A nosebleed (epistaxis) may cause a loss of blood sufficient to result in shock.

The blood seen flowing from the nose may not be a true indication of the amount of bleeding that is occurring since most of the blood may flow into the throat and be swallowed. Sometimes the blood can block the casualty’s airway or be aspirated.

a. Causes of Epistaxis. A nosebleed can be caused by a blow to the face or head (possible skull fracture), infection such as sinusitis, high blood pressure, digital trauma to the nasal airway, and certain diseases.

b. Treating Epistaxis. A nosebleed can be controlled using the following procedures.

(1) Position the casualty in a sitting position with his head tilted forward. This position helps the blood to drain through the nose rather than entering the throat.

(2) Apply pressure to the nostrils. Pressure can be applied by pinching the nostrils together. Pressure can also be applied by placing a rolled piece of gauze bandage between the upper lip and gum; then pressing the bandage against the nasal region with the fingers.

(3) Apply an ice pack or ice wrapped in material to the nose. The local cooling will help to control the bleeding.

(4) Keep the casualty calm and quiet. Anxiety may cause an increase in blood pressure that may cause an increase in bleeding.

c. Monitoring the Casualty. If bleeding cannot be stopped or if the bleeding reoccurs, a more serious injury (such as posterior pharyngeal bleeding) may be present. Evacuate the casualty to a medical treatment facility. Treat the casualty for hypovolemic shock if needed and provide oxygen if available.