From the Guidelines
For most cases of epistaxis, the initial management should involve sitting upright, leaning slightly forward, and pinching the soft part of the nose firmly for 10-15 minutes without releasing, as this method is effective in controlling bleeding in the vast majority of cases, including those managed in emergency departments 1. This approach is supported by the 2024 American Heart Association and American Red Cross guidelines for first aid, which emphasize the importance of nasal pressure alone in managing epistaxis 1.
Key Interventions for Epistaxis
- Pinch the soft part of the nose firmly for 10-15 minutes without releasing to help the blood clot.
- Lean forward to prevent blood from entering the airway or stomach.
- Breathe through the mouth and spit out any blood that drains into the throat.
- Apply an ice pack to the bridge of the nose to constrict blood vessels if necessary.
When to Seek Medical Attention
If bleeding persists after 20 minutes of pressure, it is crucial to seek medical attention, as ongoing epistaxis can lead to complications such as anemia and shock due to blood loss 1.
Prevention of Recurrent Epistaxis
For individuals experiencing recurrent nosebleeds, using saline nasal sprays and water-based lubricants like petroleum jelly inside the nostrils can help prevent dryness and reduce the frequency of episodes, as suggested by clinical practice guidelines on nosebleed (epistaxis) 1.
Important Considerations
- Most epistaxis occurs from the anterior nasal septum (Kiesselbach's plexus) due to trauma, dryness, or irritation.
- Posterior nosebleeds, although less common, are more severe and typically require medical intervention.
- Certain medications like blood thinners, hypertension, and conditions affecting blood clotting can increase the risk and severity of nosebleeds, highlighting the need for careful management in these cases 1.
From the Research
Definition and Treatment of Epistaxis
- Epistaxis refers to bleeding from the nostrils, nasal cavity, or nasopharynx 2
- Treatment options for epistaxis include first aid measures such as external pressure and ice packing, applying topical agents like oxymetazoline, electrocautery, and nasal packing 2
Effectiveness of Topical Agents
- Oxymetazoline has been shown to be effective in stopping 65-75% of nosebleeds in emergency departments 2
- Tranexamic acid has been found to promote hemostasis in 78% of patients, compared to 35% and 31% with oxymetazoline and nasal packing, respectively 2
- However, a study found that topical intranasal tranexamic acid was no more effective than placebo in controlling bleeding and reducing the need for anterior nasal packing 3
- Another study found that oxymetazoline was superior to tranexamic acid and epinephrine-lidocaine in achieving rapid hemostasis and reducing recurrence in epistaxis 4
Nasal Packing and Other Treatment Options
- Nasal packing can be applied with non-absorbable materials, absorbable materials, or newer hemostatic materials, which are more effective and have fewer complications 2
- Endoscopic ligation of arteries and endoscopic cauterization are also effective treatment options for epistaxis, with success rates of 97% and higher than conventional nasal packing 2
- Embolization can be used for intractable cases, with a success rate of 80% and comparable efficacy and complications to surgical methods 2
Outpatient Management
- Epistaxis can be managed in the outpatient setting, with compressive therapy, oxymetazoline nasal spray, and directive nasal cautery being useful adjuncts 5
- Topical therapy and nasal packing can be used if other methods are unsuccessful, but posterior epistaxis is more likely to require hospitalization and nasal packing 5