Epistaxis is the most common otolaryngologic emergency. Its severity may range from mild to life threatening. Management of acute epistaxis varies depending on its severity, etiology, and site of bleeding. Endoscopic control of epistaxis is considered a highly effective and cost-effective treatment. It is important for the surgeon to weigh the potential benefits and risks. Ligation and cauterization of the sphenopalatine artery and anterior and posterior ethmoidal arteries is discussed. A plan of action and control of catastrophic bleeding from the internal carotid artery or cavernous sinus are also discussed.