Under Pressure

Today’s guest columnist is Dr. Jeremy White, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

“Not the table!” I shrieked, peering through my fingers at the slow-motion tragedy unfolding before me. It was my first night ever babysitting, for some family friends’ two-year old daughter. Mom and Dad had no sooner backed out the driveway for their night out, before WHAM!  Gracie had tripped and smacked her petite nose on the sturdy dining table. She didn’t cry at first, even giggled a little, until she saw blood on her hands.  Deep gasp….

Parents, kids, and even babysitters sometimes panic when they see bleeding. They can get frantic: when will it stop, that’s so much blood!, can my child breathe? Often the kid has smeared blood all over his face and clothes like a horror-movie victim, increasing everyone’s anxiety. Then when they get to the Emergency Department, most times the bleeding has stopped.

Many nosebleeds result from injuries: football passes gone awry, wrestling matches, or that pesky furniture that “leaps out” at toddlers. No matter how it happens, the mainstay of treatment of any bleeding is applied pressure. For nosebleeds, that means pinching the nostrils closed for 10 minutes. You don’t have to squeeze hard, gentle pressure is enough.

Often we anxiously check too soon to see if the bleeding has stopped, letting go of the nose to have a look. This isn’t really applying pressure. When we say pressure for 10 minutes, we mean 10 minutes on the clock, without letting go to check. Another common mistake is tilting the head back. This doesn’t help stop bleeding; it only allows blood to trickle down the back of the throat, leading to coughing, gagging, and nausea.

When do we need to take kids to a doctor?  Come in If the nose is obviously broken- crooked or dramatically swollen. If the child is in a lot of pain, or the bleeding just won’t stop after multiple attempts of 10 minutes of steady pressure, that should be seen. However, don’t panic. We’ve never ever had a child die of nose bleeds.  Apply pressure, don’t succumb to it!

I’ve been on several annual retreats to the Rocky Mountains with students from my old high school. When we would get off the bus at our destination, some kids would climb down with blood coming from their nostrils. One year six students got bloody noses!  Between the high-altitude thin air and super-low humidity, some kids’ noses just let go.

When kids breathe cold dry air, the inside of their noses gets dried out and can crack. Sometimes those cracks cut into blood vessels and POW!- bloody nose. This explains why we see nose bleeds so much in August, after we’ve been living in air conditioning all summer. That water you see dripping out of an air-conditioner is the moisture sucked out of the indoor atmosphere.

We also see lots of nosebleeds in the winter, when the air’s naturally cold and dry. Kids get more head colds in winter too. When excess snot from those spewing noses dries out and cracks, nasal blood vessels crack too. If your child has frequent nosebleeds, a bedside humidifier can keep nasal passages moist at night, when the air is driest. For allergic kids who aren’t supposed to use vaporizers (they can be mold-growers), saline nasal spray is another option.

Some children have extra-fragile blood vessels in their noses. With repeated bleeds, they get raw patches that don’t heal well. If your child has nosebleeds that keep recurring, then it’s time to see an Ear/Nose/Throat (ENT) specialist. The ENT has skinny scopes for looking inside noses and finding those raw spots. If necessary, the bad patches can be cauterized.

As we said above, children never lose a significant amount of blood, though parents sometimes panic when the kid paints his face, pajamas, and bedroom red. However, it always looks worse than it is. When a child is actively bleeding, gently squeeze the nostrils shut for 10 minutes on the clock, with no letting go during that time to check if it’s stopped. Again, no head tilting back either.  Don’t panic- as we also said above, apply pressure, don’t succumb to it!

Meat-Eating Babies

Baby was starting to walk, holding on to furniture as he toddled around. This time he missed his grip on the coffee table and hit his mouth on it’s edge. The cut on his gums bled an alarming amount, to the parents.  After examining the baby, I reassured them that he didn’t need stitches, and though it looked like he bled a lot- he had smeared blood all over his cheeks and forehead- he didn’t need a transfusion. The parents breathed a sigh of relief, and Dad was even able to crack jokes- “it looks like he’s been eating raw meat!” Everyone laughed, horror-movie baby joining in.

We see all kinds of bleeding kids in the Pediatric Emergency Department. The vast majority of them have insignificant blood loss. The sight of blood unnerves many parents, especially when their children paint their faces and clothes red. Nosebleeds are a common ER visit, with blood “pouring” from kids’ noses. They’ve usually stopped bleeding by the time we see them, and never need transfusions. Mouth injuries, forehead and scalp lacerations also look terrible, but aren’t life-threatening.

Some children do need blood transfusions.  Kids in car or ATV crashes sometimes  injure blood-filled internal organs like the liver or spleen, and need blood.  Occasionally a kid will crash his bike or skateboard into a door or window, lacerate a major vessel in the arm, and need blood and surgery too.

Trauma patients aren’t the only ones who need blood products.  Children with certain cancers need occasional transfusions when chemotherapy, or the cancer itself, impedes their ability to make their own blood. Some NICU babies need transfusions, and patients with Sickle Cell Disease needs lots of blood throughout their lives.

Unfortunately, nowadays blood donations are way down. The Coronavirus Pandemic has kept people away from blood banks, afraid that going will put them at risk. There’s been far fewer blood drives at schools and places of work, as these have been closed.  Now Acadiana’s blood supply, and the national supply, are critically low. Yet people’s need for blood hasn’t diminished.  The message is clear: Do something life affirming, GIVE BLOOD!

