Question 1

A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be performed to evaluate this condition? (Select all that apply.)&#10;A) BUN and creatinine&#10;B) CBC with type and crossmatch&#10;C) Liver function tests&#10;D) PT and PTT&#10;E) PT/INR

Accepted Answer

Recurrent epistaxis may be caused by bleeding disorders, so laboratory tests to evaluate coagulation status are appropriate. These include CBC with type and crossmatch, PT and PTT, and PT/INR. BUN and creatinine are measures of kidney function and liver function tests evaluate liver function, neither of which are directly related to recurrent epistaxis.

Question 2

A patient is in the emergency department with unilateral epistaxis that continues to bleed after 15 minutes of pressure on the anterior septum and application of a topical nasal decongestant. The provider is unable to visualize the site of the bleeding. What is the next measure for this patient?

A) Chemical cautery
B) Electrocautery
C) Nasal packing
D) Petrolatum ointment

C

Accepted Answer

Nasal packing is the next measure for this patient. It will help apply continuous pressure on the site of bleeding and aid in clot formation. Chemical or electrocautery should only be considered if conservative measures have failed, as they carry the risk of further damage to the nasal mucosa. Petrolatum ointment may be used after the bleeding has stopped to prevent further drying and irritation of the nasal mucosa.

Question 3

A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient?&#10;A) Apply firm, continuous pressure to the nostrils.&#10;B) Assess airway safety and vital signs.&#10;C) Clear the blood with suction to identify site of bleeding.&#10;D) Have the patient sit up straight and tilt the head forward.

Accepted Answer

The first priority in any medical emergency is to assess airway safety and vital signs. In this case, the patient is actively bleeding from both nostrils and the pharynx, which increases the risk for airway compromise and hypovolemia. Applying firm, continuous pressure to the nostrils may help control the bleeding, but the patient's overall condition must be assessed first to determine the appropriate course of treatment. Clearing the blood with suction may be necessary to identify the site of bleeding, but it is not the initial intervention. Having the patient sit up straight and tilt the head forward may increase the risk of blood entering the airway and potentially causing aspiration.

Deck 71: Epistaxis