Virtual Patients - Rhinology - Epistaxis

You attempt nasal cautery, however, the bleeding is too brisk and subsequently you decide to insert an anterior nasal pack (rapid rhino) into the left nostril, parallel to the nasal floor. You inflate this with 10ml of air and this achieves good haemostasis. Knowing this is a painful procedure you prescribe good regular and PRN analgesia.  

Unfortunately 50 minutes later the nurse calls you concerned the patient is now bleeding again, this time from the mouth and left the eye. You confirm this to be true upon your review. 

 

The following information is now also available. 

 

Bloods

Hb 95              Na+ 140

WCC 10.5        K+ 3.8

Plt 110              Urea 9.0

MCV 90          Creat 80

 

INR 2.8

 

Observations

Pulse 100bpm

BP 165/90

Sats 100% on Air 

RR 16

Question

 

Using all the information you now have available, which of the following would be the best next management step?