Treating Emergent Nosebleeds

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You might be asking yourself, an ambulance for a nosebleed, give me a break. However, a nosebleed can be or become a serious medical problem. Patients with nosebleeds may call EMS instead of self transporting because they have repeated nose bleeds, they are on blood thinning medications or have underlying disease process that effect blood clotting, friends and family notice the worrisome signs of hypovolemia, the patient begins to cough or vomit blood, or they are unable to drive to the hospital.

The nasal cavity is highly vascular. A combination of small vessels brings blood to the external nose, nasal septum, nasal cavity, and sinuses. One of these networks of vessels, called the Kiesselbach plexus, perfuses the anterior nasal septum, which is where most nosebleeds occur. A thin nasal mucosa covers nasal septum vessels. This makes the nose susceptible to bleeding from trauma and medical causes. When the mucosa dries, scabs or falls off vessels are vulnerable to bleeding. Nosebleeds, especially in dry and cold climates, are most common in the winter.

Use these Everyday EMS Tips to control a nosebleed:

1. Apply direct pressure by pinching the nostrils together. The patient if able can do this on their own. Continue pressure for at least 10 minutes.

2. Have the patient sit upright and lean forward slightly.

3. Instruct the patient to spit out any blood in their mouth. Swallowing blood can quickly lead to nausea and vomiting.

4. Only use nosebleed powders or packing materials if you are trained and authorized to do so.

5. Monitor the patient for signs of hypovolemia. As indicated, start an IV and deliver a fluid bolus.

Finally, assess the patient for other injuries. If the nosebleed is the result of facial trauma consider the significance of the mechanism as a cause for c-spine injury, traumatic brain injury, or facial bone fracture. Always identify and treat ABC life threats with the tools and training you have.

Learn more about Nose: Bleeds, Breaks, and Obstructions at RapidCE.com – a 1.0 CECBEMS approved online education lesson written and designed by Greg Friese, MS, NREMT-P and emergency physician Randal Wojciehoski, DO.

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