Plugging the Dike... Stopping that Nose Bleed
Wednesday, October 18, 2006
Healthline
If you develop a nose bleed, don’t panic. Just find a comfortable place to sit for a few minutes--preferably somewhere where you can see a clock or a watch. Pinch your nose at its tip, at the point just below where the bone ends and the soft part (cartilage) begins. Pinch firmly with your thumb and forefinger and hold it. Hold it for 10 straight minutes, and no peeking. You’re allowing a clot to form, and if you get impatient and peek too soon, you’ll pull that clot off the blood vessel and have to start all over again. There’s no advantage to cool compresses on the forehead or the back of the neck--unless they feel good and help you to relax. It may help for you to lean slightly forward to keep blood from draining down the back of your throat. Swallowed blood can make you nauseated.
If, after 10 minutes of constant direct pressure, the bleeding continues, keep up the pressure and head to the ER for evaluation. If you are taking medications that affect your blood’s clotting abilities (eg, aspirin, coumadin, Plavix, Aggrenox), you are more likely to need professional help to get the bleeding stopped. In the ER, the physician will try to identify the precise site of bleeding and stop it (using topically applied agents and possibly chemical cautery or a nasal balloon or pack to keep pressure on the site). In rare cases, the bleeding is coming from a site farther back in the nose, and this will require more specialized care, including possibly an evaluation by an Ear, Nose & Throat specialist (ENT).
If you have hypertension, once the bleeding is stopped, get your blood pressure checked, though the relationship between high blood pressure and nosebleeds remains pretty speculative, unless the blood pressure is very high.
To prevent nosebleeds, stay well hydrated--drink plenty of water and non-caffeine/non-alcoholic fluids during the day. Consider using a humidifier in your home if your air is particularly dry. You can also apply just a spot of petroleum jelly (e.g., Vaseline) to the inside of your nasal septum (the tissue in the middle) with the just the tip of your little finger. And, most importantly, if you’re a “nose picker”… just say “No”.
Stay alert and stay safe.
- Dr. Bob
19 Comments:
At Wed Oct 25, 07:57:00 AM 2006,
Anonymous said…
Thanks, Dr. Bob, I needed to know that vaseline trick. Can you say how often, if ever, a persistent (arterial) nosebleed might require an ER-OR of the anterior ethmoid artery, which accompanies the dorsal nasal nerve to the nose?
I imagine that this is usually from nasal trauma further than you mention, I just wondered of its occurrence in your experience.
thanks!
At Thu Oct 26, 05:23:00 AM 2006,
Robert L. Norris, MD, FACEP said…
Hope the petroleum jelly trick helps! Though I'm not an ENT/Otolaryngologic surgeon, the need for surgical management of nose bleeds is uncommon. The vast majority of patients with nosebleeds never even come to the ER. Of those that do, most are successfully discharged home after ER management. Of those few requiring admission (and I had one yesterday), less than 10% end up requiring a surgical procedure (such as arterial ligation or endoscopic cautery).
Best wishes!
At Tue Oct 31, 08:51:00 PM 2006,
Anonymous said…
vaseline has never worked for me i suffer from nosebleeds daily, and have been for a few years, now i am wondering if they could be the result of my high blood presure medication, ziac, i have been on a low dose for 15 years, and all the time the nosebleeds have gotten progressivly worse, to the point i am now, sending me to seek the help of a ent.he wants to cauterize the vessels in my nose, i am scared,the pain in healing is more than a little unconfortable,from the last time he packed my nose with a sponge,any thoughts, advice? thanks
At Wed Nov 01, 04:50:00 PM 2006,
Robert L. Norris, MD, FACEP said…
Sorry to hear of your persistent problem. It sounds as though you are doing precisely the right thing in seeking specialist consultation with an ENT. Done well, cautery can certainly help folks who have persistent, recurrent bleeds amenable to such therapy. Hope all goes well!
