Epistaxis, the medical term for a nosebleed, is a common occurrence involving bleeding from the delicate blood vessels lining the nasal passages. While most nosebleeds are minor and resolve quickly, persistent or recurrent bleeding may require cauterization. Cauterization is a precise medical treatment performed by a physician that seals the bleeding vessel to stop the flow of blood. This procedure should never be attempted by the general public using improvised methods.
Proper First Aid for Nosebleeds
The immediate action during an active nosebleed is to apply direct pressure and maintain proper positioning. First, sit upright and lean the head slightly forward to prevent blood from draining backward into the throat and stomach. Swallowing blood can cause nausea or vomiting, which may restart the bleeding due to strain.
Next, use the thumb and forefinger to firmly pinch the soft part of the nose below the bony bridge. This manual compression applies pressure directly to the nasal septum, where most nosebleeds originate in a densely vascularized spot known as Kiesselbach’s plexus. Breathing should be done through the mouth while maintaining this firm, constant pressure.
Hold the pressure continuously for a minimum of 10 to 15 minutes without releasing it to check if the bleeding has stopped. Disrupting the pressure prematurely can dislodge any forming blood clot, leading to the resumption of bleeding and prolonging the episode. Applying a cold compress or ice pack to the bridge of the nose may also help constrict the blood vessels.
After the pressure is released, gently rest quietly for a few hours. To prevent re-bleeding, avoid activities that increase blood pressure in the head, such as bending over, heavy lifting, or strenuous exercise for the rest of the day. Also avoid blowing or picking the nose for at least 24 hours, as this can easily disturb the fragile clot and cause the nosebleed to recur.
The Clinical Procedure of Cauterization
Medical cauterization is a targeted intervention performed by healthcare professionals, often an Ear, Nose, and Throat (ENT) specialist, to permanently seal the problematic blood vessel. The procedure begins with applying a topical anesthetic, such as lidocaine, often combined with a vasoconstrictor to numb the nasal lining and temporarily reduce blood flow. The physician then uses a nasal speculum and a light source to accurately identify the small vessel responsible for the bleeding.
One common method is chemical cautery, which uses an applicator stick tipped with silver nitrate. The silver nitrate is applied directly to the bleeding site for a few seconds, creating a controlled chemical burn. This process causes protein denaturation and coagulation in the tissue, effectively sealing the vessel and forming a protective scab, or eschar, over the site.
A second technique, known as electrocautery, is used for more severe or persistent bleeding, or when chemical cautery is insufficient. This method uses a fine electrical probe to deliver a low-level current, which generates heat to burn the blood vessel closed. Electrocautery is a more intense procedure and is sometimes performed under anesthesia or sedation, particularly if the bleeding source is deeper within the nasal cavity.
Following cauterization, patients may experience mild nasal pain or a stinging sensation that typically subsides within a few hours and can be managed with over-the-counter pain relievers. Patients are advised to gently apply a moisturizing agent, such as petroleum jelly, to the treated area for one to two weeks to promote healing. They must also avoid activities that could raise blood pressure or cause trauma to the nose, such as strenuous activity or nose-blowing, for approximately one week to ensure the site heals completely.
Indicators for Medical Intervention
While most nosebleeds stop with proper first aid, certain circumstances require professional medical assessment, which may lead to cauterization or other treatments. Seek immediate medical attention if the bleeding continues for longer than 20 minutes despite correctly applying firm, continuous pressure. This prolonged duration suggests a more serious or posterior bleeding site that home care cannot manage.
Frequent nosebleeds, such as multiple episodes per week, also warrant a doctor’s visit to investigate underlying causes and determine if a visible vessel needs to be sealed. A professional evaluation is necessary if the amount of blood loss is significant, or if the nosebleed is accompanied by symptoms like dizziness, weakness, or paleness.
If a nosebleed occurs following a facial or head injury, or if the patient is currently taking anticoagulant medications, seek immediate medical care. Anticoagulants, or blood thinners, make it more difficult for the body to form a clot. A physician may need to adjust the medication or use specialized packing materials to stop the bleeding effectively, ensuring any underlying condition contributing to the bleeding is identified and properly addressed.