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