Snapshot A 8-year-old boy presents to the pediatric emergency department for a nose bleed. His symptoms began after he was hit in the face with a basketball. He denies any shortness of breath, hemoptysis, or hematemesis. Family history is unremarkable. On physical examination, there is small volume bleeding. He is asked to bend at the waist and press on his nasal alae. Hemostasis is eventually achieved. Introduction Overview acute bleeding from the nasopharynx or the nose Associated conditions nasal trauma Epidemiology Demographics occurs in children or in the elderly (most common) Risk factors digital trauma to the nose (most common) nasal mucosal drying (e.g., dry air) rhinitis septal deviation coagulopathy medications (e.g., antiplatelet and anticoagulant therapy) foreign body ETIOLOGY Pathophysiology anterior nose bleed damage to Kiesselbach plexus which results in bleeding posterior nose bleed damage to the posterolateral branches of sphenopalatine artery login to view 1 more bullet Presentation Symptoms bleeding from the nose anterior nose bleed login to view 1 more bullet posterior nose bleed login to view 1 more bullet Studies Nasal endoscopy Serum studies in cases of severe bleeding complete blood count type and screen PT/INR and aPTT Differential Hemoptysis differentiating factors blood with coughing signs of respiratory distress Hematemesis differentiating factors bloody emesis history of gastrointestinal illness (e.g., peptic ulcer disease) melena Malignancy/mass juvenile angiofibroma assess with CT/MRI Treatment Conservative and lifestyle squeeze alae and bend at the waist indication login to view 1 more bullet anterior nasal packing indication login to view 1 more bullet posterior nasal packing indication login to view 2 more bullets Medical and pharmacologic oxymetazoline indication login to view 1 more bullet Surgical and interventional cautery indication login to view 1 more bullet modality login to view 2 more bullets endoscopic ligation or embolization indication login to view 1 more bullet Complications Hypovolemia Angina and myocardial infarction Prognosis Most nosebleeds are benign and self-limiting Most cases of anterior epistaxis are responsive to local treatment