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ENT & Audiology
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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/Altered voice in Adults and Children
Ear Wax Removal
Feeling Something Stuck in Throat
Hearing problems in adults
Hearing loss in children
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
Patients suffering with 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 or warfarin. 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 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 to A&E should be submitted by phone to the nearest hospital.
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: October 2017
