Management

• Stabilize patients using the ABCDE approach, including:

  • Immediate hemodynamic support for hemorrhagic shock

• Keep the patient's head elevated and tilted forward.

• Control bleeding by applying uninterrupted, bilateral pressure.

  • Pinch the nasal ala against the nasal septum for 15–20 minutes.

• For anterior epistaxis with the bleeding site identified, consider:

  • Topical vasoconstrictors (e.g., oxymetazoline, phenylephrine)

  • Nasal cautery

• If bleeding persists or the bleeding site cannot be identified, place nasal packing.

• For refractory or recurrent bleeding, consider arterial embolization or endoscopic ligation of the bleeding vessel, i.e.:

  • Anterior ethmoidal artery for anterior epistaxis

  • Sphenopalatine artery for posterior epistaxis

In rare cases, retained nasal packing can cause toxic shock syndrome.