Nosebleed (Epistaxis, Nose Bleed, Bloody Nose)

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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When should you call your doctor or go to an emergency room for a nosebleed?

  • If bleeding cannot be stopped or keeps occurring.
  • If bleeding is rapid, or if blood loss is large.
  • If you feel weak or faint.
  • If your nosebleed is associated with trauma to the face, loss of consciousness, or blurry vision.
  • If your nosebleed is associated with a fever or headache.
  • If your infant or baby has a nosebleed, contact the pediatrician.

What should I do if the doctor has placed nasal packs?

Nasal packs are used when less conservative measures fail. These packs are frequently placed in both sides of the nose. The packs are usually made of a material called "Merocel" which is a compressed sponge-like material or a gel gauze-wrapped balloon (called a "Rhino Rocket") used to help compress the area of the nose that is bleeding. The doctor usually leaves them in for several days. This requires a follow-up appointment so your doctor can remove the packs.

The patient will need someone to drive them and bring them home after the nasal packs are removed. During this time, the patient may be prescribed antibiotics and pain medication as needed.

It is not uncommon for the nose to drain a blood-tinged material. Folded gauze taped under the nose (a mustache dressing) is often useful. The doctor may permit the patient to clean the nostrils with hydrogen peroxide soaked Q-tips. Prevention methods described previously should be considered to help to avoid bleeding again.

Picture of Mustache Dressing
Picture of Mustache Dressing

Patients with nosebleeds should not take aspirin or any other blood thinning products. If patients are already taking these medications when the nosebleed is noticed, they should notify their doctor.

REFERENCES:

Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2012.

Alter, Harrison, MD et al. "Patient information: Nosebleeds (epistaxis) (Beyond the Basics)." UpToDate. Mar, 11, 2014
<http://www.uptodate.com/contents/nosebleeds-epistaxis-beyond-the-basics>

Claire Shovlin, PhD, FRCP. Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). 26 June 2015. 28 August 2015
<http://www.uptodate.com/contents/hereditary-hemorrhagic-telangiectasia-osler-weber-rendu-syndrome?source=search_result&search=Osler-Weber-Rendu+syndrome&selectedTitle=1~52>.

Suh MD, Jeffrey D. and Rohit Garg, MD, MBA. Epistaxis (Nosebleeds). 2011. 28 August 2015
<http://care.american-rhinologic.org/epistaxis>

Medically Reviewed by a Doctor on 9/11/2015

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