Severe Epistaxis in the Pediatric Patient: A Simulation for Emergency Department Management.

Severe, uncontrolled epistaxis in a pediatric patient can lead to a compromised bloody airway and the potential need for significant volume resuscitation secondary to hemorrhagic shock if not managed emergently. In this report, a simulated 11-month-old patient with underlying liver disease presents to the emergency department setting. The goal was to familiarize advanced pediatric emergency medicine trainees and experienced providers with immediate bedside interventions and clinical management steps for a patient with severe, difficult-to-control epistaxis to increase preparedness for future clinical scenarios. Additionally, this case highlights resuscitation considerations for patients with liver disease, including sources of bleeding, consulting services, medications, and approach to massive transfusion in liver disease.