Chapter 71: Epistaxis Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient?

a. Apply firm, continuous pressure to the nostrils.

b. Assess airway safety and vital signs.

c. Clear the blood with suction to identify site of bleeding.

d. Have the patient sit up straight and tilt the head forward.

ANS: B a. Chemical cautery b. Electrocautery c. Nasal packing d. Petrolatum ointment

Bilateral epistaxis into the pharynx is more indicative of a posterior bleed which is more likely to be severe. The most important intervention is to ensure airway safety and determine stability of vital signs. Other measures are taken as needed.

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?

ANS: C

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Nasal packing is used if bleeding continues after initial measures. Chemical cautery and electrocautery are used only if the site of bleeding is visualized. Petrolatum ointment is applied once the bleeding is stopped.

Multiple Response

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.)

a. BUN and creatinine b. CBC with type and crossmatch c. Liver function tests d. PT and PTT e. PT/INR

ANS: B, D, E

A CBC with type and crossmatch is part of the diagnostic workup along with coagulation studies. LFTs and renal function tests are not used to evaluate recurrent epistaxis.