Following head injury with nose and ear bleed, what is the most appropriate immediate action?

• A. Pinch the nostrils closed to stop bleeding
• B. Cover ear and nose with loose gauze pad
• C. Insert a nasal airway
• D. Apply pressure to ears

Answer: (B)

When there’s head trauma with bleeding from the nose and ears, basilar skull fracture must be considered. The safest immediate action is to place loose gauze over the nose and ears to absorb blood without occluding passages or applying direct pressure to delicate areas. This protects the airway and avoids pushing any blood or potential CSF deeper or into the skull. Do not pack the nose or ears, do not insert a nasal airway, and avoid pressing on the ears. Pinching the nostrils tightly isn’t recommended because it can drive blood toward the throat and doesn’t address the underlying risk of skull fracture.