Nosebleed

Symptoms

DEFINITION

• Bleeding from one 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.

Risk Factors for Getting a Nosebleed

• Environmental: Environmental factors include temperature and dryness of the air.
• Local: Local factors include URI, nasal drug inhalation, nasal tumors, septal deviation, too vigorous nose blowing, and nose picking.
• Systemic: Systemic factors include hypertension, arteriosclerosis, and coagulopathies.
• Medications: Certain medications can increase bleeding: aspirin, NSAID's (e.g., ibuprofen, naproxen) , heparin, coumadin, Plavix (clopidogrel).

See More Appropriate Topic (instead of this one) If

• Nosebleed from NOSE INJURY

FIRST AID Advice for Nosebleed:

• First blow the nose to clear out any large blood clots.
• Placing your thumb and index finger over each side of the soft lower portion of the nose, firmly pinch the nostrils together. Pinch the nostrils together for 10-15 minutes.
• Lean slightly forward; this keeps the blood from trickling down the back of your throat.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE FOR MILD NOSEBLEED

1. Reassurance:
   • Nosebleeds are common.
   • It sounds like a routine nosebleed that we can treat at home.
   • You should be able to stop the bleeding if you use the correct technique.
   • Remember to Sit up and lean forward to keep the blood from running down the back of your throat.
2. Treating a Nosebleed - Pinch the Nostrils:
   • First blow the nose to clear out any large clots.
   • Sit up and lean forward (Reason: blood makes people choke if they lean
     backwards).
   • Gently squeeze the soft parts of the lower nose (nostrils) together. Use your thumb and your index finger in a pinching manner. Do this for 15 minutes. Use a clock or watch to measure the time. Your goal is to apply continuous pressure to the bleeding point.
3. Treating a Nosebleed - Inserting a Gauze with 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.
   • Example decongestant medication:  Afrin (oxymetazoline) nasal spray is available over-the-counter and is a nasal decongestant.
4. CAUTION: Nasal Decongestants:
   • Do not take these  medications if you have high blood pressure, heart disease, prostate enlargement or an overactive thryroid.
   • Do not use these medications if you are pregnant.
   • Do not use these medications if you have used a MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the past 2 weeks. Life-threatening side effects can occur.
   • Do not use these medications for more than 3 days (Reason: rebound nasal congestion).
5. Prevention: 
   • Dry air in your house or workplace can increase the chance of nosebleeds occurring. If the air is dry, use a humidifier in your bedroom to keep the nose from drying out. You can also apply petroleum jelly to the center wall (septum) inside the nose twice daily to reduce cracking and to promote healing.
   • Bleeding can start again if you rub your nose or blow the nose too hard. Avoid touching your nose and nose picking. Avoid blowing the nose.
   • Do not take aspirin or other anti-inflammatory medications (e.g., ibuprofen, Advil, Motrin, Aleve), unless you have been instructed to by your physician.
6. Call Your Doctor If:
   • Nosebleed lasts longer than 30 minutes using direct pressure
   • Lightheadedness or weakness occurs
   • Nosebleeds become worse
   • You become worse
7. 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.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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