Epistaxis - persistent or recurrent


North South North West Statewide

Pre-referral work-up


All referrals should comply to the referral standards and include:

  • Trauma (including nose picking), recent nasal surgery
  • Anterior or posterior epistaxis on history
  • Coagulopathy, anticoagulants
  • Nasal obstruction, change in sense of smell, epiphora, diplopia
  • Bleeding stigmata over Little's Area/posterior pharyngeal wall/intranasal mass


  • FBE
  • Coagulation screen

Interim/GP management

To refer a patient with this condition, please see the ENT clinic page for the full referral process and templates.

  • Direct pressure to nostrils compressing Little's Area
  • Prescribe topical bactroban qds to Little's Area for anterior epistaxis
  • Silver nitrate (AgNO3) cautery following topical anaesthesia, if not resolving and clinician has previous experience

For more information please see the Tasmanian Health Pathways website.


Persistent bleeding despite first aid measures– refer immediately to ED

Urgent / category 1

Recurrent epistaxis with no overt cause but associated additional history and items italicised in Evaluation – Category 1 (contact ENT Registrar)

Semi-urgent / category 2

Recurrent epistaxis on background of nasal trauma

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.


Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 8302  Fax: (03) 6777 5201
MCH ED – Phone: 0409 867 492  Fax: (03) 6441 5923
NWRH ED – Phone: 0459 848 725  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6101  Fax: (03) 6173 0489


Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.


We will endeavour to see these patients within 12 weeks


Next available appointment