First aid measures in the management of epistaxis

Initial management should be as follows:

• to make the patient sit up (so that the head is above the level the heart) (1)
• to tilt head forward slightly and breathe through their mouth
  • prevents pooling of blood in the posterior pharynx
  • prevents nausea and airway obstruction (2)
• using the thumb and index finger, the front of the nose should be compressed (by applying direct pressure to the septal area) and held for five minutes. (2)
• the affected nostril should be plugged with gauze that is soaked in a topical decongestant
• an ice pack or a plastic bag of crushed ice can be applied simultaneously to the bridge of the nose o this slows blood flow
• after five minutes, the nose is released to observe if it is still bleeding
• the ice pack may be kept on for another 10 to 15 minutes
• if it is still bleeding, the nose should be compressed for an additional 10 minutes

In addition to above methods, using a topical vasoconstrictor (oxymetazoline) may be useful in some patients (3)

When bleeding does not respond to simple compression and nasal plugging, the source of bleeding should be identified.

Failure to stop recurrent unilateral epistaxis by simple conservative means should raise suspicion of a neoplasm (3)

• CT, MRI or endoscopic evaluation should be considered in patients with recurrent unilateral epistaxis to rule out any serious underlying condition (3).

Reference:

• 1. Nosebleed (Epistaxis). medical content reviewed by the faculty of Harvard Medical School, 2007
• 2. Kucik CJ. Management of epistaxis.American Family Physician 2005; 71(2)
• 3. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. 2009;360(8):784-9