“I keep getting nosebleeds — the latest one wouldn’t stop for ages, and I’m on blood thinners”

EPISTAXIS management starts with correct FIRST-AID: sit up and lean FORWARD (not back), pinch the SOFT part of the nose (not the bony bridge) firmly and continuously for 10–15 minutes without releasing to check, breathe through the mouth and spit out blood (don’t swallow), and a cold pack on the bridge of the nose may help — avoiding lying back, sniffing or blowing afterwards. Most nosebleeds are ANTERIOR (Little’s area) and benign (nose-picking, dryness, trauma, URTIs), but in an anticoagulated/antiplatelet patient REVIEW the anticoagulation (which drug, indication, DOAC dose against weight and renal function, interacting drugs, control — INR if on warfarin, balance of risks; BNF), without stopping it on impulse (a shared decision with the prescriber), and the HYPERTENSION (optimise per NICE NG136). Know the ESCALATION/admission criteria: bleeding not controlled by 10–15 minutes of correct pressure repeated once, heavy or POSTERIOR bleeding (blood pouring down the throat, no visible anterior source), haemodynamic compromise (dizziness, tachycardia, hypotension), or significant bleeding while anticoagulated — posterior/uncontrolled bleeds need ENT/emergency care (packing). In primary care, examine face to face (pulse, BP, anterior rhinoscopy) and treat an anterior bleeding point with topical antiseptic cream (e.g. Naseptin, dose per BNF) and/or, by a trained clinician, nasal CAUTERY (silver nitrate) of a visible vessel, and refer to ENT for recurrent/refractory epistaxis. Keep RED FLAGS in mind: persistent UNILATERAL nasal bleeding/obstruction or a nasal MASS (possible sinonasal tumour → ENT), and features of a bleeding disorder (FBC and clotting) or hereditary haemorrhagic telangiectasia (recurrent epistaxis, telangiectasia, family history; Curaçao criteria, international HHT guidelines 2020). Advise prevention (nasal humidification/saline/emollient, avoid picking/forceful blowing) and arrange anticoagulation/BP review. The skill is correct first-aid + anticoagulation/BP review + escalation criteria + red-flag awareness.