Red flags In patients with epistaxis, the following findings are of particular concern: Signs of hypovolemia or hemorrhagic shock Anticoagulant use Cutaneous signs of a bleeding disorder Bleeding not stopped by direct pressure or vasoconstrictor-soaked pledgets Multiple recurrences of epistasis, particularly with no clear cause Interpretation of findings Many cases of epistaxis have a clear-cut trigger (particularly nose blowing or picking), as suggested by findings (see table).