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.
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