Q. A 45-year-old male presents to the emergency room vomiting significant amounts of blood. His wife reports the patient has vomited blood 3 times while they were driving to the hospital. Staff report the patient had another episode of emesis of approximately 250 ml in the waiting area. He has a known history of liver disease and portal hypertension, and his home medications include propranolol, furosemide, and spironolactone. On physical examination, his temperature is 37.5 degrees Celsius (99.5 degrees Fahrenheit), blood pressure is 80/40 mm Hg, heart rate 120/min, respiratory rate 20/min, and oxygen saturation is 90 percent on room air. The patient appears to be in distress and is diaphoretic. He is alert but confused. Jugular venous distension is present. His abdomen is distended and tender to palpation with marked hepatosplenomegaly. Lung examination reveals decreased breath sounds with bilateral rales. Capillary refill time is prolonged. The patient has another episode of hematemesis during your examination. You order two large-bore IVs to be placed, the patient’s blood to be typed and crossed, and STAT labs. While waiting for his laboratory results, you use an endoscope to examine his oropharynx and esophagus (see image). His blood work returns as follows: Hemoglobin: 6 g/dL Platelet count: 50,000/mm3 Prothrombin time: 14 seconds International normalized ratio: 2.5 Albumin: 2 g/dL Bilirubin: 8 mg/dL Alanine aminotransferase: 200 U/L Aspartate aminotransferase: 300 U/L Based on the information you have at this point in time, which of the following is the next best step in the management of this patient?