MDM - Epistaxis

[##]-year-old [male/female] with history and exam consistent with epistaxis from [anterior/posterior] source.

Initial considerations in this patient included anterior and posterior vessels as a source of epistaxis, nasal bone fracture and displacement, coagulopathy, nasal foreign body, and nasal tumor among others.

Patient presented [with/without] reported trauma [describe mechanism] with bleeding [not/poorly/minimally] controlled with direct pressure.  On exam the patient was noted to have [no] evidence of symptomatic anemia in the setting of report of approximately [##] mL of blood loss.  Patient [reports/denies] current use of anticoagulants [describe medication/but does report current use of Aspirin].  Direct nasal pressure applied upon presentation to the ED [with/without] adequate control of bleeding.  [Anterior/Posterior] packing with [a anterior Rapid Rhine/Merocel/Foley catheter/a tranexamic acid (TXA) soaked dressing] placed [with/without] adequate control of bleeding.  On speculum examination of the [right/left] nare a bleeding vessel was identified [and packing was placed/it was cauterized].  [Discussed/Considered holding anticoagulation in the setting of bleeding FURTHER.]  Doubt nasal bone fracture given [absence of significant swelling or deformity/absence of significant trauma].

Epistaxis controlled and patient observed in the ED for [duration] without evidence of re-bleeding.  Prior to discharge, we discussed return precautions, specifically for recurrent bleeding, treatment with [packing/antibiotics/discontinuing anticoagulation/etc.], and follow up with primary care doctor within 1-2 days for repeat evaluation [and consideration of restarting anticoagulation], and the patient demonstrated understanding and agreement with this plan.