Patient With Nosebleed

Brett Patterson

Hi Brett:

I am asking your guidance in relation to administering aspirin when the patient was bleeding or recently had a bleed. I believe that the aspirin should be administered in these cases (correct me if I am wrong), but before I would respond to the staff member query, I was hoping to have a little clinical rationale on why it should be withheld if the patient had vomited blood or coffee grounds or passed black or bloody stools in the last 24 hours. I have added the EMD’s query below and would appreciate if you could provide some rationale.

Just wanted to check something. In the Chest Pain Protocol I never used to give aspirin if someone was bleeding. A call came in for someone with chest pain, and they had had a nosebleed just previous. Is it appropriate to give aspirin? I know it only asks if they are vomiting blood or coffee grounds, but I have never given it with any blood being passed. I have never really thought about it, but I am mentoring so just want to give the right advice for future calls.

Tracey McFerran

Quality Assurance Auditor

Northern Ireland Ambulance Service

Belfast, Northern Ireland

Hi Tracey:

This question has been previously reviewed by our Standards Council, and there is consensus NOT to consider nosebleed a contraindication for ASA administration in the presence of heart attack symptoms. Nosebleed is, essentially, a peripheral bleed that can be controlled with direct pressure until further treatment, if necessary, can be provided at the hospital, whereas evidence of recent/ongoing internal bleeding with unknown cause may contraindicate ASA use. In fact, due to the proven benefits of early ASA administration in heart attack patients and the relatively minor effects a single dose of ASA has on active bleeding, the decision to withhold it, even with evidence of active GI bleeding, is still a bit controversial.

Brett A. Patterson
Academics & Standards Associate
Chair, Medical Council of Standards
International Academies of Emergency Dispatch

Brett Patterson is Academics & Standards Associate and Chair of the Medical Council of Standards for the IAED. His role involves protocol standards and evolution, research, training, curriculum, and quality improvement. Prior to working with the IAED, he spent 10 years working in the Pinellas County EMS System, Florida. He answers members’ protocol questions in the Journal FAQ column. (brett.patterson@emergencydispatch.org) 

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