Immediate management of epistaxis: bloody nuisance or ominous sign?

Epistaxis typically originates from the nasal septum when the nasal mucosa overlying a dilated blood vessel is injured. Epistaxis may, however, signal an underlying condition such as a coagulation disorder, so the treating physician must be alert for signs of serious illness. Most nosebleeds stop spontaneously within 5 minutes with or without pressure to the forehead, nose, or upper lip. Some require anterior nasal packing. A few arise from posterior arteries and require anterior-posterior nasal packing and a referral.