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著者:Katie M. Wells and Deborah Governale
 
Abstract
Many patients present for epistaxis that is not controlled on arrival. Careful history taking, followed by inspection for the bleeding source and management of the bleeding, is recommended. Vasoconstriction and anesthetic are recommended and then can use manual pressure, chemical cautery, or packing.
 
Keywords
epistaxis
hemorrhage
nasal hemorrhage
nosebleed

Presentation  
    Patients may arrive in the emergency department (ED) or urgent care center with active bleeding from their nose or spitting up blood that is draining into their throat from a nasal source. There may be a report of minor trauma, such as sneezing, nose blowing, or nose picking. On occasion, the hemorrhage has stopped, but the patient is concerned because the bleeding has been recurrent or the bleeding was copious. In rare instances, the bleeding may be brisk requiring resuscitation. Bleeding is most commonly present at the anterior aspect of the nasal septum, within Kiesselbach plexus or from the inferior turbinate. Sometimes, especially with posterior epistaxis, a specific bleeding site cannot be determined. This chapter refers to the care of patients with epistaxis who do not require resuscitation or have airway compromise.
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