How should epistaxis be managed in a wilderness setting?

• A. Have the patient lie flat and tilt their head back.
• B. Apply heat to the nose.
• C. Let the patient blow nose repeatedly.
• D. Have the patient lean forward, pinch the soft part of the nose for 10–15 minutes, apply gauze, check for nasal or facial injury, evacuate if bleeding persists or worsens.

Answer: (D)

In a wilderness setting, epistaxis is managed by stopping the bleed with direct, sustained pressure while protecting the airway and checking for injuries that may require evacuation. Have the patient lean forward slightly instead of lying flat or tilting the head back; this keeps blood from running into the throat and reduces the risk of choking or aspiration. Pinch the soft part of the nose—the lower, cartilaginous area—firmly and continuously for about 10 to 15 minutes to compress the bleeding vessels and allow a clot to form. A gauze pad can be held against the nose to absorb blood and help maintain pressure. Also look for nasal or facial injuries, since trauma can signal a more serious source of bleeding or fracture and may necessitate evacuation. If the bleeding continues after the full 10–15 minutes of sustained pressure, or if there are signs of lightheadedness, ongoing heavy bleeding, or airway concerns, evacuate promptly. Avoid blowing the nose, hot treatments, or repeatedly checking for bleed status during the interval, as these can disrupt clot formation.