Emergency Care Institute Patient Fact Sheet

Published on 20 Jul 2022 Printed on 10 Aug 2022


Nosebleed

This fact sheet is for people who have presented to the emergency department with this condition.

This fact sheet provides general information. If you have specific concerns, speak to your healthcare professional for further information and advice.

What is nosebleed (epistaxis)?

Having a nosebleed (epistaxis) is common and is usually mild.

More severe cases can occur for people who:

  • are elderly
  • are being treated with blood thinning medication
  • have a known blood disorder.

What causes a nosebleed?

There is a delicate network of blood vessels just inside the nose. This area can spontaneously bleed, or some of the following can cause it to bleed:

  • Picking the nose
  • Colds and blocked stuffy noses, such as with hay fever
  • Blowing the nose
  • Minor injuries to the nose
  • Cocaine use
  • Blood clotting disorders
  • Blood thinning medications (e.g. rivaroxaban, apixaban, aspirin, warfarin)

Some people with high blood pressure (hypertension) or heart failure have a higher risk of having a nosebleed that lasts longer.

Bleeding sometimes comes from other areas further back in the nose. Such bleeds are sometimes due to uncommon disorders of the nose, or to serious injuries to the nose. Bleeding due to these causes, always need to be dealt with in the emergency and or by an ear nose and throat (ENT) specialist.

Treatment

For most nosebleeds, simple first aid can usually stop the bleeding such as:

  • sitting up and leaning forward
  • blowing your nose, followed by pinching the fleshy end of your nose (closing both nostrils) and applying strong pressure (it should not hurt) for 10-20 minutes
  • if available, using a cold flannel or compress around the nose and front of face can help by closing (constricting) the blood vessels.

If the bleeding stops, avoid blowing or picking of your nose as you may dislodge a clot and the bleeding may recur

In the emergency department some of the following measures may be applied

  • The nose will be sprayed with substances that help to close (constrict) the blood vessels.
  • The nose may be packed for a few hours with watery compresses that are inserted and expand in your nose to apply pressure from the inside out.
  • Sometimes it is possible to see exactly where the nose is bleeding from and to 'burn' (cauterise) the bleeding point. This is a minor, painless procedure which is usually successful in stopping bleeds.

What to expect

Return to the emergency department if you experience any of the following:

  • Heavy bleeding or bleeding that does not stop within 20-30 minutes
  • You are feeling dizzy or lightheaded
  • You feel breathless or have chest pain

Seeking help

In a medical emergency call an ambulance – dial triple zero (000). If you have any concerns, see your local doctor or healthcare professional. If this is not possible return to the emergency department or urgent care centre.

For more information

Ask your local doctor or healthcare professional. You can also call healthdirect 24 hours a day on 1800 022 222 or visit healthdirect.gov.au.

Evidence informedBased on rapid evidence check of grey literature and, where there is no research, based on clinical expert consensus.
CollaborationDeveloped in collaboration with the Agency for Clinical Innovation (ACI) Emergency Care Institute members and the ACI's Surgical Services Taskforce.
Currency Due for review: July 2027.
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