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Step 1
Note the duration and side of the initial bleeding. When any significant bleeding has been controlled, inquire about previous episodes of epistaxis or prolonged bleeding after minor surgery. Recurring epistaxis should cause a nasal pathology to be suspected, even if the episodes were self-limiting.
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Step 2
Check for a history of easy bruising, hypertension or systemic diseases, especially those related to the liver. Document any use of medications that has epistaxis as a side effect, such as aspirin, dipyridamole, heparin, ticlopidine or warfarin.
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Step 3
Perform a thorough examination of the nasal cavity. The patient should blow their nose to remove clots. A vasoconstrictor should be applied so the source of the bleeding may be more easily pinpointed.
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Step 4
Insert a nasal speculum gently and spread the naris. This usually permits anterior sources of bleeding to be identified, although a posterior source is frequently more difficult to visualize.
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Step 5
Distinguish massive epistaxis from hematemesis or hemoptysis. Nosebleeds almost always originate from the anterior part of the nasal cavity, but blood dripping from the nasopharynx also will confirm that the blood is coming from a nasal source.