At Tue Apr 17, 08:37:00 PM 2007,
Anonymous said…
I work at an elementary school and have come across many nose bleeds in the 8 years that I have worked on "boo-boo patrol". Most nose bleeds are just a minor nusiance, however, I get half dozen or so a year that I would consider pretty major. What I have consistantly found, is if a child is able to blow their nose on the side that is bleeding, they usually blow out what I would call a large clot like substance. After this clot is out, the nose stops bleeding within moments. My theory is that this clot is in the nasal passage for reasons unknown (some moms suspect that their child is suffering from allergies at this time, may or may not be related), the clot ruptures which produces the nose bleed. The nose bleeds tend to be pretty heavy (10-15 tissue changes with at least a quarter size amount of dark red blood). Then I have them blow their noses hard, the clot comes out, and the nose stops bleeding. Again this is my theory, but I would like to know if there is any science to back up this theory.
Thanks,
At Fri Apr 20, 08:29:00 AM 2007,
jessica said…
hiya dr.bob i hope that pinching my nose will put a stop to the constant nose bleeds that i keep having because i think that all of your advice is great from jessica age 12
At Mon Apr 23, 02:17:00 PM 2007,
Robert L. Norris, MD, FACEP said…
Dear Anonymous,
You are to be congratulated on your powers of observation! Indeed, one of the things that can keep a nosebleed from being effectively stopped is the presence of a large blood clot sitting in the nose and making attempts at applying pressure less effective. In those unusual circumstances, it may help to have the patient blow his nose gently to get the clot out, then follow with the direct, concentrated application of pressure as mentioned in the blog.
Good work!
Dr. Bob
At Mon Apr 23, 02:19:00 PM 2007,
Robert L. Norris, MD, FACEP said…
Dear Jessica,
Thanks for writing! I hope the tips help. I, too, had a problem with nosebleeds when I was your age, but fortunately outgrew them. Hopefully you will as well. If your nosebleeds are happening a lot, it might be worthwhile to go see your pediatrician for a check.
Best wishes!
Dr. Bob
At Sat Jun 09, 03:04:00 AM 2007,
marla said…
Just a question about the blood clot 'theory'. I have noticed a similar type of result until my daughter's most recent nose bleed. Twice a large clot was removed from her nostril and the nose bleed continued at a very rapid pace. So I made an effort to not remove a third such 'clot' as my daughter was beginning to feel faint...eventually she did faint but without the removal of the clot the bleeding subsided. During this process we had steady pressure just below the bridge of the nose and ice on the bridge or the nose. As a rough estimate I might guess the nose bleed continued for nearly 20 minutes. Since the weather where we are is hot and humid, I was wondering if dehydration cause nose bleeds?
My daughter is 11 and not on any medications. Do you have any further advice on bringing a nose bleed to a quick halt? And should I seek further medical advice.
At Mon Jun 11, 08:43:00 PM 2007,
Robert L. Norris, MD, FACEP said…
Marla,
No doubt, nose bleeds can be a challenge to stop, and the same approach may not work in every case. Whether a blood clot prevents adequate pressure on a bleeding vessel in the nose really depends on where it is sitting in relationship to the oozing vessel.
Without doubt, there are occasional bleeds that need professional attention to get them stopped and prevent recurrence. That's why I generally recommend to folks that if they can't get the bleeding stopped themselves after about 10 minutes of continuous pressure, that it's probably time to head to the doc's office or ER.
Dehydration may increase the chances of nosebleed as it may result in drying of the nasal membranes. When the membranes are dry, the blood vessels on their surface are more likely to crack and bleed with minimal trauma.
I hope your daughter is well and "nosebleed-free". If not, it may be time to see her doctor about the problem.
Best wishes,
Dr. Bob
At Wed Sep 12, 11:58:00 PM 2007,
Anonymous said…
My daughter is 6 years old is tall and thin weighs 43# she is very fit. Started having nosebleeds 3 years ago they gradually got worse 5-6 per day 30- 45 min long last year the ent cauterized her nose twice. She just started 1st grade and now we are back to the 5-6 per day lasting 15-20 min, my question can playing to much start them for example 3 recesses, and p.e, walking 1/4 mile home from school per day does physical activity help or hurt. Also could she lack certain vitamins and minerals could she be anemic and could that make them worse? thanks
At Thu Sep 13, 01:38:00 PM 2007,
Robert L. Norris, MD, FACEP said…
Dear Anonymous,
Obviously, without further details, and examination, and, depending on other information, potentially some lab work, it would be impossible to make a diagnosis or firm recommendation re: what's going on with your daughter. I assume she is otherwise completely healthy and has no other bleeding problems (severe bruising with little trauma, bleeding from the gums, etc),and takes no medications (including those that can make one more prone to bleed [eg, ibuprofen]). It is certainly possible, over time for the vessels in the region of the nose responsible for most nose bleeds to begin bleeing again, even after prior cautery. The vessels grow back into the area and can ultimately bleed again. I am aware of no direct association between exercise and nosebleeds. Perhaps if she is spending a lot of time playing in a particularly dusty environment, that could dry and inflame her nasal membranes, making recurrent bleeding a greater possibility. The one thing I can suggest, is to have her seen by her ENT physician again for re-evaluation.