I was riding my bike and hit a gravelly patch. That’s slippery for bike tires, and I’d previously taken that turn gingerly.  This time I was a little too fast and cutting a little too tightly. Seeing what was coming, I thought, “Darn, this is going to hurt!” Splat!  I got up, inspected the bloody scrapes on my right side, concluded I was okay, and kept riding. I must have looked a mess though, judging by the alarmed looks on people’s faces.  I got home, showered, dressed my wounds, and went to work, thinking nothing more of it.  Until I was seeing a girl who had been in a car crash. She paused in her account of the crash, eyes bugging out at me- “what happened to your elbow!?”

Bleeding alarms many people, like the parents of our baby above, who smeared blood from his mouth injury all over his face. However, very few skin, mouth, or nose injuries require transfusions. Like we discussed above, there’s children who do- cancer patients, kids with Sickle Cell Disease, traumas, and some NICU babies.

The Pandemic has cut blood donations to critical lows.  People have stayed home, rightfully so. Going out and mixing with others is a risk for catching Coronavirus. But this means they’ve been staying away from blood donation centers and blood drives.  There’s been fewer places to hold blood drives too, with closed schools and businesses.

Other reasons why donations are down: weekly hurricanes!. People have been prepping for storms, riding them out, and then busy with the inevitable clean-up. Donations have been down too because of the lagging economy. Blood drives depend on businesses with full stocks of employees ready to donate. Since the economy has tanked, many businesses closed or are running on skeleton crews.

While blood donations are down, needs are not.  Blood banks, like Vitalant on Bertrand Drive, are super-safe places to visit.  They’ve always been keen to avoid infections; now they’ve gone many extra miles to be sure COVID isn’t a risk for donors.

Want to volunteer for something critically needed, and life affirming? GIVE BLOOD!

The Elixir Of Life- Blood!

We read about these things in our books, but when they happen for the first time it’s a surprise.  The parents rushed their 8 year-old girl into the Emergency Department.  She had been riding her bike, turned the handlebars too sharply, and tumbled off.  When she fell down the end of the handlebars speared her in the belly.  Soon she was pale and weak.

Examining her, the only mark was a quarter-sized bruise just above her belly button.  But she certainly was pale, and when I sat her up, she said “I can’t see,” like she was passing out.  Laying her flat, she suddenly could see again. She clearly was fainting from blood loss, and I had read about the “handlebar-spear” as a risk for internal injury.  While my nurse started the IV and slapped on the monitor leads, I ran and grabbed a second nurse, “I need blood and I need you to hang it!”  Next I called a surgeon, and my girl was off to the OR.

Lots of kids need blood.  Some are injured, like our girl above.  But also kids with cancer need blood products too.  The most common childhood cancer is leukemia, which affects bone marrow.  Bone marrow manufactures blood, and leukemia crowds out the good, blood-making cells with cancer cells, and those kids thus need transfusions.  Some chemotherapy drugs also impair marrow function.  Children (and adults) who have heart surgery also need lots of blood, to keep up with surgical losses and to feed the heart-lung bypass machine.  Occasionally premature babies need blood transfusions too.

Where does all that blood come from?  You!  Blood doesn’t come from a pharmaceutical factory, but from donors, in our area and across the nation.  Our local blood bank, United Blood Services keeps that vital stuff coming. UBS is a non-profit, charitable organization that provides this crucial resource.  There are UBS centers across the country, and one on Bertrand Drive here in Lafayette.  Their blood-mobiles fan out across Acadiana, going to charity events and churches, schools and universities, stores and work places, to collect blood from volunteers.

Giving blood is easy, except this one time for me: I was in medical school, and there was a blood drive in the cafeteria.  The night before, I had been on call in the hospital, too busy to eat or sleep.  I came to the drive pale, hungry, and exhausted, but ready to do my part.  Giving the blood wasn’t bad, but after they put the bandaid on, I saw that they had free cookies and juice.  I leaped out of my chair, bellied up to the table of goodies, and started chowing down.

Suddenly, I couldn’t see.  “Gee, that’s weird,” I thought.  Several blood drive staff noticed that I was more pale, had stopped chewing, and was staring off and starting to sway.  While I was still puzzling over my vision black-out, they helped me back into my chair before I fainted completely.

Soon my body began to send more blood to my brain and my vision returned.  I learned an important lesson on donating blood- get up slowly after.  Your body needs to adjust to losing a pint.  Also, start eating slowly, sitting down.  When you’re eating, your body shunts blood to your digestive system to absorb all those nutrients.  If the dipstick is low, there may not be enough blood to go around, and it’s harder to pump it up into your head when you’re standing.

Giving blood is easy (for well-rested non-medical students), and it’s important!  Like we discussed above, lots of kids in Acadiana need blood to save their lives: accident victims, kids with cancer, children who need heart surgery, and the occasional premature baby.  Donations are down in Acadiana, with the oil down-turn.  Fewer people have an hour to spare to donate.  Companies that once sponsored blood drives have laid off employees that used to be donors.  The employees that are left have to work harder and fear taking company time to donate, not wanting to be labeled a slacker and lose their jobs too.

Donations are down, but need isn’t.   Donating is voluntary, and a really good deed.  You might even get a t-shirt or a chance to win a prize.  And I still like free cookies and juice too.