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Epistaxis - Management
Overview of management for acute epistaxis

  • If the person is haemodynamically compromised, telephone 999 for an emergency ambulance and advise first aid measures while awaiting its arrival.
  • If the person is not haemodynamically compromised:
    • Advise first aid measures.
    • Assess:
      • Blood loss.
      • The site of bleeding (which nostril, and if it is from the anterior or posterior nasal area).
      • What attempts have been made to stop the bleeding before seeking medical help.
    • Determine if there is a likely underlying cause or comorbid condition that may influence the decision to refer the person (for example warfarin therapy).
    • If bleeding stops with first aid measures, consider topical treatment.
    • If bleeding does not stop after 10–15 minutes of pressure and the appropriate expertise and facilities for cautery or packing are not available in primary care, send the person to the Accident and Emergency department immediately.
    • If bleeding does not stop after 10–15 minutes of pressure and the appropriate expertise and facilities are available in primary care, consider:
      • Nasal cautery — if the bleeding point can be seen.
      • Nasal packing — if nasal cautery is ineffective or the bleeding point cannot be seen.
    • Consider whether admission is warranted.
    • Consider referral to an ear, nose, and throat specialist if epistaxis is recurrent despite treatment, or there is a high risk of a serious underlying cause.
    • Offer self-care advice after the bleeding has stopped.

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