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Rick Pescatore, DO and Mike Weinstock, MD
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Epistaxis is a common presentation to the Urgent Care. Understanding the rapid assessment and management of a patient with nasal bleeding is critical for the UC provider. Mike and Miz chat with Rick Pescatore to discuss treatment strategies as well as high-risk complications and considerations in these patients.

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William M. -

The day I heard this segment on my ride into work, I encountered a challenging epistaxis patient . It was an elderly female on both clopridogel and rivaroxaban that presented with what appeared to be an anterior nosebleed that was a slow trickle from the right nostril. I was super excited to apply my strengthened knowledge to tackle this patient's nosebleed woes. However, as I went in to search for the bleed, I encountered a solid mass in the affected nostril. I was taken aback by this - I wiped away the blood to find a large whiteish-yellow mass within both the affected and non-affected nostrils. Was it bone? Was it a foreign body? Was it a calcium deposit of some sort? Regardless of what it was, it was solid, firmly attached to the septum, and in no way did it leave straight, identifiable track to place packing into. I consulted ENT and they suspected rhinoliths (what?!?), which was ultimately confirmed with CT scanning. My attending and I never saw this before. ENT guided me to pack as much Surgicel as I could into the nose. That I did. Fortunately, the bleeding completely stopped and the patient was later seen by ENT as an outpatient. Who would have thunk it - rhinoliths, the bane of epistaxis management.

Mike W., MD -

Hi William,
Thx for your comments - you are not alone! I have never heard of a rhinolith either... but now have one more item to add to my ddx thanks to you - great feedback!

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Ice, Ice Baby Full episode audio for MD edition 185:05 min - 87 MB - M4AHippo Urgent Care RAP - November 2017 Written Summary 488 KB - PDF