Acute nose bleeds

Refer to emergency department

• Known coagulation disorder e.g. haemophilia
• Trauma
• Severe post nasal bleeding

Check if the patient is taking aspirin, clopidogrel, prasugrel, antiplatelet or anticoagulant. If so, bleeding is less likely to stop easily

First aid measures

• Sit patient down
• Lean patient forward (ideally over sink or table)
• Pinch the lower part of the nose between the thumb and forefinger. Pinch the nose for 5 minutes. Do not release the pressure for 5 minutes. If persists repeat twice more.
• Consider inserting nasal tampon if familiar with use
  • Remove after 24 hours and observe for 30 minutes, if further bleeding insert and discuss with on call ENT
• Spit out the blood
• Consider silver nitrate cautery if bleeding point is visible

Bleeding has not stopped and.or the patient is hemodynamically un-well

• Emergency referral to the nearest A&E department

Bleeding has stopped and the patient is hemodynamically well

• Apply ointment/ cream (e.g. naseptin see formulary 12.2 Nose), to the nose bleed side twice daily for 1 week

Emergency referrals should be submitted by phone to local on-call ENT service

Evidence

This guideline has been developed by Royal Devon and Exeter Healthcare Foundation Trust based on local guidelines.

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: December 2016