Nosebleed

Alternative Names

Home Care

Sit down and gently squeeze the soft portion of the nose between your thumb and finger (so that the nostrils are closed) for a full10 minutes. Lean forward to avoid swallowing the blood and breathe through your mouth. Wait at least 10 minutes before checking if the bleeding has stopped. Many nosebleeds can be controlled in this way if enough time is allowed for the bleeding to stop.

It may help to apply cold compresses or ice across the bridge of the nose. DO NOT pack the inside of the nose with gauze.

Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed.

When to Contact a Medical Professional

Get emergency care if:

• Bleeding does not stop after 20 minutes
• Nose bleeding occurs after an injury to the head -- this may suggest a skull fracture and x-rays should be taken
• Your nose may be broken (for example, it is misshapen after a blow or injury)

Call your doctor if you or your child has repeated nosebleeds, particularly if they are becoming more frequent and are not associated with a cold or other minor irritation.

The doctor will perform a physical examination. In some cases, you may be watched for signs and symptoms of hypovolemic shock. The doctor will ask you questions about your nosebleeds, including:

• Is there a lot of bleeding?
• Do the nosebleeds stop quickly when you press on the nostrils?
• Did they begin recently?
• Do they occur frequently or repeatedly?
• Does the bleeding always occur on one or both sides?
• What other symptoms do you have?
• Is there blood in the stools?
• Are you vomiting blood?
• Do you bruise or bleed easily?
• Are there tiny red or purple spots on the skin ( petechiae)?
• Are you taking blood thinners (Coumadin) or aspirin?

Diagnostic tests that may be done include:

• Complete blood count
• Nasal endoscopy (examination of the nose using a camera)
• Partial thromboplastin time measurements
• Prothrombin (PT)
• X-rays of the skull

Treatment is usually focused on the cause of the nose bleeds, and may include:

• Controlling blood pressure
• Closing the blood vessel using heat, electric current, or silver nitrate sticks
• Nasal packing
• Reducing a broken nose or removing a foreign body
• Reducing the amount of blood thinners or stopping aspirin

You may be referred to an ear, nose, and throat (ENT) specialist to diagnose and treat the condition.

Prevention

A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray and water soluble jelly (such as Ayr gel) can help prevent nosebleeds, especially during the winter months.

References

Pallin DJ. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005; 46(1): 77-81.

Kucik CJ. Management of epistaxis. Am Fam Physician. 2005; 71(2): 305-311.

Pfaff JA, Moore GP, Otolaryngology. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002: chap 71.

Massick D, Tobin EJ. Epistaxis. In: Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo: Mosby; 2005: chap 40.