What are the initial steps in managing a patient with a first episode of epistaxis in primary care?

Initial steps in managing a first episode of epistaxis in primary care:

• Advise the patient to sit with their upper body tilted forward and mouth open to avoid swallowing blood and reduce aspiration risk.
• Instruct them to firmly pinch the cartilaginous (soft) part of the nose for 10–15 minutes continuously without releasing pressure, while breathing through the mouth.
• Avoid lying down unless feeling faint.
• Observe the patient for 15 minutes to ensure bleeding is controlled.
• Advise the patient to avoid blowing or picking the nose, heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot drinks for 24 hours after the episode to prevent re-bleeding.
• Do not routinely pack the affected nostril in primary care unless bleeding persists and appropriate expertise and facilities are available.
• If bleeding continues or the bleeding point cannot be identified, consider nasal packing only if trained and equipped, using topical local anaesthetic with vasoconstrictor prior to packing.
• Offer topical antiseptic treatment such as Naseptin® cream (chlorhexidine and neomycin) applied four times daily for 10 days to reduce crusting and vestibulitis, unless allergic to neomycin, peanut, or soya.
• Assess for any underlying causes, especially in children under 2 years or if recurrent episodes occur, and consider referral to ENT or paediatric specialists if serious underlying pathology is suspected.
• Provide written information on epistaxis self-care and first aid.

These steps aim to control acute bleeding safely, prevent recurrence, and identify any underlying causes requiring specialist input.

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