Nose Bleed / Epistaxis

Not sure where the rumor started that it’s best to pinch the bridge of the nose to stop a nose bleed, but I’m typing now to end it. You’d be amazed how often I meet freaked out patients, with rolls of tissue jammed up their noses, while clamping down on their nasal skull.

Instead, please pinch the softer nose low so the bleeding actually stops. If you feel air passing through your nose, then you get an F.

Red Flags:

• Blood thinners like warfarin
• Head injury
• Elderly
• Anemic
• Syncope
• Bleeding down both nostrils and the throat that won’t stop with a good pinch …(suggesting a posterior bleed)

Happy Words

• Bleeding from one nostril
• Stopped already
• Stopped with proper pinch
• “This happens when I’m in dry climates.”

Typically we instruct patients to blow clots out of their nostrils into a sink or emesis basin, and then we spray in some Afrin (oxymetazoline). This constricts blood vessels and hopefully gives time for coagulation. Then we use either a low tech or high tech clamp as shown. Then we prop patients up with the hospital bed (use your lazyboy at home) and wait, preferably with dim mood lighting and some soothing music.

Most nose bleeds are anterior, meaning from the front of the nose. If bleeding is from only one nostril this is likely the case. The large majority of these resolve on their own with or without a pinch. Some eventually receive a packing. Very, very rarely a “posterior pack” is required.

If you’re on the fence for which way to proceed, just give us a call.

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