Acute nose bleeds - North & East

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North Devon District Hospital ENT Service Provision Acute fractured nose Acute nose bleeds Acute sinusitis AQP Audiology referral guide for practice staff Benign Paroxysmal Positional Vertigo Chronic recurrent nose bleeds Chronic rhinosinusitis with or without polyps Dysphonia Ear Wax Removal Feeling of something stuck in the throat Hearing loss in children Hearing problems in adults Management of discharging ear Myringotomy commissioning policies Otitis Externa Perforated Tympanic Membrane Recurrent Tonsillitis/Tonsillectomy Snoring Tinnitus Tonsillectomy commissioning policy

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Acute nose bleeds

Scope

This guideline covers patients suffering with acute nose bleeds.

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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 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

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: November 2017