Dublin Coroner's Court has heard that a 34-year-old man died of blood loss due to a nosebleed described by a doctor as 'torrential’.
Joao Carlos Araujo from Elton Court in Leixlip, Co Kildare died at Connolly Hospital Blanchardstown in Dublin in July 2016.
"These are usually spontaneous, they just occur. There seems to be no real reason behind them," state pathologist Professor Marie Cassidy said of the fatal nosebleed.
Consultant in emergency medicine at Connolly Hospital Dr Niamh Collins said she had 'never seen anything this extreme’.
Mr Araujo, originally from Portugal, went to the emergency department twice on 6 July 2016, the day before his death.
Dublin Coroner's Court heard that he told staff he had heard a hissing sound in his right ear before the bleeding began.
Mr Araujo first arrived in the emergency department at Connolly Hospital at 9.10am.
He was discharged at midday after the bleeding stopped without intervention.
Mr Araujo returned to hospital at 12.50pm when he was spitting blood and doctors inserted a nasal pack to stop the bleeding.
Doctors contacted an ear, nose and throat specialist who advised that the nasal pack be left in place for between one and two hours with observation of the patient following removal of the pack.
The bleeding stopped and Mr Araujo was discharged with the advice that he should contact his GP or go to Beaumont Hospital if required.
Mr Araujo stayed at home overnight and the bleeding continued, according to his partner, Marcia Pereira.
"He was really tired, full of pain, unable to eat. He had a headache," she said.
Ms Pereira said her house was full of blood stains as the bleeding continued throughout the next day.
"There was drops of blood all over the house," she said.
At 6pm that evening she saw her partner collapse, with blood coming from his nose and mouth and she phoned an ambulance.
Mr Araujo was rushed to Connolly Hospital in cardiac arrest.
The emergency medical team battled to save his life for three hours.
"The bleeding was torrential, it was like turning on a tap, despite him being in cardiac arrest," Dr Collins said.
She said the team did everything possible to save him.
"Other than blocking his artery, I had exhausted everything I knew how to do. Everything we did as a team, did not work," she said.
The man was pronounced dead at 10pm.
"All of us involved found his case devastating... I have never witnessed anything this extreme," Dr Collins said.
An artery at the back of the nose was identified as the source of the bleeding.
Professor Cassidy gave the cause of death as hemorrhage and shock due to a nosebleed with obstruction to the airway due to blood as a contributory factor.
The pathologist said the only other fatal nosebleed she had dealt with during her career was forty years ago.
Coroner Dr Myra Cullinane returned a narrative verdict setting out the facts of the case.