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  • The Review Course in Family Medicine

Stop the Flow - All You Need to Know to Manage Epistaxis in Your Practice

Epistaxis, commonly known as nosebleeds, can be a sudden and unsettling occurrence that requires prompt management. Here are five essential steps to effectively handle epistaxis in your practice.

1. Pressure, pressure, pressure! Always start with direct pressure to the nasal alae (lower third of nose) while tilting the head forward.

2. Next consider topical medications like oxymetazoline or Tranexamic acid (TXA) on a cotton pad to control the bleeding. If the source is visualized, use electro/chemical cautery but never bilaterally to avoid septal perforation.

3. Resorbable packing can be used in patients with bleeding disorders as they do not need removal, although if the bleeding is persistent, they may need tamponade with non-resorbable pack.

4. Use caution in anticoagulated patients because they are twice as likely to require admission for severe epistaxis.

5. Aftercare is key! Moisturizers, lubricants, and humidifiers are a nose’s best friend. Remind patients to avoid nose picking, heavy lifting and smoking to prevent rebleeding.

By following these recommended strategies, you can confidently address epistaxis in your practice, providing effective care and guidance to patients while minimizing the risk of complications.


Anterior Epistaxis

Ameen Biadsee, Alan Gob and Leigh Sowerby

CMAJ October 03, 2022 194 (38) E1322; DOI:



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