• As in any patient who is hemorrhaging, assess
airway, breathing, and circulation first.
• Wear protective eyewear, gown, and gloves; maintain universal
• Once hemorrhage is controlled, instruct the patient against sneezing
or coughing with his or her mouth closed, bending over, straining,
or nose picking or blowing.
• Do not discharge a patient as soon as the bleeding stops; rather,
observe him or her for at least 30 minutes to ensure that the patient
is stable and the bleeding does not recur.
• Always look in the posterior oropharynx, behind the uvula, to
ensure that blood is not dripping down and being swallowed.
• Do not cauterize both sides of the septum. Loss of the perichondrial
layers on both sides of the septum can result in cartilage necrosis
and septal perforation.
• If a patient has recurrent epistaxis, consider a neoplastic process,
especially if bleeding always occurs on the same side.
• Always provide systemic antibiotic coverage against Staphylococcus species.