Stopping a nosebleed can be daunting, but there are some tried and true tricks to help you do so quickly and without panic.
Last week, I was abruptly awakened to the most petrifying shrieks that no parent ever wants to hear, especially in the middle of the night. One of my identical twin preschool-aged girls was screeching in terror. Terrifying enough to trigger my most powerful fight or flight response and push it into full gear, with my heart pumping fast and furious, nearly beating out of my chest.
Was there an intruder in the home? And then I remembered that we thankfully have a fully engaged surveillance and alarm system fit for the Pentagon. Did my girls fall off the bed and sustain a fracture of some sort? Are they injured in some way? The worst parental thoughts were running through my mind.
I instantaneously sprinted out of bed ready to take on anything in my way. Within seconds, I had invaded their room to find one of my girls dripping in a gruesome pool of blood. How did this happen? Before panicking, I realized … the blood was dribbling from her nose.
Yes, she had a nosebleed.
I felt an immediate sigh of relief. As a physician, I fully realize that nosebleeds can be a rather frightening sight—for both the parent and the child. But I also know they are not life-threatening. Certainly nothing to deserve terrifying shrieks at 2 in the morning. But to a 4-year-old, it can undeniably traumatic.
Anatomy of a Nose
The inner lining of our nasal passages are termed the “nasal mucosa.” The lining, not unlike the lining of our other orifices (mouth, rectum, labia, etc.), is smooth and holds an underlying layer of blood vessels in its superficial layers. This surface requires moisture, and if lacking, these blood vessels are more easily palpable and irritated, and can therefore bleed.
The front, lower portion of our nasal passages, called the “anterior” segment, is by far the most common site of bleeding. This is the region that is closest in proximity to the air in our environment, and the region that is most easily accessible. Therefore, it tends to mimic the surrounding air—if you’re in the desert, it will quickly turn dry. If there’s humidity, it will absorb the moisture.
The upper/deeper portion of the nasal passages is termed the “posterior” segment, and nose bleeds from this region are much less common (especially in kids). Albeit, they are more concerning. Bleeding from the posterior region can cause severe bleeding, deeming it a more urgent situation.
What Causes a Nose Bleed?
Now that you know a little about the anatomy of the nose, you may be wondering what can cause it to bleed?
Besides trauma, which is perhaps the most common reason for nosebleeds, here are some more common causes:
1. Dryness: Well, like I’ve stated, dry weather creates the right environment to trigger nose bleeds. Those living in Southern California and dry climates will be more susceptible.
2. Viruses: Anything that irritates the mucosal lining of the nasal passages will also be more likely to irritate the blood vessels in the area. Upper respiratory infections, commonly due to viruses, are notoriously famous for wreaking havoc on the nose. Therefore, suffering from the common cold or flu can contribute to nosebleeds.
3. Allergies: Similarly, allergens in the air (like grass, pollen, dust, mold, cat or dog dander, etc.) can inflame the mucosal lining of the nasal passages and cause the tiny blood vessels to bleed more easily.
4. Manual Manipulation: This is just a fancy and more medically acceptable way to describe, you guessed it … nose-picking. Some adults may also fancy this, but children are infamously known for exploring their nasal orifices. So it’s no surprise that they are the most common population to suffer from nose bleeds. Investigating the parts of the body is really a normal stage in development, and certainly nothing to deserve reprimand for.
5. Blood thinners: Aspirin, anti-inflammatory drugs (ibuprofen, naproxen, etc.), coumadin, and other blood thinners used to treat certain heart conditions and clotting disorders can thin the blood out and cause bleeding. As a side note, NEVER give aspirin to a child—there’s a risk of Reye’s Syndrome and liver toxicity.
6. Medications: Intranasal steroids (often used to treat postnasal drip from persistent allergies) and antihistamines can dry out the nasal mucosa.
How to Treat a Nosebleed
The first rule of thumb is do not panic—especially if the one bleeding is your child. The last thing you want to do is to induce panic and imprint a phobia in your child's mind. Remain calm and reassure your child that the bleeding will cease. Here’s how to make it so:
1. Proper Positioning: Keep your child (or adult) facing directly forward, with a slight tilt forward at the waste. The head should not be tilting down, which can cause the blood flow to drain out of the nostrils. And the head should not be tilted back, either, because that will only cause the blood to drain down and irritate the throat.
2. Pressure: Apply direct pressure to the anterior (front segments) of the nose for 5 to 10 continuous minutes. Pressure is the number one treatment of almost every bleed. It allows the blood to more easily clot, hence, diminishing the flow. Set a timer, because 2 minutes may seem 10 minutes when you have a distraught child to console. Releasing the pressure too soon will just prolong the cessation process.
3. Humidifier: For those dry seasons, especially when the kids are also sick, a humidifier is a useful tool to return some of that moisture back into the air. Use water without additional additives, and run it at night in the child's bedroom. Just remember that for infants less than age 1, a cool mist (rather than warm mist) is key for SIDS prevention. For infants, also keep the humidifier from spray directly near the crib.
4. Moisture: In addition to a humidifier, applying a thin layer of petroleum jelly using a cotton-tip applicator to the anterior nares a couple of times a day can help prevent the tissue from bleeding so easily.
5. Tissue Inserts: Inserting a very small amount of hanging tissue paper in to the affected anterior nostril and then applying pressure can also aid in the cessation of bleeding. Although, I would be careful not to shove it up any further than the anterior (front) portions of the nose, and keep half the length of the paper hanging outside the nostril for easy removal (and to avoid risking it rising up where you can't find it).
At the same time, there can be times when you do need to worry about a nosebleed. Keep reading for some times you might consider visiting your doctor.
When to Worry About a Nosebleed
Nosebleeds are typically benign and easily controlled and treated. However, there are some instances where a visit to your doctor may be worthwhile:
1. When the nose bleeds are recurrently worrisome. Like I’ve mentioned, many kids experience nosebleeds, and many do so recurrently. But if it seems too frequent, severe, or there seems to be a pattern of progression—increased frequency or flow through time, for instance—it is enough to warrant a visit. Always air on the side of being safe than sorry when it comes to your health.
2. If the nosebleeds are difficult to control despite the above steps (remember, minimum five minutes is key).
3. If there are concurrent bruising, especially on other areas of the body than the lower extremities (which are very commonly bruised in healthy, physically active kids).
4. If injury or trauma was the inducing factor.
5. If you are on a prescription blood thinner, call your doctor right away.
Share your ideas and learn more quick and dirty tips with us on the House Call Doctor’s Facebook, Twitter, and Pinterest pages! If you learned anything here today, or simply enjoy all-things-medical, you can also listen and subscribe to the House Call Doctor podcast on iTunes, Spotify, Soundcloud, GooglePlay, and Stitcher.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Tidak ada komentar:
Posting Komentar