Myth Busting: How to Treat a Nosebleed
Over the past year, I’ve been writing a regular column for SisterShip Magazine. It’s a fun format where I take a medical myth and bust it wide open, replacing misinformation with the real thing. My goal, as always, is to educate boaters on handling medical emergencies on the water in a quirky and entertaining way. Please join me for the third installment where we take on nosebleeds.
When I was working as an ER nurse, I was always bucking to have a bright red “hot phone” installed in the department for anyone who was thinking of doing something dodgy. You call me and I’ll tell you what I think. For instance,”I’m thinking of letting my drunken mates pull me behind a pick up truck around a snowy field on the hood of an old car”, or “I’m planning on crossing the lake on my snowmobile since there’s not much open water”. And then I say, “Please don’t do that.” I could have saved so much embarrassment and so many lives.
In the world of offshore medicine, I am asked questions that make the words “Please don’t do that” spring forth again. Now my beloved red phone meets paper. We’re going to bust medical myths, call out the Old Wives, answer the questions that plague us and maybe learn a thing or two about handling medical emergencies on the water.
Nosebleed Myth: Tipping the Head Back
Today we clean up nosebleeds – or epistaxis, the fancy medical word for bleeding from the nose. Nosebleeds can be a big mess and the amount of blood can be scary. Additionally, bleeding in general tends to invoke anxiety for the patient and caregiver alike. We’ve all heard that the first thing to do in the event of a nosebleed is to tip your head back. PLEASE DON’T DO THAT! It will not help and could potentially make things worse. Ice packs won’t help either.
Tipping the head back allows the blood to run down the back of the throat and into the stomach. Blood is very irritating to the stomach and can cause vomiting which, in turn, will increase the pressure inside the nose thus compounding the problem. Worse yet, the blood draining down the throat can plug up the airway, making breathing difficult.
The proper position when trying to get an uncomplicated nosebleed to stop is sitting up, relaxed, with the head tilted slightly forward. This allows the blood to drain out through the nostrils (better out than in) and facilitates easier breathing. Avoid the head-between-the-knees position as well. This also tends to increase the pressure inside the nose. Keeping the head above the heart, if possible, is the best option.
How to Treat a Nosebleed
The first line of defense for any bleeding is to apply direct pressure. This is absolutely the case where the nose is concerned. When a blood vessel inside the nose begins to bleed, it is most often one that is located toward the front of the nose, nearest the nostrils. Direct pressure is easily applied by pinching the nose closed with the thumb and index finger on the fleshy part of the beak.
Feel down the sides of your nose with me now, starting at the bridge and going down toward the nostrils. Notice the hard, bony part that runs about halfway to the tip, then ends abruptly? This is NOT the part to pinch closed. Pinching the hard, bony part will not compress the bleeding vessel inside the nose. Instead, apply pressure just below that on the softer, lower part of the nose. Hold pressure here for 15 minutes. No peeking, no picking! We may have to hold pressure longer for someone taking blood thinners, which is just one reason we should always know what medications our crew is taking.
If you sail short handed, consider investing a few dollars in a nasal clip. It’s a kinder, gentler medical clothespin for applying hands-free pressure.
Squirting a little over-the-counter nasal decongestant spray containing the ingredient oxymetazoline, such as Afrinⓡ, Neo-Synephrineⓡ, or Dristanⓡ, up the bleeding side of the nose, then holding pressure, can be effective for hard to stop bleeds. Oxymetazoline acts by shrinking the blood vessels of the nasal passages. These sprays, however, are only for short term use. Overusing them can cause stuffiness.
Once the bleeding has stopped, avoid bending over, straining, heavy lifting, blowing, and/or picking the nose which could cause re-bleeding. It’s important to give the schnoz a few days for the broken vessel(s) to heal.
Some common causes of nosebleeds include dryness, picking, injury, high blood pressure and blood thinning medications such as warfarin, aspirin, and non-steroidal anti-inflammatories. Most nosebleeds can be handled on the boat, but some may require medical care.
Prevention goes a long way. If the cause is dry air: consider a humidifier or vaporizer; the application of topical moisture (like petroleum jelly) to the inside of the nose; or moisturizing saline nasal sprays. Limit the use of over-the-counter blood thinning drugs like aspirin and ibuprofen. Avoid using cold and allergy medications too often as they also dry out the nose. Follow your physician’s instructions regarding the use of prescribed blood thinners. If you have high blood pressure, talk to your doctor and get it under control. It’s damaging more than just your nose. Don’t smoke and use nice, soft tissues when blowing. Be kind to your nose!
When You Need Help With Nosebleeds
When do you need help? Seek emergency medical treatment if: you can’t get the bleeding to stop despite applying pressure in the correct place, firmly enough and long enough; the bleeding is more than you would expect from a nosebleed, causes weakness and/or dizziness; the bleeding affects your ability to breathe; there are other injuries that require care like broken facial bones or a head injury.
The good news is that most nosebleeds appear worse than they really are, can be stopped easily with direct pressure, and usually don’t require emergency medical attention.
An internet search may give other remedies, but remember you can’t always trust Mr. Google. He’s only as good as the questions we ask him and he doesn’t have malpractice insurance!
Have a medical myth you want busted? Bring it on! Contact me and we’ll get to the bottom of it!
Medical Disclaimer: I am not a physician. I am an offshore medicine certified RN with 20+ years of ER experience and a heck of a lot of common sense. Follow up with your healthcare provider for any questions or concerns. Read my full disclaimer here.