Epistaxis, the medical term for a nosebleed, is a highly common occurrence. Most nosebleeds are considered anterior, meaning they originate from the front part of the nasal septum in an area called Kiesselbach’s plexus where several small blood vessels converge. These anterior bleeds are typically minor and often stop on their own. However, when bleeding is prolonged or recurrent, professional medical attention is required to identify and seal the source.
Immediate Action: Treating Nosebleeds at Home
The immediate goal for any active nosebleed is to stop the flow of blood and allow a clot to form. The correct first-aid protocol involves sitting upright and leaning the head slightly forward. This prevents blood from running down the throat, which can cause nausea or vomiting.
The person experiencing the bleed should use their thumb and index finger to firmly pinch the soft, cartilaginous part of the nose just above the nostrils. Apply continuous pressure for a minimum of five minutes; ten minutes is often recommended for effective clot formation. Breathing should occur through the mouth, and the pressure must remain uninterrupted.
Applying a cold compress or ice to the bridge of the nose may also help constrict the blood vessels, but this must be done while simultaneously maintaining firm pressure on the nose. After the initial pressure period, gently release the nose. If bleeding persists, reapply pressure for another ten minutes. If the nosebleed was caused by minor irritation, such as dry air, applying petroleum jelly inside the nostrils after the bleeding stops can help prevent recurrence.
Urgent Care’s Role in Nosebleed Treatment
Urgent care facilities manage most simple anterior nosebleeds that fail to stop with home treatment. The most common procedure is chemical cauterization, performed using a silver nitrate stick. This chemical agent is applied directly to the visualized bleeding vessel, causing a controlled burn that seals the blood vessel and promotes the formation of a protective scab.
Before the procedure, the healthcare provider will numb the inside of the nose with a topical anesthetic spray, often containing a vasoconstrictor to slow the bleeding. Chemical cauterization is effective for the small, superficial vessels found in Kiesselbach’s plexus. To prevent damage, providers only cauterize one side of the nasal septum during a single visit.
If the bleeding point cannot be identified, or if chemical cauterization fails, the next step is nasal packing. This involves inserting specialized gauze or a small balloon device into the nasal cavity to apply direct pressure to the bleeding site. Nasal packing is a temporary measure to control bleeding until the patient can receive further treatment. Urgent care centers do not utilize electrocautery, which uses heat via an electric current, as this equipment is reserved for hospital or Ear, Nose, and Throat (ENT) clinics.
When Advanced Care or Specialist Referral is Needed
Certain characteristics indicate the need for medical care beyond urgent care capabilities. A nosebleed that is heavy and cannot be stopped after 15 to 20 minutes of continuous pressure requires an Emergency Room (ER) visit. If the bleeding is profuse, or if the patient is swallowing blood that leads to vomiting, they should proceed directly to the ER.
Nosebleeds following significant facial trauma or a blow to the head must also be evaluated in an ER setting to rule out underlying fractures or severe injuries. Posterior nosebleeds originate from deeper vessels in the back of the nasal cavity. These less common bleeds present a greater risk, often manifesting as blood draining down the throat, and frequently require specialized hospital intervention because they are difficult to control.
Patients who experience recurrent nosebleeds should consult an otolaryngologist, or ENT specialist. A specialist can perform a detailed examination using an endoscope to investigate underlying causes, such as structural abnormalities, chronic inflammation, or a bleeding disorder. If initial cauterization or packing at urgent care fails, a referral to an ENT is the appropriate next step for advanced treatment, which may include electrocautery or surgical ligation of the blood vessel.