Refer to emergency department

• Know 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

12.2 Drugs acting on the nose

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 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 (eg naseptin see formulary section 12.), to the nose bleed side twice daily for 1 week

Joint Formulary Chapter 12. Ear, nose & oropharynx

Referral Instructions

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: December 2016