65/M with Epitaxis secondary to HTN.

 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:-




I) 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.










After 1 unit of PRBC transfusion on 8/6/23



Diagnosis:

Anterior Epistaxis secondary to Denovo uncontrolled  Hypertension 1 episode of vasovagal Syncope with COPD. 

Treatment

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






Popular posts from this blog

Medicine Case Discussion

  Online Blended Bimonthly assignment towards summative assessment for the month of May 2021 Pulmonolgy 1) A 55yr old female with Shortness of breath,pedal edema and facial puffiness.  A) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem? Ans:At the month of january that year during which time she was working in a paddy field. For the next 8 years the patient has suffered from similar episodes of SOB every year each lasting aproximately 1 week For the past 12 years she has been having an yearly episodes now lasting around a month again around january. Until her latest episode the SOB was of grade II Her latest episode of shortness of breath started 30 days ago, her SOB was insidious in onset and gradual in progression. Initially the SOB occurred on exertion and was relieved upon rest. From 2 days ago she started having SOB even a
Read more

Dengue with thrombocytopenia

Image
  Dengue with thrombocytopenia.  Name: Raveela  Roll no. 95 ICU bed no 3. Under the guidance of 28yr old male resident of nalgonda came with the chief complaints of fever since 5days ,pain abdomen since 2days .  NS1+ve ,  platelets 23000 HOPI; Fever since 5days high grade intermittent relived on medication, pain abdomen difuse, history of vomiting 1episode 5days back which is non bilious and non projectile.  No history of cough, loose stool, sob.  Went to the local hsptl and tested dengue NS1+ve, and bought to our hsptl with low platelet count (23000).  Past history; No h/o DM/HTN/ASTHMA/EPILEPSY/TB. PERSONAL HISTORY Farmer by occupation Appetite-decreased Regular bowel and bladder movements No addictions  On Examination; No signs of pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema.  VITALS ; temp:101 F  PR: 88bpm RR: 20/min BP :110/70 mm /hg Spo2: 98 GRBS:95mg % SYSTEMIC EXAMINATION; cvs :s1s2 heard RS :NVBS PA: soft, and tenderness present in right hypochondriac region.  C
Read more

45 yr /F Paraparesis secondary to Trauma with disphagia

 C/O Generalized weakness of lower limbs since 10 years Difficulty in swallowing since 15 days  HOPI: Pt was apparently asymptomatic till 1999 then she delivered a baby(by c-section due to cord entanglement) she also stated that she started developed Generalized weakness ( due to low haemoglobin levels ) not associated with pain and was able to perform her daily activities Her husband also left as she couldn't perform her daily activities.Her son currently stays in the hostel   She previously used to work as mandal officer. And in 2012 she stopped going to work because she started developing weakness insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances and she managed to to perform daily activities In 2023 Jan she alleged had h/o slippage in bathroom following which she was normal for 5 days  Next day she couldn't get up from bed which is sudden in onset and non progressiv
Read more