What is a nose bleed?

A nose bleed is when blood flows from one or both nostrils. It's normally caused by the tiny blood vessels inside the nostrils being ruptured.

Common causes of nose bleeds include a blow to the nose, sneezing, picking or blowing the nose, and high blood pressure.

Most nose bleeds are minor and only last a few minutes, but they can be dangerous if someone loses a lot of blood or if they have frequently nose bleeds.

If someone has had a blow to the head, the blood may appear thin and watery. This could mean that their skull is fractured and fluid is leaking from around the brain. If that happens, it is very serious and you should call 999 or 112 for emergency medical help. See advice for head injuries.

If someone is having a nose bleed, your priority is to control the bleeding and keep their airway open. To stop a nose bleed:

• Get them to sit down (not lie down) as keeping the nose above the heart will reduce bleeding.

• Get them to lean forward (not backwards), to make sure the blood drains out through their nose, rather than down their throat which could block their airway.
  

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• Ask them to breathe through their mouth and pinch the soft part of the nose, taking a brief pause every ten minutes, until the bleeding has stopped.

• Encourage them not to speak, swallow, cough, spit or sniff because this may break blood clots that may have started to form in the nose.

• If the bleeding is severe, or if it lasts more than 30 minutes, call 999 or 112 for medical help.

Notera: these hints are no substitute for thorough knowledge of first aid. St John Ambulance holds first aid courses throughout the country.

When you go and see your local doctor about a nosebleed, they will ask you questions about the bleeds, such as how often they occur and how long they last? Do both nostrils bleed or does it tend to be one side? They will try to discover what might have caused the bleeding. They will ask about what medicines you take, if any, and any family history of bleeding disorders. Then they will examine the inside of your nose and take your blood pressure. A high blood pressure can cause nose bleeds.

Sometimes the GP may be able to see a bleeding point (a small blood vessel) in the nostril and cauterise it. This might be with electrocautery or silver nitrate. This can be quite uncomfortable to tolerate and similar results are obtained using a cream called Naseptin® for a few days. If they cannot stop the bleeding they will pack the nose with soft dressing material. This applies pressure to the small blood vessels and stops the bleeding.

• Try to avoid picking your nose and keep your fingernails short.

• Blow your nose less often and do so gently.

• Don't allow your nostrils to become dry. If you feel the skin is dry, you can help by applying a small amount of petroleum jelly.

• If you use a nasal decongestant, follow the instructions carefully. Overusing them can cause nosebleeds.

Adapted from the St John Ambulance leaflet: nose bleeds. Copyright for this leaflet is with St John Ambulance.