Rhinology Q6

You are the ENT senior house officer (SHO) on call. An 11-year-old boy attends the emergency department with his mother because of a nosebleed. He is leaning forward while pinching his nose and he appears calm. The nosebleed started 30 minutes ago, and he has been pinching his nose ever since. He tends to pick his nose and suffers from recurrent nosebleeds. Nil past medical history. Observations are Respiratory Rate 18, Temperature 37.5 degrees Celsius, Oxygen Saturations 98% on room air, Heart Rate 85, Blood Pressure 114/68, alert. On examination, he is mouth breathing and there is no coughing or choking. There is blood dripping from his right nostril when he takes his hand away. On closer examination, you can see a bleeding site on his right septum.

What is the next most appropriate management step?

  • A) Nasal cautery
  • B) Nasal packing
  • C) Direct Compression for 10-15 minutes
  • D) Nasal balloon catheter
  • E) Transnasal endoscopy with direct cautery