{"id":3912,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/epistaxis\/"},"modified":"2026-09-04T15:10:27","modified_gmt":"2026-09-04T14:10:27","slug":"epistaxis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/nose\/epistaxis\/","title":{"rendered":"Epistaxis"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Assessment<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Duration, predisposing factors, history of injury<\/li>\n\n\n\n<li>Determine whether bleeding is unilateral or bilateral<\/li>\n\n\n\n<li>Determine whether bleeding is anterior or posterior<\/li>\n\n\n\n<li><strong>Medications<\/strong>\u00a0\u2013 NSAIDS, aspirin, Warfarin or DOACs<\/li>\n\n\n\n<li><strong>Past medical history<\/strong>\u00a0\u2013 coagulopathy, platelet disorder or hypertension. If suspecting blood dyscrasia<\/li>\n\n\n\n<li>Thorough history (including bruising, bleeding)<\/li>\n\n\n\n<li>Family history of bleeding disorder.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Examination<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>BP, pulse if active bleeding<\/li>\n\n\n\n<li>Anterior rhinoscopy \u2013 ?bleeding point, visible vessels in Little\u2019s area, crusting, septal perforation, mass present<\/li>\n\n\n\n<li>Posterior epistaxis indicated by failure to visualise an anterior source, haemorrhage from both sides or oro-pharyngeal blood.\u00a0\u00a0<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Investigation<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If significant blood loss or recurrent episodes check FBC<\/li>\n\n\n\n<li>If on anticoagulants or suspect coagulopathy check clotting, renal and liver function.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Sinonasal neoplasm is very rare but can present with unilateral persistent epistaxis. Red flags to be aware of include facial pain\/swelling, otalgia, unilateral nasal obstruction, reduced sense of smell, visual and dental symptoms \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/nose\/rhinosinusitis-adult\/\" target=\"_blank\" rel=\"noopener\">Rhinosinusitis (Adult) \u2013 RefHelp<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.M &#8211; 4-9-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\"><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Adult ENT services are sited in Lauriston Buildings and St John\u2019s Hospital.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>Emergency referral to A&amp;E:<br><\/strong>If episode of epistaxis not controlled with first aid measures and still bleeding after 20 minutes compression, especially if cardiovascularly unstable transfer to A+E who will refer to ENT if necessary.<\/mark><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>ENT referral:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recurrent epistaxis not improved with primary care management refer to adult service for routine review. Consider withholding any anticoagulants.<\/li>\n\n\n\n<li>If recurrent epistaxis resulting in significant drop in Hb or has history of haematological problem (low platelets\/abnormal clotting) refer as urgent for review in Outpatients.<\/li>\n\n\n\n<li>If epistaxis is unilateral and associated with lesion visualised in anterior nose or significant pain\/obstruction refer as urgent for review in Outpatients.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>First aid advice for patients &#8211;<\/u><\/strong> <a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/ears-nose-and-throat\/nosebleed\" target=\"_blank\" rel=\"noopener\">Nosebleed | NHS inform<\/a><strong>:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sit patient down<\/li>\n\n\n\n<li>Lean patient forward<\/li>\n\n\n\n<li>Pinch the lower part of the nose between the thumb and forefinger<\/li>\n\n\n\n<li>Pinch nose for 10 minutes<\/li>\n\n\n\n<li>Do not release the pressure.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Primary care options:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Neomycin \/ chlorhexidine ointment twice daily\u00a0for 2 weeks (NOT SUITABLE FOR PEANUT ALLERGY in which case Mupirocin is an option)<\/li>\n\n\n\n<li>Cautery using silver nitrate sticks if able to provide in community (avoid cautery bilaterally at same time; only undertake if the bleeding site is visible in Little\u2019s area; stage cautery one side and then the other 4-6 weeks later)<\/li>\n\n\n\n<li>If epistaxis recurs on stopping topical antibiotic ointments, try petroleum jelly prn.<\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Assessment Examination Investigation Sinonasal neoplasm is very rare but can present with unilateral persistent epistaxis. Red flags to be aware of include facial pain\/swelling, otalgia, unilateral nasal obstruction, reduced sense of smell, visual and dental symptoms &ndash; see Rhinosinusitis (Adult) &ndash; RefHelp. C.M &ndash; 4-9-26<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4183,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[151],"class_list":["post-3912","page","type-page","status-publish","hentry","category-epistaxis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entadult\/nose\/epistaxis\/\" rel=\"tag\">Epistaxis<\/a>","rttpg_excerpt":"Assessment Examination Investigation Sinonasal neoplasm is very rare but can present with unilateral persistent epistaxis. Red flags to be aware of include facial pain\/swelling, otalgia, unilateral nasal obstruction, reduced sense of smell, visual and dental symptoms &ndash; see Rhinosinusitis (Adult) &ndash; RefHelp. C.M &ndash; 4-9-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3912","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3912"}],"version-history":[{"count":1,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3912\/revisions"}],"predecessor-version":[{"id":29852,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3912\/revisions\/29852"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4183"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3912"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}