Nosebleed (Epistaxis): Management and Treatment
How are nosebleeds stopped?
Follow these steps to stop a nosebleed:
- Sit down and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause nausea, vomiting, and diarrhea. (Do NOT lay flat or put your head between your legs.)
- Breathe through your mouth.
- Use a tissue or damp washcloth to catch the blood.
- Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop bleeding.
- Keep pinching your nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
- You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then hold apply pressure to the nose as described above. WARNING: These topical decongestant sprays should not be used over the long term.
- Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy; and DO NOT blow, rub, or pick your nose for several days.
How might an emergency room doctor treat the nosebleed?
The doctor will ask you questions about your nosebleed and examine your nose to try to determine the source of the nosebleed. He or she will use a small speculum to hold the nose open and can use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but need not be painful. Occasionally x-rays or blood tests are ordered.
Treatments, depending on the cause, could include:
- Cauterization. The application of a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
- Nasal packing. The placement of strips of gauze into the nasal cavity to create pressure on the bleeding site. Alternately, other materials that promote clotting may be used.
- Medication adjustments. Reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary.
- Foreign body removal.
- Repair of nasal fracture.
- Correction of a deviated septum.