Which action is the preferred treatment for a severe anterior epistaxis (nosebleed) in the field?

• A. Having the patient pinch his own nostrils and then lie supine.
• B. Packing both nostrils with gauze pads until the bleeding stops.
• C. Placing a rolled 4×4 dressing between the lower lip and gum.
• D. Pinching the patient's nostrils and having him lean forward.

Answer: (D)

Direct manual pressure on the soft part of the nose while the patient leans forward is the best in-field approach for a severe anterior nosebleed. Pressing firmly on the nostrils compresses the bleeding vessels at the front of the nose, and leaning forward prevents blood from running back into the throat, reducing the risk of choking or aspiration. Lying the patient flat can cause blood to pool in the airway, making things worse. Nasal packing or placing a dressing under the lip and gum doesn’t address the source of bleeding in the nose and is not the preferred first step in the field. If bleeding persists after several minutes of steady pressure, seek further care.