What are the treatment recommendations for a bloody nose (epistaxis) at home?

Home Treatment for Epistaxis (Nosebleed)

The first-line treatment for a nosebleed at home is firm sustained compression to the lower third of the nose for at least 5 minutes, and up to 15 minutes if bleeding continues. 1, 2

Initial Management Algorithm

1. Apply proper compression technique:

   • Sit upright and lean slightly forward (to prevent blood from flowing down the throat)
   • Pinch the soft part of the nose (lower third) firmly between thumb and index finger
   • Maintain compression for at least 5 minutes, extending to 15 minutes if bleeding continues
   • Breathe through the mouth during compression

2. If bleeding persists after initial compression:

   • Clear any blood clots by gently blowing the nose once
   • Apply over-the-counter vasoconstrictor nasal spray (if available):
     • Oxymetazoline or phenylephrine (2 sprays in the bleeding nostril)
     • Success rate of 65-75% 2, 3
     • Continue compression for another 5 minutes after application

3. Adjunctive measures:

   • Apply ice or cold compress to the bridge of the nose
   • Avoid swallowing blood (can cause nausea)
   • Avoid checking frequently if bleeding has stopped (disrupts clot formation)

When to Seek Medical Care

Seek immediate medical attention if:

• Bleeding continues despite 15-20 minutes of proper compression
• Bleeding is profuse or causing lightheadedness/weakness
• Bleeding occurs from both nostrils simultaneously
• Blood flows down the back of throat despite compression
• Patient is taking anticoagulant medications
• Signs of significant blood loss (rapid pulse, dizziness, pallor)

Prevention of Recurrent Nosebleeds

• Nasal moisturization:

  • Use saline nasal spray or gel 1-3 times daily 2
  • Consider using a humidifier, especially during dry seasons or in dry environments

• Avoid triggering factors:

  • Digital trauma (nose picking)
  • Vigorous nose blowing
  • Excessive dryness (use humidifier)
  • Nasal irritants (smoke, chemicals)

• Special considerations for at-risk patients:

  • Those on anticoagulants or antiplatelet medications should be particularly vigilant about nasal moisturization 2
  • Patients with recurrent nosebleeds should consider regular use of saline gel for prevention

Pitfalls to Avoid

• Incorrect compression technique: Compressing the bony bridge of the nose rather than the soft lower third
• Inadequate compression time: Not maintaining pressure for at least 5 minutes
• Head position errors: Tilting head backward (can cause blood to flow down throat and risk aspiration)
• Checking too frequently: Repeatedly releasing pressure to check if bleeding has stopped
• Prolonged use of vasoconstrictors: Using nasal decongestant sprays for more than 3-5 days can cause rebound congestion 2

The American Academy of Otolaryngology-Head and Neck Surgery guidelines emphasize that proper compression technique and adequate duration are the most critical factors in successful home management of nosebleeds 1, 2. When performed correctly, this simple intervention can effectively control most anterior nosebleeds without the need for medical intervention.