EMS Airway Management Tips

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EMS Airway Management Tips

Everyday EMS
by Greg Friese

Controlling Nose Bleeds

The nose filters, humidifies, and warms air as it passes through the nose, mouth, and into the trachea. The nose is a combination of soft tissue, cartilage, and bone. It is rich with arterial blood vessels with forward flow, progressively warming incoming air. If the nose is physically traumatized, the underlying facial bones responsible for nose, skull, and eye formation may become injured as well.

Most nosebleeds are known as anterior nosebleeds and occur in the front (anterior) of the nose. Facial trauma, falls, collisions, nose picking, and irritation from a foreign body or cold air are some known causes of this type of nosebleed. Anterior nosebleeds typically involve only one nostril, with blood visibly draining out of the nasal openings.

Posterior nosebleeds are less common and are generally derived from an arterial source from the back (posterior) of the nasal cavity. Posterior bleeding usually drains into the mouth, frequently causing the affected individual to spit or swallow blood. If swallowed, the blood can either obstruct the upper airway or induce vomiting.

General treatment for any nosebleed:

1) Blow nose to remove any poorly formed clots.
2) Apply well-aimed direct pressure by firmly pinching the nose with thumb and pointer finger.
3) Lean forward to minimize swallowing blood.
4) Spit blood out of mouth.

Do not let the patient swallow blood, as it is very irritating to the stomach. Maintain pressure for 10-15 minutes before inspecting. Applying ice to the upper lip or neck has little or no effect on blood flow. Focus treatment on well-aimed direct pressure and keeping the airway free of blood.

About the author

Greg Friese is Editor-in-Chief of EMS1.com. He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at greg.friese@ems1.com.
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Zach Davies Zach Davies Monday, January 30, 2012 2:03:44 PM I'm only a rookie medic compared to guys like you, but one thing I've learnt from my time in EMS and my time as a 'touchline medic' is to get a bit of cardboard you usually need about 3-4inch long and 2-3 inch wide piece (perhaps from the glove box in your rig) and fold it into a rectangle. then put the between the upper front teeth and the top lip. with that, and well aimed direct pressure, the bleeding should subside within about a minute. I've had footballer patients who's nose is pouring blood, but doing that, stops it in moments. it's almost unrealistic.