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em@3am

EM@3AM: Pediatric Epistaxis

A previously healthy 2-year-old boy presents with 3 days of recurrent nosebleeds. He had no adverse birth history and is up to date on his vaccinations. The patient’s mother denies any known trauma and the patient denies picking his nose. In addition, he has no fever, headaches, nausea, hematuria, dysuria, vision changes, or known toxic ingestions. The patient’s uncle previously had issues with bleeding after surgery. Physical exam is remarkable for ongoing epistaxis via bilateral nares. Initial laboratory results include white blood cell count 10,900/μL, hemoglobin 10.9 g/dL, platelet count 200 × 103/μL, APT 45.6s. What's the diagnosis, and what are your next steps in evaluation and management? 

em@3am

EM@3AM: Epistaxis

A 62-year-old male presents holding a bloody wash cloth pinched over his nose spitting blood into a coffee mug.  His wife walks in behind him with a grocery bag full of medications.  Among them you recognize a common blood thinner. What is the diagnosis, and what are your next steps?

practice updates

The Emergency Department Management of Posterior Epistaxis

On first glance, you observe active bleeding from the bilateral nares. Direct pressure has obtained hemostasis. What is your next step? Topical vasoconstrictors? Nasal packing? Can this patient go home, or does he need to be admitted? Let’s discuss a few key points about the management of posterior epistaxis.

practice updates

R.E.B.E.L. EM – Epistaxis Myths Part I – Do Patients with Epistaxis Managed by Nasal Packing Require Prophylactic Antibiotics?

Traditional teaching argues that patients with nasal packs should be given prophylactic antibiotics to prevent serious infectious complications. Is there evidence to support this dogma? Read this post as Dr. Swaminathan discusses the evidence to bust this myth.