Epistaxis (Nosebleed)

Also: nosebleed · nasal bleeding

Epistaxis (nosebleed) is common and usually self-limiting, but can occasionally be severe. Severity scoring and a stepwise approach guide first aid, cautery, packing and escalation.

The relevant tools and pathways are gathered here.

Calculators & scores

EpiScore for Epistaxis Severity

Epistaxis
Epistaxis Severity Score (ESS)

Epistaxis

Decision pathways

Epistaxis Management

ENT-UK / NICE

Drugs

Adrenaline (ICU — Vasopressor/Inotrope)

Catecholamine Vasopressor/Inotrope
Tranexamic Acid (ICU/Trauma/Surgical)

Antifibrinolytic
Mepivacaine with adrenaline

Amide LA + vasoconstrictor
Bupivacaine with adrenaline

Long-acting amide LA + vasoconstrictor
Adrenaline with articaine hydrochloride

Local anaesthetic with vasoconstrictor
Adrenaline (Epinephrine)

Vasopressor
Tranexamic Acid (TXA)

Antifibrinolytic
Adrenaline (Anaphylaxis Protocol)

Auto-injector / IM adrenaline for anaphylaxis
Lidocaine with adrenaline

Local anaesthetic + vasoconstrictor
Tranexamic Acid 500mg Tablets (Epistaxis)

Antifibrinolytic agent (haemostatic)
Naseptin Nasal Cream

Nasal Decolonisation / Recurrent Epistaxis
Tranexamic Acid

Antifibrinolytic

Decision support only. These tools are aggregated by topic to aid navigation — always apply clinical judgement and the relevant national or local guideline.