Nose Bleeds

Care and Prevention

Most nose bleeds are mere nuisances; but some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two different types:

Anterior Nose bleed: The nose bleed that comes from the front of the nose and begins with a flow of blood out of one or the other nostril if the patient is sitting up or standing.
Posterior Nose bleed: The nose bleed that comes from deep in the nose and flows down the back of the mouth and throat even if the patient is sitting up or standing.

Obviously if the patient is lying down even the anterior nosebleeds seem to flow in both directions, especially if the patient is coughing or blowing the nose. Nevertheless, it is important to try to make the distinction since posterior nosebleeds are often quite severe and almost always require care from a doctor. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure or taking aspirin or warfarin medication and in cases of injury to the nose or face.

Nosebleeds in children are almost always of the anterior type. Anterior nose bleeds are common in dry climates and when the air is dry. The dry air parches the nasal membranes so that they crust, crack and bleed. This can be prevented if you will place a of lubricating cream or ointment (eg Vaseline) about the size of a pea on the end of your fingertip and rub it up the nose, especially on the middle portion (the septum). Many physicians suggest any of the following lubricating creams or ointments; A and D ointment, Mentholatum, Vicks Vaporub and Vaseline. Up to three applications a day may be needed, but usually every bedtime is enough. Antibiotic cream such as Foban or Bactroban applied for 4-5 days after a series of small nose bleeds can be very helpful. You need a prescription from the doctor for this.

Warfarin, Aspirin (or Aspirin-containing products) and non-steroidal anti-inflammatories (Naproxen, Brufen, Voltaren, Orudis) thin the blood and can both cause the bleeding or the bleeding to persist.

If the nosebleeds persist you should see your doctor who may recommend cautery to the blood vessel that is causing the trouble.

To stop an anterior nosebleed:

If you or your child has an anterior nosebleed, you may be able to care for it yourself by taking the following steps:

  1. Pinch all the soft parts of the nose together between your thumb and two fingers

  2. Hold it for 5 minutes (timed by the clock)

  3. Keep head higher than the level of the heart – sit up or lie with head elevated

  4. Apply ice (crushed in a plastic bag or washcloth) to nose and cheeks

  5. Sucking ice is also helpful

To prevent re-bleeding after bleeding has stopped:

  1. Do not pick or blow nose (sniffing is alright)

  2. Do not strain or bend down to lift anything heavy

  3. Keep head higher than the level of the heart

If re-bleeding occurs:

  • Clear nose of all blood clots by sniffing forcefully

  • Spray nose four times on both sides with decongestant nasal spray (such as Drixine or Otrivine)

  • Pinch the soft parts of the nose together between your thumb and two fingers for five minutes (to stop an anterior nose bleed)

  • Call your doctor if these measures fail.

When to call the doctor or go to the Accident and Emergency:

  • If bleeding cannot be stopped or keeps reappearing within a short period of time

  • If bleeding is rapid or if blood loss is large

  • If you feel weak or faint, presumably from blood loss

  • If bleeding begins by going down the back of your throat rather than the front of the nose

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