# Simple nosebleed



## Cindigo (Feb 27, 2012)

Studying for a test tomorrow. I get pinching the nostrils together for fifteen minutes and sitting in a forward position, but why the gauze pad between the upper lip and gum?

Also, in my half assed search before I asked here, I came across this:

"When you get a nosebleed, take some cayenne pepper right away. Red pepper, or chile pepper, or tabasco sauce will do. Take about a teaspoonful. Your nosebleed should stop within 5 minutes or less. Take cayenne pepper every day for the next few days or so, and try to eat foods spiced with cayenne pepper on a more regular basis. *Cayenne pepper acts to stop all kinds of bleeding very quickly, you can even pour it directly onto a wound in an emergency*."

What the!!!???? I was considering cutting my roommate and then throwing some cayenne on it as a experiment, but she's in a bad mood today, and I have a feeling that stabbing her and then throwing cayenne on it, even in the name of science might be too much for today.

The whole website was questionable.

Also, I just read in my book that a home remedy for opioid overdose is milk (kind of makes sense for someone to think that) and....ice on the crotch. Ice on the crotch?


----------



## STXmedic (Feb 27, 2012)

Cindigo said:


> Studying for a test tomorrow. I get pinching the nostrils together for fifteen minutes and sitting in a forward position, but why the gauze pad between the upper lip and gum?
> 
> Also, in my half assed search before I asked here, I came across this:
> 
> ...



LOL!!! You need to start paying attention to the sources you use! :rofl:


----------



## DesertMedic66 (Feb 27, 2012)

According to my old EMT instructor there is a vein that runs between your upper lip and gum. When gauze is placed there is pinches the vein off. 

I haven't bothered to look it up so I don't know if it is in fact true.


----------



## mycrofft (Feb 27, 2012)

*Cindigo, use your textbook. Not the one from Hogwarts.*

I don't believe in a "simple nosebleed". It can be retronasal (inside the skull), it can be nasopharyngeal (anything from a basilar skull fx to blowing your nose too hard), it can be nasal (picking the nose, blowing the nose too hard too many times) etc. I saw a guy who sneezed, and the resultant nosebleed required two large bore IV's with blood  to get him to the specialist surgeon.
The concept of ice or packing under the lip is to compress some contributing vessels to slow it down and let it clot. It also gives the subject something to do besides get panicky, blow the nose, pick the nose, etc.

Ask about meds and allergies, then get your penlight:
1. Check back of throat for bleeding, and if so, how bad. Might use ototscope to observe the tympanic membrane for bleeding there.
2. Watch for CNS s/s.
3. Sit pt down, not lying down, and pinch the nose just where it becomes soft enough to pinch shut, high up near the bony process. A rolled 2X2 in each nostril will help. Icing the entire face will help, but be careful. Lastly, depending upon hx and mech of onset or injury, maybe needs to see the doc? (Or C spine precautions?).

PS: swallowing blood can cause vomiting, vampire movies to the contrary.


----------



## Cindigo (Feb 27, 2012)

mycrofft said:


> I don't believe in a "simple nosebleed". It can be retronasal (inside the skull), it can be nasopharyngeal (anything from a basilar skull fx to blowing your nose too hard), it can be nasal (picking the nose, blowing the nose too hard too many times) etc. I saw a guy who sneezed, and the resultant nosebleed required two large bore IV's with blood  to get him to the specialist surgeon.
> The concept of ice or packing under the lip is to compress some contributing vessels to slow it down and let it clot. It also gives the subject something to do besides get panicky, blow the nose, pick the nose, etc.
> 
> Ask about meds and allergies, then get your penlight:
> ...



Thanks for taking the time to write all that. All good info. Sometimes when I write, I may come off as a little flip, but, I'm very much not.

I rechecked Emergency Care and Transport of the Sick and Injured, and it says to apply to 4" x 4" rolled gauze between the upper lip and gum, but it doesn't say why.

Don't knock Hogwarts, you'd be surprised what a little eye of newt and cayenne pepper can accomplish.


----------



## Doczilla (Mar 2, 2012)

Remember, if the bleed isn't posterior, then your pressure should be just behind the tip--- in a place called "kiesselbach's plexus", where several vessels converge in that little hidey hole. Knowing this anatomy is super helpful for practical use, but remembering that name is a good way to blow your instructors away as well. I attatched a pic to show what I mean. 

On a side note, one of the best adjuncts for nosebleed control is Oxymetazoline, or "Afrin". Most clinics and E.D.'s soak some gauze in it and place it where needed. Works like a charm.


----------



## Cindigo (Mar 2, 2012)

Doczilla said:


> Remember, if the bleed isn't posterior, then your pressure should be just behind the tip--- in a place called "kiesselbach's plexus", where several vessels converge in that little hidey hole. Knowing this anatomy is super helpful for practical use, but remembering that name is a good way to blow your instructors away as well. I attatched a pic to show what I mean.
> 
> On a side note, one of the best adjuncts for nosebleed control is Oxymetazoline, or "Afrin". Most clinics and E.D.'s soak some gauze in it and place it where needed. Works like a charm.



Great! Great! Great! The pic was really helpful.

