Male: If you see a bloody nose, and from your experience, first, is there anyway of stopping a nose bleeding if you are at home that maybe you will get a little better control with, are there any suggestions?
Dr. Dolitsky: That is good question, I think of all the things that I see in pediatric EENT, the one that people have the most misguided information is about nosebleeds. For some reason, and I know someone who suffered from nose bleeds as a child, and I have had my nose cauterized several times. For some reason most people feel that the proper thing to do when someone is having a nose bleed is to pinch on the hard part of the nose, the part of the bone up here. And that is absolutely the wrong thing to do. The other thing people tend to do is to tell the child to lean backward. What that does leaning backward is it makes the blood drip down the back of the throat so it is not visible but in fact the child is more likely to gag on it and potentially vomit or potentially choke on it. The overwhelming majority of nose bleeds that occur in children occur from a blood vessel on the nasal septum which is the middle wall of the nose, right behind the skin, maybe a quarter of an inch into the nasal cavity. So the best way to stop it to apply direct pressure to that area and the best way to do that is to pinch the soft part of the nose, over here, and hold that. Most people will clot within five to seven minutes, so if someone holds the nose, pinches the nose like I demonstrated for five to seven minutes, unless the child has some underlying bleeding disorder or has been taking a non-steroidal anti-inflammatory drugs such as Motrin or Advil or Aleve, the bleeding should stop very quickly. The blood vessels that cause bleeding in that part of the nose are very small caliber and essentially very, very little pressure or no pressure. So a very gentle pressure is all it takes to stop the bleeding and if it is done properly, meaning holding it in the right position and holding it for a long enough period of time the blood should stop and at that point, it helps to keep the nose lubricated. Most nose bleeds occur from dryness. That part of the nose gets dry, it gets chapped just like your skin gets chapped, the difference is on that part of the nasal septum that is just behind the skin in here, the blood vessels are very superficial. So when the mucus membrane gets dry and gets chapped and it cracks, the blood vessel cracks along with it. When your hands get dry and chapped and they crack, the blood vessels are deeper so the hands don’t typically bleed, but on the nose it does. So to take care of a nose bleed, pressure for five to seven minutes on the soft part of the nose and then to prevent the nose bleeds from coming back, you want to provide a way of humidifying the inside of the nose. The best way to do that is to put some type of gel or ointment in the nose. The best is a water-based gel or ointment. A particular name that I can mention is called Rhinaris. It is a water-based gel that has no medication. The problem with some of the commonly used things such as Petroleum jelly, Aquapore, Vaseline is they are oil based and over a period of time they cannot irritate the mucous membrane. So with water based gel, suddenly it looks like KY jelly is typically a very good way of keeping the nose moist and not irritating the mucus membrane and some kids will have nose bleeds during certain times of the year, most commonly when it is cold or when there is a weather change. And if you know that your child is prone to nosebleeds at that time that is a good time to start, using some form of humidification in the nose. When that does not work, that is when the child needs to be seen by an Ear, Nose, and Throat specialist for possibly cauterizing the nose with a chemical that sort of burns and destroys the blood vessel.
Male: Is there any justification using ice packs against nose?
Dr. Dolitsky: In general, ice or anything very cold tends to make blood vessels constrict or narrow and close off. So there is a little bit of help by putting ice but the most important thins is to put direct pressure on the area. If you are doing that, ice probably is not necessary. Another thing that is helpful while there is nosebleeds I find that if you take a piece of cotton an put some ointment or gel on it, put it on the side of the nose that is bleeding and then put pressure. When you pull the cotton out of the nose, you frequently will remove any clots in the nose and it is helpful to move clots because clots have enzymes in there that prevent the nose from further clotting and when you remove the clots, the bleeding usually stops.
Male: If there are any indications, if any of these nose sprays that would help stop the bleeding, you just sniff…
Dr. Dolitsky: The only kind of nose sprays that help or drops that help are those that are constrictive agents. Again things that make the blood vessels narrow down or close off and those are sprays or drops that are safe to use for a very, very finite period of time, usually not more than two or three days. So that can help in the nose that seems to be bleeding significantly. In addition to pressure, one can either place on a piece of cotton or spray the nose a vasoconstrictive agent which is a nasal decongestant. Examples would be Neo-Synephrine the generic name being phenylephrine or Afrin, the generic name being oxymetazoline. Other pharmacists can direct you to wear nasal constrictive agent. And that is probably helpful again for a temporary period of time. But it is not the kind of thing you want to use for more than a few days because over a long period of time, the nose can actually have a rebound effect, which means, if anything has a negative effect on the nose and you want to stop using it.
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