You finish an extraction, and the socket starts bleeding excessively. What is the first thing you should do?

The first and most important step in managing post-extraction bleeding is to apply direct pressure using folded gauze placed over the socket and having the patient bite down firmly for 20-30 minutes. This achieves hemostasis through pressure and clot formation. If bleeding continues, adjunctive measures include local anesthetic with vasoconstrictor (epinephrine), placement of resorbable hemostatic agents (such as oxidized cellulose, gelatin sponge, or collagen), suturing of the socket, or topical thrombin. Gelfoam alone without pressure is not the first step.