First Aid & Emergencies

Nosebleeds

Medical Treatment for Nosebleeds

Anterior nosebleed

• A minor nosebleed that has stopped may require no treatment at all. Frequently, the body will form a clot at the site of the bleeding that stops any further bleeding.
• If the source of the bleeding is a blood vessel that is easily seen, a doctor may cauterize it (seal the blood vessel) with a chemical called silver nitrate. Cauterization is most effective when the bleeding is coming from the very front part of the nose.
• In more complicated cases, a nasal packing may be required to stop the bleeding. The idea behind this is to put pressure from inside the nostril to halt the bleeding. Many different types of packings are available, ranging from petroleum (Vaseline) gauze to balloon packs to synthetic sponge packs that expand when moistened. The decision as to which one to use is usually made by the doctor.
• Most people who receive an anterior nasal packing go home with it in place. Because these packings block the drainage pathways of the sinuses, antibiotics may be started to prevent a sinus infection. The packing is usually left in for 24-72 hours.

Posterior nosebleed

• A posterior nosebleed that does not stop bleeding on its own requires admission to the hospital. A posterior nasal packing is required. Different types of packings are available, though a balloon pack is most commonly used.
• Unlike the anterior nasal packings, posterior nasal packings are very uncomfortable and frequently require sedatives and pain medications. Complications can be associated with these packs, including infection and blockage of the breathing passages. Admission to the hospital and close monitoring are required.
• Posterior packings are usually left in place for 48 to 72 hours. If this does not stop the bleeding, surgical or radiologic procedures can be performed.

Next Steps for Nosebleeds

• Most people can be seen and discharged from a doctor’s office or the hospital's emergency department after treatment for a nosebleed. If nasal packing has been placed, do not try to remove the packing yourself. You need to be seen again, usually within one to three days, at which time the packing will be removed.
• Try to avoid any further irritation of the nose. Do not blow your nose. Try not to sneeze or cough, if possible. Avoid any strenuous activities, such as heavy lifting or exercise.
• If possible, try not to take any drugs that may interfere with normal blood clotting. These medications include aspirin or anti-inflammatory drugs such as ibuprofen (Motrin or Advil) or naproxen (Aleve or Naprosyn). If you take these drugs for a chronic medical condition, consult with your doctor about to what to do. Acetaminophen (Tylenol) can be taken for fever or pain.

Nosebleed Prevention

• Most nosebleeds occur during the winter in cold, dry climates. If you are prone to nosebleeds, use a humidifier in your home. Use petroleum jelly (Vaseline), an over-the-counter nasal lubricant spray, or a saline nasal spray to keep your nasal passages moist.
• Avoid picking your nose or blowing your nose too vigorously.
• If the nosebleed is related to another medical condition, such as liver disease or a chronic sinus condition, follow your doctor’s instructions to keep that problem under control.
• Stop smoking. Smoking contributes to nasal dryness and irritation.