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Epistaxis (Nosebleed)

Also known as: nosebleed · epistaxis · nasal bleeding

Bleeding from the nose — usually anterior (Little's area) and self-limiting, occasionally posterior and serious. First aid controls most; find and treat the cause.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

All ages; nose-picking/trauma and dry air in children; hypertension, anticoagulants/antiplatelets and vascular fragility in adults.

Red flags — escalate / refer

Heavy or posterior bleeding (blood down the throat, not controlled by pinching), haemodynamic compromise, or anticoagulation → resuscitate + ENT.

Work-up / diagnosis

1First aid first, then assess.
2Identify anterior vs posterior source; check BP; review anticoagulants/bleeding history; bloods (FBC, coagulation) if heavy/recurrent.

Management — overview

First aid: sit up and lean FORWARD, pinch the soft part of the nose firmly for 10–15 minutes, and breathe through the mouth; apply ice.
If it continues: a topical vasoconstrictor, then nasal cautery (silver nitrate) for a visible anterior bleeding point.
Persistent/posterior bleeding: anterior (± posterior) nasal packing and refer to ENT.
Correct/withhold anticoagulants as appropriate; treat the cause and prevent recurrence (humidification, avoid picking).

In-depthFull dosing & advanced protocol

Drug dosing

Topical vasoconstrictor + nasal cautery (silver nitrate)

Anterior bleed with a visible point

Adult dose: Per procedure
Route: Topical

Caution: Lean forward (not back) to avoid swallowing/aspirating blood.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Nasal packing

Uncontrolled/posterior bleed

Adult dose: Anterior ± posterior packing; refer ENT
Route: Procedure

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Posterior bleeds & recurrence

Posterior bleeds are harder to control — packing, ENT, and occasionally arterial ligation/embolisation.
Recurrent epistaxis: review anticoagulation, consider HHT, and treat local causes.
In children, most are benign anterior bleeds from Little's area.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute Otitis MediaAn acute middle-ear infection, common in children — ear pain, fever and a bulging, red tympanic membrane. Most are self-limiting; analgesia is the priority.Acute Pharyngitis & TonsillitisAcute inflammation of the pharynx/tonsils — sore throat, pain on swallowing, fever and tender neck nodes. Most cases are viral; the key is spotting group-A streptococcal ('strep') throat, which benefits from antibiotics and prevents complications.Allergic RhinitisIgE-mediated nasal inflammation from allergen exposure — sneezing, itch, watery rhinorrhoea and nasal blockage, often with itchy watery eyes. It is part of the atopic spectrum and strongly linked with asthma.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Topical vasoconstrictor + nasal cautery (silver nitrate)

Nasal packing

📈 Posterior bleeds & recurrence

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Topical vasoconstrictor + nasal cautery (silver nitrate)

Nasal packing

📈 Posterior bleeds & recurrence

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Posterior bleeds & recurrence

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Posterior bleeds & recurrence

References