What is the FIRST step when managing a patient who is bleeding excessively after a dental extraction?

Correct answer: D. Press on the socket with a gauze pad

• A. Lab studies are useful for underlying coagulopathy workup but are not the first clinical action when a patient is bleeding.
• B. Tranexamic acid is a systemic antifibrinolytic used in patients with clotting disorders — not the first step in routine post-extraction bleeding.
• C. Hemostatic agents like gelatin sponge or oxidized cellulose are useful, but direct pressure with gauze is the initial first step before placing any material.
• D. The FIRST and simplest step for post-extraction bleeding is to apply direct pressure using a folded gauze pad placed over the socket and instruct the patient to bite firmly for 15–30 minutes. This achieves initial hemostasis in most cases. ✓