What are the recommended first-line management strategies for an adult patient experiencing an acute nosebleed?

First-line management strategies for an adult patient experiencing an acute nosebleed include:

• Advise the patient to sit with their upper body tilted forward and mouth open to avoid swallowing blood and reduce the risk of aspiration.
• Instruct the patient to firmly pinch the cartilaginous (soft) part of the nose and hold the pressure continuously for 10–15 minutes without releasing it, while breathing through the mouth.
• Avoid lying down unless the patient feels faint.
• Observe the patient for 15 minutes to ensure bleeding is controlled.
• Advise the patient to avoid blowing or picking the nose, heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot drinks for 24 hours after the episode to prevent re-bleeding.
• Do not routinely pack the affected nostril in primary care unless bleeding persists or the bleeding point cannot be identified and appropriate expertise and facilities are available.
• If nasal packing is necessary, anaesthetize the nasal cavity with a topical local anaesthetic spray with vasoconstrictor (e.g., lidocaine with phenylephrine) and use nasal tampons or inflatable packs according to manufacturer instructions, ensuring the patient is sitting with head tilted forward and breathing through the mouth.
• Offer written information on epistaxis to the patient.

These steps represent the recommended first-line management in primary care for acute epistaxis in adults.