What is the treatment for epistaxis (nosebleed) in a 15-year-old male?

From the Guidelines

For a 15-year-old male with a nosebleed, the most effective initial treatment is to sit upright and lean slightly forward, pinching the soft part of the nose firmly for 10 to 15 minutes without releasing pressure or checking if bleeding has stopped, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is based on the most recent and highest quality evidence available. The guidelines suggest that if the bleeding does not stop after 15 minutes of continuous manual pressure, or if the individual becomes lightheaded, they should seek medical attention 1.

Key Considerations

• The patient should avoid blowing their nose, picking their nose, or engaging in strenuous activity for 24 hours after the bleeding stops to prevent recurrence.
• Applying petroleum jelly inside the nostrils several times daily for 3-4 days can help prevent dryness and recurrence.
• A humidifier in the bedroom and adequate hydration can help prevent future episodes by keeping nasal passages moist.
• If bleeding persists or is heavy, or if the patient experiences dizziness, weakness, or frequent nosebleeds, medical attention should be sought.

Additional Treatment Options

While the initial treatment involves manual pressure, other options like topical vasoconstrictors such as oxymetazoline may be considered if bleeding persists, as they have been shown to be effective in resolving nasal bleeding in a significant percentage of patients 1. However, the most recent guideline from 2024 takes precedence in guiding the initial management approach 1.

When to Seek Medical Attention

It is crucial to seek medical attention if the bleeding does not stop after 15 minutes of continuous pressure, if the bleeding is extremely heavy, or if the patient experiences signs of trauma, such as obvious nasal deformity or signs of facial fracture, as indicated by the guidelines 1.

From the Research

Treatment Options for Epistaxis

The treatment for epistaxis (nosebleed) in a 15-year-old male can vary depending on the severity and cause of the bleeding. Some treatment options include:

• First aid measures such as external pressure and ice packing, which can stop 65-75% of nosebleeds 2
• Topical agents like oxymetazoline, which can stop bleeding in 65-75% of cases 2
• Electrocautery, which is more effective and has fewer recurrences than chemical cauterization 2
• Nasal packing with non-absorbable or absorbable materials, such as petroleum jelly, BIPP gauze, or nasal tampons 2, 3
• Endoscopic ligation of arteries, mainly the sphenopalatine artery (SPA), which is more effective than conventional nasal packing 2, 4
• Endoscopic cauterization, which is more effective than ligation 2
• Embolization using gelatin sponge, foam, PVA, or coils, which has an 80% success rate and comparable efficacy and complications to surgical methods 2

Surgical Management

In cases where epistaxis is severe or refractory to conventional treatment, surgical management may be necessary. This can include:

• Electrocauterization of the bleeding site, which was sufficient in 35% of patients in one study 3
• Cauterization and/or arterial ligation, which was necessary in 65% of patients in one study 3
• Earlier indications of surgical treatment may decrease the need for blood transfusion, especially in high-risk populations such as those with coagulopathies or post-operative bleeding 3

Anesthetic Management

In cases where epistaxis occurs during general anesthesia, anesthetic management may be necessary. This can include:

• External pressure to the affected nares for a short period of time, which can usually resolve mild epistaxis 5
• Thorough evaluation and intervention by otolaryngology in cases where epistaxis is difficult to control with non-invasive methods 5