This chapter describes the evaluation and acute management of a patient with epistaxis, a common ENT emergency. The chapter contains a detailed description of the history that needs to be elicited in such patients. A detailed description of the assessment of a patient with acute epistaxis follows. The importance of general and local examination is highlighted. The common sites of epistaxis are described and amply illustrated with diagrams as well as clinical pictures. This chapter describes the role of rigid nasal endoscopy in both diagnosis and treatment (e.g. nasal cauterization). The method of immediate management of patients with epistaxis, whether active or inactive, is described in detail. Different types of anterior and posterior nasal packs are available and their relative advantages and disadvantages are described with illustrations. Advanced techniques to control intractable epistaxis are also described and illustrated. Boxes and tables on the differential diagnosis of causes for epistaxis, method of making a medicated nasal pack and history taking in these patients are provided. A flow chart on the immediate management of epistaxis is provided. Different clinical presentations of a patient with epistaxis, including patients with torrential or continuous, untreated epistaxis who present in shock, are described in this chapter. First-aid techniques to control active epistaxis are also described. There are four videos with links provided for this chapter that cover the following areas: correct manner of nasal packing, diagnostic endoscopy in a case of recurrent epistaxis, bipolar diathermy of the anterior ethmoidal artery intra-operatively and bipolar diathermy of bleeding sites in a case of postoperative epistaxis.