Management of Epistaxis in the Urgent Care Setting

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Publication Date: November 2024 (Volume 3, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 11/01/2027.

Author

Peer Reviewer

Abstract

Epistaxis, or bleeding from the nose, is a common presentation in the urgent care setting, and it can be distressing for patients. Although most cases resolve without complicated intervention, patients may seek medical care if bleeding is severe, refractory, or recurrent. Unusual conditions that present with epistaxis can be serious; therefore, the urgent care clinician should be familiar with the wide differential diagnosis to aid in distinguishing between the benign causes of epistaxis and those that require referral to the emergency department. This review discusses the various etiologies of epistaxis, along with evaluation and management recommendations for patients with epistaxis.

Case Presentations

A 75-year-old man  who has a history of recurrent pulmonary emboli and is currently taking warfarin presents with significant bleeding from the left nostril…

• The patient states the bleeding started spontaneously earlier in the day as he was watching television. He denies any history of recurrent nosebleeds.
• He states he has not put anything in his nose such as nasal sprays, saline rinses, or his fingers. He denies any recent trauma or injury.
• It is currently summer.
• He has not missed any doses of his medications and has not been on any new medications recently. He denies any new changes to his diet.
• He attempted to hold pressure on his nose at home, which did not abate the bleeding.
• He denies light headedness or dizziness.
• You wonder if this patient should be referred to the ED…

A 9-year-old girl presents to urgent care with her mother due to recurrent nosebleeds...

• The patient’s mother states the patient has had nosebleeds several times lately. The bleeding today was concerning to the patient’s mother because this was the sixth nosebleed the patient has had in the past 2 weeks.
• The patient is typically able to resolve the bleeding on her own by holding pressure.
• The patient does not have a history of recurrent nosebleeds or any recent trauma.
• Should this patient be seen by an otolaryngologist?

A 1-year-old infant presents to urgent care with his mother due to a nosebleed this morning…

• The patient’s mother states the patient sometimes has nosebleeds that typically self-resolve.
• The mother attributes the previous nosebleeds to dry air in the home, and she has been running a humidifier.
• The patient’s mother states today the patient accidentally rolled off the couch and then started to bleed from his nose. He did not have any loss of consciousness and cried immediately.
• The patient appears irritable.
• What additional history and physical examination findings should you be looking for?

Accreditation:

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