Information: Nosebleeds

Epistaxis! What a lovely word! It comes form the Greek word epistazo which means to bleed from the nose (duh!).

Most of us will have nosebleeds at one point in our lifetime. It is said that up to 60% of us will have nosebleeds in our lifetimes, but only 6% will require medical attention, and only a further 6% in that group will require admission to a hospital (and you shall see me!). However, from an ENT Surgeon’s point of view, it is the most common ENT emergency that gets referred to us. Nose bleeds are becoming increasingly common as many people are now on blood thinners such as aspirin, clopidogrel, plavix, warfarin, coumadin, dabegatran, rivaroxaban, fish oil, krill oil, etc.

Let me just mention that big group of nosebleeds for whom medical attention is not required. Guess where is the driest part of the human body? No, not the wallet. It’s the inside of the tip of your nose.  The nose is divided left and right by a soft cartilage called the septum. That septum is a narrow passage for air (and dust, and pollen, and grass, and perfumes, and body odours etc). It gets dry very, very easily. (If you don’t believe me, try pinching your nose and breathe through your mouth. See how quickly your mouth dries up.) So to keep the septum from becoming too dry, we set up a massive camp for blood vessels there to warm and humidify the air that gets through the nose past the septum.

That’s a tricky combination isn’t it? To warm the inhaled air, we need lots of blood vessels under the surface. Yet when it gets too dry and crusty, these vessels bleed easily.

So what should one do when one is epistaxising (nose-bleeding)? Here are some simple tips:

1. Relax. It happens some time.

2. Don’t tip your head back. Guess where the blood will go? Swallowed into your belly, which will make you sick. Or inhaled into your lungs, which is not nice, coz you’ll splutter and cough. Tip your head down.

3. Press on the lower half of the nose, the soft, fleshy cartilage part. You see the top half of your nose is bone, and the bottom half fleshy. No point pressing on the bony part. Normally you bleed form one side of the nose, so press on that bleeding side. You may still be able to breathe from the other side.

4. Open your mouth slightly. Take slow deep breath.

5. Point number 4 above is also applicable when giving birth.

6. Suck on ice, or have some cold drinks, preferably non-alcoholic and without a mini umbrella in the cup as it may poke you in the eye. Suck like a kid. Ice cream, icy poles, milkshakes, etc. The cold may help constrict blood vessels and give you a bit of brain freeze too. Have some ice compresses to your forehead or back of neck as well if you like. Call room service if you can’t do this alone.

7. Wait a few minutes. Update your facebook status, tweet, or blog.

8. Most bleeds will settle.

9. Once the bleed settles, remember that inside your nose is a raw area that needs time to heal over a few days. So bungee jumping the next day may result in a repeat bleed.

10. Moisturise the nose over the next 2 weeks or so. My recommendation: go to the local chemist and get normal saline nasal sprays or sesame seed oil sprays. There are multiple sprays and oils that can be sprayed up the nose to trap moisture in the nose and allow the crusted area to heal up.

11. Do not withhold your usual blood thinners unless you’ve spoken to your doctor.

These simple steps will help in managing most bleeds. These are also good advice any doctor can give when managing a patient with epistaxis. But of course, many these often don’t get as far as the doctors or the ENT surgeons (thankfully).

Prevention?

1. Preempt situations where your nose will get really dry: camping, bushwalking, springtime, airconditioned rooms, summer sports day, etc.

2. During those times of increased bleeding risk, spray the nose with normal saline sprays or nasal moisturisers several times during the day. This will keep the nose wet and reduces the risk of drying and bleeding.

What happens when you get bigger bleeds that doesn’t stop after basic first aid as above?

1….

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