The association between hypertension and epistaxis is probably a myth. Although hypertension is common when patients present with acute bleeding the incidence of undiagnosed hypertension found on follow up is no higher than would be expected in the general population.


  • Initial assessment - First Aid

    • Maintain a calm attitude around the patient - but protect yourself (gloves, gown and goggles - the 3Gs).

    • Resuscitate the patient (if necessary) - remember the ABCD(E) of resuscitation.

    • Take a quick history:

      • Which nostril is bleeding? Is there blood the pharynx?

      • How much blood loss has there been? Are there symptoms of hypovolaemia?

      • Is the bleeding recurrent? What measures have been tried before?

      • Past medical history (e.g. recent trauma) and current medication (especially aspirin or warfarin).

    • Get the patient to sit upright, leaning slightly forward; and to squeeze the bottom part of the nose (NOT the bridge of the nose) for 10-20 minutes to try and stop the bleeding . Patient should breathe through the mouth and spit out any blood/saliva into a bowl. An ice pack on the bridge of the nose may help.

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