How to treat a nose bleed

Nose bleeds (epistaxis) is extremely common. Not every patient requires cauterisation. About 97% of all nose bleeds occur at the front of the nose on the septum (midline) as there are major vessels that arise from the floor of the nose to supply the septum. The nose at that part is extremely dry due to the constant airflow (breathe from your mouth and see how quickly your mouth dries up). This means that any abrasion due to nose-digging or any trauma to the thin lining of the septum can cause a dry rupture of the blood vessels. Of course, some patients are at much higher risk due to previous surgery, trauma, bleeding disorder or blood thinning medications (fish oil, aspirin, warfarin, clexane, rivaroxaban, dabegatran, etc.) So the key is to apply pressure to the specific spot and keep the nose as wet as possible. If this bleed happens on your knees or elbows, you can all easily put your finger on it. The only issue with the nose is just its location.

Here are a few tips: 
Do not look up to pinch the bone bridge. This does nothing to the bleeding spot and could cause aspiration of blood into the throat/airway.

Tilt head down, check which side is bleeding and put a gentle pressure on the nasal alar on to the septum (the soft outside pressed in).

Wait for 10minutes and most bleeds will stop.

Do not put any tissues up the nose as all it does is dry the blood and rips off the scab when the tissue is removed.

Blood clot or scab is the body’s natural bandaid solution.

Wet wet wet the nose for the next week or two.

Saline sprays, vaseline, sorbolene, saline gel, Nozoil, and anything else that keeps the nose wet so the scab doesn’t dry up while the septum is healing.

Some studies show that there is a higher carrier rate of bacteria in the nose of those with nosebleeds, so your GP might start you on chlorsig, bactroban or kenacomb ointment. Apply it 3 times a day to the inside of your nose for 1-2 weeks.

If you’re on blood thinners, your blood thinners will always win no matter what we do to the nose.

If the nose continues to bleed despite these basic treatments, then perhaps cauterisation is needed. Some kids won’t tolerate cautery depending on age.

Cautery is basically silver nitrate chemical burn to the area of bleeding. There is no magic. It’s just chemical burns in the hope that the big vessels are destroyed. But the body will form a new scab and new blood vessels, so cauterisation is never 100% successful.

Ultimately, keeping the nose wet wet wet is the best preventative method while the nose takes time to heal.

In extremely severe situation, we can do electrical cautery, septoplasty, closure of the nasal cavity, nasal endoscopic keyhole procedure to clip the sphenopalatine artery at the back of the nose or do a radiological interventional embolisation to the blood vessels. 

But the vast majority of patients do well with simply keeping their nose wet.