65 Y/OLD MALE WITH ANTERIOR EPISTAXIS SECONDARY TO DENOVO HYPERTENSION

June 10, 2023

CHIEF COMPLAINTS

A 65 Y/old male came to the casualty with chief complaints of bleeding from nose since 1 week.

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 1 week back then he developed  B/L  nasal bleeding, sudden in onset, profuse in nature, Subsided after going to RMP and taking medication. Later he again developed bleeding after 1 day and 2 days back 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, and Yet the bleeding was not subsiding so they referred to higher centre. 

No H/o of trauma to nose.

No H/o of antiplatelet medication. 

No H/o bleeding and clotting disorders. 

PAST HISTORY

Not a known case of DM, HTN,CAD,ASTHMA, TB, EPILEPSY.

H/o of similar complaints 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 years

Smoking- around 20 cigars per day

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 felt

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.

CVS:-

S1S2 heard,no murmurs.

Respiratory system examination

Bilateral air entry present.

Normal vesicular breath sounds present.

CLINICAL IMAGES

Pending

INVESTIGATIONS


Pending



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



















Comments

Post a Comment

Popular posts from this blog

IRON DEFICIENCY ANEMIA WITH GRADE 4 HEMORRHOIDS

Image
GENERAL MEDCINE CASE REPORT; 22 JULY,2021; SAI PRANEETH BATHINEEDI; ROLL NO 116; 3 SEMESTER STUDENT; HELLO GUYS, This is an online e log book to discuss our patient de-identified health data shared after taking his/her/guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evidence based input I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. CHIEF COMPLAINT; 35 YEARS OLD MALE WHO IS AN ELECTRICIAN BY OCCUPATION FROM CHOUTUPPAL CAME TO THE OPD WITH CHIEF COMPLAINTS OF SUDDEN WEAKNESS AND GIDDINESS WHICH CAUSED HIM TO FALL DOWN; HISTORY OF PRESENTING ILLNESS; The pati...
Read more

Facial puffiness with associated pedal edema

Image
  June 11, 2023 This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from an available global online community of experts to solve those patients clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box are welcome. a 53-year-old male, a Hotel owner and chef by occupation, The patient presented to the hospital with chief complaints of Swelling of both Legs since 10 days Swelling of face since 7 days HISTORY OF PRESENTING ILLNESS   The patient was apparently asymptomatic 10 days ago.In the first week of June he had a binge of alcohol on occasion of local festival. Later he observed abdominal distension, followed by Bilateral Pedal odema which is pitting type extending up to the kn...
Read more

Sudden onset involuntary movement of lower limb

Image
 3/7/23; This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. Ihave been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. A 52 year male, resident of lingotam,farmer by occupation came to the casualty with chief complaints of; Involuntary movements of the right lower limb since morning(6:00am); Numbness of right lower limb...
Read more