Nosebleeds

Also called Epistaxis

Usually trivial. The first aid most people were taught is wrong, and on blood thinners they are not trivial at all.

What it is

Nosebleeds are extremely common, particularly in children and in people over 65.

Most come from Little's area, a web of small vessels just inside the nostril, and stop with correct pressure.

The reason for an entry is that almost everybody applies the wrong first aid, and that in older people on anticoagulants a nosebleed can cause significant blood loss.

The two errors taught for generations: tipping the head back, which sends blood down the throat causing vomiting and hides how much is being lost, and pinching the bony bridge, which compresses nothing useful.

Correct technique is: lean forward, and pinch the soft part of the nose, firmly, for ten to fifteen minutes without letting go to check.

Signs you might notice

Bleeding from one nostril, usually.

Bleeding from both nostrils, or down the back of the throat, suggests a posterior bleed, which is more serious and commoner in older people.

Signs of significant loss: pallor, dizziness, a fast pulse, feeling faint.

Frequent nosebleeds with easy bruising, or bleeding elsewhere, needs investigating.

Recurrent bleeding from one side, particularly with blockage, needs assessment to exclude a growth.

How it can affect day-to-day life

In care settings, nosebleeds in a resident on warfarin or a DOAC should not be treated as routine. Blood loss can be substantial, and the anticoagulation may need reviewing.

Dry air, central heating, nose picking and nasal steroid sprays are the common everyday causes, and technique with the spray matters: aiming outward rather than at the septum prevents most spray-related bleeds.

Children's nosebleeds are almost always benign and frightening out of proportion.

Supporting someone well

Lean forward, not back. Pinch the soft part of the nose, not the bridge. Hold for a full ten to fifteen minutes without releasing.

Spit blood out rather than swallowing it.

A cold pack on the back of the neck or the bridge helps a little.

Afterwards, avoid blowing the nose, hot drinks, alcohol and heavy lifting for 24 hours.

Use petroleum jelly or a saline gel inside the nostril to prevent recurrence in dry conditions.

Check nasal spray technique.

Take nosebleeds seriously in anybody on anticoagulants, and get advice if bleeding is heavy or recurrent.

Where to get help

A and E if bleeding does not stop after 20 minutes of correct pressure, if it is heavy, or if the person feels faint.

Same-day advice for anybody on anticoagulants with a significant nosebleed.

A GP for recurrent nosebleeds, one-sided bleeding with blockage, or bleeding with easy bruising.