Plugging the Dike... Stopping that Nose Bleed | Straight Talk from the Stanford ER

Plugging the Dike... Stopping that Nose Bleed

Nose bleeds are common, especially in the cooler months of the year when we are relying on artificial heat sources to keep us warm… and dry out our mucus membranes! They’re also common in those who have a habit of “picking their nose” (common in children and more than a few “closet” adult “pickers”). There is a very nice array of blood vessels in the front part of the nose, lining the septum (the cartilaginous tissue inside the middle of the nose). Those vessels are designed to help heat and moisten the air we breathe in. But when that air is especially dry, the membranes over the vessels can become dehydrated and cracked, setting the stage for nose bleeds.

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
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The Stanford Emergency Room is the center of emergency care at Stanford University.