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Abstract

<p id="94f0">Dry air, often cold dry air is also a contributor to nose bleeds. So again, if prevention is of interest (and you are prone to nosebleeds perhaps) consider using a soft cotton swab to coat the inside of your nostrils with Vaseline occasionally, especially during prolonged exposure to cold dry air.</p><p id="db36">High blood pressure (although often found in nosebleed patients) does not CAUSE the bleeding but may contribute to its continuance. The bottom line here — if you have high blood pressure, take your medications. Also, don’t panic if you have a nosebleed and drive your blood pressure through the roof. Just remain calm and all will be well (please continue reading).</p><h2 id="349a">Self-treatment</h2><p id="bf9d">The bottom line first — direct pressure stops most nosebleeds.</p><p id="40b9">So what do I do?</p><ol><li>Use your thumb and index finger to pinch both sides of your nostrils shut.</li><li>Grab the <b>soft part</b> of your nose between thumb and index fingers and pinch your nostrils shut.</li><li>Do this for 10 to 15 minutes.</li><li>Do NOT check for bleeding during this time.</li><li>Just pinch and hold for 10 to 15 minutes.</li><li>Open your mouth and breath through it during this time.</li><li>Spit if you have to; but don’t let go of your nose.</li><li>Stay “head up” during this time.</li></ol><h2 id="72b1">What’s magic about 10 to 15 minutes?</h2><p id="b307">That’s the time it takes blood to clot.</p><h2 id="87ae">What about if I’m pinching both sides shut and there’s TONS of blood going down my throat?</h2><p id="eb8a">Continue to pinch, spit as much as possible, remain calm, and come to the emergency department. Call 911 if you think you need to.</p><h2 id="0c9c">What does it mean if there’s TONS of blood going down my throat while I’m pinching the front part of my nose shut?</h2><p id="0097">It MAY mean that you have a “posterior” nose bleed (one in the “back” of your nasal passages, the part you can’t reach with your finger). A doctor can make that determination.</p><h2 id="80c1">Why else should I come to the emergency department with a nose bl # Options eed?</h2><ul><li>tons of blood (as above)</li><li>nonstop bleeding after 10–15 minutes of pressure (as above) (you can still continue to try pinching, there’s nothing to lose and it may still work)</li><li>you’re on medications that can cause bleeding or interfere with timely blood clotting</li><li>you have certain medical conditions that cause easy bleeding or bruising</li><li>you’ve had nasal trauma (punch, car crash, fall, etc.)</li><li>difficulty breathing</li><li>other symptoms or problems that in your judgment are an emergency</li></ul><h2 id="837c">Other helpful advice</h2><ul><li>don’t panic (I may have mentioned this once or twice already)</li><li>pinch and hooooold, stay upright, don’t check for more bleeding until 10 to 15 minutes have passed (ditto for this one)</li><li>DON’T do anything else like stuff ANYTHING up your nose, put ice anywhere, tilt your head any which way or anything else you may be told to do by non-doctors or by “WWW wisdom”</li><li>come to the emergency department if you need to</li><li>swallowed blood irritates the stomach and may cause nausea and vomiting</li><li>if you do vomit you may see the swallowed bright red blood or so-called “coffee grounds” material in your vomit</li><li>A day or so after you swallow blood, your feces may be black and sticky (like road tar)</li></ul><h2 id="55b4">The answer</h2><p id="acfa">You got it — A.5.</p><h2 id="f9a3">More</h2><p id="68da">If you’ve got questions, send them my way. I’m happy to try and answer them for you.</p><p id="52e3">Stay safe out there!</p><figure id="9a38"><img src="https://cdn-images-1.readmedium.com/v2/resize:fit:800/0*QmracACYUzdqww8J"><figcaption>Photo by <a href="https://unsplash.com/@nci?utm_source=medium&utm_medium=referral">National Cancer Institute</a> on <a href="https://unsplash.com?utm_source=medium&utm_medium=referral">Unsplash</a></figcaption></figure><p id="ef8c"><i>Warning — NONE of the information presented above is a substitute for proper medical care. The material above is for general advice and does NOT constitute medical care or treatment.</i></p></article></body>

Medicine

Your Nose is Bleeding — What Should You Do Next?

