HTN on Paul Nystrom

Bloody Noses

Fri, 01 May 2026 00:00:00 +0000

The first thing to know about coming to the ER with a bloody nose is that it will stop. (In fact, the only guarantee in medicine is that all bleeding stops eventually.) And the second thing to know is that you will likely be very unsatisfied with the visit.

A couple things to know about bloody noses, referred to medically as epistaxis. The bleeding is most often from small veins along the septum of the nose. The septum is the middle part of the nose that divides your nasal passages in half. These veins are close to the surface of the mucosa/skin that lines the septum and when they get disrupted or irritated, they can bleed.

When You're a Hammer, Everything Looks Like a Nail

Sat, 14 Mar 2026 00:00:00 +0000

Hypertension (HTN) in the ER is one of the least interesting things we deal with. Through many discussions with colleagues, this is a fairly universal sentiment among ER doctors. There are very few conditions in which we need to immediately lower a patient’s blood pressure. Aortic dissections, hypertensive emergencies, acute strokes, acute coronary syndrome, and preeclampsia are about the only ones that come to mind. These are referred to as “end-organ damage,” i.e., the HTN is actually causing an acute issue damaging the brain, heart, or kidneys, and it needs correcting.

Do you have any medical problems?

Tue, 17 Feb 2026 00:00:00 +0000

Do you have any medical problems?

I ask patients this question frequently. Some immediately get irritated with me and tell me to “just look in the computer.” And as with every patient, I do look in the medical record regarding their prior medical problems, recent clinic/ER visits/hospital admissions, and medications. However, asking the question tells me a lot about how tuned in they are to their medical problems, and it gives me some idea of their medical literacy. Their involvement and degree of concern about their medical problems often figure into whatever is going on.