Severe Epistaxis

Overview

A practical and academic approach to severe epistaxis during an ENT shift. A nosebleed is not always “just a bleeding nose.” It may be an anterior septal bleed, a posterior arterial bleed, an anticoagulated patient, facial trauma, a vascular lesion, HHT, or the first sign of hemodynamic collapse. The on-call principle is simple: do not stare into a nose full of clots. Stabilize the patient, sit them forward, apply correct pressure, use topical vasoconstriction, suction and dry the field, identify the bleeding point if possible, then escalate in a structured sequence: cautery, anterior packing, posterior...