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November 21, 2019

Is there a MacGyver onboard? When a patient started hemorrhaging midflight, this doc and NP had to get creative.

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 17, 2021.

    In an ED, a gushing nosebleed like the one Jay Wellons, a pediatric neurosurgeon at Vanderbilt University Medical Center, encountered midflight would be treated with special glue and a microcatheter. Writing for the New York Times, Wellons describes how he and a nurse practitioner managed to "essentially" stop the hemorrhaging with over-the-counter nasal spray and two tampons.

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    How it happened

    Wellons writes that in the middle of the flight, he was woken up by a flight attendant asking if there were any medical professionals onboard. One of the other passengers, a middle-aged man, was covered in blood, holding a "a cantaloupe-size wad of tissue under his nose from which blood was pouring out as if a spigot had been opened," Wellons writes.

    Wellons, alongside a nurse practitioner named Susan, came to the aid of the man. Wellons pinched the bridge of the man's nose and asked what happened. A flight attendant told Wellons the man said he hit had his face on a counter when he went to pick up a briefcase earlier that day. However, according to the man, his nose had stopped bleeding before he boarded the plane—and he hadn't experienced any bleeding inside his nose until just recently.  

    As the flight attendant explained the situation, Wellons realized that pinching the bridge of the man's nose wasn't stopping the flow and that "blood continued to pour out of his nose."

    A flight attendant informed Wellons that the man had had vodka right before the nosebleed started, which Wellons realized could "raise the blood pressure acutely in some people, particularly those with high blood pressure already," he writes.

    Wellons asked the man if he took blood pressure medication and if he had any on the plane. The man answered yes to the first question and no to the second.

    Wellons then realized what had happened. The man had "a severe disruption of the plexus of blood vessels in the mucosa underneath the bridge of the nose, possibly worsened by elevated blood pressure," Wellons explains.

    In a hospital, Wellons writes, his colleagues would treat a situation like this "by snaking a tiny microcatheter up from the groin into the arteries of the nose to inject a type of glue directly into the vessels." Needless to say, those tools aren't available on an airplane.  

    Instead, Wellons asked if anyone had Afrin nasal spray. "Afrin is basically neosynephrine, a potent vasoconstrictor, and would be ideal to put on a tissue stuffed deeply in the nose," he writes.

    Susan then asked if anyone on the plane had a tampon to help push the medicine deep into the man's nose. After acquiring both Afrin and two tampons, Wellons and Susan doused the tampons in Afrin and "quickly shoved it up the man's nose … as far as humanly possible."

    The procedure worked, Wellons writes. "The blood flow had essentially stopped," Wellons notes, and he and Susan switched off keeping external pressure on the man's nose.

    After the plane landed, two emergency medical technicians came onboard "and found the patient in seat 24B with two bloodstained tampons sticking out of both sides of his nose, the strings hanging down toward his shirt," Wellons writes. "He managed to give another thumbs up to the EMTs and a smile" (Wellons, New York Times, 11/16).

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