Epistaxis

HISTORY:

Nosebleeds for ‍ ‍hoursdays

Onset: ‍spontaneoustraumatic, following ‍

Frequency: ‍sporadicdailymultiple times a day

Volume of blood loss: ‍minimalmoderatelarge, approximately ‍ ml ‍per episodeoverall

Location: ‍right nostrilleft nostrilboth nostrils

Treatments tried: ‍none, ‍effectiveineffective

‍nasal congestion

‍nasal discharge

‍fatigue

‍pallor

‍easy bruising

‍bleeding gums



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy



ASSESSMENT:

‍Epistaxis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍INR, ‍PTT

- Nasal endoscopy

- CT scan of the sinuses

- ‍Nasal packing

- ‍Topical vasoconstrictors

- ‍Topical hemostatic agents

- ‍Cauterization

- ‍Antibiotics if packing is used

- ‍Analgesics

- Petroleum jelly to nasal mucosa BID

- Keep ambiant humidity 50%

- Avoidance of nasal irritants

- Smoking cessation counseling

- Blood pressure management

- Referral to ENT specialist

- Follow-up in ‍ ‍daysweeks

- Return if epistaxis recurs, if unable to control bleeding, or if signs of significant blood loss develop