycardia, hypotension, and pallor may be present.
- Anterior and Posterior Nasal Examination: A careful examination using a nasal speculum can help identify the source of bleeding (anterior or posterior).

Step 3: Conclusion.
Clinical features typically involve active nasal bleeding with nasal obstruction. In severe cases, signs of hypovolemia may be present. Thorough examination helps identify the source and severity of the bleeding.