Much of the population has had some experience of minor epistaxis. More major bleeding, however, frequently precipitates attendance at the accident and emergency department, along with considerable anxiety on both the part of the patient, and sometimes the attending doctor. In this article, the relevant anatomy, classification, aetiology, treatment strategies and some notable predisposing causes are discussed, with the aim of dealing efficiently with the more trivial cases, while streamlining the treatment of more serious bleeds, which may in some cases be very brisk or fatal. It is the author's opinion that all too often, patients falling between these two extremes can experience prolonged hospital stays and uncomfortable and ineffective repeated nasal packing in the face of failure of simple anterior packing. The structured intervention ‘ladder’ presented in this article should help to reduce such occurrences.
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