96 194 Definition Bleeding from the nose mostly caused by dryness and picking (also known as nosebleed). It also can be caused by trauma to the nose or head, a vascular disorder, spontaneous erup- tion, oral infection, medications, high altitudes, hypertension, illicit drug use (particularly snorting), or occupational exposure, such as to chromium. Characteristics Either profuse bleeding from the nose or slight visible bleeding however, blood might flow backward into the nasopharynx. Policy Minor nosebleeds can be treated on-site however, evaluate the employee in the occupa- tional health unit. Objectives Clinical Assessments and Interventions Referral for Medical Action Epistaxis ● Persistent bleeding for 15 minutes or more. ● Repeated episodes of bleeding. ● Bleeding caused by an injury. ● Need for nasopharyngeal packing to stop bleeding. ● Hypotension from epistaxis. Follow-up Actions ● Re-examine employee the follow- ing day for other nasal abnor- malities. ● Advise employee to lubricate nasal system (for anterior nose- bleed), to avoid aspirin and NSAIDs (for recurrent symptoms), and to increase humidity at home if air is dry. ● For recurrent symptoms in office workers, assess air quality, includ- ing humidity. ● For recurrent symptoms, consult Material Safety Data Sheets for chemical exposures and safe han- dling practices. Stop bleeding. Determine extent and severity of problem. Teach employee self-care measures. ● Keep employee in sitting position with head leaning slightly forward. If signs of shock, position recumbent. ● Apply pressure to the soft tissue of the nose for 5–15 minutes until the bleeding stops. ● Apply ice pack or cold compress to the bridge of the nose. ● If skull fracture is suspected, do not attempt to stop bleeding. ● Check blood pressure and pulse. ● Determine history of repeated episodes, hypertension, and occupational association with nosebleed. ● Observe standard/universal precautions (see page 21). ● Advise to avoid blowing nose for 2 hours after bleeding and to sneeze with mouth open. ● Advise to gently apply a small amount of topical antibiotic ointment per standing order to affected nostril (with top of finger) to keep nasal mucosa and healing scab soft and for infection prevention. ● Advise not to tilt head back (to avoid blood trickling down back of throat) and to spit or cough out any blood. ● Advise to use humidifier at night in the bedroom to counteract drying effects. ● Advise to stop smoking. Guideline continues on next page