Epistaxis & Nasal Trauma
Control initial bleeding safely and identify septal or systemic complications.
Quick revision ↓ Medical Dictionary
01Initial nosebleed care
For a conscious stable patient, sit upright, lean forward and compress the soft part of the nose continuously for 10 to 15 minutes while breathing through the mouth. Avoid tilting the head back or repeatedly releasing pressure to check. Heavy bleeding, breathing difficulty, faintness or ongoing bleeding despite first aid requires urgent assessment.
02Assess severity and cause
Evaluate airway, circulation, blood loss and relevant observations. Ask about trauma, recurrence, anticoagulants, bleeding disorders and nasal medicines. Blood running into the throat may be difficult to quantify. Do not assume a visible small anterior bleed accounts for every episode of instability; resuscitation and escalation may be needed in parallel with local control.
03Definitive control
Trained clinicians may use targeted cautery or packing depending on the bleeding site and severity. Avoid blind or excessive cautery and follow local precautions to prevent septal injury. Persistent or suspected posterior bleeding may require hospital care and specialist intervention. Changes to anticoagulants require an individual clinical decision, not automatic unsupervised discontinuation.
04Septal haematoma
After nasal injury, examine for a septal collection as well as external deformity. New obstruction with a soft septal swelling may indicate a haematoma even if the nose appears straight. Urgent ENT assessment and treatment are needed to protect cartilage and prevent infection. Do not delay this concern until a routine fracture review after swelling settles.
05Other trauma and follow-up
Assess associated facial, eye and head injuries, including clear fluid leak or neurological symptoms. Isolated nasal fracture management is guided by examination and specialist timing rather than routine imaging alone. Provide bleeding precautions, a review plan and return advice. A patient with a pack needs explicit arrangements for monitoring and removal according to the treating service.
High-Yield Revision
- Compress the soft nose while leaning forward.
- Septal haematoma is urgent even without obvious deformity.
- A nasal pack needs a documented follow-up plan.
Common Pitfalls
- Tilting the head back during a nosebleed.
- Stopping anticoagulants automatically without clinical review.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.