Nosebleed (Epistaxis)

Think for a moment on the absurdity of what happened to me today.  I was outside running and in the midst of a satisfying fast clip, I felt some wetness under my nose.  Thinking it was sweat or a runny nose I did what most guys of my generation naturally do—wiped my nose with my hand and then onto my shirt.  I wore a light reddish shirt (NOT pink) so no problem there.  The darn nose kept running so I wiped it again but this time I caught a glimpse of the hand prior to the ritual shirt-wiping and noticed it was really red. 

As a doctor with years and years and years of practice under my belt, I naturally concluded, “Blood.  Man that’s blood!  I got a bloody nose.  Damn!”

As an ENT doc I knew exactly what to do: firmly press the nostril towards the midline against the septum.  Usually I advise my patients to simply pinch the nose but this requires closing both nostrils, forcing one to mouth-breath.  But I still had my run to do and I wasn’t about to call it quits, so I used one hand to occlude my nose and went about my merry way.

Call me crazy, but I’ve had nosebleeds while running before and this technique works like a charm.  Except for today.

Funny thing about nasal anatomy—the nasal cavity goes a lot farther back than you think, and occluding the nostril wasn’t working this time since I could still feel a warm stream flowing on my hand and the taste of something salty in the back of my throat.  I cleared my throat and hocked a loogie onto the sidewalk.   It was bright red.  “Darn it!”  Fortunately I was on my way home anyway.  I fumbled for my key in the hydration pack keeping a hand against my nose and got in the house.  I went into the bathroom and was a bit shocked by all the blood on my face.  No wonder the guy down the street gave me a freaked-out look.

Next, I blew my nose.  Counter-intuitive I know, but sometimes blowing out the clot slows the bleeding.  It’s called a local coagulopathy effect which is medical jargon for “the clot could keep it bleeding.”  It was still bleeding though and I got a little panicked—just a little--thinking I might need to call the ENT doctor on-call until I realized that was me!  My luck--an ENT doc with an ENT problem.   Nosebleeds can be frustrating to treat a times.  I then applied my years and years and years of ENT training to handle the situation with the finesse of a true surgeon: I packed my nose with a long rolled piece of toilet paper.

This is called a make-shift nasal pack.  Just make sure it’s long enough so there’s quite a bit of the T.P. sticking out, otherwise you might not be able to retrieve it afterwards (I almost lost a wad of blood-soaked tissue once, nearly freaked me out).  Just look at the picture above for a very outstanding demo.

While applying pressure against the ala (nostril) which added more pressure to stop the bleeding, I went about the house to clean the blood off the door knob, house keys, sink, counter-top and floor before the wife came home.  And like many things that befall men of good intention, she came home and for some strange reason went into the bathroom by our front door and commented, “What’s with all this blood?”  I swear to God, when I went back into the bathroom I had to look really hard to see the few minute drops of dried blood I missed.

So that’s the remedy for most nosebleeds.  Fortunately, I had an anterior bleed, which is closer to the front.  The pinching or finger pressure or packing works because most bleeds arise from an area on the nasal septum (the partition that divides the left from the right side of the nose) called Killian’s Plexus, a naturally vascular part of the septum.  I’ve heard of some people using tampons or dental rolls—whatever floats your boat.  Also, if you have some afrin (oxymetazalone) or neosynephrine spray, shoot a couple of squirts in the bleeding side after you ‘ve blown your nose to remove any clots.  You can also put some of this spray onto a large cotton ball and put it in there.  These sprays are vasoconstrictors—meds that constrict or narrow blood vessels to resolve bleeding, and you can get these over-the-counter, usually in the cold medication section of a grocery store or pharmacy.  Usually you need to leave the pack or continue pinching the nose for a good 15-20 minutes or more to get the bleeding to stop.  Of course, if the bleeding continues, go to your nearest Emergency Room.  They can cauterize the bleeding site, or in many cases, place a much larger pack to control the bleeding.  Sometimes an ENT doc might be called in if the bleeding persists, and occasionally this requires a trip to the operating room to try and localize the site to control it.

©Randall S. Fong, M.D.