NHS Tayside RefGuide
The vast majority of epistaxis can be managed in the community by the steps below but occasionally the bleeding is so heavy or frequent that further ENT assessment is indicated.
- Frequent local causes are trauma (nose picking), inflammation (rhinitis), neoplasia and iatrogenic.
- Systemic causes play a role and these need to be addressed in primary care. These include anticoagulation, hypertension, diseases of the blood and raised venous pressure (chronic cough).
Acute bleeding
- Initial first aid advice regarding acute management
- Lean forward
- Pinch (as hard as possible) on the soft (cartilagenous) part of nose for 15mins
- Ice to back of neck or bridge of nose
- If not stopping then resuscitate as able in the GP practise.
- Arrange transfer to A+E for assessment and further management.
Chronic or recurrent bleeding
Screening for other potential causes:
- Rhinological history
- Nasal block, other discharge, anosmia, facial pain.
- Family history of hereditary haemorrhagic telangectasia or frequent recurrent bleeds
- Red flags
- Changes in vision or epiphora, paraesthesia on the face or change in dentition/denture fitting
- Unilateral nasal block or discharge.
Try to identify common triggers:
- Nose picking or trauma
- Crusting/drying from central heating
- Hypertension
- Over anticoagulation (check the reason for anticoagulation and if it is still needed or if a pause is appropriate)
Initial medical management
- Check haemoglobin, LFTs, U+E and coagulation as indicted by type and length of symptoms.
- Naseptin for TDS for 2 weeks (check no peanut allergy)
- Following this regular emollient BD
- If you have the skills and equipment to cauterise with silver nitrate this is an option. Avoid bi-lateral cautery.
- Avoid steroid sprays unless there is another reason to be on them as they often exacerbate the cause of epistaxis