Pediatric emergency medicine trisk 0572 0572
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Epistaxis
i
Rapid screen for severe blood
loss, altered vital signs
Unstable
Stable
i
When stable
Complete history,
physical examination
Yes
Nasal findings?
lNo
Elevated blood pressure?
i
i
i
Yes
i
1. Stabilize patient.
2. ENT Consult.
3. Initiate hematologic workup.
Tumor
Telangiectasia
Polyps
Furuncle
Foreign body
Bacterial rhinitis/sinusitis
Rhinitis sicca
Local trauma/irritation
No
t
Flypertension
Suspicion of occult nasal lesion or hemorrhagic diathesis,
and/or severe epistaxis, frequent recurrence by history ?
i
i
Yes
No
i
1. ENT Consult
2. CBC, PT, PTT von Willebrand screen
Laboratory evidence of
hematologic disorder ?
jNo
Yes
i
Minor trauma and/or local
inflammation
Hemophilias, leukemia,
aplastic anemia, ITP,
or other bleeding disorder
Nasal lesion
Mild hemorrhagic disease
(von Willebrand disease,
primary platelet disorders),
or other systemic disease
FIGURE 26.1 Approach to diagnosis of epistaxis. ENT, ear, nose, and throat specialists; ORL,
otorhinolaryngology; CBC, complete blood count; PT, prothrombin time; PTT, partial
thromboplastin time; ITP, idiopathic thrombocytopenic purpura.
All patients discharged from the emergency department (ED) after evaluation
for significant epistaxis should be given specific instructions on nares
