Be a Potential Hero – Learn CPR

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it's easier than checking each one. 

Earlier this month the Arkansas Legislators passed a bill to put AED devices in all public schools in our state. The bill was sponsored by Senator Tracy Steele. It is estimated that about $1 million dollars will be needed to pay for the devices. The money is expected to come from the recently passed increased tobacco tax (an extra 56 cents per pack).

The Antony Hobbs III Act was named in honor of 17 yr Parkview High School basketball player who died after collapsing at a game. He died of complications from an undiagnosed heart defect.

I renewed my ACLS this past Thursday evening. Some of my nurse friends ask me to go with them as a way of getting together. They needed to recertify and assumed I might. We meet for dinner before the class and enjoyed the time together.

During the evening, the EMT who reviewed the AED devices with us mentioned having responded to the collapse of Antony Hobbs. He wanted to stress the importance of knowing basic CPR and BLS as most arrthymias are not shockable. He ask if we wanted to guess how many people at the basketball game attempted to help.

Can you guess?

When the crowd was asked if there were any medical folks there, one nurse stood up and responded. None of the teachers, coaches, parents responded “I know CPR. Can I help?”

I found that sad. CPR is much more important in most life situations than ACLS. I would like to encourage all to learn CPR. Even if the AED finds a shockable rhythm, the recommendation is a minimum of 2 minutes of good quality CPR immediately after the shock even if a normal rhythm is seen.

So having the AEDs in airports, in schools, at your work place does not replace the need for CPR. We all need to know how to do good quality CPR. It is the CPR that is most likely to save some one.

It is easy to find classes. Look to your local Red Cross chapter. They have classes on a regular basis to teach basic CPR and AED use. Or contact a group like America First Response.

Get your entire family to take the class. Learn CPR --you might end up being a hero.

Sources

Arkansas Online

Red Cross CPR Classes

American First Response

Nose Bleeds

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

I am one of those people who have periodic nose bleeds from dry mucosa (and the trauma of blowing my nose – allergies and/or colds).  I have had them since childhood.  There have never been any polyps or other issues noted on the couple of exams I have had.  So I learned long ago how to deal with mine.  I thought I would review some basic information with you.

The technically correct medical term for nose bleeds is epistaxis.  It is classified on the basis of the primary bleeding site

Anterior (90% of nose bleeds) 

• The most common source  if bleeding is from the Kiesselbach plexus which is an anastomotic (think multiple roads coming together) network of vessels on the anterior portion of the nasal septum. (photo credit)
• May also be due to bleeding anterior to the inferior turbinate.

Posterior

• Bleeding will originate from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx.
• This is much more serious and usually require admission to the hospital and management by an otolaryngologist.

CAUSES of NASAL BLEEDING (epistaxis)
Most cases have no easily identifiable cause.
Local trauma (ie, nose picking, blowing too vigorously, foreign bodies) is the most common cause.  Other local causes include:

• facial trauma or surgery
• nasal or sinus infections
• allergies
• nasal polyps
• prolonged inhalation of dry air (climate or too warm house)
• tumors

Systemic causes include

• Blood disorders (hemophilia, leukemia, polycythemia vera, thrombocytopenia, von Willebrand’s disease, etc)
• Acquired platelet dysfunctions (related to use of aspirin, NSAIDs, dipyridamole, etc
• Anticoagulation therapy (ie warfarin, enoxaparin, etc)
• Hypertension is rarely (if ever) a direct cause of epistaxis.  Therapy should be focused on controlling bleeding before blood pressure reduction.
• Vascular abnormalities that contribute to epistaxis may include the following:

1. Arteriovenous Malformations
2. Hereditary Hemorrhagic Telangiectasis
3. Sclerotic Vessels
4. Neoplasm (tumor)
5. Septal abnormality (ie perforation or deviation)
6. Endometriosis

WHAT TO DO at HOME
As with all bleeding the first thing to do is remain calm, then apply pressure.   How do you apply pressure correctly?

• Sit up straight.
• Lean your head forward rather than back.  This way you won’t swallow the blood which can irritate your stomach and make you nauseated.
• Pinch the nostrils together with your thumb and index finger for 5-10 minutes. Pinch them tightly and don’t let go early.  Yes, it will be uncomfortable if you have enough pressure.  (photo credit)
• Repeat for another 5-10 minutes, if the bleeding hasn’t stopped.  You may not have held consistent pressure the first time.

Things that can help prevent a nose bleed or re-bleed:

• Avoid local trauma.  No nose picking.  Try not to blow your or sneeze for 24-48 hrs after the nose bleed.
• Minimize exposure to dry air.  This can be a problem if you live in Arizona or in a heated home in the winter.  Adding moisture to the air with a humidifier or vaporizer will help.
• Using salt water nasal spray can help.   This can be used with abandon, no limits.
• Using vaseline occasionally to help keep the lining of your nose moisturized.  Don’t overdo this.

WHEN it’s appropriate to go to the hospital

• You are still bleeding after REALLY pinching the nose for 10 minutes.
• You are having repeated episodes of nosebleeds over a 12-36 hour period.
• You feel dizzy or light-headed or like you are going to pass out.
• Your doctor instructs you to go to a hospital's emergency department.

WHEN it’s appropriate to call your doctor

• Repeated episodes of nosebleeds.  You may need to see a specialist to make sure there are no polyps, etc in your nose.

• Additional bleeding from places other than the nose, such as in the urine or stool.  You may have a blood abnormality or other health issue.

• Bruising easily and are not on a blood-thinner.  This may be a sign of another health issue.

• If you are on any blood-thinning medications, including aspirin or warfarin (Coumadin).  Your doctor should know about your bleeding, as they may wish to change your dosage if you bleed too often or it is difficult to stop.

• If you have any underlying disease that may affect your blood clotting, such as liver disease, kidney disease, or hemophilia (inability of blood to clot)

• If you recently had chemotherapy.  Again your doctor should now, so they can check and make sure you aren’t having other issues.

For anyone interested in more information, may I recommend the following articles.

REFERENCES
Epistaxis by Jeffrey A Evans, MD and Todd Rothenhaus, MD; eMedicine Article; Nov 28, 2007
Epistaxis by Quoc A Nguyen, MD; eMedicine Article; Nov 29, 2007
Nasal Pack, Anterior Epistaxis by Eric Goralnick MD and Rick Kulkarni MD; eMedicine Article, Oct 10, 2008
Nasal Pack, Posterior Epistaxis by Eric Goralnick MD and Rick Kulkarni MD; eMedicine Article, Oct 3, 2008
Current Approaches to the Management of Epistaxis;  JAAPA May 2003;16:52-64; Richard M Bishow, MPAS, PA-C
Nosebleeds; eMedicineHealth Article