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One of our most favorite things: the bloodbath that ensues when a student gets a random nosebleed at school and runs through the halls to the nurse for help, all the while leaving a trail of blood in their wake. What’s a busy school nurse to do?
First thing’s first: we need to get that under control then we can ask questions about what happened and what they were doing when it started. Did they get punched in the face? Is it super hot inside or outside? Do they have allergies? Were they picking? Is it winter and the forced air heat is on drying everyone’s mucus membranes out? Did they stick something up there? Do they maybe just get nosebleeds sometimes when they are stressed or upset? Very importantly, do they have a bleeding disorder (hemophilia, Von Willebrand’s)?
Back to getting the bleeding under control: Here are some conventional and unconventional tips.
- Grab some tissues or paper towels (preferably NOT those waterproof brown ones we all know so well) and get to pinching the lower part of the nose so the nostrils are closed. Instruct the student to tip their head FORWARD not backward. Leaning forward will reduce pressure on those veins allowing them to form clots and lighten the bleeding some. Additionally, leaning forward will help avoid getting the blood in their throat potentially causing choking, aspiration, and upset stomach.
- Continue to pinch the nose for a good 5-10 minutes. You can try using a clothespin or a nose clamp to help pinch the nose correctly, or just pinch with a gloved hand.
- If there is a large clot in the nostril you may have the student gently blow and remove that and then continue pinching the nose until bleeding stops.
- Try putting ice on the bridge of the nose. Putting ice in this spot will help constrict the blood vessels and slow or stop the bleeding.
- Try putting ice on the back of the neck. While the scientific research does not support this, it is said that ice on the back of the neck can constrict the blood vessels in the nasal mucosa. It might not work but many feel that it does and it can’t hurt right? People also swear by using cold keys or a cold butter knife on the back of the neck in a pinch. https://www.baltimoresun.com/news/bs-xpm-2008-05-01-0805010077-story.html
- Try putting ice in the mouth – ice cubes or popsicles. Have the student try to hold the ice on the roof of their mouth with their tongue. According to physician responders to an article in the British Medical Journal, ice packs to the neck or nasal bridge are less effective than placing ice in the mouth. https://www.bmj.com/content/344/bmj.e1097/rapid-responses
- Try the “thumping the foot” method. You determine which nostril is bleeding, then remove the shoe from the OPPOSITE foot and give two whacks with the heel of your hand to the heel of the bare foot (not so hard that you hurt them though!). Alternatively, have the child stomp their foot on the ground hard with the opposite foot from the bleeding nostril. Again, this is a non-scientific method but allegedly it works!
- Try placing a cotton roll or rolled up gauze under the top lip inside the mouth and give a little pressure to the upper lip frenulum.
- Try wetting a teabag and placing it on the outside of the nose or inside the nostril. Black tea contains a natural antiviral called Quercetin and also the tannins in black tea can help reduce bleeding and inflammation. You may have also heard of using this method after teeth have been removed to help with bleeding and pain. https://www.home-remedies-for-you.com/askquestion/45354/remedy-for-nose-bleeds-with-tea-bag.html
- Try comercial nosebleed products that should stop the bleeding (if you are allowed to use them in your health room) like nasal gels, quickseal nose plugs, or the Bleedcease brown seaweed things. Use at your own risk though, these types of products may not be approved for use in the school health room but might be helpful at sports or at home.
- Try the old wives tale of placing a copper penny on the forehead while also pinching the nose and tilting forward. No one knows why this allegedly works but people swear by it. Maybe it is related to the cold near the blood vessels helping them to constrict or maybe it’s just buying time for the bleeding to stop on it’s own. There is no scientific merit to this but perhaps we will experiment and see…
- Do not use nasal sprays at school for nosebleeds. This may be the standard of care in an ER or at home but it is not appropriate to use medications at school. That being said, at home an adult can try using Afrin nasal spray or a nasal spray with Phenylephrine to constrict the blood vessels and stop the bleeding. Again, this method is not for use at school by the school nurse for kids.
- You should try to avoid using packing, tampons, or things that are inserted into the nose to stop a nosebleed. This will have to be removed later and can cause more bleeding when removed. Leave the nasal packing to the ER docs. https://www.med.umich.edu/pdf/Nosebleed-Dos-and-Donts.pdf
Now that the bleeding has stopped, What should we do going forward?
- Once the bleeding is under control, the nurse can carefully put some plain vaseline into the nostril to moisturize the mucus membrane using a long cotton tipped applicator. This will not always stop the bleeding but can prevent further damage from dry nasal passages causing increased bleeding. Neosporin also works but for many it is considered a medication and thus prohibited for use in the health room without an order.
- If it is permitted in your district you can give some nasal saline in the nose to help moisturize.
- Instruct the student to refrain from picking their nose, sticking tissues or anything up there, and not to blow their nose for a while after to prevent re-bleeding.
- Inform the parent about the nosebleed and instruct them to use vaseline, saline nasal spray, and if possible a cool mist humidifier at home if it is a dry air season.
When is a nosebleed an emergency?
- When the bleeding does not stop by 30 minutes.
- When the bleeding is so heavy that it is pouring down the throat and out of the nose causing a potential choking hazard.
- When the patient is lightheaded, pale, or has a decreased level of consciousness.
- When the nosebleed is accompanied by severely elevated blood pressure, rapid heart rate, chest pain or lightheadedness.
- When the patient is on blood thinners.
- When the patient has a bleeding or clotting disorder such as hemophilia or Von Willebrand’s.
- When the nosebleed is caused by a severe head or facial trauma.