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Assessment of patient with epistaxis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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assessment of patients with epistaxis

Stabilise the patient (including control of significant bleeding and airway patency) before obtaining the history (1).

Patients should be assured that most nose bleeds are not life threatening and a thorough history should be taken which should include:

  • initial onset, duration, frequency, and severity of epistaxis
  • how are nose bleeds controlled?
  • whether
    • blood is running out of the nose, usually from one nostril - anterior bleeding
    • blood running into the throat or from both nostrils - suggests posterior bleeding
  • history of recent trauma (e.g. - nose picking) or nasal surgery
  • past medical history including any conditions predisposing to bleeding
    • especially hypertension and coagulopathies in the patient or their family
  • current medication - aspirin, clopidogrel or warfarin, any homeopathic medicines
  • symptoms and signs of anaemia - in patients with heavy and prolonged bleeding
  • presence of
    • unilateral (or at least asymmetric) symptoms like nasal obstruction, headache, rhinorrhea, facial pain, anosmia - consider juvenile nasopharyngeal angiofibroma
      • these are rare benign tumours that tend to bleed
      • occur in the nasopharynx of prepubertal and adolescent males (1)

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