Epistaxis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of nosebleeds

Onset was ‍spontaneoustraumatic, started ‍whileafter ‍

Frequency: ‍sporadicdailymultiple times a day

Volume of blood loss: ‍minimalmoderatelarge, approximately ‍ mL ‍per episodedailyoverall

Located on ‍right nostrilleft nostrilboth nostrils

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nasal congestion

‍nasal discharge, ‍clearcolored

‍facial pain

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍dizziness

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍fatigue

‍pallor

‍bruising

‍bleeding gums

‍hematuria

‍melena, ‍withwithout strong foul smell

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots



Contributing factors:

‍recent upper respiratory infection

‍inhaled drugs

no history of: ‍hypertension, ‍liver disease, ‍bleeding disorders

no use of: ‍anticoagulants, ‍antiplatelets, ‍nasal steroids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍





ASSESSMENT:

‍Epistaxis ‍likelysuspectedpossible

DDx: anterior epistaxis, posterior epistaxis, uncontrolled hypertension, nasal tumor, foreign body, trauma to the nose, medication side effect, nasal dryness, allergic rhinitis, chronic sinusitis, nasal polyps, deviated septum, liver disease, thrombocytopenia, cocaine use





PLAN:

Investigations:

- Blood work: ‍CBC, ‍INR, ‍PTT

- Nasal endoscopy

- CT scan of the sinuses

Treatments:

- ‍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

Further care:

- 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