Nosebleeds

Introduction

Bleeding from the nose most commonly occurs when tiny blood vessels inside the nostrils are ruptured, either by a blow to the nose, or as a result of sneezing, picking or blowing the nose. Nosebleeds may also occur as a result of high blood pressure.

A nosebleed can be dangerous if the casualty loses a lot of blood. In addition, if bleeding follows a head injury, the blood may appear thin and watery. The latter is a very serious sign because it indicates that the skull is fractured and fluid is leaking from around the brain.

Your aims

to control blood loss
to maintain an open airway.

Treatment

Ask the casualty to sit down
Advise them to tilt their head forwards to allow the blood to drain from the nostrils
Ask the casualty to breathe through their mouth (this will also have a calming effect) and to pinch the soft part of the nose
Reassure and help if necessary
Tell the casualty to keep pinching their nose
Advise them not to speak, swallow, cough, spit or sniff because this may disturb blood clots that may have formed in the nose
After 10 minutes, tell the casualty to release the pressure. If the bleeding has not stopped, tell them to reapply the pressure for two further periods of 10 minutes
Once the bleeding has stopped and with the casualty still leaning forwards, clean around their nose with lukewarm water
Advise the casualty to rest quietly for a few hours. Tell them to avoid exertion and in particular, not to blow their nose, because these actions will disturb any clots.

Caution

Do not let the head tip back; blood may run down the throat inducing vomiting
If bleeding stops and then restarts, tell the casualty to reapply pressure
If the nosebleed is severe, or if it lasts longer than 30 minutes in total, take or send the casualty to hospital in the treatment position.