When is a Bloody Nose an Emergency?

Bloody noses are common and caused by a variety of factors including dehydration, dry air, sinusitis, allergies, blood thinning medications, and trauma. More often than not a combination of these factors is to blame. For example, you'll be more likely to get a bloody nose after accidentally bumping it if you're already dehydrated or suffering from sinus problems. At any rate, we all get bloody noses from time to time but when does a simple bloody nose become a full-blown emergency?

For most healthy individuals you should be able to stop a bloody nose at home in about twenty minutes or less. Leaning forward and gently pinching your nostrils together should do the trick. If you have a bleeding disorder it may take longer. You should talk to your doctor about methods and wait times when it comes to bloody noses if you're on blood thinning medications or have a condition such as hemophilia.

Too much blood loss can make a bloody nose an emergency. Medical professionals will often say that 5 milliliters of blood looks like 30! It's true, if you're judging by the amount of blood on your shirt, it may look like you need a transfusion when you've really lost no more than a few tablespoons. If you're gushing blood, however, you need to call 911.

The best thing to do when you get a bloody nose is to lean forward and gently pinch your nostrils together with a clean tissue. This facilitates clotting. If it's still dripping, however, grab a container to catch the blood. If possible this container should be a measuring cup. This allows you to accurately describe your blood loss to medical personnel. Blood loss will be of most concern if you have a history of blood diseases such as anemia, hemophilia, or if you have been taking medications that thin the blood such as aspirin, Coumadin (warfarin), or Lovenox. So how much blood is acceptable to lose? That depends on your overall health and whether you're having symptoms of anemia. It's best to consult your doctor with a good idea of how much blood you've actually lost.

Symptoms of too much blood loss (anemia) include:

• fatigue
• feeling dizzy or light-headed
• pale skin color
• confusion
• rapid heartbeat
• chest pain

If you have experienced any of the symptoms above, you should call 911, go to the emergency department or consult your doctor immediately.

Trauma, especially a blow to the head, can make a bloody nose an emergency. We've all been bumped in the nose, or fallen down and gotten a minor bloody nose, but that's not what I'm talking about. If you've fallen down the stairs, collided with another individual, been in a skiing accident, fight, or other traumatic incident that has resulted in a bloody nose, you could have a very serious medical emergency on your hands. What starts out as a bloody nose, with a little bit of time and swelling, may soon make it almost impossible to breathe. That's not even to mention possible fractures (ie. broken noses), concussions or spinal cord injuries. Just do yourself a favor and get some emergency medical care.

A bloody nose becomes an emergency when it is caused by high blood pressure. In this case the nosebleed will come on seemingly spontaneously. If this occurs, especially if you have a history of high blood pressure, or if the bloody nose is accompanied by a pounding headache or mental confusion, contact your doctor. 

Bloody noses towards the front of the nose are usually less severe and can be stopped with pressure. However if you can taste blood, you likely have a posterior bleed (located towards the back of the nose). These bleeds tend to be more severe and cannot be stopped by pinching your nostrils. These tend to be related to major blood vessels, so you should go to the emergency department immediately.