8
Treatment
Table 3. Summary of Evidence-Based Statements
Statement Action Grade
1: Prompt
management
At the time of initial contact, the clinician
should distinguish the nosebleed patient
who requires prompt management from
the patient who does not.
Recommendation
2: Nasal
compression
e clinician should treat active
bleeding for patients in need of prompt
management with firm sustained
compression to the lower third of the
nose, with or without the assistance of
the patient or caregiver, for five minutes
or longer.
Recommendation
3a: Nasal packing For patients in whom bleeding precludes
identification of a bleeding site despite
nasal compression, the clinician should
treat ongoing active bleeding with nasal
packing.
Recommendation
3b: Nasal packing
in patients
with suspected
increased
bleeding risk
e clinician should use resorbable
packing for patients with a suspected
bleeding disorder or for patients who
are using anticoagulation or antiplatelet
medications.
Recommendation
4: Nasal packing
education
e clinician should educate the patient
who undergoes nasal packing about the
type of packing placed, timing of and plan
for removal of packing (if not resorbable),
postprocedure care, and any signs or
symptoms that would warrant prompt
reassessment.
Recommendation
5: Risk factors e clinician should document factors
that increase the frequency or severity of
bleeding for any patient with a nosebleed,
including personal or family history of
bleeding disorders, use of anticoagulant
or antiplatelet medications, or intranasal
drug use.
Recommendation
6: Anterior
rhinoscopy to
identify location
of bleeding
e clinician should perform anterior
rhinoscopy to identify a source of
bleeding aer removal of any blood clot
(if present) for patients with nosebleeds.
Recommendation
7a: Examination
using nasal
endoscopy
e clinician should perform, or should
refer to a clinician who can perform,
nasal endoscopy to identify the site of
bleeding and guide further management
in patients with recurrent nasal bleeding,
despite prior treatment with packing or
cautery, or with recurrent unilateral nasal
bleeding.
Recommendation
