Which is the most appropriate next step for epistaxis not controlled at home with bilateral nasal ooze and septal ulcers?

• A. Nasal decongestant
• B. Oral tranexamic acid
• C. Nasal cauterization
• D. Nasal Packing

Answer: (D)

When epistaxis remains uncontrolled at home and there are bilateral nasal ooze with septal ulcers, the priority is to achieve rapid, definitive control of bleeding through mechanical tamponade. Nasal packing provides direct pressure on the bleeding mucosa, including ulcerated areas, to stop the bleed and stabilize clots. This approach works quickly and for diffuse anterior bleeding where there isn’t a single identifiable vessel to cauterize. Other options don’t offer immediate, widespread compression: decongestants rely on vasoconstriction but aren’t sufficient for active, ongoing bleeding; oral tranexamic acid can help reduce bleeding but does not stop the bleeding immediately; cauterization requires a visible, accessible source and is less effective when multiple ulcers are bleeding. After packing, arrange evaluation for underlying causes and plan for removal and potential posterior packing if bleeding recurs.