1 Direct compression of the nasal alae (lower third of the nose) with the head tilted forward will stop many bleeds
Epistaxis is the primary reason for 1 in 313 ED visits. (1) Correct application of pressure is the only intervention required in about 20% of cases. (2)
2 Topical medications and cautery can control anterior nasal bleeding that cannot be resolved with direct compression
Topical medications (such as oxymetazoline, tranexamic acid or lidocaine with epinephrine on a cotton pad) can help control bleeding. (3) Once a source of bleeding is visualized, it can be cauterized using chemical (silver nitrate) or electrical cautery. Bilateral cauterization of the septum can cause septal perforation and should be avoided.
3 Resorbable packing or tamponade may be necessary in about one-fifth of cases
Around 20% of epistaxis cases that...