A lot of us have experienced or known someone with nose bleeds (epistaxis). Nose bleeds are usually a benign problem, but they can also be life-threatening. It is very common in the young (less than ten years) and also the old (more than fifty years).

The causes of epistaxis could be local or systemic.

They may be as a result of a local problem like chronic sinusitis, rhinitis, trauma, cocaine use, cigarette smoke, prolonged use of medications like topical steroids, foreign bodies, and trauma. Frequent sneezing and cough could bring on or exacerbate nasal bleeds.

Systemic causes include a high blood pressure, medications like blood thinners, aspirin, NSAIDs (e.g. Advil or Ibuprofen), liver disease, platelet dysfunction, and hemophilia.

Epistaxis could also be an Anterior or posterior bleed

Anterior bleeds are usually obvious with the patient actively bleeding from one or both nostrils

Posterior bleeds may be less obvious (but more dangerous). However, large posterior bleeds may be massive and sudden.

Acute Treatment

For anterior bleeds, apply direct pressure on anterior nares for between 5 – 20 minutes, the patient should sit with the head leaning forward. If unsuccessful, or if profuse bleeding head to the ER.

For posterior bleeds, a patient can only be managed at the ER.