A 34 year-old male with no past medical history presents with 3 days of intermittent epistaxis. The bleeds have been light for the past few days consisting of mostly a few blood streaks on the tissue. This current bleed however, has lasted nearly 20 minutes and has been a steady flow of brighter colored blood. He has tried to hold pressure for 10-20 minutes, but as he eases up the bleeding starts again. He denies lightheadedness, dizziness, chest pain, palpitations, or shortness of breath. He has never experiences prolonged bleeding episodes and denies any recent skin changes. He has otherwise been in good health and denies any weight changes, headaches, photophobia, cough, coryza, abdominal pain, nausea, vomiting, diarrhea or constipation. He has no family history of bleeding disorders and no recent travel.
Medications: OTC antihistamines PRN
Social: No drugs, alcohol or tobacco
PE: Tm: 98.6, HR: 96, RR: 18, BP: 126/78
GEN: Lying in bed, well-dressed, and comfortable
HEENT: Crusting of blood at nares bilaterally; nasal septum midline; active venous bleeding; unable to visualize any active blood vessel
PULM: Breathing comfortably, speaking full sentences; clear to auscultation bilaterally
CV: Tachycardia, regular rate and rhythm
ABD: Normal bowel sounds, soft, non-tender, non-distended; no rebound or guarding
Ext: No cyanosis, clubbing, or edema
Na: 140, K: 4.2, Cl: 99, Bicarb: 22, BUN: 21, Cr: 0.96, Glucose: 125
Protein: 6.5, Albumin: 3.49, Calcium: 8.4, AST: 18, ALT: 4, Alk Phos: 158, Tbili: 1.6,
WBC: 11, Hb/Hct: 13.5/41, Plt: 144
PT: 9.3 PTT: 34 INR: 1.0
ECG: Normal Sinus Rhythm
Just as you get back to your seat, the patient tells you he feels fine, but the bleeding has picked up again.
Are there any medications that might help stop the bleeding?
If you had to pack the nose, what would be your technique?
You have now packed the nose. Will you prescribe antibiotics?