Stopping nosebleeds: how to stop a nosebleed - mild moderate and severe

A concise and practical guide to nosebleeds, brought together from ambulance crews and hospital doctors!

There's plenty of information out there, but I've found none of it to be concise, and plenty of it to be wrong! I suffered from severe nosebleeds well into my late teens, and have heard every piece of advice there is.

Where does a nose bleed from?

90% of the time nose bleeds originate from the midline nasal partition or 'nasal septum'. Thats the divide between each nostril, the piece of bone/cartilage that separates the nostrils. Blood vessels and capillaries lie close to the surface here.The following list applies to nosebleeds of all severity. The nose should be held for at least fifteen minutes, gently checked, then repeated until the bleed stops.

What to do:

Pinch the bridge of the nose firmly with two fingers
Use tissue if its more comfortable. This applies direct pressure to the nasal septum. Once pinched, try to keep your hand steady, and if you need to switch hands, do it gently and seamlessly - remember the blood is trying to clot, you don't want to undo its work by aggravating the area with movement.
Tilt head slightly forward
The key word here is forward. This will limit the amount of blood that may travel to the throat. Note - if the patient needs to spit out some blood, this is perfectly safe and normal.
Sit down, keep calm
This is very important, and is the key to stopping moderate / severe nosebleeds. Lowering the heart rate and blood pressure is the aim here. This is usually all thats necessary to avoid more invasive treatment.
Apply ice pack directly to the area, and back of the neck
Anything frozen will do here. Wrapping ice cubes in a tea towel is a good one. When applying directly to the nose, do so gently. Applying ice to the nose and neck encourages the blood vessels to restrict, as a reaction to the cold. This decreases blood flow.

What not to do:

Don't tilt the head back
The classic piece of bad advice. The nose, throat, eyes and ears are all linked, and all passages that blood may take. Tilting the head back encourages blood to travel back down the throat, and whilst this is not dangerous, it is unpleasant and can be frightening. Its unnecessary, and makes it hard to keep calm.
Don't talk to much
Keep movement to a minimum. Remember we're trying to lower the heart rate and blood pressure, and limit and movement around the affected area so the blood has the best chance of clotting.
Don't listen to or take to bad advice
When someone has a nosebleed, they are usually inundated with pieces of advice that can sound like orders if you're the one receiving them! If its a bad bleed, just say 'no' to them, don't waste time explaining, keeping calm and quiet is the best cure. Explain afterwards if needed, but use common sense, and filter out the nonsense!

Other Treatment

If the bleed lasts more than a few hours, its time to ring a doctor for advice. I've had bleeds lasting 5 or 6 hours and its always been fine, but best to be safe. There are a number of things a hospital can do that we can't at home. They can insert small cotton tubes into each nostril, and fill these tubes with a liquid so they expand and plug the nose. This is more effective than pinching the nose, and means the patient can sit back and relax more.

Cauterizing a nose bleed

A doctor may choose to cauterize the bleed. I've had this done several times, and its nothing to be scared about - its uncomfortable, but is immediately effective. It involves first applying a local anesthetic (pain killer) to the area, usually in the form of a nose spray. Then something looking like a long match is inserted into the affected nostril, and dabbed against the bleeding area. The 'match end' reacts with the blood and seals the area shut.

Surgery

For recurrent severe nose bleeds, surgery is an option although I've never had any. I don't have any details, other than its performed under a general anesthetic, and solves the problem when repeatedly cauterizing the area has failed.

Written by Tom Bates

Tom Bates

14:06 GMT, 14th November 2012

Thanks a bunch!