What should be included in the history of present illness template for a patient presenting with epistaxis?

From the Guidelines

A comprehensive history of present illness (HPI) template for epistaxis should include onset timing, duration of bleeding episodes, frequency of occurrences, and which nostril is affected, as well as relevant medical history and current medications, particularly anticoagulants and antiplatelets, as highlighted in the clinical practice guideline by 1. When evaluating a patient with epistaxis, it is essential to consider the potential impact of anticoagulation and antiplatelet medications on the severity and recurrence of bleeding, as noted in the study by 1. The HPI template should also document the estimated blood volume lost, any associated symptoms like lightheadedness or syncope, and aggravating factors such as nose picking, trauma, or excessive blowing.

Key Components of HPI Template

• Onset timing (sudden vs. gradual)
• Duration of bleeding episodes
• Frequency of occurrences
• Which nostril is affected (unilateral vs. bilateral)
• Estimated blood volume lost
• Associated symptoms (e.g., lightheadedness, syncope)
• Aggravating factors (e.g., nose picking, trauma, excessive blowing)
• Alleviating measures attempted (e.g., pressure application, ice, over-the-counter medications) and their effectiveness
• Relevant medical history (e.g., hypertension, coagulation disorders, recent upper respiratory infections)
• Current medications (particularly anticoagulants, antiplatelets, NSAIDs, or nasal sprays/medications)
• Family history of bleeding disorders and environmental factors (e.g., humidity levels, altitude changes, seasonal allergies) The guideline by 1 emphasizes the importance of distinguishing between patients who require prompt management and those who do not, and documenting factors that increase the frequency or severity of bleeding. By following this comprehensive approach, clinicians can determine the cause of epistaxis, assess severity, guide immediate management, and inform preventive strategies while identifying patients who may need more urgent intervention or specialist referral, as supported by the study by 1 and 1.

From the Research

History of Present Illness Template for Epistaxis

The history of present illness (HPI) for a patient presenting with epistaxis should include the following key elements:

• Chief complaint: The patient's primary concern, which in this case is epistaxis (nosebleed) 2, 3, 4
• Location and severity of bleeding: Anterior or posterior, and the amount of blood loss 2, 5
• Duration and frequency: How long the bleeding has been occurring and if it's a recurrent issue 3, 5
• Associated symptoms: Such as headache, facial pain, or nasal congestion 2
• Triggers: Recent trauma, nose picking, or other potential causes of the bleeding 3
• Medical history: Including any co-morbidities, such as hypertension, and current medications, especially anticoagulants or antiplatelet agents 3, 6, 5
• First aid measures: Any initial treatments the patient has tried, such as applying pressure or using ice packs 3

Additional Considerations

• Coagulation screening: May be useful in patients on anticoagulant medication or with a history of bleeding diatheses 3, 6
• Assessment of vital signs: Including blood pressure and pulse, to evaluate for signs of hypovolemia or other complications 2
• Nasal examination: Using a nasal speculum and good light source to visualize the nasal cavity and identify the source of bleeding 2