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Emergency Department Discharge Instructions

Nose bleed

Emergency Care Discharge Instructions

Instruction summary

If you came to the ER with a nose bleed, one of several things may have occured in order to stop the bleeding:

  • A cotton gauze with medicine in it may have been put inside your nose.
  • A silver nitrate stick may have been used to burn or "cauterize" the bleeding blood vessel inside the nose.
  • A kind of gauze (also called “packing”) may have been pushed into your nose to both apply pressure and stop the bleeding.
If you don’t have packing in your nose

Try not to blow your nose. If you must, blow it very lightly (without force). To prevent more bleeding, put a humidifier in your room to moisten the air. You can also use a nasal decongestant spray (as directed on the bottle), which will cause the blood vessels in the nose to tighten up, allowing the overlying skin to heal over them.

However, if you do use a nasal decongestant spray, it is very important that you do not use it for more than three days. Using it for more than three days can result in a rebound effect, which causes more nosebleeds. These sprays can raise your blood pressure, so check with your doctor about using them if you have very severe high blood pressure.

Lastly, gently applying Vaseline or Polysporin inside the bleeding nostril (on the centre wall of the nostril, not the outer wall) may keep the area moist and help the area to heal.

If you have packing in your nose

You were likely also prescribed an antibiotic. Take the antibiotic as long as you have the packing inside your nose. Once your packing has been removed (usually in 2-3 days), you do not need to take the antibiotics anymore. See your family doctor in 2-3 days to remove the packing.

If your nose starts to bleed again without packing inside, lean forward (not back) and pinch your nose just below where the bony part ends for a full five minutes. If you are on a blood thinner like warfarin (which is the same thing as Coumadin), apixaban (same thing as Eliquis), dabigatran (same thing as Pradaxa), or rivaroxaban (same thing as Xarelto), pinch your nose for 10 minutes (use a clock to measure the time). Don’t "peek" before the time is up! If you are on aspirin or clopidogrel (Plavix), you may also take longer to stop bleeding.

If the blood goes down the back of your throat, don’t swallow it as this can make you feel sick. Spit it out instead.

Reasons to return to the ER
  1. If you are bleeding despite several attempts of applying pressure for a full five minutes (or 10 minutes if on one of the blood thinners listed above)
  2. If you are bleeding even though you have packing in your nose (bleeding around the packing)
  3. Feeling light headed when you stand up
  4. If you can feel the packing (ribbon gauze) down the back of your throat