When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Epistaxis

Last reviewed: 29 Jun 2025
Last updated: 26 May 2021

Summary

Definition

History and exam

Key diagnostic factors

  • blood at both sides of nose
Full details

Other diagnostic factors

  • bleeding starting at the nares
  • recurrent epistaxis
  • septal deviation
  • tachycardia
  • bleeding starting in the throat
  • hypotension
  • syncope
  • dizziness or lightheadedness
  • pallor
  • hypoesthesia and pain in the distribution of the second branch of the trigeminal nerve
Full details

Risk factors

  • dry weather and low humidity
  • prior nasal or sinus surgery
  • nasal cannula oxygen or continuous positive airways pressure (CPAP)
  • nasal and other facial fracture
  • other nasal trauma
  • topical nasal drugs
  • primary coagulopathy (e.g., hemophilia)
  • medication (e.g., aspirin, anticoagulant, antiplatelet, nonsteroidal anti-inflammatory drugs)
  • familial hereditary hemorrhagic telangiectasia
  • juvenile nasal angiofibroma
  • chronic kidney or liver disease
  • septal deviation
  • nasal foreign body
  • environmental irritants
  • barotrauma
  • ulceration secondary to infection (e.g., herpes zoster, or bacterial infection)
  • forceful coughing
  • sinonasal neoplasm
  • chronic granulomatous disease
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • CBC
  • coagulation studies (prothrombin time, activated partial thromboplastin time, platelet function tests)
  • BUN, serum creatinine
  • LFTs
  • autoimmune screen/autoantibodies
  • CT scan of paranasal sinuses
  • MRI of head
  • internal and external carotid angiography
  • nasal endoscopy and nasopharyngoscopy
  • plain nasal or sinus x-ray
Full details

Treatment algorithm

INITIAL

active epistaxis: initial measures

ACUTE

active epistaxis: persistent bleeding precluding identification of bleeding site

active epistaxis: bleeding site visible

ONGOING

quiescent but recurrent epistaxis

Contributors

Authors

Darren Pinder, BSc(Hons), MB BChir, MSc(Med Ed), FRCS(ORL)

Consultant ENT Surgeon

Royal United Hospital Bath NHS Trust

Bath

UK

Disclosures

DP declares that he has no competing interests.

Peer reviewers

Ethan Cumbler, MD

Assistant Professor

Department of Internal Medicine

University of Colorado Health Sciences Center

Denver

CO

Disclosures

EC declares that he has no competing interests.

Samuel J. Stratton, MD, MPH

Professor

UCLA School of Public Health and David Geffen School of Medicine

Los Angeles

Medical Director

Health Disaster Management/Emergency Medical Services

Orange County Health Care Agency

Santa Ana

CA

Divulgaciones

SJS declares that he has no competing interests.

Janet Wilson, BSc, MD, FRCSEd, FRCSEng

Professor of Otolaryngology - Head and Neck Surgery

Newcastle University

Honorary Consultant Otolaryngologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Divulgaciones

JW declares that she has no competing interests.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Tan L, Calhoun K. Epistaxis. Med Clin North Am. 1999 Jan;83(1):43-56. Resumen

Perretta L, Denslow B, Brown C. Emergency evaluation and management of epistaxis. Emerg Med Clin North Am. 1987 May;5(2):265-77. Resumen

Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-28.

Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-61.

Santos P, Lepore M. Epistaxis. In: Bailey B, Healy G, Johnson J, et al., eds. Head & neck surgery-otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 2001:415-428.

Massick D, Tobin E. Epistaxis. In: Cummings C, Flint P, Harker L, et al., eds. Otolaryngology-head and neck surgery. Philadelphia: Elsevier Mosby; 2005:942-961.

Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(1 suppl):S1-S38.Texto completo  Resumen

Pond F, Sizeland A. Epistaxis: strategies for management. Aust Fam Physician. 2000 Oct;29(10):933-8. Resumen

Randall DA. Epistaxis packing. Practical pointers for nosebleed control. Postgrad Med. 2006 Jun-Jul;119(1):77-82. Resumen

Ruddy J, Proops DW, Pearman K, et al. Management of epistaxis in children. Int J Paediatr Otorhinolaryngol. 1991 Apr;21(2):139-42. Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Epistaxis images
  • Diferenciales

    • Hemoptysis
    • Hematemesis
    Más Diferenciales
  • Guías de práctica clínica

    • Clinical practice guideline: nosebleed (epistaxis)
    • Clinical guideline: epistaxis
    Más Guías de práctica clínica
  • Folletos para el paciente

    Nosebleeds in children

    Nosebleeds (epistaxis) in adults

    Más Folletos para el paciente
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Insertion of an anterior nasal pack

    Más vídeos
  • padlock-lockedInicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad