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A previously healthy 4-year-old boy presents for evaluation of a unilateral nose bleed refractory to compression lasting for 1.5 hours. He has had episodes of epistaxis in the past secondary to nasal manipulation but none this severe. Three weeks ago he had a runny nose and congestion, which are now resolved. His family denies vision changes, headaches, nausea, hematuria, dysuria, any known ingestions, or any skin flushing. There is no history of bleeding disorders in his family.

On physical examination he is afebrile, with a heart rate of 121 beats per minute, a respiratory rate of 24 breaths per minute, a right arm blood pressure of 200/130 mm Hg, and an oxygen saturation of 99% on room air. His weight is 17 kg (50th...

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