Nosebleed First Aid and Prevention

What do I do during a nosebleed?

1. Sit up and lean forward

   Stay calm and sit up, keeping your head higher than your heart. Lean forward so the blood runs out the front of your nose rather than down your throat. Spit out any blood.

2. Gently blow out any clots

   Clots can keep the bleeding going. Then spray 2 sprays of a decongestant spray such as Afrin (oxymetazoline) into the bleeding nostril, if you have one, holding the bottle upright (upside down, it sprays far more). If you had nose or sinus surgery in the past week, do not blow your nose: follow your recovery guide instead.

3. Pinch the soft part of your nose

   Use your thumb and index finger to pinch the whole soft part of the nose shut, below the hard, bony bridge. Breathe through your mouth.

4. Hold for 10 to 15 minutes

   Hold steady pressure for 10 to 15 minutes by the clock. Do not let go to check whether it has stopped: that can start the bleeding again.

5. Do not pack your nose

   Do not stuff cotton, tissue or gauze into your nose. It can irritate the lining and restart the bleeding when it comes out.

6. Still bleeding? Repeat once

   Repeat these steps and hold pressure for another 10 to 15 minutes. If it is still bleeding after that, call us or go to the ER.

Heart disease or a past stroke? Ask your doctor ahead of time whether Afrin is right for you. Pinching alone still works.

What should I do after it stops?

• For the next 24 hours, avoid blowing your nose, bending over, heavy lifting and straining, which can dislodge the clot.
• Start the prevention steps below to help keep it from happening again.

How can I prevent nosebleeds?

Most nosebleeds start in the front of the nose, where the lining is thin and dries out easily. A moist nose bleeds less.

• Saline spray: use nasal saline spray in both nostrils every 3 to 4 hours while you are awake.
• Nasal gel: with a cotton swab, apply a saline nasal gel (such as Ayr Saline Nasal Gel) just inside each nostril every morning and evening. Do not go deep.
• Humidifier: run one by your bed at night, especially in dry weather. Keep the room between 30% and 50% humidity (an inexpensive hygrometer from a hardware store shows it), fill it with distilled water, empty and refill it every day, and clean it every 3 days or as the maker directs.
• CPAP or oxygen: use the humidifier on your machine.
• No picking or rubbing, and no forceful nose blowing. For children, keep fingernails short.
• Pain relievers: ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin can make bleeding more likely, so avoid them unless a doctor prescribed them. Acetaminophen (Tylenol) does not.

Blood thinners: if you take aspirin or another blood thinner a doctor prescribed and your nose bleeds often, check promptly with the doctor who prescribed it. Do not stop it on your own: these medicines usually treat or prevent serious problems. If a nosebleed is severe, do not take your next dose until you have been seen, and get seen right away.

What if we sealed a blood vessel?

If we treated your nosebleed by sealing (cauterizing) a blood vessel in the office, let the area heal:

• For at least 1 week, avoid nose blowing, strenuous activity and heavy lifting, and do not put cotton or tissue in your nose.
• Use saline gel or spray 1 to 3 times a day to keep the area moist.

When should I see an ENT?

See us if you have nosebleeds more than once a week, if they are hard to stop, if they keep coming from the same side, or if you take a blood thinner and have nosebleeds. Also tell us if you bruise or bleed easily, or if frequent nosebleeds run in your family, so we can check for a bleeding problem or an inherited cause. We can find where the bleeding starts and treat it, for example by sealing a fragile blood vessel in the office. Our article on how to stop a nosebleed covers common causes and what an ENT visit involves.

When should I call?