5.0 of 3 Ratings
A 16-year-old boy presents to the emergency department due to right-sided hearing loss, headache, and nasal bleeding. He reports that for the past few months, he has found it difficult to breathe through his nose and has had nasal drainage. He also states that he has not been able to stop his nose from bleeding for the last few hours. His right-sided hearing loss began around the same time as his difficulty with nasal breathing. He denies any history of trauma to the nose, uncontrollable bleeding, and easy bruising. His family history is unremarkable. His temperature is 99°F (37.2°C), blood pressure is 112/67 mmHg, pulse is 95/min, and respirations are 20/min with an oxygen saturation of 99%. On physical examination, the patient appears anxious. There is an amber fluid collection in the right ear appreciated on otoscopy. Physical exam is notable for the finding in Figure A which does not remove with irrigation or the patient blowing their nose. Which of the following is the most appropriate next step in management?
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A 14-year-old boy presents to the emergency department with an intractable nosebleed. Pinching of the nose has failed to stop the bleed. The patient is otherwise healthy and has no history of trauma or hereditary bleeding disorders. His temperature is 98.9°F (37.2°C), blood pressure is 120/64 mmHg, pulse is 85/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for multiple clots in the nares which, when dislodged, are followed by bleeding. Which of the following location is the most likely etiology of this patient's symptoms?