When should you call 111 for a nosebleed?

Nosebleeds, also known as epistaxis, are a common problem that most people will experience at some point in their lives. While nosebleeds are usually not serious, it’s important to know when a nosebleed requires prompt medical attention. Calling 111 for a nosebleed can help you access the NHS’s free urgent care helpline and get advice on whether you need to seek emergency treatment.

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What causes nosebleeds?

There are many possible causes of nosebleeds, including:

Dry air – Dry or cold air can dry out and irritate the nasal membranes, causing cracks and bleeding.
Nose picking – Picking your nose can damage the delicate blood vessels inside the nose and trigger bleeding.
Foreign objects – Objects stuck in the nose, like a piece of toy, can scratch the nasal lining and lead to nosebleeds.

Nasal sprays – Overuse of medicated nasal sprays can irritate the nasal lining and blood vessels.
Allergies – Allergic rhinitis causes inflammation in the nose which can make it more prone to bleeding.
High blood pressure – High blood pressure can make the nasal blood vessels more likely to bleed.

Medications – Blood thinners, aspirin, and nonsteroidal anti-inflammatory drugs can increase bleeding risk.
Nose trauma – Any trauma to the nose, like a sports injury, fall, or physical blow, may rupture nasal blood vessels.
Nose picking – Picking your nose can damage the delicate blood vessels and cause bleeding.

In some cases, frequent or severe recurring nosebleeds may be a sign of an underlying health condition requiring medical treatment, like:

Hypertension
Blood clotting disorders

Chronic sinusitis
Tumors
Vascular malformations

Consulting a doctor can help determine if an underlying condition is causing frequent or severe nosebleeds.

First aid for nosebleeds

When a nosebleed occurs, try these first aid measures while waiting for it to stop or deciding if medical attention is needed:

Sit upright and lean forward. This will keep blood from running down the back of your throat and choking you. Spit out any blood from your mouth.

Pinch your nose. Use your thumb and index finger to pinch the soft part of your nose shut just below the nasal bone. Hold for 5-10 minutes as this pressure can help stop bleeding.
Apply an ice pack. Applying an ice pack or cold compress to the bridge of the nose can constrict blood vessels and slow bleeding.
Don’t tilt your head back. This used to be standard advice but can actually cause blood to run down your throat instead of out the nostrils.

Don’t pick or blow your nose.This can disrupt clot formation and restart bleeding.
Loosen any tight clothing around your neck. Tight collars or ties can restrict blood flow and make bleeding worse.
Apply petroleum jelly. After bleeding stops, apply petroleum jelly or nasal saline gel inside your nostrils to keep them moist and prevent renewed bleeding.

If bleeding doesn’t stop after 20-30 minutes of these self-care measures, call 111 or seek medical help.

When should adults call 111 for a nosebleed?

Adults should call 111 if:

Bleeding doesn’t stop after 30 minutes of first aid treatment.

Bleeding is very heavy or uncontrollable.
You feel weak, dizzy or lightheaded – signs of blood loss.
You have swallowed a lot of blood and are vomiting blood or bleeding from the mouth.

You have nosebleeds frequently, especially if you don’t know the cause.
You have nosebleeds along with other unexplained symptoms like headaches, double vision.
You take medication that affects blood clotting, like warfarin, heparin, aspirin, or clopidogrel.

The nosebleed was caused by a head injury that may have fractured your nose or skull.

Calling 111 will connect you to a trained advisor who can assess your symptoms, provide self-care advice, and direct you to the most appropriate NHS treatment if needed. This could include an out-of-hours GP appointment, walk-in centre, urgent care centre or A&E.

When should you take a child to A&E for a nosebleed?

Take a child to A&E immediately if:

Bleeding doesn’t stop after 30 minutes of pinching the nose shut.
Your child feels faint, weak or dizzy.
Blood loss seems excessive.

Your child has swallowed a lot of blood and is vomiting.
Bleeding started after a head injury.
Your child has bleeding disorders.

Your child is under 2 years old – their smaller nasal passages can fill up quickly with blood.

Otherwise, call 111 or your GP for prompt advice. Seeking emergency care quickly is important, as young children can go into shock from blood loss faster than adults.