This might be a really simple question, but how do you determine where the bleeding is coming from. I'm trying to think of the last time I had a nose bleed and if I could have told you where it was bleeding from. Look up the nose with a pen light? Mabye the MOI could tell you something? I know Mycroft said check the throat. I guess maybe I should have thought more before asking (a novel concept). Blood in the back of the throat=posterior nose bleed or something else. Check the ears. It seems like shining a penlight up the nose isn't going to give you much information.

It's a weird thing being new, questions that you think maybe seem simple on the surface, when you get to the mechanics of it and then add it the human element become very much more complex. And then there's the more basic aspect of just being comfortable in the position of at least pretending you're knowing what your doing enough to stick a penlight up someone's nose....or some such thing.

I just did my first ED shift and a few days before that first ambulance ride along. I've only been in school for EMT-B since January. I have so much more confidence in dealing with people just in those few days. I can't wait to go out again. 

It's also great that the program that I'm in is connected with a teaching hospital in the city. I've been told that it's the best, and the teachers, people and situations I've been exposed to so far have only reenforced that. 

As a student, I'm thrilled to be affiliated with this hospital. If I was a passed out drunk or drug user....maybe not quite so much. Not that the care is bad, but, they might do alot of "precautionary" procedures on you. Did the guy high on meth and benzos and a laundry list of whatever else really need a spinal? Well, before he passed out for the fifth time, he swore up and down that he wasn't on anything ("M'am, I would NEVER. NEVER! I don't do that. I would never do that") and who knows, he *could* have had meningitis. His CT was clear, and no one could really figure out was was going on.

It was me holding the guy down and the NP trainee doing her second spinal ever with a doc standing by talking her through. Fortunately, he didn't wake up. But it was a little nerve wracking since I had seen him wake up enraged from zero several times during the day. I'm not that big, and the ED was understaffed.

Wow.....that went off on a tangent.


----------



## medickat (Mar 2, 2012)

firefite said:


> According to my old EMT instructor there is a vein that runs between your upper lip and gum. When gauze is placed there is pinches the vein off.
> 
> I haven't bothered to look it up so I don't know if it is in fact true.



This interested me, so I asked my BSN boyfriend about it. He says that while this is true, that vein (between the lip and gum) does not supply the nose in such a way that pinching it would stop a nosebleed. In his opinion, placing gauze there is "probably some kind of urban legend." 

Also, apparently, a common method that nurses use to stop a severe nosebleed is to place a foley catheter in and inflate the balloon to block it off -- I'd never heard of that before!


----------



## DrankTheKoolaid (Mar 2, 2012)

*re*

Don't forget that Icepacks to the back of the neck will also help to slow/stop bleeds.  Though you get mixed results in literature studies


----------



## Cindigo (Mar 2, 2012)

medickat said:


> He says that while this is true, that vein (between the lip and gum) does not supply the nose in such a way that pinching it would stop a nosebleed. In his opinion, placing gauze there is "probably some kind of urban legend.



Not that it couldn't have slipped through but, it was listed as one of the treatments for episitaxis in my book for school. Although I have v.9 of Care ad Transport of the Sick and Injured and the most up to date version is v.10.


----------



## medickat (Mar 2, 2012)

Cindigo said:


> Not that it couldn't have slipped through but, it was listed as one of the treatments for episitaxis in my book for school. Although I have v.9 of Care ad Transport of the Sick and Injured and the most up to date version is v.10.



Not saying that it isn't listed in the books, I know it is. Just that there doesn't seem to be any physiological reason for it.


----------



## Handsome Robb (Mar 3, 2012)

Cindigo said:


> Not that it couldn't have slipped through but, it was listed as one of the treatments for episitaxis in my book for school. Although I have v.9 of Care ad Transport of the Sick and Injured and the most up to date version is v.10.



I don't remember if it was in any of my books or not but I have heard of it. Never seen it used. We have little nose-pinchers things that work pretty well. Lately all my partner and I's calls have either been really sick people or nosebleeds lol.


----------



## EMT91 (Mar 6, 2012)

I use cayenne pepper for many things, including drinking a cayenne pepper water mixture for my sinuses when they are all clogged up. I know this much- while it has many uses, I would not use it in the field, as it could get a person in trouble. My professor stated that we are not even to use aloe vera on burn patients, so I cannot imagine using cayenne for a nosebleed.


----------



## JDub (Mar 7, 2012)

medickat said:


> Also, apparently, a common method that nurses use to stop a severe nosebleed is to place a foley catheter in and inflate the balloon to block it off -- I'd never heard of that before!



But depending on where the nosebleed was originating from wouldn't that just prevent the blood from coming out of nose and not actually stopping the bleeding? I would imagine that would cause more blood to go down the throat which could lead to more swallowing of it.


----------



## EpiEMS (Mar 9, 2012)

Any idea if tampons might work?


----------



## SoCal911 (Mar 9, 2012)

firefite said:


> According to my old EMT instructor there is a vein that runs between your upper lip and gum. When gauze is placed there is pinches the vein off.
> 
> I haven't bothered to look it up so I don't know if it is in fact true.



It was in my Emt book so I'd assume it true


----------

