Nosebleed (Epistaxis)

Nosebleeds are common occurrences that can be alarming but are usually not serious. They happen when blood vessels in the nose break and bleed, most often from the front part of the nasal septum where five arteries converge in an area called Kiesselbach's plexus. While most nosebleeds are minor and stop on their own, some can be severe or indicate underlying health issues. Children and older adults experience nosebleeds most frequently, though they can occur at any age. Understanding proper first aid, recognizing warning signs, and knowing prevention strategies helps manage this common condition effectively. Most importantly, staying calm during a nosebleed helps control the situation better.

⚠️ Seek Emergency Care For:

  • Bleeding lasting >20-30 minutes
  • Heavy bleeding or blood loss
  • Difficulty breathing or swallowing
  • Bleeding after head injury
  • Signs of significant blood loss (dizziness, weakness)
  • Frequent nosebleeds (>1 per week)
  • Bleeding with blood thinners
  • Vomiting blood
  • Pale skin or rapid pulse
  • Bleeding from both nostrils

First Aid for Nosebleeds

Immediate Steps

  1. Stay calm and sit upright
  2. Lean slightly forward to prevent blood going down throat
  3. Pinch soft part of nose firmly with thumb and index finger
  4. Hold for 10-15 minutes without checking
  5. Breathe through mouth during this time
  6. Apply ice to bridge of nose
  7. Don't lie down or tilt head back

After Bleeding Stops

  • Don't blow nose for several hours
  • Don't pick or rub nose
  • Keep head elevated when resting
  • Avoid strenuous activity for 24 hours
  • Use saline spray to keep nose moist
  • Avoid hot showers or drinks

Types of Nosebleeds

Anterior Nosebleeds

  • 90% of all nosebleeds
  • Front of nose
  • Usually one nostril
  • Easier to control
  • Common in children
  • Often from picking/trauma

Posterior Nosebleeds

  • 10% of nosebleeds
  • Back of nose
  • Both nostrils often
  • More serious
  • Common in elderly
  • May need medical care

Common Causes

Environmental Factors

  • Dry air (winter heating, low humidity)
  • High altitude
  • Cold weather
  • Air conditioning
  • Allergens and irritants
  • Chemical exposure

Physical Causes

  • Nose picking
  • Blowing nose too hard
  • Foreign object in nose
  • Facial trauma
  • Nasal surgery
  • Deviated septum

Medical Conditions

  • High blood pressure
  • Blood clotting disorders
  • Liver disease
  • Kidney disease
  • Leukemia
  • Nasal tumors
  • Hereditary hemorrhagic telangiectasia

Medications

  • Blood thinners (warfarin, aspirin)
  • Nasal sprays (overuse)
  • Anti-inflammatory drugs
  • Antiplatelet medications
  • Some supplements (ginkgo, garlic)

Risk Factors

Age Groups

  • Children 2-10 years
  • Adults 45-65 years
  • Elderly >65 years
  • Different causes by age
  • Severity varies
  • Treatment differs

Health Conditions

  • Allergies
  • Sinusitis
  • Hypertension
  • Bleeding disorders
  • Vascular malformations
  • Chronic conditions

Lifestyle Factors

  • Cocaine use
  • Excessive alcohol
  • Smoking
  • Dry environments
  • Contact sports
  • Occupational hazards

Seasonal Patterns

  • Winter months highest
  • Indoor heating
  • Cold/flu season
  • Allergy seasons
  • Weather changes
  • Humidity levels

Medical Evaluation

When to See a Doctor

  • Frequent nosebleeds (weekly)
  • Bleeding hard to control
  • Large amount of blood loss
  • Associated symptoms (bruising, bleeding gums)
  • Taking blood thinners
  • Known bleeding disorder

Diagnostic Tests

  • Nasal examination: Direct visualization
  • Endoscopy: Detailed nose inspection
  • Blood tests: Clotting studies, CBC
  • Blood pressure: Check for hypertension
  • Imaging: CT scan if tumor suspected

Medical History

  • Frequency and duration
  • Triggering factors
  • Medications taken
  • Family history
  • Other bleeding issues
  • Previous treatments

Medical Treatment Options

Conservative Treatment

  • Nasal moisturizers
  • Saline sprays
  • Petroleum jelly
  • Humidification
  • Avoiding irritants
  • Treating allergies

Medical Procedures

  • Silver nitrate cautery
  • Electrical cautery
  • Nasal packing
  • Balloon catheter
  • Surgical ligation
  • Embolization

Medications

  • Topical vasoconstrictors
  • Tranexamic acid
  • Antibiotics (with packing)
  • Pain relievers
  • Blood pressure meds
  • Clotting factors

Follow-up Care

  • ENT specialist referral
  • Allergy testing
  • Blood work monitoring
  • Medication adjustment
  • Preventive strategies
  • Regular check-ups

Prevention Strategies

Environmental Control

  • Use humidifier (40-60% humidity)
  • Apply nasal saline regularly
  • Petroleum jelly in nostrils
  • Avoid nasal irritants
  • Keep fingernails short
  • Treat allergies promptly

Lifestyle Modifications

  • Don't pick nose
  • Blow nose gently
  • Sneeze with mouth open
  • Avoid smoking
  • Limit alcohol
  • Stay hydrated
  • Manage blood pressure

Medical Management

  • Review medications with doctor
  • Monitor blood thinners
  • Treat underlying conditions
  • Regular check-ups
  • Prophylactic cautery if needed

Special Considerations

Children

  • Usually from picking or trauma
  • Teach proper nose care
  • Keep nails trimmed
  • Address allergies
  • Humidify bedrooms
  • Rarely serious

Elderly

  • Often posterior bleeds
  • More serious outcomes
  • Medication interactions
  • Fragile blood vessels
  • Need closer monitoring

Pregnancy

  • Increased blood flow
  • Hormonal changes
  • More common occurrence
  • Usually not serious
  • Gentle prevention methods

Potential Complications

  • Anemia: From chronic blood loss
  • Aspiration: Blood in lungs
  • Sinusitis: From nasal packing
  • Septal perforation: From repeated cautery
  • Hypovolemia: Severe blood loss
  • Infection: From packing materials
  • Toxic shock: Rare with packing

Related Symptoms

Nasal Congestion

May contribute to nosebleeds.

Easy Bruising

May indicate bleeding disorder.

Headache

Can occur with severe nosebleeds.

Dizziness

May indicate blood loss.