Saturday, January 5, 2013


A nosebleed like this can have absolutely nothing to do with cocaine use !

  Epistaxis is the medical term for nosebleed.  Most people who have a nosebleed have a fairly self limiting bleed from one of their nostrils. However, there are people who experience nosebleeds which can be compared to water dripping from a faucet. Within my nursing career of almost 30 years, I have seen this many times.   In epistaxis, there may be a true hemorrhage from the nose. In the anterior variety, the blood is leaking from the nose in profuse amounts leaking over clothing and hands.  In the posterior variety, the blood may be leaking, also rather profusely down the throat. This is a problem for two reasons. It can cause vomiting and furthur disruption of the clot later, and I have also seen it disrupt breathing, as blood enters the lungs and the patient is left trying to cough out profuse streaming blood.  Most often, we are able to treat the anterior variety of epistaxis at home, and the posterior variety is the type which is more likely to need the expertise of the emergency room or of an ear nose and throat specialist or otolaryngologist. Rarely, blood can come out from the nasolacrimal duct of the eye, in a significant epistaxis.
       First, how does this happen ?  How can a person go one moment from being perfectly okay, to the next moment where they have a spontaneous bleed which is traumatic not only to themselves but to others ?
There are a myriad of reasons this may occur.  Some of us have blood vessels in our noses and some of them are fairly superficial. In winter, or when our home heat is on, these areas can dry and leave the person more prone to the beginnings of a bleed.  Secondly, some people, particularly those with uncontrolled high blood pressure, may not have a history of superficial nasal blood vessels but may develop a dripping epistaxis from that alone.  Blood pressure should always be assessed following control of a severe epistaxis. Some of us have slight unusual malformations inside our noses and this also leaves us more prone to this occurrence. Interestingly, red haired girls seem to experience bleeding longer following childbirth and also following epistaxis than others, and therefore having red hair is a risk factor.   Another reason this may occur is that prior to a menstrual period, it has been discovered that women's platelets drop to half the normal complement, presumably to allow menstruation.  This can have the nasty side effect in some of them, in terms of producing a significant epistaxis during periods.  Certainly those who have clotting disorders or certain cancers may also experience epistaxis. Rarer causes can be certain types of anemias, envenomation injuries which disrupt clotting, heart failure, etc.   Since one episode of significant epistaxis could be the only indicator of a new systemic illness, this should be brought to the attention of your primary physician, whether you see the emergency room or not.

       First Aid for Epistaxis is as follows:

     The patient should be tilted forward allowing blood to drain out rather than down the back of the throat where vomiting ot disruption of breathing is more likely to occur.  The nares or nostrils should be gently pinched closed from the end or tip of the nose using gentle and constant pressure so as not to disrupt a forming clot, and patient should be kept still and calm.  A frozen sponge or ice pack on the back of the neck has been proven to be beneficial (it's not just an old wive's tale anymore) because it constricts the blood supply to the nose somewhat. This can take 5-20 minutes.

       Patients who continue to profusely bleed for longer than 20 minutes, should be seen in an emergency room.  There, the bleed can be chemically cauterized and packed, and referred to an ENT physician for follow up.  In the few days which follow a true epistaxis, while the mucosa is still healing, the patient is still at high risk for this occurring again.  Some ENTs recommend the use for a couple of days of nosedrops called phenylephrine hydrochloride which is marketed in the US as Neosynephrine.  This should be added to your emergency kit. It should not be used for longer than a couple of days

    This is also why I advocate the keeping of frozen sponges and frozen wet handiwipes kept in freezer bags and then covered with paper towels. 
A new wet sponge can be places in a freezer bag and frozen for many first aid uses.  As they melt they tend to conform to the body part you seek to cool.  These should be covered with a wash cloth or paper towel before direct usage on a body part.

     Patients who experience habitual and severe epistaxis may need surgery to revise the internal structure of their noses.  Fortunately,  surgical intervention is usually not necessary.

 This physician makes some excellent points concerning proper first aid with regard to epistaxis:

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