The most probable cause of this particular bleed is accelerated hypertension. Epistaxis or nasal bleeds are classified into anterior or posterior (front or back part of the nose) based on the region from where they bleed. In your case, I would definitely consider posterior epistaxis as typically, and these bleeds are more torrential as they usually happen from the woodruff's plexus (venous leash of blood vessels draining the back part of your nose). Moreover, in posterior bleeds, the blood immediately trickles down into the throat, which can come out from the mouth, or you might end up swallowing some blood, causing gastric irritation and consequent emesis or vomiting. The reason why I have considered accelerated hypertension is because of your age. Moreover, in these bleeds, it is always typical that by the time you reach the emergency room, your blood pressure would have come back to normal and bleeding stops making everyone wonder why it bled in the first place. You would have never been hypertensive earlier. In this entity, there are episodes when the blood pressure transiently shoots up to high levels. The easiest area for the body to exhaust this sudden increase in blood pressure is the posterior nose part, precisely speaking. Moreover, in these bleeds, every other parameter that you would have got investigated would be normal. My advice to you would be to measure your blood pressure at home every four hours and document it so that if required, appropriate oral antihypertensives can be started. I am sure that the bleeding should stop, and there is absolutely nothing that you need to worry about as this is a treatable entity. One more aspect worth mentioning is that please do not panic when it bleeds, as it can further shoot up the blood pressure, causing the bleeds to last for a longer duration. These episodes might continue for a while until appropriate treatment for the cause is initiated. I hope this helps. Warm regards.
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