Skip to main content

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

















Comments

Post a Comment

Popular posts from this blog

10

  Case History and Clinical Findings A 50 YEAR OLD MALE WITH C/O COUGH SINCE 20 DYAS,FEVER SINCE 1 WEEK SHORTNESS OF BREATH SINCE 5 DAYS BILATERAL PEDL EDEMA SINCE 30 DAYS DECERASED URINE OUTPUT SINCE 1 DAY ALTERED SENSORIUM SINCE 8 HRS PATIENT WAS APPARENTLY ASYMPTOMATIC 20 DAYS AGO THEN HE DEVELOPED COUGH SINCE 20 DAYS,PRODUCTIVE TYPE WITH YELLOWISH WHITE COLOURED SPUTUM,SCANTY IN NATURE,NOT BLOOD TINGED AND FOUL SMELLING FEVER SINCE 1 WEEK,LOW GRADE,NOTT ASSOCIATED WITH CHILLS AND RIGORS SHORTNESS OF BREATH SINCE 5 DAYS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE PROGRESSED FROM GRADE 2 TO GRADE 4.ORTHOPNEA PRESENT NO PND. BILATERAL PEDAL EDEMA SINCE 3 DAYS,DECREASED URINE OUTPUT ,N/H/O VOMITINGS,LOOSE STOOLS,PAIN ABDOMEN K/C/O HTN SINCE 3 YEARS NOT ON REGULAR MEDICATION CKD SINCE 6 MONTHS ON CONSERVATIVE MANAGEMENT PERSONAL HISTORY : DIET :MIXED APPETITE : GOOD SLEEP : ADEQUATE BOWEL:REGULAR ALCHOL ISTORY- OCASSIONAL SINCE 20 YEARS STOPPED 6 MONTHS BACK GENERAL EXAMINATI...
Post a Comment
Read more

21

  Case History and Clinical Findings 57 YEAR OLD MALE PATIENT CAME WITH C/O OF SLURRED SPEECH 4PM ON 5/08/2023 C/O RIGHT UPPER LIMB &LOWER LIMB WEAKNESS SINCE 4PM. PATIENT PRESENTED TO CASUALITY WITH ALTERED SENOSIRUM SINCE 4PM HOPI: PATIENT HAS A H/O SLURRED SPEECH AND H/O RIGHT UPPER LIMB AND LOWER LIMB WEAKNESS SINCE THEN ASSOCIATED WITH FALL. NO LOC, NO ENT BLEED NO H/O FEVER, BURNING MICTURITION, LOOSE STOOLS NO H/O SOB, PALPITATIONS, ORTHOPNEA, PND HISTORY OF PAST ILLNESS: NOT A K/C/O HTN,DM,EPILEPSY, THYROID DISORDERS. O/E: GCS-E5 V4 M5 BP- 90/60MMHG PR- 68BPM CVS- S1S2 + RS- NVBS + SPO2- 97% ON RA CNS- TONE: RIGHT LEFT UL INCREASED INCREASED LL INCREASED INCREASED POWER: UL &LL COULDNT ELICIT REFLEXES: B +++ ++ T + + S + + K - + A - - P FLEX FLEX PUPILS- B/L CONSTRICTED, SLUGGISH REACTIVE COURSE OF ADMISSION: PATIENT WAS ADMITTED I/V/O ABOVE MENTIONED COMPLAINTS. NECESSARY INVESTIGATIONS WERE DONE. MRI FINDINGS- ACUTE INFARCT IN LEFT CAUDATE AND LE...
Post a Comment
Read more

20

  Case History and Clinical Findings A 45 YEARS OLD MALE, CAME WITH COMPLAINTS OF ABDOMINAL DISTENSION AND SHORTNESS OF BREATH AND SWELLING OF BOTH LOWER LIMBS SINCE 1 WEEK HOPI: PATIENT WAS ASYMPTOMATIC,6 YEARS AGO AND THEN HE DEVELOPED A MINOR INJURY TO NECK WHICH WAS NOT HEALING AND THEN WENT FOR REGULAR CHECKUP AND WAS DIAGNOSED AS HAVING DIABETES AND STARTED ON OHA, AND 3 YEARS AGO HE WAS DIAGNOSED TO BE HAVING HYPERTENSION AND STARTED ON TAB. TELMISARTAN 40MG/OD,AND WAS ASYMPTOMATIC 7 MONTHS AGO AND THEN IN THE EVENING HE SUDDENLY BECAME ,UNRESPONSIVE AND IRRELEVANT TALK AND WAS TAKEN TO HOSPITAL AND WAS FOUND TO BE HAVING HYPOGLYCAEMIA AND WAS ASKED TO STOP OHA,AND WAS FOUND TO BE HAVING JAUNDICE AT THAT TIME AND WAS ASKED TO AVOID ALCOHOL BUT HE DIDN’T STOPPED ALCOHOL CONSUMPTION. AND 5 MONTHS AGO,HE DEVELOPED SIMILAR COMPLAINTS AND WAS ADMITTED HERE AND WAS DIAGNOSED TO BE HAVING,ACUTE DECOMPONSATED LIVER DISEASE AND WAS KEPT ON CONSERVATIVE MANAGEMENT, A DIAGNOSTIC AND TH...
Post a Comment
Read more