Management of Nasal Epistaxis

Initial Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends first-line treatment should focus on direct nasal compression for 10-15 minutes while sitting upright with the head slightly tilted forward, followed by application of topical vasoconstrictors if bleeding persists 1, 2
Position the patient sitting upright with head slightly tilted forward to prevent blood from entering the airway or stomach 2
Apply firm sustained compression to the lower third (soft part) of the nose for at least 10-15 minutes without checking if bleeding has stopped 3, 2

Apply a topical vasoconstrictor such as oxymetazoline or phenylephrine spray (2 sprays in the bleeding nostril) 3, 2
This approach resolves 65-75% of epistaxis cases that don't stop with compression alone 2

No need to discontinue or adjust psychiatric medications for an isolated epistaxis episode 4
First-line treatments should be initiated before considering any medication adjustments 4, 3

Once bleeding has stopped, apply hydrating or lubricating agents such as petroleum jelly to prevent recurrence 3, 2
Recommend regular use of saline nasal sprays to keep the nasal mucosa moist 3

If bleeding does not stop after 15 minutes of continuous pressure 3
If the patient experiences dizziness due to blood loss 3
If bleeding is severe (duration >30 minutes over a 24-hour period) 3
If the patient shows signs of hemodynamic instability such as tachycardia or hypotension 2

If epistaxis persists despite initial measures, evaluation by an ENT specialist may be necessary 3
Options such as nasal cauterization, nasal packing, or in severe cases, arterial ligation may be considered 3, 2
Nasal endoscopy may be performed to examine the nasal cavity and nasopharynx when bleeding is difficult to control 2