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Last updated: 30 March, 2020 15:59pm

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Epistaxis (Nose Bleeds) – Information for GPs

Referral Criteria/Commissioning position

Refer to secondary care if:

  • primary care management has been unsuccessful in resolving the issue

Red flag symptoms

  • Prolonged (>20 minutes) and/or severe acute bleeding with no response to usual measures, such as local pressure and cooling
  • Discharge of large or multiple clots
  • Sickness with or without haematemesis
  • Systemic / cardio-vascular compromise
  • Signs for a possible underlying clotting problem
  • Long standing intermittent bloody discharge for no apparent reason: adults – suspect malignancy, children or other potentially vulnerable patients – suspect foreign body
  • Unusual presentation in children under the age of two years

Investigations prior to referral

Usually none needed, consider FBC and clotting before a referral

Information to include in referral letter

The GP referral letter should contain:

  • Duration and possible patterns
  • Details of treatments and measures tried including outcomes (e.g. nasal cautery)
  • Investigations so far (if any)
  • Blood pressure measurement
  • Relevant past medical/surgical history including occupational history and possible risk factors in adults (smoking, sniffing etc.)
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient information leaflets

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