What should I do if I experience sudden epistaxis (nosebleed)?

What to Do for Sudden Nosebleed (Epistaxis)

Sit forward and pinch the soft lower part of your nose firmly for a full 10-15 minutes without checking if bleeding has stopped—this simple compression alone resolves the vast majority of nosebleeds. 1, 2

Immediate First Steps

• Position yourself correctly: Sit upright with your head tilted slightly forward (not backward) to prevent blood from flowing down your throat 1, 3, 2

• Apply firm continuous pressure: Pinch the soft, lower third of your nose (not the bony bridge) between your thumb and index finger 1, 2

• Hold for the full duration: Maintain compression for at least 10-15 minutes continuously without releasing to check if bleeding has stopped—this is critical 1, 3, 2

• Breathe through your mouth and spit out any blood rather than swallowing it 1, 3, 2

If Bleeding Continues After 15 Minutes

• Clear blood clots: Gently blow your nose once to remove clots 1, 2

• Apply topical vasoconstrictor: Use over-the-counter oxymetazoline (Afrin) or phenylephrine nasal spray—spray 2 times into the bleeding nostril 1, 3, 2

• Resume compression: Continue firm pressure for another 5-10 minutes after applying the spray 1, 3, 2

• Success rate: This combination stops bleeding in 65-75% of cases 3, 2, 4

Prevention After Bleeding Stops

• Apply nasal moisturizers: Use petroleum jelly, saline gel, or nasal saline spray 1-3 times daily to keep nasal passages moist 1, 3, 2

• Use a humidifier: Especially helpful in dry environments or during winter months 1, 3, 2

• Avoid trauma: Do not pick your nose, blow vigorously, or insert tissues/cotton into your nostrils for at least one week 1, 5

• Limit physical activity: Avoid strenuous exercise, heavy lifting, or straining for at least one week 1, 6

When to Seek Emergency Care

Go to the emergency department or call 911 if: 1

• Bleeding does not stop after 15-20 minutes of proper continuous compression 1, 3, 5

• You feel dizzy, lightheaded, or weak from blood loss 1

• Bleeding is severe (lasting more than 30 minutes total over 24 hours) 1, 3

• You experience signs of significant blood loss such as rapid heartbeat, fainting, or low blood pressure 1, 3

• Blood is flowing from both nostrils simultaneously or down your throat despite proper compression 1

Special Considerations for Patients on Blood Thinners

• Do not stop your anticoagulant or antiplatelet medication without consulting the prescribing physician—these medications prevent serious conditions like stroke or heart attack 1, 3

• Seek evaluation promptly if bleeding is severe, but standard first-aid measures should still be attempted first 1, 3

• In the absence of life-threatening bleeding, first-line treatments should be initiated before considering reversal of anticoagulation 1, 3

Common Mistakes to Avoid

• Insufficient compression time: The most common error is checking too soon—you must maintain pressure for the full 10-15 minutes without peeking 3, 2

• Wrong head position: Tilting your head backward causes blood to flow down your throat and does not help stop bleeding 1, 3, 2

• Incorrect compression site: Pinching the bony bridge of the nose is ineffective—you must compress the soft, lower portion 1, 2

• Inserting materials into the nose: Avoid placing tissues or cotton inside your nostrils as they can be aspirated or cause trauma upon removal 5

When to See a Doctor (Non-Emergency)

• Recurrent nosebleeds (more than once weekly) despite preventive measures 5

• History of easy bruising or family history of bleeding disorders 5

• Nosebleeds that recur after initial successful treatment 2