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First Aid - Nosebleed
First Aid - Nosebleed

Definition
  • Bleeding from one or both nostrils

General Information

  • Most nosebleeds (90%) originate from the front part of the nose (anterior nasal septum). Thus, most nosebleeds will stop when pressure is correctly applied over the bleeding area. The correct method is to squeeze the soft parts of the nose using thumb and index finger, thus applying pressure inside of the nose. Hold for 10-15 minutes.
  • Leading causative factors for nosebleeds include upper respiratory infections (colds) and nose picking. There is a higher incidence of nosebleeds in the 60-80 year old age group. Individuals in this age group often have a couple of causative factors for bleeding. A typical elderly adult with a nosebleed might be 72, have high blood pressure, and be exposed to dry winter air.

Risk Factors for Getting a Nosebleed

  • Environmental: Environmental factors include temperature and dryness of the air.
  • Local: Local factors include URI, nasal drug inhalation, nasal tumors, septal deviation, too vigrous nose blowing, and nose picking.
  • Systemic: Systemic factors include hypertension, arteriosclerosis, and coagulopathies.
  • Medications: Certain medications can increase bleeding: aspirin, NSAID's (e.g., ibuprofen, naproxen) , heparin, coumadin, Plavix (clopidogrel).

If not, see these topics

First Aid:

FIRST AID Advice for Nosebleed:

  • Placing your thumb and index finger over each side of the soft lower portion of the nose, firmly pinch the nostrils together. Pinch the nostrils together for 10-15 minutes.
  • Lean slightly forward; this keeps the blood from trickling down the back of your throat.
When to Call Your Doctor

Call 911 Now (you may need an ambulance) If
  • Passed out (fainted)
  • Too weak to stand following large blood loss
Call Your Doctor Now (night or day) If
  • You feel weak or very sick
  • Bleeding does not stop after 20 minutes of direct pressure
  • Bleeding recurs 3 or more times in 24 hours despite direct pressure
  • Large amount of blood has been lost
  • Skin bruises or bleeding gums not caused by an injury are also present
  • Pale skin (pallor) of new onset or worsening
  • Taking coumadin or known bleeding disorder (e.g., thrombocytopenia)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Easy bleeding present in other family members
  • Hard-to-stop nosebleeds are a recurrent problem
Self Care at Home If
  • Mild nosebleed and you don't think you need to be seen
HOME CARE ADVICE FOR MILD NOSEBLEED

  1. Sit up and lean forward to keep the blood from running down the back of your throat.
  2. Treating a Nosebleed - Pinch the Nostrils:
    • First blow the nose to clear out any large clots.
    • Sit down and lean forward (Reason: blood makes people choke if they lean
      backwards).
    • Gently squeeze the soft parts of the lower nose (nostrils) together. Use your thumb and your index finger in a pinching manner. Do this for 15 minutes. Use a clock or watch to measure the time. Your goal is to apply continuous pressure to the bleeding point.
  3. Decongestant Nose Drops: If applying pressure fails, insert a gauze wet with decongestant nose drops (or petroleum jelly).  The gauze helps to apply pressure and the nose drops shrink the blood vessels. Then repeat the process of gently squeezing the lower nose for 10 minutes.
    • Phenylephrine nose drops (e.g., Neo-Synephrine) are available over-the-counter. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time.
    • CAUTION: Do not take this medication if you have high blood pressure, heart disease or prostate enlargement. Do not take these medications if you are pregnant. Do not take these medications if you have used a MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the past 2 weeks. Life-threatening side effects can occur.
    • Do not use these medications for more than 3 days (Reason: rebound nasal congestion).
    • Read the package instructions thoroughly on all medications that you use.
  4. Prevention:
    • If the air is dry, use a humidifier in your bedroom to keep the nose from drying out.
    • Apply petroleum jelly to the center wall (septum) inside the nose twice daily to reduce cracking and to promote healing.
    • Avoid blowing the nose.
    • Avoid touching your nose and nose picking.
    • Do not take aspirin or other anti-inflammatory medications (e.g., ibuprofen, Advil, Motrin, Aleve), unless you have been instructed to by your physician.
  5. Expected Course: Over 99% of nosebleeds will stop following 15 minutes of direct pressure if you press on the right spot. After swallowing blood from a nosebleed, you may feel nauseated because the blood can irritate your stomach. You may also later pass a dark stool that contains the blood.
  6. Call Your Doctor If:
    • Unable to stop the bleeding with 20 minutes of direct pressure
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 10/25/2008

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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