Nose Bleeds:


Bleeding from the nose or EPISTAXIS occurs when blood vessels within the nostrils are injured (ruptured). They are very common in children and are usually mild and easily treated. However sometimes in older people or people with other medical problems such as blood disorders, bleeding can be severe. If bleeding is severe or mild bleeding does not stop within 20-30 minutes then get medical help quickly.



The common site for nosebleed is just inside the entrance of the nostril on the middle hard part of the nose (Nasal Septum). The blood vessels are quite fragile here and can rupture easily for no apparent reason. This area is most likely to bleed following:


  • Picking.
  • Blowing the nose.
  • Colds and blocked stuffy nose.
  • Minor injury to the nose.
  • Cocaine use.


In the above the bleeding tends to last only a short time and is usually easy to control. It can be made more difficult if the person has heart failure, a blood clotting disorder or is taking anticoagulants (blood thinning drugs) such as Warfarin or aspirin. Another underlying cause might well be high blood pressure.


Bleeding can occur further back in the nose and could be due to an uncommon disorder of the nose or serious injury.


Signs & Symptoms:

  • History of a blow, sneezing or picking.
  • After a blow to the face/nose blood may appear to be thin and watery. This may indicate a fracture.
  • Patient's visual appearance (holding nose or leaning back wards).




  • If the patient is feeling faint, sit them down, advise them to tilt head forward, allowing blood to drain from the nostrils.
  • Ask patient to breath through their mouth.
  • With a finger and thumb show them how to pinch the lower fleshy soft end of the nose for at least 10 minutes (it is useless to put pressure on the root of the nose or the nose bones).
  • If available a cold flannel or compress around the nose is helpful as the cold helps the blood vessels to constrict (close down) and stop bleeding.
  • Advise patient if possible not to speak, swallow, cough or spit.
  • Give patient a cloth or tissue to mop up any blood.
  • After 10 minutes ask patient to release the pressure. If bleeding has not stopped reapply pressure.
  • If bleeding has not stopped after 30 minutes, or the patient is taking ‘anti-coagulant' drugs i.e. Warfarin, take them to hospital.
  • Frequent nose bleeds requires a visit o their GP for further investigation.



  • Do not tilt the patient's head backwards; blood to the back of the throat may induce vomiting.
  • If the nosebleed last longer than 30 minutes take or send patient to hospital.


We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.


You might also be interested in our blog. In this particular post, Sheila Mithcard explains why being a paramedic is like being a detective inspector.


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