What to expect when you call 111 about a nosebleed

When you call 111 about a nosebleed, the advisor will ask questions to assess the severity of bleeding, including:

How long has the bleeding lasted?
How heavy is the bleeding – steady oozing or forceful, uncontrollable bleeding?
What color is the blood – bright red or dark colored?

Have you swallowed or vomited blood?
Do you feel faint or dizzy?
Is bleeding coming from one or both nostrils?

Have you injured your nose or head recently?
Do you take any blood-thinning medications?
Do you have any bleeding disorders or take anticoagulants?

How old are you?
Have you had frequent or severe nosebleeds before this incident?

Based on your answers, the 111 advisor will be able to judge whether it’s safe to manage the nosebleed at home with self-care or if you need to be seen urgently by a healthcare professional. Advisors can book appointments at urgent treatment centres, out-of-hours GP centres, or direct you to A&E if red flags like heavy bleeding, dizziness, or vomiting blood are present.

Nosebleed advice and treatment from 111

Based on your symptoms, 111 advisors may recommend:

Home treatment – Advice to pinch your nose, sit upright, apply ice packs and use nasal saline gel. Call back if bleeding continues beyond 30 minutes or worsens.
Pharmacy assistance – Local pharmacies can suggest nasal sprays, gels or other over-the-counter treatments to help stop bleeding.

See a GP today – For persistent minor nosebleeds, the GP can examine your nose, cauterize vessels and provide medication if needed.
Same day urgent care – For bleeding not stopping after 30 minutes, urgent care clinics can examine you quickly and cauterize the bleeding vessel.
A&E – Severe, heavy nosebleeds accompanied by dizziness or vomiting blood require emergency treatment to control bleeding and prevent shock from blood loss.

Follow any self-care, pharmacy or medical advice provided by the 111 advisor. Seek emergency care if bleeding becomes severe before other appointments.

What happens at A&E for a nosebleed?

At A&E, doctors can provide rapid treatment for severe nosebleeds that require emergency care. Treatment may involve:

Packing the nose – Absorbent dressings are packed tightly into the nasal cavity to apply pressure and stop bleeding.

Cauterization – The bleeding blood vessel is cauterized or “burned” with electric or chemical cautery to seal it shut.
Artery ligation – Tying off a severed artery that is uncontrollably bleeding inside the nose.
Blood transfusions – You may need IV fluids or a blood transfusion if blood loss is significant.

Surgery – Surgery to repair a nasal fracture or severely damaged blood vessel may be done along with cautery.
Medications – Estrogen creams, tranexamic acid or desmopressin can help reduce bleeding.

Most nosebleeds can be controlled in the emergency room with packing and cauterization. You may be admitted to hospital and monitored if bleeding was severe.

What are preventative treatments for frequent nosebleeds?

If you experience frequent or severe recurring nosebleeds with no obvious cause, your GP may recommend:

Cauterization – Burning the area that tends to bleed seals off the vessel.
Nasal moisturizing – Saline sprays and gels can prevent bleeding from dry nasal passages.

Medical treatments – Estrogen creams, tranexamic acid tablets or desmopressin sprays reduce bleeding.
Surgery – Tying off blood vessels, closing veins or grafting skin in the nose can stop chronic bleeding.
Blood tests – Test for bleeding disorders or problems with platelet function.

Preventing the common causes of nosebleeds like nose picking, dryness and trauma can also reduce frequency.

When to seek follow-up care after a nosebleed

You should call your GP or return to A&E if:

Bleeding restarts after being treated and stopped once initially.

You develop new symptoms like headaches, vision changes, weakness, seizures, or loss of consciousness.
Signs of infection appear, including increased pain, nasal discharge, fever.
You have nosebleeds very frequently with no obvious cause.

Other unexplained symptoms accompany your nosebleeds.

Reporting any worsening symptoms or bleeding can prompt your doctor to investigate for underlying medical conditions needing treatment.

Conclusion

Nosebleeds are common but can be scary when severe. Know when to use self-care, call 111 or seek emergency care. The 111 phone service can efficiently direct you to appropriate medical care based on your symptoms. Seek prompt care for heavy bleeding, bleeding exceeding 30 minutes, blood loss symptoms like dizziness, or vomiting blood. With appropriate treatment guided by calling 111, most nosebleeds can be well controlled.