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A case of epistaxis


A  65/yr Male  came  the casuality with the 

Chief complaints of bilateral nasal bleeding since 1 week

HOPI:

Patient was apparently asymptomatic 1 week and  then he developed  B/L  nasal bleeding, sudden onset, profuse,  Subsided after going to RMP and taking medication. Later startedt 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 subsided so they referred . 

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 since : 10 yrs

Beedi smoking occasionally. 


GENERAL EXAMINATION:-


Patient was concious coherent cooperative well built and nourished. 

Vitals:

Temp: 97.2 F

B. P:150/80mm Hg

PR:90

RR:18

Spo2:99

GRBS:98 mg/dL


Pallor : present

Icterus : absent

Cyanosis : absent 

Clubbing  : present

Lymphadenopathy : absent 

Edema : absent











SYSTEMIC EXAMINATION:-

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 . With liver dullness


AUSCULTATION :-

Bowel sounds present

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

                    Rt                    Lt

Biceps:      ++                    ++

Triceps:       ++                  ++

Supinator:  ++                   ++

Knee:         ++                    ++

Ankle:            + +                 ++

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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