Snapshot A 14-year-old boy with no significant past medical history presents to the ED after being struck in the nose during a basketball game. There is frank blood coming from the nares. Introduction Nosebleeding that can arise from either the anterior or posterior circulation anterior nosebleeds involves bleeding from Kiesselbach's plexus seen most commonly in children/adolescents most commonly caused by trauma including nose picking posterior nosebleeds involves bleeding from Woodruff's plexus seen most commonly in older adults with hypertension not incited by trauma Less common causes of epistaxis nasopharyngeal angiofibroma recurrent nosebleeds or obstruction without a history of trauma or blood dyscrasia leukemia blood dyscrasia ex) vWD, hemophilia Osler-Weber-Rendu syndrome cocaine or other intranasal drug use any cause of thrombocytopenia ex) ITP foreign bodies (pediatrics) associated with persistent symptoms and purulence Presentation Symptoms bleeding from the nose Evaluation Assess vital signs if bleed is signficant Majority do not require testing other than direct visualization Have patient sit up with body tilted forward to allow blood to be passed out of the nares instead of passing posteriorly into the pharynx Treatment In anterior epistaxis, the following treatment protocol is required compression topical vasoconstriction phenylephrine chemical/electrocautery nasal packing arterial ligation or embolization In posterior epistaxis, the following treatment protocol is required blood pressure reduction posterior nasal packing arterial ligation of embolization Prognosis, Prevention, and Complications Patient advice for future anterior bleeds compress cartilagenous portion of nose for 10-15 without releasing avoid tissue paper placement inside the nose or swallowing blood prevent with proper nasal hygiene which includes moisturization and avoidance of digital placement in the nose Patient advice for future posterior bleeds good long-term hypertension control avoid tissue paper placement inside the nose or swallowing blood