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You are the duty doctor. Whilst triaging phone calls you get an urgent message from reception to inform you that a young boy (Johnny, aged six) who is in the waiting room is having quite a severe nose bleed. He was brought in by his mother as she had been walking home from school (opposite the practice) when the nose bleed started and she was unable to stop it. Johnny’s mother Lucy thinks he might have picked his nose. On examination, Johnny’s t-shirt is covered in blood and has a blood-stained tissue pressed against his nose. He appears slightly distressed but his observations are normal. You initiate simple first-aid measures and the bleeding stops. Lucy thinks the entire episode lasted approximately ten minutes. Johnny is normally fit and well, up to date with immunisations and hasn’t had any episodes of epistaxis before.

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