From the Guidelines
When a nosebleed occurs, the patient should be instructed to spit out any blood in their mouth, as this can help prevent blood from entering the airway or stomach, according to the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The most appropriate instruction for a patient after an episode of epistaxis is to breathe through their mouth and spit out any blood, as recommended by the guidelines.
- This approach helps to prevent blood from entering the airway, which can cause trouble breathing, or the stomach, which can cause vomiting.
- The guidelines also emphasize the importance of leaning forward to stop blood from entering the airway or stomach.
- Nasal pressure alone is often sufficient to control the bleeding, and patients should be instructed to pinch the soft part of the nose closed to help the blood clot.
- It is essential to prioritize the patient's safety and prevent complications, such as anemia and shock due to blood loss, by providing clear instructions on how to manage future nosebleeds. The patient should be advised to avoid hot liquids after a nosebleed, as this can increase blood flow to the nose and worsen the bleeding, but the most recent and highest quality study 1 does not specifically address this point.
- Instead, the guidelines focus on the importance of nasal pressure and spitting out blood to prevent complications.
- The patient should be instructed to follow up with their healthcare provider if they experience any further bleeding or concerns, and to seek medical attention immediately if the bleeding is severe or persistent.
From the Research
Instructions for Managing Epistaxis
When counseling a patient after an episode of epistaxis, the following instructions should be included:
- Avoid hot liquids after a nose bleed, as they can cause the blood vessels to dilate and increase the risk of further bleeding 2.
- Drinking lukewarm beverages may help blood clot, and thus can be recommended for patients with future nose bleeds 2.
- Patients should be advised to spit out any blood in their mouth during a nose bleed, rather than swallowing it.
- There is no evidence to support the recommendation to talk during future nose bleeds to reassure people around them.
Additional Recommendations
- Topical moisturizing can facilitate mucosal healing, and oxymetazoline 0.05% nasal spray can provide a means to address rebleeding after discharge from treatment 2.
- Patients should be advised to follow up with their healthcare provider if they experience any further bleeding or discomfort.
Evidence-Based Practice
The management of epistaxis should be based on current evidence and guidelines, including the use of nasal packing, topical anesthetics, and decongestants 3, 4, 5.