What are the relevant inquiries regarding epistaxis (nose bleed)?

From the Guidelines

When dealing with a nosebleed, it is crucial to ask about its duration, frequency, and severity to determine appropriate care, as most nosebleeds can be managed at home, but some may require medical attention 1. The relevant inquiries regarding epistaxis include:

• Whether the bleeding is from one or both nostrils
• If it started spontaneously or after trauma
• If the person has recently used blood thinners like aspirin, warfarin, or clopidogrel
• Recent nasal injuries, surgeries, or infections
• Underlying conditions like high blood pressure, bleeding disorders, or liver disease For immediate management, apply firm pressure by pinching the soft part of the nose for 10-15 minutes while leaning slightly forward, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. If bleeding persists beyond 15 minutes, is extremely heavy, or is accompanied by dizziness, difficulty breathing, or swallowing blood, seek medical attention immediately, as advised by the guidelines 1. Additionally, a person with epistaxis due to trauma should seek medical attention if they experience signs of brain injury, obvious nasal deformity, or signs of facial fracture 1. It is also important to note that for individuals taking anticoagulant or antiplatelet medication, or who have a blood-clotting disorder, it is reasonable to seek care from a healthcare professional unless bleeding has stopped 1. Understanding these factors helps determine if the nosebleed is a simple case that can be managed at home or requires medical attention, as most nosebleeds occur in the anterior part of the nose and respond well to pressure, while posterior bleeds are more serious and often need medical intervention 1.

From the FDA Drug Label

Purpose: Nasal Decongestant The FDA drug label does not answer the question.

From the Research

Relevant Inquiries Regarding Epistaxis

• What are the first aid measures to control epistaxis?
  • Applying digital compression to the nasal alae and anterior septal area for 10-15 minutes can stop nosebleeds in 90%-95% of cases 2
  • Tilting the patient's head forward to reduce the risk of blood aspiration is also recommended 2
• What are the treatment options for epistaxis?
  • Topical agents such as oxymetazoline can stop 65-75% of nosebleeds 3
  • Electrocautery is more effective and has fewer recurrences than chemical cauterization 3
  • Tranexamic acid promotes hemostasis in 78% of patients 3
  • Nasal packing can be applied with non-absorbable or absorbable materials 3
  • Endoscopic ligation of arteries and endoscopic cauterization are also effective options 3
• What is the role of tranexamic acid in the management of epistaxis?
  • Tranexamic acid reduces the risk of re-bleeding when used in addition to usual care 4
  • Topical tranexamic acid is probably better than other topical agents in stopping bleeding in the first 10 minutes 4
  • Tranexamic acid can be used as an elective method in managing epistaxis in emergency department 5
• What are the outcomes of using tranexamic acid compared to other treatment options?
  • Tranexamic acid reduces the bleeding time and number of rebleeds compared to anterior nasal packing with gelfoam 5
  • Tranexamic acid is probably more effective than placebo in reducing the risk of re-bleeding 4

Healthcare Providers' Knowledge of Epistaxis First-Aid Measures

• A significant proportion of healthcare providers are not aware of the correct first-aid measures for epistaxis 2
• Increased otolaryngology training may help primary and emergency care providers improve their understanding of epistaxis first-aid measures 2