Massive epistaxis: what to do

Nosebleeds start when small blood vessels inside the nose are irritated or injured. Dry air, nose picking, forceful blowing, allergies, a cold or sinus inflammation can contribute. Some medicines and high blood pressure may also affect bleeding and should be discussed with a clinician.

Blood flowing into the throat, repeated swallowing, weakness or light-headedness can happen with a heavy bleed. A nosebleed itself does not identify one particular cause, so the amount, duration, medicines and other symptoms matter.

Sit upright and lean forward, breathing through your mouth. Pinch the soft part of the nose continuously with thumb and finger, without checking repeatedly. Spit out blood rather than swallowing it. Do not lie flat, tilt your head back, blow your nose or put tissues deep inside it.

If bleeding is heavy, continues despite firm pressure, follows an injury, or you feel faint, seek emergency care. Once it stops, avoid picking or forceful blowing and arrange advice about possible triggers such as [Allergic Rhinitis](/conditions/allergic-rhinitis/) or [Sinusitis](/conditions/sinusitis/).

Call emergency services for collapse, breathing difficulty, confusion, severe weakness or bleeding that is difficult to control. Get urgent assessment if you take blood-thinning medicine, have a bleeding disorder, or the nosebleed began after a significant blow.

A clinician may need to examine the inside of the nose, review medicines and check blood pressure. Recurrent bleeding should be assessed even when each episode settles; a [Common Cold](/conditions/common-cold/) or [Hypertension](/conditions/hypertension/) may be relevant.

Ask: Where is the bleeding likely to come from? Could a medicine, dry air or nasal condition be contributing? How should I manage another episode? Do I need an examination or blood tests?