How to Treat a Nosebleed

Nosebleeds are a common medical problem; usually they are mild and easily managed without the need to see a medical provider.

Causes:

The lining of the nose is very delicate. Any irritation to the nose can injure a small blood vessel and cause bleeding. Irritation may be caused by excessively cold or dry air, or by direct injury to the nose from trauma, fingertips, Q-tips, or vigorous nose blowing. As people age, blood vessels within the nose become more delicate and prone to injury. Anti-coagulated individuals (e.g Coumadin, Xarelto, aspirin, fish oil) are more susceptible to prolonged nose bleeds.

In the event of a nosebleed, we recommend that patients do the following:

1. Sit upright so that the nose is higher than the heart.
2. Lean forward, tipping the face downward, and tucking your chin to your chest; this facilitates blood flow out of the nostrils instead of down the back of the
   throat.
3. Pinch the nostrils closed tightly near the tip of the nose to prevent an blood loss through the nostrils; the blood pooling in the nose will clot and seal the source of
   the bleeding.
4. Hold pressure on the nostrils for 10 minutes by watch or clock, without letting blood drain through the nostrils.
5. After 10 minutes, release the nasal pressure, and if bleeding persists, hold pressure on the nostrils in the same way for another 10 minutes again using a clock or watch to ensure pressure is held for the full 10 minutes.
6. Do not blow your nose or sniff in vigorously at any point, as this interrupts the clot that is forming to stop the bleeding; in addition, if you must sneeze, do so through an open mouth.
7. If bleeding persists, you can spray 2-3 sprays of Afrin or Neo-Synephrine nasal spray into the nose and hold pressure 10 minutes one additional time.
8. If bleeding persists after holding pressure 3 times in a row, each for 10 minutes, contact your doctor or go to an Emergency Room.

If you have just had cautery:

1. Avoid nose blowing for 1 week.
2. 2 days after cautery, begin saline nasal spray 4 sprays to the inside of the nose 4 times per day for 2 weeks.
3. 2 days after cautery, begin applying Bacitracin, Aquaphor or Vaseline to the inside of the nose 3 times per day for 2 weeks.
4. Call if bleeding recurs.