Epistaxis

Template

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Bleeding historyChoose any

ExamChoose any

ProcedureChoose any

LabsChoose one

Lab listChoose anyNot in the note with these choices

PreventionChoose any

ReferralChoose one

Follow-upChoose one

Follow-up reasonChoose anyJoins the line aboveNot in the note with these choices

Counseling

Nosebleeds are common in children, especially with colds, allergies, and dry air. For a nosebleed, sit up, lean slightly forward, and pinch the soft part of the nose for 10 minutes without letting go to check. Recommended supportive care with an emphasis on saline spray or petroleum jelly inside the nose and avoiding nose picking. Return precautions given including bleeding that does not stop after a second round of steady pressure, looking pale or sweaty, bleeding after a head injury, vomiting blood, easy bruising, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Epistaxis
• Bleeding history: episodes shorter than 10 minutes, no easy bruising or bleeding, and no family history of bleeding disorders
• No active bleeding; anterior septal vessels visible
• Labs not indicated given a reassuring bleeding history and an anterior source
• Discussed proper nasal pressure technique, saline gel or petroleum jelly to the front of the septum, a humidifier, and avoiding nose picking
• Follow up as needed

Nosebleeds are common in children, especially with colds, allergies, and dry air. For a nosebleed, sit up, lean slightly forward, and pinch the soft part of the nose for 10 minutes without letting go to check. Recommended supportive care with an emphasis on saline spray or petroleum jelly inside the nose and avoiding nose picking. Return precautions given including bleeding that does not stop after a second round of steady pressure, looking pale or sweaty, bleeding after a head injury, vomiting blood, easy bruising, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Bleeding history: reassuring (exclusive) vs long episodes, bruising, family history, frequent
Anterior source
Labs not routine for simple anterior bleeds
CBC, coags, PFA, vWD for recurrent or bruising, or before ENT
Pressure first line
Silver nitrate cautery to an identified vessel
Saline gel, humidifier, no picking, steroid spray technique
ENT for unilateral or recurrent; hematology
When to call

Return precautions in the template

bleeding that does not stop after a second round of steady pressurelooking pale or sweatybleeding after a head injuryvomiting bloodeasy bruising

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.