A 65 year male with epistaxis
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65/yr Male came the casuality with the
C/o :Bleeding from the B/L nasal cavities( R>L) : 1 week
HOPI:
Patient was apparently asymptomatic 1 week back then he developed B/L nasal bleeding, sudden onset, profuse, Subsided after going to RMP and taking medication. Later development bleeding again after 1 day and at present he had bleeding from 1 Am on 8/6/23 sudden in onset, profuse and not subsiding.
Patient went to outside hospital and merocele packing was done. Yet the bleeding was not subsiding so they referred to higher centre.
Patient was N/k/c/o HTN, DM, asthma, CAD.
No H/o of nasal pricking
No H/o of antiplatelet medication.
No H/o bleeding and clotting disorders.
Past History:
H/o of similar complaints in the pastpast in summer season (4yrs back)
No past surgical History
PERSONAL HISTORY :-
Marital status : married
Diet : mixed
Appetite : normal
Bowel and bladder: regular
Sleep : adequate
Addictions :
Alcohol :consumes 90 ml whiskey daily: 10 yrs
Beedi smoking occasionally.
GENERAL EXAMINATION:-
Patient was concious coherent cooperative well built and nourished , well oriented to time place and person at the time of presentation.
Vitals:
Temp: 97.2 F
B. P:150/80 MMHG
PR:90
RR:18
Spo2:99@RA
GRBS:98 mg/dL
Pallor : present
Icterus : absent
Cyanosis : absent
Clubbing : present
Lymphadenopathy : absent
Edema : absent
SYSTEMIC EXAMINATION:-
1) Per Abdomen :
INSPECTION :-
Shape of abdomen -Flat
Umbilicus - inverted
No scars, sinuses, straie
No visible pulsations & visible peristalsis
Movements of all 4 quadrants moving equally with respiration
Palpation:
All inspectory findings are confirmed
No local rise of temperature
Tenderness present in the epigastric region
No palpable mass present
No palpable lymphadenopathy
No organomegaly
Hernial orificies - Free
PERCUSSION :-
No signs of fluid thrill & shifting dullness
Resonant note heard (except liver dullness)
AUSCULTATION :-
Bowel sounds present
No bruit heard
CNS:-
HIGHER MENTAL FUNCTIONS:
Oriented to time place and person
Immediate memory:Intact
Short term memory:Intact
Longterm memory:Intact
No delusions and hallucinations.
Motor system
Power:-
Rt UL - 5/5 Lt UL-5/5
Rt LL - 5/5 Lt LL-5/5
Tone:-
Rt UL - normal
Lt LL- normal
Rt LL- normal
Lt LL- normal
Reflexes:
Right Left
Biceps: ++ ++
Triceps: ++ ++
Supinator: ++ ++
Knee: ++ ++
Ankle: + + ++
Plantar: flexor. Flexor
CVS:-
S1S2 heard,no murmurs.
Respiratory system examination
Bilateral air entry present.
Normal vesicular breath sounds present.
Lab investigations.
Diagnosis:
Anterior Epistaxis secondary to Denovo uncontrolled Hypertension 1 episode of vasovagal Syncope with COPD.
Treatment
After 1 unit of PRBC transfusion on 8/6/23
Inj. Taxim 1 hm IV BD
Inj. Pan 40 mg IV OF
Inj. Tranexa 500 mg IV SOS
Tab. Orofer XT Po OF
Tab. Amlong 5mg po OD
Tab. Telma 40 mg PO OD
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