A 58 year old man is brought to your Emergency Department by ambulance after a spontaneous epistaxis over the last three hours. The Paramedics confirm that the patient vomitted 500mls fresh blood at the scene. There were a number of empty alcohol bottles at his house.

He has a history of severe Aortic stenosis.

Blood results show:

Hb 95 (120 – 180)

WCC 10.2 (3.5 – 11)

Platelets  155  (140 – 400)

INR  2.5  (0.8 – 1.3)

aPTT  36  (26 – 41)

Fibrinogen  0.4  (1.7 – 4.5)

D-dimer  <0.4  (<0.4)

QUESTIONS:

1. Describe and Interpret his blood results

2. Outline your steps in management

3. List the key steps in nasal packing

4. What are the main issues with regard to his Aortic stenosis