Blood from nose

[mikerault]

I had it happen on my first OW dive, but not since.

Mike

 

[M.D.]

I too get nose bleeds on nearly every dive. I chaulked it up to pinching my nose too hard when equalizing.

 

[TSandM]

The majority of nosebleeds are related to trauma. There is a dense plexus of capillaries that runs under the lining of the nostrils, particularly along the septum, and it's pretty easy to injure it. In allergy sufferers, these vessels can be dilated and the overlying tissue thin and fragile because of inflammation. Pinching or blowing too hard to equalize, especially in the presence of very dry air, can easily produce a small amount of painless bleeding. In addition, chronic allergy sufferers can have nasal polyps, which are even more fragile.

Sinus squeeze can produce bleeding, but would usually be associated with some discomfort and most of the time, with sinus-related symptoms present out of the water. Mask squeeze could produce nasal bleeding as well, but one would usually be aware of it.

Multiply recurrent bleeding should lead one to examine one's equalization procedures, and might merit a physician exam to see if there is an anatomic abnormality which might be amendable to cauterizing or other treatment.

Copious bleeding, particularly if recurrent, might merit evaluation for a problem with coagulation. In this context, I should mention that people taking prophylactic aspirin will be more likely to bleed for a prolonged period, as aspirin affects clotting time. Bleeding associated with high blood pressure is also likely to be prolonged and more difficult to stop even with treatment, but this is not actually diving-related.

 

[renpirate]

The majority of nosebleeds are related to trauma. There is a dense plexus of capillaries that runs under the lining of the nostrils, particularly along the septum, and it's pretty easy to injure it. In allergy sufferers, these vessels can be dilated and the overlying tissue thin and fragile because of inflammation. Pinching or blowing too hard to equalize, especially in the presence of very dry air, can easily produce a small amount of painless bleeding. In addition, chronic allergy sufferers can have nasal polyps, which are even more fragile.

Sinus squeeze can produce bleeding, but would usually be associated with some discomfort and most of the time, with sinus-related symptoms present out of the water. Mask squeeze could produce nasal bleeding as well, but one would usually be aware of it.

Multiply recurrent bleeding should lead one to examine one's equalization procedures, and might merit a physician exam to see if there is an anatomic abnormality which might be amendable to cauterizing or other treatment.

Copious bleeding, particularly if recurrent, might merit evaluation for a problem with coagulation. In this context, I should mention that people taking prophylactic aspirin will be more likely to bleed for a prolonged period, as aspirin affects clotting time. Bleeding associated with high blood pressure is also likely to be prolonged and more difficult to stop even with treatment, but this is not actually diving-related.

I was DMing a class a couple of weeks ago when I noticed blood in a students mask. His LOC was fine and he was experiencing no pain, but I pulled him out of the water and examined him on shore. I have dealt with a lot of bloody noses as an EMT and the standard is direct pressure and waiting for it to stop. He asked me for some vasaline to line the inside of his nose. I had never heard of that treatment before, but he related that it was what several nurses on another occasion had recommended. He said the nose bleed was due to his recent flight from the dry air. My question is have you heard of this type of treatment before and what are your thoughts?

 

[TSandM]

Vaseline won't do anything to stop the acute bleeding.

Elevate the head and apply direct pressure. Note that the top portion of the nose is bone and incompressible, and therefore, the place to apply pressure is below the bony portion. Pressure should be held CONTINUOUSLY for five minutes by the clock. This is an incredibly long time and really should be monitored. Every time you release the pressure to check for further bleeding, you restart the clock. Using something cold to do the compression is fine and might help somewhat, but pressure is the key.

If significant bleeding persists after this treatment, another round of pressure can be tried but an examination by a physician is getting more reasonable.

If somebody is aware of a tendency toward nosebleeds, related to allergies or dry air, and has no medical contraindications to using it (high blood pressure, significant heart disease or arrhythmias), a squirt of Afrin or Neo-synephrine in the affected nostril can also help stop the bleeding.

What the Vaseline can do is reduce the dessication produced by dry air (as in airplanes, or on scuba) and therefore reduce the likelihood of a bleed.

Please note that this does not constitute specifical medical advice for any individual situation, but represents a rational first response to the average case.

 

[renpirate]

Thanks for the information. It definitely reinforces what I have always been taught.

I used direct pressure, as stated, which stopped the bleeding and questioned him on his medical history. The questioning turned up no history of hypertension or other possibly related condition. He only reported one other similar situation, which is where he got the recommendation. He wanted the vasaline to moisten his nose and continue the dive.

Medical disclaimer well noted. Thanks again.

 

[Halthron]

I experienced this problem for the first time this weekend. Not a lot of blood, ,just some spotting but disconcerting all the same, especially with my sinus history. Time to head back to the clinic.

 

[SangP]

Thanks for bringing up this topic as I almost always have a nose bleed during deeper dives.

I also seem to have problems equalising in one ear not both...

The bleeding isn't copious and mostly I find out about only when I spit and it's bloody.

Other than having a sinus problem I'm not sure why I keep having these bleeds?

SangP

 

[scubaaaronh]

I used to get nose bleeds all the time, even while sleeping. Also got them from pinching my nose when i equalized. I used to use saline spray at the advice from my doc and it helped a little. Then i went to an ENT. 15 minutes later and i was told i shouldn't have another bleed. Well i haven't had to go back. You might be like me and just have an area that needs to be cauterized. Best bet is see a doc and see what they say. It worked for me.

 

[SangP]

Thanks scubaaaronh,

I just might do that, I'm getting tired of nose bleeds when the weather turns cold and dry or just dry. Got that a lot in Aus.

SangP