Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to insert a posterior nasal pack. In cases of severe posterior epistaxis that doesn't respond to direct pressure, posterior nasal packing is often necessary. This technique, while more invasive, is crucial for controlling bleeding from the posterior nasal cavity.

While administering IV fluids is important for volume resuscitation, it doesn't directly address the bleeding source. Anterior nasal packing alone is insufficient for posterior bleeds. Immediate surgical intervention, while sometimes necessary, is not the first-line treatment and should be considered only if packing fails.

Posterior nasal packing requires specific equipment (like a Foley catheter) and expertise. It's more effective for posterior bleeds and helps prevent blood from entering the oropharynx, reducing the risk of aspiration. However, it's important to note that this procedure can be uncomfortable for the patient and carries risks such as infection or vagal response. Proper technique and monitoring are crucial.

After packing, the patient will require close observation, potential admission, and possibly ENT consultation for definitive management.