Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Identification and Management of Pediatric Venous Thromboembolism in the Emergency Department right.
Case Presentation: Acute Epistaxis: A Comprehensive Overview in the Acute Care Setting
A mother brings her 2-year-old boy to the ED for profuse nose bleeding…
- The boy has no history of bleeding disorders or reported trauma. According to the mother, the nosebleed “came out of nowhere.”
- On examination, you note some bilateral periorbital bruising. The child is otherwise active and healthy.
- What are your first steps, and what are you thinking about as you formulate a differential diagnosis?
Case Conclusion
You first assessed the patient’s ABCs, and he was hemodynamically stable. However, since he was still bleeding from his left nare, you aspirated clots and then applied pressure consistently for 5 minutes, which stopped the bleeding. Because of his periorbital bruising, you performed an evaluation for nonaccidental trauma. You ordered a CT of the head, which showed multiple fractures. The child abuse, trauma, and neurosurgical teams were consulted, and the child was ultimately admitted.
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Last Updated on August 9, 2024
Concern for hematological disorder. Leukemia, TTP, HSP.
Needs CBC, Plateletet count, CMP>
I would like to evaluate for neuroblastoma, lymphoma, platelets disorders. Urgently would review the CBC with peripheral smear.
First step l will control the nasal bleeding with consult if ENT oncall dr then after stablised the baby I will reguest
Full blood count
Coaguleation profil
Liver profil
May be I will involve the Ct brane
My diffrentieal diagnosis
Non accidental injuery should be exculded in my top differnital
2- hematolgical disorders
3-accidental injurey
4- infection