Acute Epistaxis: A Comprehensive Overview in the Acute Care Setting

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Delivery Method:	Online
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Publication Date: June 2024 (Volume 21, Number 6)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 06/01/2027.

Authors

Peer Reviewers

Abstract

Epistaxis is a common problem in pediatric patients. Most cases are benign in nature and resolve with minimal intervention. However, there are many unusual conditions that present with epistaxis that can be very serious and should be promptly investigated and treated. This review aids in the distinction between the benign causes of epistaxis and those that are more serious and require further evaluation. The various etiologies of epistaxis are discussed, and recommendations for general and scenario-specific management of pediatric patients with epistaxis are provided.

Case Presentations

A mother brings her 2-year-old boy to the ED for profuse nose bleeding...

• The boy has no history of bleeding disorders or reported trauma. According to the mother, the nosebleed “came out of nowhere.”
• On examination, you note some bilateral periorbital bruising. The child is otherwise active and healthy.
• What are your first steps, and what are you thinking about as you formulate a differential diagnosis?

A 3-year-old boy who repeatedly presents with nosebleeds returns to the ED...

• On this occasion, he looks very pale. According to his mother, he has been bleeding off and on for the last 24 hours. He is not currently bleeding.
• What are the main concerns on your differential diagnosis and how should you evaluate this patient?

A 15-year-old boy with a large amount of bleeding from his nose is brought into the ED via EMS…

• The boy has been applying pressure as directed by EMS, but the bleeding has continued. Additionally, he states that this has been going on for the past year, and generally he is able to control it.
• What concerning diagnosis must be considered and how should you assess for this diagnosis? Since pressure has been ineffective, what should you do to stop his bleeding?

A 4-year-old girl is brought to the ED with frequent episodes of nosebleeds over the past 6 months...

• The mother states that she is concerned about how often it is happening. The girl is otherwise healthy and has never had any other issues with prolonged bleeding. According to the mother, the girl has seasonal allergies.
• What diagnosis is most likely? What should you recommend to manage this issue?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.