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Epistaxis (Nosebleed)

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8 Treatment Table 3. Summary of Evidence-Based Statements Statement Action Grade 1: Prompt management At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. Recommendation 2: Nasal compression e clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for five minutes or longer. Recommendation 3a: Nasal packing For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. Recommendation 3b: Nasal packing in patients with suspected increased bleeding risk e clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. Recommendation 4: Nasal packing education e clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. Recommendation 5: Risk factors e clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. Recommendation 6: Anterior rhinoscopy to identify location of bleeding e clinician should perform anterior rhinoscopy to identify a source of bleeding aer removal of any blood clot (if present) for patients with nosebleeds. Recommendation 7a: Examination using nasal endoscopy e clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. Recommendation

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