Epistaxis

What causes a nosebleed? 

Nosebleeds arise when the fragile blood vessels at the front or back of the nose become damaged. It is not always possible to find a cause for your nose bleed but the common causes include: 

• Local trauma-nose picking, knock to the nose, blowing your nose 

• Environmental - Sudden changes in temperature 

• Drugs/Medicines - Warfarin, Aspirin, Clopidogrel, Rivaroxaban, Apixaban Chemotherapy, Cocaine 

• Operations- Recent sinus/nose surgery Infection/Allergies - Common cold, Hay fever

Most nosebleeds are short lived (less than 20 minutes) and are easy to control using first aid. 

During a nose bleed 

• Stay calm, nose bleeds are rarely life threatening and most can be managed at home. 

• Sit up, lean forward with your mouth open over a bowl or sink. Breathe out through your mouth. 

• Use your middle finger and thumb to pinch your bleeding nostril shut just below the bony part of your nose. 

• You should apply enough pressure to cause discomfort but not pain for at least 15 minutes. 

• Apply an ice pack to your forehead or on the back of your neck. 

• Avoid swallowing the blood; try to spit this out into a bowl. 

• If bleeding re-starts please reapply pressure and make your way safely to the Queen Margaret Minor Injuries Unit or A&E Victoria Hospital (whichever is nearer). 

What if the bleeding does not stop? 

If the steps above fail the clinician will ask you to maintain pressure for a further 15 minutes, if the bleeding continues there are some other treatment options, these include: 

• Cauterisation ("burning") - First your nose is numbed with a local anaesthetic spay. Next, the damaged blood vessels are heat sealed to stop the bleeding. To ensure this has been successful we will observe you in the department for 30 minutes. Minor bleeding is usual and can persist for a few days. 

• Nasal packing - If cauterisation has failed or the treating clinician deems it suitable your nose will be packed. This consists of inserting a miniature balloon into your nose, and inflating this with air to apply pressure to the bleeding vessels. Thereafter you will be admitted to the ward for observation. 

On discharge

If a nasal pack has not been inserted and bleeding has stopped, you will be discharged home. 

The following steps will reduce the chances of another bleeding episode: 

• Apply the prescribed antibiotic ointment to the nose as directed by the clinician. 

• Avoid:

  • Removing the crust that develops inside your nose. 

  • Cleaning/blowing your nose. 

  • Sneezing, if necessary sneeze through your mouth for 1 week. 

  • Hot baths or showers for 24 hours. 

  • Alcohol, smoking and very hot drinks for 1 week as these expand the blood vessels in your nose. 

  • Snorting recreational drugs.