Resuscitation and First Aid Measures

Assessment of a patient with a history of bleeding, even if it appears to have stopped, must start with an initial ABC assessment concentrating on the airway and haemodynamic status.

If the patient is still actively bleeding and there is evidence of haemodynamic compromise, then both resuscitative and first aid measures should be started immediately.

First aid to stem nasal bleeding

  1. Lean the patient forward in an upright position to avoid the passage of blood into the nasopharynx. Encourage the patient to spit out any blood passing into the throat and not swallow it.
  2. Ask the patient to firmly pinch the soft part of the nose, compressing the nostrils for at least 10 minutes. If unable to comply, an
    alternative technique is to ask a relative or staff member to apply an external pressure device such as a swimmers nose clip. [14]
  3. Application of ice to the neck or forehead has not been shown to influence nasal blood flow [15]. However, sucking on an ice cube has been shown to reduce nasal blood flow [15] and applying an ice pack directly to the nose may help.

Treat epistaxis as a circulatory emergency depending on the severity especially in the elderly, patients with clotting disorders or bleeding tendency and those on anticoagulants. Always insert at least a green IV cannula and to make sure to send the FBC, U&Es, clotting and group and save (depending on blood loss) in these patients. Also try to allocate them in majors or area where they are closely observed as some times dislodgement of blood clot could lead to a catastrophic bleed in these patients.