Best wishes,
Dr. Bob
At Sat Feb 02, 09:57:00 PM 2008,
Genny said…
Hi Dr. Bob
What do you think is the cause of nosebleed during sex, the guy is in mid sixties and with hypertension.
At Wed Apr 02, 12:23:00 PM 2008,
Anonymous said…
I am a 38 year old female with persistant, daily nose bleeds for about 2 weeeks. I have experienced the same "clot" type of issues. My nose will begin to bleed profusely until I am able to blow out the clot. After the clot is out, the bleeding will stop. My question is - what is causing these bleeds? I have never had this problem before. I have also started having a somewhat sharp pain around my jaw/ear area when I chew or talk. Any suggestions?
At Sat Apr 12, 12:37:00 AM 2008,
Emily said…
4/11/08
HELP!!!! I just had my left nostril cauterized due to daily nose bleeding and the outer rim of my nostril is black, the skin has turned BLACK, it's not something i can just wipe off, it's my skin's current color!!! HOW LONG WILL THIS BE LIKE THIS??? I'M GETTING DEPRESSED. THANKS IF ANYONE CAN HELP ;( EK - California
At Tue Apr 22, 05:48:00 AM 2008,
Anonymous said…
Emily, I am the 38 year old that posted the comment directly prior to yours. I am no doctor, obviously, but I can tell you my experience. I did end up going to an ENT for my daily nose bleeds. He cauterized using silver nitrate. I had the same problem you describe about the stuff on the outer rim of the nostril. It is probably the silver nitrate used to cauterize. It wouldn't rub off and I freaked out also! It came off after a few days and my nostril scabbed over and was fine. My nose did start bleeding again after being cauterized, but after a couple of days it stopped and I have had no other problems. Hang in there!
At Wed May 07, 08:49:00 PM 2008,
Anonymous said…
Dear Dr. B ~ I just had a PFO/ASD closure on 4/28/08 and have been taking Plavix and low dose Asparin since March. Today was my first all day nose bleed ever. It was scary, it just wouldn't stop. It finally did late in the evening and about 3 hours later a large clot came out of my nose about 1 1/2" then I spit up a glob of blood the size of a small water balloon. It was pretty amazing! I quickly got the camera :) and started snapping. My question to you is, how can I stop anymore nose bleeds while on the Plavix? Do I have to let it run it's course? Thanks for your help. Living in the high desert the vasaline works for the dryness but too bad it doesn't for clotting :)
37/f/n/s
At Mon Jul 13, 01:16:00 PM 2009,
Anonymous said…
Dear Dr. Bob,
Three weeks ago i had surgery for my nose bleed which could not be controlled through the normal routes, i`ve never been in hospital and i found the whole experience worrying (to say the least) I was in and out of hospital 3 times in the course of 8 days, every time i was sent home it started again. After my 3rd admission and 5th packing experience, i was at my wits end. I was put on the emergency list. After the op, i was told that the main artery was clamped in 2 places, a main vein and a smaller one was also done for me. My question is, what is the name of the main artery that was clamped? Will there be any long term effects from having this sugery, and what are the chances of this happening again? I was told it could happen to anybody at any time and any age, and that it has nothing to do with lifestyle, as i thought it was (in my case) due to stress over a period of a few years. I am 56yrs old now, and would like to avoid at all costs this ever occuring again. Thanking you.
At Wed Nov 04, 05:16:00 AM 2009,
Anonymous said…
What is the danger of the bleeding also in the mouth? I am 60+ female
Post a Comment
<< Home