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Vincent’s S.C.A.N.S 
Ear, Nose and Throat (ENT), Head and Neck Surgery
Specialist Clinic
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Last update:  1/5/13 
EDUCATION Nose Bleeding  Epistaxis
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
MY BLOODY NOSE !
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Management In most cases, children or adult alike, if the bleeding has not yet stopped spontaneously, it can be reduced or stopped with simple first-aid measures. The following simple steps for IMMEDIATE self-treatment for minor epistaxis should be provided: Call for help if available Apply firm digital pressure on the lower part of the nose NOT THE BONY UPPER PART (see picture) continuously 5-10 minutes. Use an ice pack over the forehead or suck on some ice cubes in the mouth. Do not lie down Sit up, lean forward. If need be, let the blood or saliva drip from the nose and mouth onto a ready basin. Once a bleed has occurred, avoid taking food or fluids that may be too hot (high temperatures may cause the blood capillaries to dilate and rebleed). Avoid strenuous activity and avoid head down postures for the same reason.  Try not to swallow the blood (no harm but may cause further nausea in some people, worsening the discomfort) Practice deep, relaxed breathing. Use a nasal topical vasoconstrictor spray, if available, in between compressions onto the external part of the nose. However if the underlying cause is related to tumour, cancer, blood clotting disorders or major facial trauma, these measures may not be as effective. It is best to go to a hospital setting where more facilities are readily available. The nose may need to be packed with special nasal packing/dressing for a tamponade effect over the next 1-2 days as you rest in the in-patient ward. Where possible, an endoscopic examination of the nose by the ENT Specialist may be necessary to identify the source of bleeding and the underlying cause. TREAT THE CAUSE. Where the bleeding has stopped, treatment options include: Chemical cautery eg.silver nitrate Electrical cautery Excisional biopsy or incisional biopsy of any suspicious mass Temporary withholding any offending medication as advised. Other measures eg. blood tests, depend on further counselling by your ENT Specialist. Other precautions that can be useful: Do not use pick your nose Avoid hard nose blowing or sneezing. Sneeze with the mouth open. Avoid hot food or drinks Avoid taking hot showers. Avoid aspirin and other NSAIDs (please confirm with your doctor first). Overall, the outcome is good. When adequate supportive care is provided and underlying medical problems are controlled, most patients are unlikely to experience any rebleeding.
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Part 2 - Diagnosis and Management
To read from Nose Bleeding Part 1
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Sit up, lean forward. If need be, let the blood or saliva drip from the nose and mouth onto a ready basin.
© Vincent Tan ENT
© Vincent Tan ENT
© Vincent Tan ENT
Do not lie down
Apply firm digital pressure on the lower part of the nose
Chemical cautery in progrees
© Vincent Tan ENT
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ENT
D R. V INCENT T AN Consultant Ear, Nose and Throat, Head and Neck Surgeon, MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore) Fellowship in Head and Neck Oncology & Surgery (Amsterdam)
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