First-Line Management of Epistaxis Due to Viral URTI

Initial Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends firm sustained compression to the lower third of the nose for 5 minutes or longer, with the head slightly tilted forward, as the first-line management for epistaxis due to viral Upper Respiratory Tract Infection (URTI) 1, 2
Patients with epistaxis due to viral URTI should be instructed to breathe through the mouth and spit out any blood rather than swallowing it 2
Compression alone is sufficient to stop bleeding in most cases of epistaxis related to viral URTI 2

If bleeding persists after initial compression, a topical vasoconstrictor such as oxymetazoline or phenylephrine may be applied, which resolves 65-75% of nosebleeds 3, 1
Targeted treatment with nasal cautery may be considered if the bleeding site is visible and accessible 3

Once bleeding has stopped, moisturizing or lubricating agents such as petroleum jelly should be applied to prevent recurrences 3, 2
Saline nasal sprays are recommended to keep the nasal mucosa humid 2
The use of a humidifier, especially in dry environments, may also be considered 2

Viral URTIs cause inflammation and dryness of the nasal mucosa, making it more susceptible to bleeding 4
The anterior nasal septum (Kiesselbach's plexus) is the most common site of bleeding in URTI-related epistaxis 3
Nasal compression works by applying direct pressure to the bleeding vessels, allowing clot formation 1

Patients should avoid nasal picking, forceful nose blowing, and strenuous activity for 24 hours after the bleeding stops 5
Medications that may increase bleeding risk, such as aspirin and ibuprofen, should be avoided; acetaminophen can be used instead 5

If bleeding does not stop after 15 minutes of continuous pressure 2
If bleeding is severe (duration >30 minutes in a 24-hour period) 2
If the patient experiences dizziness, indicating significant blood loss 2
If there are signs of hemodynamic instability such as tachycardia or hypotension 1

Insufficient compression time: Compression should be maintained for at least 5 minutes without checking if bleeding has stopped 1
Neglecting prevention: Failure to address the underlying dryness of nasal mucosa can lead to recurrent episodes 2
Overuse of vasoconstrictors: Prolonged use of topical decongestants can lead to rebound congestion and worsen symptoms 3