Nosebleed is the most common ENT emergency. It represents 23% of complaints at our emergency department. In most cases it is benign and easy to manage, but in some circumstances, nosebleed may be challenging and could end in death. The management of challenging epistaxis depends on the equipment we dispose and the team training level. In this presentation we review the most important reflexes doctors must acquire in order to assure the hemodynamic stability of patients, stop the bleeding, and later on, find its aetiology.