Algorithm for the diagnosis and treatment of epistaxis

The bloody nose is a common emergency problem. The majority are spontaneous, with no identifiable cause, although many are traumatic. Causes such as hemophilia, other coagulopathies, leukemia, hereditary hemorrhagic telangiectasia or intranasal neoplasms must be considered. As usual, a complete history is taken. Use of aspirin, NSAIDs, or sodium warfarin or (coumadin) or Plavix? other anticoagulant ingestion should be ascertained. Children and many adults often cause bleeding by nose picking. A pubertal male may have an angiofibroma. A person with a long history of smoking should be examined for an intranasal or paranasal sinus epidermoid cancer. Patients may require a laboratory examination.