I’m not a doctor on TV but I play one in real life

First a multiple-choice test:

Q. Your nose has been bleeding nonstop for several minutes. The single best course of action is?

A. 1. Scream hysterically and call 911

A. 2. Lay down and put ice on the back of your neck

A. 3. Stuff your nose with tissues

A.4. Tilt your head back and just wait for it to stop

A.5. None of the above

In the interest of building suspense, and encouraging you to read this article, I’ll provide the answer later.

First a little helpful background from an ER Doc (me) who has cared for scores of patients with nosebleeds.

Although most nosebleeds (epistaxis is the medical term) are not serious, they do seem to cause panic in many people. Allow me to reassure you though with a few simple facts.

many nosebleeds stop on their own
many that don’t stop on their own can be successfully treated with VERY simple measures
you can often treat your own nosebleed successfully and get it to stop
even if you only slow the bleeding it’s still worth the effort

So what is a nosebleed; and what causes noses to bleed?

The vast majority are so-called “anterior” or at the inside front of the nose, on the septum (the firm part inside that separates your nostrils). That’s the part you can reach with your finger. And, that’s the problem. Most nosebleeds are due to “digital trauma,” AKA nose-picking. So, if prevention interests you, don’t pick your nose.

Dry air, often cold dry air is also a contributor to nose bleeds. So again, if prevention is of interest (and you are prone to nosebleeds perhaps) consider using a soft cotton swab to coat the inside of your nostrils with Vaseline occasionally, especially during prolonged exposure to cold dry air.

High blood pressure (although often found in nosebleed patients) does not CAUSE the bleeding but may contribute to its continuance. The bottom line here — if you have high blood pressure, take your medications. Also, don’t panic if you have a nosebleed and drive your blood pressure through the roof. Just remain calm and all will be well (please continue reading).

Self-treatment

The bottom line first — direct pressure stops most nosebleeds.

So what do I do?

Use your thumb and index finger to pinch both sides of your nostrils shut.
Grab the soft part of your nose between thumb and index fingers and pinch your nostrils shut.
Do this for 10 to 15 minutes.
Do NOT check for bleeding during this time.
Just pinch and hold for 10 to 15 minutes.
Open your mouth and breath through it during this time.
Spit if you have to; but don’t let go of your nose.
Stay “head up” during this time.

What’s magic about 10 to 15 minutes?

That’s the time it takes blood to clot.

What about if I’m pinching both sides shut and there’s TONS of blood going down my throat?

Continue to pinch, spit as much as possible, remain calm, and come to the emergency department. Call 911 if you think you need to.

What does it mean if there’s TONS of blood going down my throat while I’m pinching the front part of my nose shut?

It MAY mean that you have a “posterior” nose bleed (one in the “back” of your nasal passages, the part you can’t reach with your finger). A doctor can make that determination.

Why else should I come to the emergency department with a nose bleed?

tons of blood (as above)
nonstop bleeding after 10–15 minutes of pressure (as above) (you can still continue to try pinching, there’s nothing to lose and it may still work)
you’re on medications that can cause bleeding or interfere with timely blood clotting
you have certain medical conditions that cause easy bleeding or bruising
you’ve had nasal trauma (punch, car crash, fall, etc.)
difficulty breathing
other symptoms or problems that in your judgment are an emergency

Other helpful advice

don’t panic (I may have mentioned this once or twice already)
pinch and hooooold, stay upright, don’t check for more bleeding until 10 to 15 minutes have passed (ditto for this one)
DON’T do anything else like stuff ANYTHING up your nose, put ice anywhere, tilt your head any which way or anything else you may be told to do by non-doctors or by “WWW wisdom”
come to the emergency department if you need to
swallowed blood irritates the stomach and may cause nausea and vomiting
if you do vomit you may see the swallowed bright red blood or so-called “coffee grounds” material in your vomit
A day or so after you swallow blood, your feces may be black and sticky (like road tar)

The answer

You got it — A.5.

If you’ve got questions, send them my way. I’m happy to try and answer them for you.

Stay safe out there!

Photo by National Cancer Institute on Unsplash

Warning — NONE of the information presented above is a substitute for proper medical care. The material above is for general advice and does NOT constitute medical care or treatment.