The management of epistaxis (or How To Stop A Nosebleed)
So, like many doctors across the UK, I've recently jumped specialties in my training and have started my next four months in ENT surgery (ears, nose and throat). So far it's been a fun learning experience, especially with the new gadgets like headlights, nasal speculums (as opposed to the other well-known speculum I've been using in my last specialty Obstetrics and Gynaecology!), and using nifty bits of kit like microsuction to remove ear wax.
I've also been exposed to some of the acute emergencies of ENT, the mainstay of which is nosebleeds. The posh medical term for this is epistaxis. It's extremely common- I used to be a sufferer myself- and while only a handful need specialist management, I'm quite shocked at how few of my patients seem to know what to do before they present to the emergency department! Many patients also receive conflicting and sometimes even harmful advice, even from other doctors, so here I want to try and use knowledge of the anatomy of the nose to help inform the best way to manage a nosebleed.
Please note: If these measures fail, you must seek urgent medical advice. Always check with your GP if you have other medical conditions before following these instructions.
(the following is a summary taken from this article on patient.co.uk)
1. If you are not feeling faint, sit up and lean slightly forward.
The reasoning behind this is to stop blood flowing out the back of the nose and into the throat. Not only does this stop you having to swallow blood (which tastes foul), it also reduces the risk of blood falling into the trachea (air pipe) and causing airway irritation or worse, aspiration into the lungs, where infection can then spread.
2. With a finger and thumb, pinch the lower fleshy end of the nose completely blocking the nostrils. It is useless to put pressure over the root of the nose or nasal bones. Usually, if you apply light pressure for 10-20 minutes, the bleeding will stop.
This is where a lot of the misinformation comes- some patients pinch the bridge of the nose (useless as the nasal bones are not compressible and thus you're not putting pressure on anything!), while others pinch just above the soft part of the nose, which doesn't put pressure on the right area.
The commonest site for nosebleeds is Little's Area:
This is where several blood vessels join up, so makes for a heavy bleeding point. Things that can make nosebleeds worse include hot drinks/ food, as the heat causes the vessels to open up and dilate, thus feeding more blood to the area.
As you can see, this area is right on the soft, fleshy part of the nose, hence why you pinch here and no-where else.
Do NOT keep checking to see if the bleeding has stopped; keep the pressure applied for 15-20 minutes.
3. If available, a cold flannel or compress around the nose and front of face will help. The cold helps the blood vessels to close down (constrict) and stop bleeding.
As we said heat makes things worse, so the converse is true. Cooling down can help, so iced peas in a towel can help.
4. Once the nosebleed has stopped, do not pick the nose or try to blow out any of the blood remaining in the nostrils. This may cause another nosebleed.
A tiny clot is what probably is stopping the bleeding, so anything that dislodges this will cause the bleeding to restart.
5.If you feel faint it is best to lie flat on your side.
6. If the above measures fail, or if the nosebleed lasts 30 minutes or longer, you must seek urgent medical advice.
The site of bleeding may need to be cauterized (burned), or it may need packing, or even surgery to stop. These can only be done in an emergency setting.
Remember, medical blogs or sites are not a substitute for real medical opinion, so if you have any doubts or concerns, please raise them with your own doctor.