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Nosebleeds (Epistaxis): Causes, Prevention, and When to Seek Care

Common Causes

  • Dry air (low humidity, indoor heating)
  • Nasal trauma (picking, blowing, foreign body)
  • Allergic/non‑allergic rhinitis (inflammation)
  • Topical nasal steroids (improper technique → septal irritation)
  • Anticoagulants/antiplatelets, NSAIDs
  • Hypertension (often incidental, not direct cause)
  • Hereditary hemorrhagic telangiectasia (HHT), coagulopathies

First Aid

  1. Sit upright, lean slightly forward.
  2. Pinch soft part of nose firmly for 10–15 min (no peeking).
  3. Apply ice to bridge of nose/neck.
  4. Avoid packing unless trained.

When to Seek Care

  • Bleeding >20 min despite compression.
  • Large volume, hemodynamic instability.
  • Recurrent episodes (>1/week).
  • On anticoagulants with INR >3 or DOACs.
  • Suspected posterior bleed (blood flowing down throat).

Prevention

  • Humidifier, nasal saline gel/spray.
  • Avoid picking, forceful blowing.
  • Optimize BP, review anticoagulants with prescriber.

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