The history can provide valuable insight as to the location of the epistaxis. Questions that are important to ask include:
• Which side is bleeding?
• Do you have a sensation of blood in back of throat?
• Do you have a history of previous epistaxis, trauma, head/neck tumor, radiation therapy, or head/neck surgery?
• Is there a family history of bleeding disorders?
• Are you using anticoagulants, aspirin, or NSAIDs?
Typically, with anterior epistaxis, the bleeding is unilateral and the patient will not report the sensation of blood in the posterior oropharynx.
In anterior epistaxis one can often visualize the area of bleeding. However, proper lighting and suction are essential. Adequate lighting is best achieved by the use of an ENT head lamp or with a head mirror. Universal precautions must be observed by the examiner and the patient's clothing should be protected with a gown. The patient should be seated in a chair leaning forward with the head inclined anteriorly. This helps to visualize the nasal cavity, minimizes backward blood flow, and decreases gagging.1 The assessment of the patient must include a complete set of vital signs, as well as a thorough exam of the oropharynx and nasopharynx. Additionally, a general physical overview is necessary to evaluate for signs of systemic coagulopathy.
Laboratory investigation is not routinely required. Exceptions to this are in the patient with multiple or prolonged episodes of hemorrhage when there is a clinical suspicion of coexisting anemia or if coagulopathy is suggested by either the history or physical exam.
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