Contributor:  Dylan Luyten, MD Educational Pearls: Clear the nasal passages - have the patient, if stable, blow their nose to dislodge any clot that might be in the way Searching for the source of bleeding can be tough. Majority of anterior bleeding is from Kesselbach’s plexus Placing a clamp to provide direct pressure is a mainstay of treatment Application of a topical agent, which may include lidocaine epinephrine tetracaine (LET), tranexamic acid (TXA), or oxymetazoline Nasal packing with a nasal balloon or merocel may be necessary if bleeding persists Posterior epistaxis can be potentially devastating - for all practical purposes are epistaxis that does not resolve with anterior packing Interventional radiology can be a helpful consultant for controlling of posterior epistaxis, and may be just as or more helpful than ENT   References Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(7):744-749. Shargorodsky J, Bleier B, Holbrook E, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-398. Singer A, Blanda M, Cronin K, et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med. 2005;45(2):134-139. Womack JP, Kropa J Jimenez Stabile M. Epistaxis: Outpatient Management. Am Fam Physician. 2018 Aug 15;98(4):240-245. Liu WH, Chen YH, Hsieh CT, Lin EY, Chung TT, Ju DT. Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature. Am J Emerg Med. 2008 May;26(4):516.e3-5. doi: 10.1016/j.ajem.2007.07.036. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD