Volume 27, Number 2 - Wilderness Medical Society

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ild Med 101: Nosebleeds in the Backcountry Sam Schimelpfenig, MD FAAP Photo by Rob Hart N Nosebleeds, also known as epistaxis, are very common, and most people will get one at one time or another. Although the bleeding can be impressive, it rarely causes any serious problems. The source of the bleeding is most often the anterior portion of the nasal septum, from a region rich in superficial blood vessels called the Kiesselbach Plexus. Most of the bleeding from this area is due to drying of the nasal mucosa which tends to occur in hot, dry climates, and during the winter months when home heating lowers the relative humidity indoors. However, in the wilderness setting, trauma (even mild) may contribute epistaxis. Morbidity from epistaxis is low, and typically results from underlying medical conditions that contribute to the nosebleed. Thus, in a wilderness setting, it is important to make sure the patient does not have any serious illnesses that could be of concern. Medications such as aspirin and other blood-thinning agents will inhibit the clotting process and make control of a nosebleed more difficult. The simplest way to treat a nosebleed is to gently squeeze the soft parts of the nose against the nasal septum; application of pressure to the hard nasal bones will not help control bleeding. Pressure is applied until the nosebleed stops, which can occasionally take as long as 10 to 15 minutes. Often a cold pack if available may help. The patient should lean slightly forward so that blood does not drip down the back of the throat. Tilting the head back may prevent blood from getting on the patient’s clothing, but the blood will then drain down the back of the throat into the stomach, where it typically causes nausea and vomiting. Occasionally, a nosebleed will need to be packed to control the bleeding. The myriad of methods for nasal packing available in an emergency department are not typically carried in a first aid kit; but packing can be improvised with Vaseline gauze or sterile gauze. Vaseline impregnated gauze is preferable as it easier to remove without causing additional trauma and bleeding. If only dry sterile gauze is available, try applying a topical antibiotic cream to the gauze so it easier to apply and remove. The packing should be gently applied from the anterior to the posterior portion of the nostril using forceps or a similar device. Packing can also be applied to the opposite nostril to provide additional compression of the nasal septum. The packing should be inserted as far as possible into the nostril, but not so far that it cannot be easily removed. A common mistake is to apply packing to the nasal opening only, where it simply serves as a plug and not a source of pressure against the bleeding vessel. The packing should be removed as soon as possible to avoid developing a serious infection, ideally in less than 48 hours, and the patient should be started on a prophylactic antibiotic. If available, constricting nasal sprays such as Afrin or Neo-Synephrine can be used as directed in conjunction with packing to help control a nosebleed. An expedition first aid kid may carry some of the commercial nasal packing devices typically used in a clinic or emergency department setting (e.g. Merocel nasal tampon, Rapid Rhino nasal tampon). If available, they should be placed in the nostril according to the accompanying directions. Again, the packing should be removed as soon as possible and the patient started on an oral antibiotic to help prevent infection. The patient should be counseled on not exerting, straining, or sneezing over the next 24 – 48 hours, as this may precipitate a rebleed. Epistaxis should rarely be a cause for concern in the backcountry; but if the bleeding cannot be controlled or there is a medical history that is of concern, the patient should be evacuated. Also, if the nosebleed was a result of trauma or the patient also has an altered mental status, control of the bleeding is an important part of making sure the airway is properly managed. Typically, epistaxis that requires packing to achieve hemostasis should be followed up by an otolaryngologist. 18 WILDERNESS MEDICINE // Spring 2010
Mount Hood SAR Operations On December 9th, 2009, three climbers ascending Mount Hood’s treacherous Leuthhold Couloir were reported missing. Dr. Van Tilburg’s mountain rescue team, Crag Rats, of Hood River, Oregon, was dispatched along with Portland Mountain Rescue, and American <strong>Medical</strong> Response’s Reach-and-Treat Team stationed in Government Camp. Late in the day, one body was recovered. In the days following, the search was limited due to extreme avalanche danger. At press time, two climbers remained missing. Photos by Christopher Van Tilburg MD, FAWM 11:00 am Ascending Triangle Moraine, before turning back shy of the summit due to high avalanche danger, below freezing temps, double digit wind gusts, and 50-foot visibility. 2:40 pm Scarfing turkey sandwiches, staying warm, packing gear. 8:00 am Summit team at Timberline Lodge, jittery. 1:30 pm Redeployed to Illumination saddle and built a deadman anchor. 3:00 pm Traversing in a white-out above Mississippi Head cliffs, in the “Mount Hood Triangle,” good thing for GPS. 4:30 pm Long ride down, the day’s ice starting to melt. 2:00 pm Rope raising system inside the ping pong ball – sky and snow undistinguishable. 9:00 am Snowcat ride to 8,470 feet, freezing rain. 10:10 pm Search called off for tomorrow due to avalanche danger, turn off 4 am alarm. 10:00 am Wind picks up, temperatures plummet: no country for a soft shell. 2:15 pm Raising the SKED with the Portland Mountain Rescue “Hogsback Kit.”
Page 1 and 2: SPRING 20 10 Volume 27, Number 2 Di
Page 3 and 4: EditorIAL STAFF SPRING 2010 INSIDE
Page 5 and 6: Dispatches froM Haiti Paul S. Auerb
Page 7 and 8: Photo by Eric Holden. January 20…
Page 9 and 10: January 24… January 25… It was
Page 11 and 12: 82nd Airborne preparing for a food
Page 13 and 14: sion Congo Michael Hauty MD, FACS P
Page 15 and 16: Garden of "Villages des Mamas" set
Page 17: Nature, however, is a cruel prankst
Page 21 and 22: What’s in Your Pack? We invite yo
Page 23 and 24: AWLS Instructor Cory Kreutzer demon
Page 25 and 26: SOCIETY MATTERS News & Announcement
Page 27 and 28: Members in the News Kenneth W. Kize
Page 29 and 30: CLIFF NOTES Catherine Chamberlin MS
Page 31 and 32: 2010 conference calendar & affiliat

Volume 27, Number 2 - Wilderness Medical Society

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