NOSEBLEED

Symptom Definition

  • Bleeding from 1 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.
  • Causative factors:
    • Environmental - Environmental factors include temperature and dryness of the air.
    • Local - Local factors include upper respiratory infections (colds), nasal drug inhalation, nasal tumors, nasal septal deviation, too vigorous nose blowing, and nose picking.
    • Systemic - Systemic factors include high blood pressure, arteriosclerosis, and bleeding problems.
    • Medications - Certain medications can increase bleeding: aspirin, ibuprofen/Motrin, heparin, and coumadin.

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WHEN TO CALL YOUR DOCTOR FOR NOSEBLEED

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
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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. Apply Pressure: Gently squeeze the lower soft parts of the nose against the center wall for 15 minutes. (Goal: apply continuous pressure to the bleeding point.) Use your thumb and your index finger in a pinching manner. If the bleeding continues, move your point of pressure and repeat again for another 15 minutes.
  3. Decongestant Nose Drops: If applying pressure fails, insert a gauze wet with decongestant nose drops (or petroleum jelly).  (Reason: 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.
    • Decongestant nose drops (e.g. phenylephrine/Neo-Synephrine) are available over the counter.
    • Do not take this medication if you have high blood pressure, heart disease or prostate enlargement.
    • Do not use this medication for more than 3 days. (Reason: excessive decongestant use can rebound nasal congestion.)
    • Read and follow the package instructions carefully.
  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 or develop any of the "Call Your Doctor" symptoms.
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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.

Adult HouseCalls Online. Copyright © 2000-2004 David Thompson, M.D. FACEP

Reviewed 8/2004

Revised 8/2004

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