In the ED, their vitals/exam are as above.  Patient with anal fissure on exam.  No concern for significant GI bleed.  No concern for abscess or deeper infection. 
– Labs/Tests: None
– Imaging: None
– Treatments: Consider injection of fissure with 1% lidocaine with epinephrine, consider figure-of-eight stitch if patient is still bleeding after injection
– Consults: None
– Dispo: Likely discharge with Anusol (2.5% hydrocortisone rectal cream), sitz bath with instructions, high-fiber diet instructions, increased hydration instructions, and general surgery follow-up