Acute nose bleeds

Scope

Patients suffering with acute nose bleeds.

Red Flags

Refer to emergency department
  • Known coagulation disorder e.g. haemophilia
  • Trauma
  • Severe post nasal bleeding

Investigations

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

Management

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 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

Referral

Emergency referrals to A&E should be submitted by phone to the nearest hospital.

Supporting Information

Pathway Group

This guideline has been signed off by South Devon and Torbay CCG

Publication date: October 2017

 

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