Duration of Epistaxis After Nose Injury
Most epistaxis from nasal trauma stops spontaneously within 5 to 15 minutes with proper nasal compression, and bleeding that persists beyond 15 minutes of continuous manual pressure requires medical evaluation. 1
Expected Timeline for Traumatic Epistaxis
Immediate bleeding (0-5 minutes): Most nosebleeds from trauma are self-limited and resolve spontaneously within the first 5 minutes, even without intervention 2
With proper compression (5-15 minutes): When firm sustained compression is applied to the lower third of the nose for 10-15 minutes with the head tilted slightly forward, the vast majority of traumatic epistaxis cases will stop 1
Bleeding beyond 15 minutes: If epistaxis continues after 15 minutes of continuous manual pressure, this indicates need for immediate medical attention 1
Severe bleeding threshold: Bleeding duration greater than 30 minutes over a 24-hour period is considered severe epistaxis and warrants prompt medical evaluation 1
Critical Red Flags Requiring Immediate Medical Attention
Seek emergency care immediately if the traumatic epistaxis is accompanied by: 1
- Signs of brain injury (altered mental status, severe headache, confusion)
- Obvious nasal deformity suggesting fracture
- Signs of facial fracture (facial asymmetry, malocclusion, periorbital swelling)
- Lightheadedness or signs of hemodynamic instability (tachycardia, syncope, orthostatic hypotension) 1
Factors That May Prolong Bleeding Duration
Anticoagulant or antiplatelet medications: Patients on these medications should seek medical care unless bleeding has completely stopped, as they are at higher risk for prolonged or recurrent bleeding 1, 3
Bleeding disorders: Personal or family history of bleeding disorders increases risk of prolonged epistaxis 1
Bilateral bleeding or bleeding from mouth: Suggests more severe injury or posterior source requiring immediate evaluation 1
Common Pitfalls to Avoid
Insufficient compression time: Many patients check if bleeding has stopped before completing the full 10-15 minutes of continuous pressure, which prevents adequate clot formation 4, 5
Incorrect head position: Tilting the head backward allows blood to enter the airway or stomach, potentially causing breathing difficulty or vomiting 1
Premature cessation of pressure: Releasing pressure too early disrupts clot formation and prolongs bleeding duration 1
Recurrent Bleeding After Initial Control
Rebleeding can occur within the first 24 hours after initial control, particularly if the nasal mucosa remains dry or traumatized 6, 7
Application of moisturizing agents (petroleum jelly) after bleeding stops helps prevent recurrence 4, 5
More than 3 recent episodes of nasal bleeding may indicate need for specialist evaluation 1