Death From a Severe Nosebleed

Image by RIs from Wikipedia

Attila the Hun was one of the most feared enemies of the Roman Empire. Ruler of the Huns from the year 434 until his death in 452, his empire stretched from Ural River to the Rhine River and from the Danube River to the Baltic Sea.

Although there are numerous theories as to how he died, the conventional account is that he died from a severe nosebleed on his wedding night.

Some may scoff that only people in historical times die from nosebleeds... but it unfortunately still even happens in the present.

Yes... a life-threatening nosebleed can be fatal whether a historical figure like Attila or a modern day individual. And I am talking in people who are otherwise completely healthy (no hemophilia, ITP, Osler-Weber-Rendu, etc).

Indeed, a Seattle lawyer died from a nosebleed in 2008.

Two British individuals died from a nosebleed in 2008 and in 2011.

And those are just the ones that are reported in the media.

It is estimated that in 1999, 4 out of 2.4 million deaths in the United States was due to a nosebleed [link].

Fatal nosebleeds in a normal healthy individual are almost always due to an arterial bleed, notably the sphenopalatine artery located in the back of the nose. Other less common fatal nosebleeds may be attributable to the ethmoid arteries located in the top of the nasal cavity.

Treatment of such life-threathening nosebleeds depends on the situation, but may include:

• Nasal packing
• Embolization
• Surgical

Cautery as shown in the video below is rarely successful.

Sources:
Man died after suffering two-hour nose bleed. Mirror News 11/24/11

Man Dies From Severe Nosebleed. ABC News 12/2/11

Woman sues hospital after her husband dies of nosebleed. KOMONews 5/4/13

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Foley Catheter to Stop Nosebleed???

A foley catheter, as shown above, is normally used to drain urine from the bladder, but it can also be used to stop severe nosebleeds... albeit under dire circumstances and when there is no other suitable alternative.

Normally, for a severe nosebleed, the nose can be packed with a tampon like packing material. The packing material I like best is a rapid rhino which is illustrated below.

Nasal packing like the rapid rhino exerts pressure within the nose to the point whereby the bleeding stops (like putting direct pressure on a leg wound to stop bleeding).

However, if there's no nasal packing around and the person is having a severe life-threatening nosebleed which almost always is due to a posterior bleeding site, and all you have is a foley catheter...

Use the foley catheter!

Insert the foley through the nose on the side that is bleeding just like an naso-gastric tube...

Once inserted so the catheter can be seen in the back of the mouth, inflate balloon with saline. After inflating the foley balloon, pull the foley catheter back out as if to take the foley catheter out. However, given the foley balloon is inflated, it will snug up in the back of the nose such that it can't be taken out.

Pull on the foley catheter with enough pressure to equal the amount of pressure desired to stop the nosebleed. Once at the correct tension, clamp the foley at the nasal entrance to prevent it from falling back into the nose. Packing with gauze in the front of the nose can also be performed to prevent bleeding coming out the front.

Of course, this is a TEMPORARY measure and should be replaced as soon as possible with appropriate nasal packing material.

But, it certainly works when in a bind.

Here's a video showing how cauterization can stop nosebleeds.

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Bacon Can Stop Nosebleeds! No joke...

When I saw this research, I had to re-read it to believe it... Nasal packing with good-old fashioned bacon stops nosebleeds!!!

Yes... you heard me correctly... and it was actually published in a reputable ENT journal in Nov 2011. AND, it was conducted here in the USA (Detroit, Michigan).

"Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae … To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia."

The current standard of care for nasal packing to treat nosebleeds is using synthetic hemostatic products that appear similar to tampons used for menstruation.

However, this publication in 2011 wasn't the first to document use of bacon for nosebleeds.

There have been reports on use of bacon since 1940 sporadically (see references below).

In this day and age of cost-cutting and finding cheaper alternatives, bacon is pretty much as cheap as one can go to address nosebleeds. Compare this to synthetic nasal packing which costs on upwards of $50 or more.

Read more about nosebleed management.

Another unusual nosebleed management includes the application of female hormone estrogen (vaginal premarin cream) to the nasal mucosa.

Traditional nosebleed treatment includes nasal emollient application, humidification, nasal cauterization, septoplasty, and eventually nasal packing.

References:
Nasal Packing With Strips of Cured Pork as Treatment for Uncontrollable Epistaxis in a Patient With Glanzmann Thrombasthenia. Ann Otol Rhinol Laryngol 2011;120:732-736.

Rendu-Osler-Weber Disease— Is Embolization Beneficial? Arch Otolaryngol. 1976;102(6):385.

GENERAL PRINCIPLES IN TREATMENT OF NASAL HEMORRHAGE. AMA Arch Otolaryngol. 1953;57(1):51-59.

USE OF SALT PORK IN CASES OF HEMORRHAGE. Arch Otolaryngol. 1940;32(5):941-946.

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