For anterior epistaxis, which initial management step is recommended?

• A. Cauterization
• B. Epinephrine-saturated gauze
• C. Elevating the head
• D. Apply pressure for up to 10 minutes

Answer: (D)

Direct nasal compression is the first step because most anterior nosebleeds stop with mechanical tamponade of the bleeding vessels in the front part of the nasal septum. Pinch the soft part of the nostril and hold for about 10 minutes without releasing, while the patient leans forward to prevent blood from running into the throat. This simple technique often controls the bleed without needing invasive measures. If bleeding persists after 10 minutes of continuous pressure, then consider additional steps such as topical vasoconstrictors or cautery if a visible source is identified, or anterior nasal packing. Elevating the head isn’t the preferred initial move since it doesn’t assist with stopping the bleed and can increase swallowing blood.