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It is important to check your vital signs for indicators of significant hypertension and intravascular volume depletion (tachycardia, hypotension). Treatment and evaluation occur simultaneously when there is active bleeding. Inspection is challenging when there is active bleeding, so efforts are first attempted to control the bleeding as explained below. A nasal speculum and a bright head lamp or head mirror are then used to inspect the nose, freeing up one hand to operate suction or an instrument.
Direct inspection frequently reveals anterior bleeding sources. Further testing is not necessary if there is no obvious site and there have only been one or two small Epistaxis. Fiberoptic endoscopy might be required if the bleeding is severe or persistent and no location is seen. In addition to any intranasal masses, the general examination should check for symptoms of bleeding diseases such as petechiae, purpura, and perioral and oral mucosal telangiectasias.
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