From the Guidelines
To manage a nosebleed, first sit upright and lean slightly forward to prevent blood from flowing down your throat, then pinch the soft part of your nose firmly with your thumb and index finger for 10-15 minutes continuously 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.
General Approach to Nosebleeds
When experiencing a nosebleed, it is essential to remain calm and follow proper first aid techniques to minimize blood loss and promote clotting.
- Sit upright and lean forward to prevent blood from entering the airway or stomach.
- Pinch the soft part of the nose firmly with your thumb and index finger for 10-15 minutes without releasing pressure.
- Breathe through your mouth during this time and spit out any blood.
Additional Measures
If the bleeding persists after 20 minutes of pressure, seek medical attention. For recurring nosebleeds, use a saline nasal spray or apply petroleum jelly inside the nostrils with a cotton swab to keep the nasal passages moist, as suggested by clinical practice guidelines for nosebleed (epistaxis) 1.
Prevention and Recurrence
To prevent nosebleeds, avoid picking your nose, blowing forcefully, or inserting objects into your nostrils. Most nosebleeds occur in the anterior part of the nose where blood vessels are close to the surface and easily damaged, and are commonly caused by dry air, trauma, allergies, or excessive nose blowing, as noted in the clinical practice guideline: nosebleed (epistaxis) executive summary 1. If you experience frequent or severe nosebleeds, especially if you're on blood thinners, have high blood pressure, or if the bleeding follows a head injury, consult a healthcare provider promptly, as advised in patient FAQs for nosebleeds 1.
From the Research
General Approach to Nose Bleeds
The general approach to nose bleeds, also known as epistaxis, involves several steps and treatment options.
- First aid measures such as external pressure and ice packing can be applied to stop the bleeding 2.
- Topical agents like oxymetazoline can be used to stop 65-75% of nosebleeds in emergency departments 2, 3.
- Other treatment options include electrocautery, chemical cauterization, and applying tranexamic acid to promote hemostasis 2.
- Nasal packing can be applied using non-absorbable or absorbable materials, and newer hemostatic materials are more effective and have fewer complications 2, 4.
Treatment Options
Different treatment options are available for epistaxis, including:
- Oxymetazoline, which has been shown to be superior to tranexamic acid and epinephrine-lidocaine in achieving rapid hemostasis and reducing recurrence 3.
- Tranexamic acid, which promotes hemostasis in 78% of patients 2.
- Endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing 2.
- Endoscopic cauterization, which is more effective than ligation 2.
- Embolization, which can be applied using gelatin sponge, foam, PVA, and coils with an 80% success rate 2.
Management of Epistaxis
The management of epistaxis can be simplified by using:
- Silver nitrate application to the decongested and anesthetized nasal mucosa 4.
- Inflatable anterior nasal balloon packs to control most nosebleeds 4.
- Addition of a Foley catheter nasopharyngeal balloon pack to manage most posterior epistaxis 4.
- Cautery and packing techniques to treat most cases not requiring otolaryngology consultation or interventional radiology 4.
- Topical moisturizing to facilitate mucosal healing, and oxymetazoline 0.05% nasal spray to address rebleeding after discharge from treatment 4, 5, 6.