## Management Algorithm for Anterior Epistaxis **Key Point:** Anterior epistaxis (80% of cases) from Little's area (Kiesselbach's triangle) is managed conservatively with topical measures before considering invasive interventions. **High-Yield:** The stepwise approach is: 1. First aid (head elevation, ice, pressure) — 10–15 minutes 2. Topical vasoconstrictor (epinephrine 1:10,000 or phenylephrine) + local anaesthetic (lignocaine 4%) — allows visualization and haemostasis 3. Anterior nasal packing (if bleeding persists after topical measures) 4. Posterior packing or endoscopic cautery (if anterior packing fails) 5. Angiographic embolization (last resort for recurrent/severe bleeding) **Clinical Pearl:** Little's area (junction of septal mucosa and cartilage) has rich vascular supply from branches of sphenopalatine artery; most anterior bleeds respond to topical measures and packing. **Mnemonic: STEP-A** — Sit upright, Topical vasoconstrictor, Examine (rhinoscopy), Pack (anterior), Assess (if fails → posterior pack/cautery/embolization). ### Why This Patient Needs Anterior Packing - Bleeding persists after first aid (45 minutes) - Identified source (Little's area) on rhinoscopy - No signs of posterior bleed (would have posterior pharyngeal bleeding on exam) - Topical measures + packing are standard of care before escalation **Warning:** Do NOT jump to imaging or embolization for uncomplicated anterior epistaxis — these are reserved for failed packing, recurrent bleeds, or posterior epistaxis. 
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