When faced with a patient with epistaxis, use this mnemonic to think broadly and consider "What else can it be?"
TIME to stop the BLEED:
T - TRAUMA: nose picking, fractures I - INFECTION: Sinusitis, rhinitis M - MEDS: coumadin, ASA, clopidogrel, thrombin inhibitors, Factor Xa inhibitors E - EXOGENOUS AGENTS: cocaine, foreign bodies, nasal sprays, dry air
BLEEDing: Von Willebrands, thombocytopenia, hemophilia, or bleeding disorder
With any bleed, be sure to ensure that the patient is stable! Remember with any patient who has a bleed (even if it's a mild nosebleed, a heavier-than-usual menstrual period, spotting during pregnancy, or rectal bleeding) it's crucial that you consider, assess, and document that the patient has been assesed for stability.
The Review Course has developed several exam habits that will help you automatically consider these factors on the exam. To all of you signed up for The Review Course - we look forward to meeting you in person in just a few weeks!
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Image credit: "Epistaxis1" by I, Welleschik. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Epistaxis1.jpg#/media/File:Epistaxis1.jpg