The EM Educator Series: Nosebleed that won’t stop

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Cases:

#1: A 26-year-old female presents in winter with a nosebleed. She appears well and is currently pinching her nose with a napkin. Her VS are normal.

#2: A 74-year-old male presents with a nosebleed. He has been bleeding profusely for 2 hours and has been unable to stop the bleeding.  He takes warfarin for atrial fibrillation and is also on aspirin for heart disease. He is tachycardic but is hypertensive.

Considerations:

1. What’s the difference between anterior vs posterior epistaxis?
2. Who’s at risk?
3. What’s a stepwise approach to control?
4. Who can help the Emergency Physician?
5. What’s the disposition, and what about follow-up?
6. Myths/controversies: Does hypertension cause epistaxis? Are prophylactic antibiotics needed for packing?

From Dr. Katy Hanson at Hanson’s Anatomy:

Suggested Resources:

• Articles:
  • LITFL – Epistaxis
  • Emergency Medicine Updates – Management of Epistaxis
  • emDOCs – The Emergency Department Management of Posterior Epistaxis
  • EM Lyceum – Epistaxis
  • E.B.E.L. EM – Do Patients with Epistaxis Managed by Nasal Packing Require Prophylactic Antibiotics?
  • E.B.E.L. EM – Do Patients with Posterior Epistaxis Managed by Posterior Packs Require ICU Admission?
  • CORE EM – Topic TXA in Epistaxis
  • E.B.E.L. EM – Topical TXA in Epistaxis

• Podcast:
  • CORE EM – Epistaxis