"My Nose is Bleeding!"

Short of loss of consciousness there are few common medical conditions that cause more anxiety and acute concern than a nosebleed.  Most of the time they are almost inconsequential and are easily managed at home.  Let’s talk about their significance and how to manage them, and when they are more serious and in need of professional care.

First, don’t panic and make things worse by doing a lot of wiping and blowing of the nose.  Avoid walking back and forth to the bathroom sink.  This will just make it harder for a stable clot to form over the bleeding site and take longer to stop.

THE BASICS: Grab a large towel for your lap and perhaps a large basin.  Immediately pinch firmly the entire soft part of the nose between your thumb and forefinger.  Over handed with the wrist bent downward should work best.  Pinching the hard bony upper part of the nose is useless.  Then, very important, SIT DOWN and try to CALM DOWN.  Parents can pinch a child’s nose for him/her and it’s ok to switch hands carefully without releasing pressure if necessary.  A comfortable chair to sit in with arms high enough on which you can brace your elbows doing the pinch maneuver while sitting upright with your head just slightly bowed down is in my view the best position.

This will calm you and allow the clot to seal the hole in the bleeding blood vessel.  Please know that nosebleeds even in older people are not a warning sign of stroke, and elevated blood pressure is almost invariably present due to anxiety.  It will come down as the bleeding is controlled.

Most importantly, keep your nose pinched continually for at least 20-30 minutes while seated quietly upright.  The vast majority of nosebleeds will stop by doing the above.

If after releasing pressure the nosebleed starts up again, there is one more very useful measure that may help.  If you have a decongestant nasal spray such as Afrin or Neosynephrine do the following.  Take it with you to a large sink.  Blow all clot from both sides of your nose.  Spray 3-4 large puffs of the spray up both nostrils then restart the 20-30 minute pinch – sitting process.

The decongestant spray will shrink the blood vessel to a much smaller diameter and make it easier for your own clotting system to work.  People with complex severely high blood pressure should ask their doctor if they are allowed to use such medications in a nose bleed emergency.

If you have done the above and are still bleeding I think it is best that you access the nearest emergency facility. These facilities have the necessary resources to address the problem at a higher level of care.

A LITTLE MORE GENERAL INFORMATION:  The root cause of nosebleed is some type of injury to a blood vessel.  Pre-existing inflammation from a recent cold can make them more delicate and more easily injured.  Most problem nosebleeds occur in winter.  Breathing dry household air dries liquid secretions into coarse hard crusts almost like very coarse sandpaper.  A casual wipe of the hand across the nose can abrade tiny arteries and veins a fraction of a millimeter below the lining of the nose.  A tiny wound is created most commonly on the flexible wall dividing the two nostrils known as the septum.  The “pinch” maneuver allows direct pressure to stop the bleed.

Nosebleeds that you can’t stop at home may be complicated by the fact that someone is on aspirin or related medications such as ibuprofen, vioxx, naprosyn, etc. or potent blood thinners like coumadin.  These drugs suppress the natural clotting reaction.  Also, especially in senior citizens we see nose bleeds more commonly because they are more likely to be on the above medications and the lining of their nose much more fragile.

Additionally, the elderly are more prone to bleeds that may have a source fairly far up the nasal airway within the bony passages that cannot be compressed with the simple pinch.  Pinching the nose just allows the nasal cavity on the affected side to fill up with a blood clot and fresh blood will shortly spill over to the other nostril that was not initially bleeding.

Continued bleeding of this type will cause blood and clot to spill into the throat.  This type of bleed becomes clearly problematic within 5-10 minutes of trying the simple pinch maneuver.  Professional help is often needed in such circumstances and emergency evaluation is recommended if bleeding has been repetitive or continued more than 20-30 minutes.

PREVENTION:  Keeping your household air humidified is an excellent preventative measure.  Another very simple one is to gently apply a coat of Vaseline or Triple antibiotic ointment to the inside of the nose 2-3 times a week during winter months.

--Michael M. Ward, M.D.

Dr. Ward graduated from the University of North Carolina at Chapel Hill, Chapel Hill, NC. He is Board Certified in Emergency medicine and has been a practicing physician with Eastern Carolina Emergency Physicians since 1997, and can be reached at (910) 452-1400.