Nose Bleed (Epistaxis)

I think most of us ENTs (in independent practice) would open our offices after hours for a colleague with a nosebleed. I’d much rather treat a nosebleed in my office than the ED (no offense meant toward my ED colleagues). I have most of the instruments and lighting that I would need there, ready to go. Definitely would favor an ED rather than a UCC.

Some “anterior” nosebleeds can bleed like stink. This is because bleeding is from a higher pressure arteriole. If you have Afrin or Neosynephrine at home (and it’s actively bleeding), I would advise using (after blowing to evacuate clots, as clot begets bleeding by depleting the clotting factors). Then firmly pinch the lower collapsible soft part of the nose (thumb and finger, tongue blades, clothes pin, I’ve even seen patients use a “chip clip”) for 10-15 minutes BY THE CLOCK. (Remember normal Ivy bleeding time is 3-10 minutes — but bleeding times are sadly no longer being done most places.)

If you have a bit of knowledge of internal nasal anatomy, you could try wetting an appropriate sized piece of cotton with decongestant and carefully slipping it into the nostril before pinching the nose.  Keep the head elevated. Pressure on the upper lip below the nose can decrease the blood pressure in anterior septal arterioles. Ice on the forehead and/or back of the neck might help.  If you are in the ER, use their LET Solution on a cotton ball—has the topical 1:1000 epi and is incredibly effective at constricting the offending arterioles.

Finally, and I’ve brought this up on other threads before, if you have some bacon (and no religious objections) you could cut off a generous portion (as fatty as possible) and gently stuff it snuggly into the nostril before going to the ED. Pork fat has a water soluble compound that promotes platelet adhesion (making them “super platelets”) and I have used salt pork with a number of patients on anti-coagulants as well as with thrombocytopenia. It has not failed me yet — this is after other, more “traditional” methods have failed.

Try to avoid sticking dry or abrasive materials into the nose (e.g. Kleenex, toilet paper, or even dry cotton). To prevent future bleeds I recommend: humidification, avoidance of NSAIDs (especially Toradol.

Take 250-500mg Vitamin C daily (promotes hydroxylation of proline and collagen formation).