Objective: To describe and to argue protocol of emergencies attendance for topographical diagnosis and severe carried through endoscopic surgical treatment in patients with epistaxis. Material and methods: Between March of 2004 to February of 2012, 59 patients with epistaxis had been treated severe endoscopicaly. The patients were submitted the endoscopic examination for the topographical diagnosis and then established the cauterization of the hemorrhagic point or tie of the arteries esfenopalatine and/or ethmoidal previous. In the cases suspicious the complementation was carried through computerized tomography. The patients had been operated by endoscopic technique with optics of 30 and 45 degrees and adequate material. Results: Of the total, 36 cases were related the nasal-sinusal postoperative complication, 20 spontaneous cases and 3 of epistaxis related the nasal-sinusal tumors. In 49,1% of the cases epistaxis was identified posterior and was necessary the tie of the esfenopalatine artery and the branches. In 8,4% of the cases the hemorrhagic point in the body or tail of cornet was visualized inferiorly demanding cauterization in 5 patients. Still, in 3,3% of the cases if it identified posterior bleed in septum demanding cauterization in 2 patients. In 17% of the cases epistaxis was identified superior and was necessary the tie of previous the ethmoidal artery. In 22% of the cases the focus of epistaxis was not identified necessarily and thus was proceeded tie from the arteries esfenopalatine and ethmoidal previous. No patient generally presented new episode of epistaxis in the postoperative one receiving high hospital between 8 to 48 hours. Conclusion: The endoscopy demonstrated to be a useful tool in the topographical diagnosis and the endoscopic surgical techniques had been safe and efficient in the treatment of epistaxis severe.