a. Posterior bleeding can cause significant loss of blood. Because posterior packs can interfere with oxygenation, consider admission to an ICU or stepdown unit to monitor oxygenation.

b. Posterior packs are painful. Although adequate analgesia is mandatory for patient comfort, injudicious use of narcotics can increase the risk of hypoventilation and hypoxia. Supplemental oxygen can be given when indicated, but not at the risk of depressing respiratory drive in patients with CO2 retention.

2. Antibiotics. Administer antistaphylococcal antibiotics to prevent sinusitis associated with packing.

3. Consult. Consultation with an otolaryngologist may be the most effective and expedient way to effect control of bleeding.

4. Other actions. Obtain CBC with differential, platelet count, PT, and PTT. Transfusion may be warranted. After discharge, consider iron replacement.

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