Points to note on the history

  • Any history of trauma
  • Timing of onset, duration and side of bleed
  • Is it continuing to bleed
  • Any blood being swallowed, or sensation of blood in the pharynx
  • Previous episodes
  • PMHx e.g. previous nasal surgery, hypertension, sinusitis
  • Recent URTI/rhinitis, TB, sarcoid, wegeners', nose picking, septal defects
  • Drug history e.g. antihypertensives, steroid nose drops/sprays, aspirin / warfarin
    • cocaine, sympathomimetic nose drops, xylometazoline, ephedrine

Points to note on examination

  • Any airway compromise?
  • Pulse, BP, capillary refill
  • Side of bleed
  • Presence of obvious bleeding point in Littles' area
  • Blood in oropharynx/ blood being coughed up or fresh haematemesis
  • Epistaxis can be life threatening
  • All patients must have baseline observations carried out
  • Rapid primary survey then more detailed history and examination
  • Patients should be  and be reassessed regularly


To examine the nose, if there is clot blocking your view, ask the patient to gently blow the nose, one nostril at a time to clear it. Then, gently, elevate the tip of the nose with one finger, whilst shining a torch into the nasal antrum. This should allow a view of Littles' area. Thudicums may be used, and are available in nasal packing packs, or ENT emergency packs.

Any septal deviation should be noted, as well as bony deformity on external inspection (especially in the case of traumatic epistaxis).

The oropharynx should be visualised with a tongue depressor and torch.

General advice


Correct Epistaxis Instructions
Other than in the above cases, the first line treatment of epistaxis is conservative. Instruct the patient to squeeze hard over Littles' area with one hand, whilst putting an ice pack on to their forehead. Instruct them to remain like that for at least 20 minutes, without releasing pressure to see if the bleeding has stopped.

To stop epistaxis

Further management

If you are successful in stopping bleeding

Content by Dr Íomhar O' Sullivan 02/02/204. Reviewed by Dr ÍOS 15/05/2005, 29/07/2007, 20/07/2008.Last review Dr ÍOS 14/02/14.