Salt pork. No, really.

I’ve written about nosebleeds before, but not in any helpful way. Since Dan wants a post on nosebleeds, and since I’m easy, here it is. But read my disclaimer first.

The great majority of nosebleeds are due to bleeding from Kiesselbach’s plexus, AKA Little’s Area, a dime-sized region on the nasal septum which is conveniently within reach of eager fingers. (I’m always amazed how few of my patients know what the septum is. The septum is that sheet of bone and cartilage which separates one nasal passage from the other.) For every nosebleed I see from somewhere else, I must see ten to twenty from Kiesselbach’s plexus.

This is useful information for you, the lay person, since it enables you to do some first aid which will probably keep you out of the Emergency Room. But first, let’s take a look at things which don’t help. I usually ask my nosebleeders: What do you do if you get a nosebleed? Here’s a selection of responses, none of which work:

• I pinch my nose. (The patient pinches the nasal bridge, between her eyes.)
• I lie down. (Great. So now it’s pouring into your throat.)
• I put a cold rag on my forehead.
• I put a cold rag on my neck.
• I put a bit of brown lunch bag paper under my upper lip.

That last one is a head-scratcher. But I’ve heard it a number of times, and people swear by it.

Here’s what works most of the time:

Take a cotton ball (half or whole, depending on the size of your shnoz) and moisten it with a 12-hour decongestant spray like Afrin or Neosynephrine. Yes, this advice assumes you’re not allergic or sensitive to those drugs. Now blow any clot out of the bleeding side, and then shove the moistened cotton firmly into your nasal passage, just past the nostril. Now, pinch. This woman is pinching in the correct location: right ABOVE the rims of the nostrils, not high on the nasal bridge.

Hold for at least five minutes. If you’re on any sort of blood thinner, you might have to hold longer than five minutes. Blood thinners include most arthritis medications (e.g., ibuprofen or Aleve), aspirin, coumadin/warfarin, and Plavix.

I recommend people leave the cotton up there as long as they can tolerate it. Overnight is great, if you have the patience of a saint. When you’re ready to remove it, moisten it with saline spray or with the nasal decongestant spray, and gently pull or blow it out. Have another moistened cotton ball ready to go if the bleeding cuts loose again.

Other things that work include Nasal QR Powder and, yes, salt pork. I’m not sure anyone knows how salt pork works, and like anything else I might suggest, it doesn’t always work. Yes, bacon will work, too, but please use the fat only. The fat gets slippery and eventually falls out (in one direction or the other). Meat would rot. Eeew.

When do you need to go to the doctor?

• If you try one of these maneuvers once or twice and it doesn’t work — especially if you’re on a prescription blood thinner, or aspirin;
• If it works only temporarily, and recurs several times;
• If the bleeding looks arterial (squirts out in time with your pulse);
• If the bleeding is so excessive you have become symptomatic from the anemia (lightheadedness, shortness of breath, chest pain)
• If you have any symptoms that suggest this nosebleed is unusual, i.e. not from Kiesselbach’s plexus.

And those unusual symptoms would include . . .

• Double vision or blurry vision
• Numbness of the cheek, pain in the cheek, or swelling in the cheek
• A change in the way your teeth come together
• A change in voice (especially a “stuffy nose” sort of voice)
• Loose teeth, numb teeth, or dental pain

I would add that if you have a history of head or facial trauma, you should take a nosebleed very seriously. One of the most dramatic nosebleeds I ever saw was a teenager who had been in a car accident some months before. She developed a carotid-sphenoid fistula, which was . . . impressive. Yeah, that’s a good word. Fire-hose impressive. Would have freaked out the director of Saw. But it wasn’t that way at first; in the beginning, it looked just like any other nosebleed.

One other thing. Let’s say you’re standing or sitting upright. If you’re bleeding from Kiesselbach’s plexus, most of the blood should come out of your nostril. In a more aggressive nosebleed, the blood may go down your throat, cross over and come out the other side of your nose, or even squirt out of your tear duct, which is great fun at parties, by the way. If most or all of the blood goes down your throat when you’re standing or sitting upright, this is a posterior nosebleed, and it’s not something you can take care of on your own. Get your ass to an ER.

Any questions? (As for what we ENTs do to fix the stubborn nosebleeds: I’ll leave that for another day. In this post, I wanted to give you some simple first aid measures, as well as tips on when to get professional help.)

D.