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Nosebleeds are fairly common among children and occasionally occur among adults. Any
condition which induces nasal trauma such as frequent or aggressive nose blowing or digital
manipulation (nose picking) can increase your risk of developing a nose bleed. Dry climate,
prescription nasal sprays, allergies, nasal debris (crusting), stress, and high blood pressure are
common risk factors. Use of blood thinners including aspirin or other non-steroidal antiinflammatory
agents (e.g. ibuprofen-Advil®), Coumadin-Warfarin, high dose vitamin E, ginko
biloba, and Plavix are risks factors for bleeding to be harder to control once it starts. Rarely,
nose bleeds can be a sign of a hereditary condition, or even an indication of a benign or
malignant tumor.

Blood from the nose is called epistaxis and can be divided into two types. These are anterior
bleeds and posterior bleeds. The anterior nose bleeds arise towards the front of the nose and
typically seen on the septum in an area called Killsebach’s plexus (aka Little’s area) or on the
soft tissue prominence across from the septum called the inferior turbinate. In otherwise healthy
individuals, anterior epistaxis is typically can be controlled at home , the less common posterior
epistaxis usually requires a visit to either the emergency room or to a specialist-this may require
hospitalization, embolization, or surgery.

When to seek help if:

  •  mount of blood from your nose is frightening to you
  •  If you have repeated episodes without an obvious explanation
  •  If you take blood thinners
  •  If you have anemia, kidney disease, liver disease, blood borne infection, uncontrolled blood pressure, or history of heart disease

If you are an active patient (seen within the last year):
And if you do not use a blood thinner, do not have risk factors for high blood pressure, heart
attack or health concern which would prevent you from following these instructions (including
but not restricted to the above information) then you may:

1. Spray your nose with water or salt water to moisturize the lining and break up any crusts or
clots
2. Clean out you nose by gently blowing clots out.
3. Apply pressure to the soft (mobile) portions of your nose for a minimum of 15 minutes.
Additionally you may:

a. Apply cool pack on the nose bones
b. Place ice chips in your mouth
c. Spray oxymetazoline (Afrin) in your nose after you cleaned out the clots.
(CAUTION: Do not use this spray if you have any safety concerns listed in
the product information which comes with the Afrin.) This spray will
constrict small blood vessels inside your nose and decrease the rate of bleeding.

  •  If after taking appropriate measures you continue to bleed, please go to your nearest emergency room!

Once the bleeding as stopped:

1. Breathe quietly in and out through your nose.
(The air gently passing through your nose will help slow any remaining bleeding)
2. Do not blow or manipulate your nose.
3. Avoid all bending, lifting or straining

Try to assess:
1. Which side did the bleeding first come from?
2. How long has it been going on?
3. How much blood have you lost?