There are many exciting places we can turn to when we need to help a patient. The resuscitation room, gyn room, and decontamination shower may come to mind immediately. But another chamber of healing is your local “Break Room.” This bleak refuge often contains a wonderland of overlooked medical remedies hidden amongst the soy sauce packets, roaches, lonely plastic forks, and perpetually defiled refrigerator (Fig. 1).
Explore This IssueACEP News: Vol 32 – No 05 – May 2013
Bite that bag
Even minor oral mishaps can be messy, especially for patients on systemic anticoagulation. Small tongue lacerations, bleeding tooth sockets, and buccal or labial injuries don’t always need suturing, but they still can ooze blood for days.
One of the recommended treatments in many textbooks is to have the patient “bite on a teabag,” because the tannic acids from black tea have a pro-thrombotic effect. You can find plenty of tea bags in most break rooms, overlooked and lonely beneath the shadow of the more popular coffee machine.
Most teabags are not particularly virile. They are flimsy, wispy, flaccid things that just drift around in your mouth. They aren’t large enough to put a significant amount of pressure on the oral mucosa even if the patient is biting down as hard as he can. To allow physical pressure to work in concert with the coagulant effect of the tea leaves, take a roll of gauze and suture the teabag to it (Fig. 2).
Next, saturate the teabag in lidocaine with epinephrine (sometimes I even add a single spray of neosynephrine nasal spray to the mix). Remember, these are going to be topically applied vasoconstrictors, so the concern over injected epinephrine into an end capillary field really doesn’t apply here. Place the whole contraption into your patient’s mouth with the teabag in contact with the bleeding surface, and tell the patient to bite down. Keep it in place for at least 30 minutes.
Once you remove the teabag-gauze combo, you should see resolution of the bleeding. The area will also be anesthetized, allowing you to do a little touch-up cautery with a silver nitrate stick (highly recommended in certain cases).
As with any item you put in the mouth of a patient, make sure he can protect the airway, is not dangerously intoxicated, and can breathe through the noses before you place a wad of gauze, tea, and vasoconstrictors into the oropharynx. Black tea works best.