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Primary Care Liaison

Epistaxis - pre-referral

  • This pre-referral guideline covers Epistaxis in children from 1-16 years of age.

    Initial work-up

    • History and physical examination
      • Rule out allergic rhinitis.
    • If suspecting  blood dyscrasia
      • Through history (i.e. bruising, bleeding).
      • Family history.
    • Blood tests - (PT, APTT) if indicated by history


    Pre-referral treatment

    • Trial of antibiotic/steroid ointment to anterior septum 2x a day for 2 weeks
    • Observation of side
    • Acute bleeding usually settles with local pressure to the lower nasal septum


    When to refer

    • Not responding to conservative management i.e. no nose picking , strong nose blowing, application of topical nasal steroid
    • Epistaxis that is severe or occurs frequently
    • Attach blood tests results if done
     Referral form Referral form (Word)   
     Parent handout  Parent handout (pdf)



    Kids Connect (RCH Primary Care Liaison)

    Kids Health Info (Parent factsheets online)

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      Contact information                 

    Clinical advice


    Switchboard - ask for ENT specialist
    consultant or registrar on-call:

    (03) 9345 5522

    RCH Emergency Department:

    (03) 9345 6477


    Booking enquiries 
    appointment rescheduling
    (03) 9345 6180 
    Rural doctors only (03) 9345 6789 

    Admission enquiries

    General admission enquiries: (03) 9345 6172

    ED admission enquiries:

    (03) 9345 6477

    After hours / Switchboard:

    (03) 9345 5522


    Seriously unwell child: (03) 9345 7007

    RCH Drug info-line:

    (03) 9345 5208



    Paediatric Handbook(2009)Ear, Nose and Throat Conditions, Chapter 21 (pp312-324);Robert Berkowitz and Michael Marks;Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia

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