How should treatment proceed if direct pressure fails to control a nosebleed?

When direct pressure fails to control a nosebleed, the next appropriate step in management is the application of topical vasoconstrictors, such as oxymetazoline. This medication helps to constrict the blood vessels in the nasal mucosa, which can effectively reduce bleeding. It works quickly and can be administered directly in the form of a nasal spray or applied with a cotton ball to the affected area.

While nasal packing can also be a valid approach to managing bleeds that do not respond to direct pressure, the immediate application of a vasoconstrictor can often control the bleeding faster and be a simpler intervention before more invasive measures are needed. Cautery is typically reserved for cases of localized bleeding that can be visualized and accessed, and an emergency room referral may be necessary if bleeding continues despite these measures, but treating at the scene with oxymetazoline is a more immediate and practical option in many cases.