Acute Nose Bleeds

This guideline covers patients suffering with acute nose bleeds.

Red Flags

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 noseFirst 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.

Supporting Information

Pathway Group

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

Publication date: December 2016


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