A 75yrs old female came to casualty with c/o spontaneous bleeding from nose since 2days
HOPI
Patient was apparently asymptomatic 1month back then had H/O-headache,giddiness, and swaying(on and off) which patient has ignored.
2days back she developed bleeding from left side nasal cavity spontaneous in onset ,painless,decreased with applying pressure on nose for which patient visited a local hospital,said to have high BP , started her on Tab.Aten 50mg OD,bleeding stopped with nasal packs and pressure.
Since 2days,patient was on Tab.Aten50mg again she experienced similar complaints ,she herself applied nasal pressure and nasal packings
On presentation to casualty,no active bleeding from nose.ENT opinion taken -advised Direct nasal endoscopy after Bp stabilisation.
Past history
K/c/o hypertension since 2days -on Tab Aten 50mg
H/O biofuel exposure for 30 years
N/k/c/o DM,TB,CAD
Personal history
Diet-mixed
Appetite-lost
Sleep-adequate
Bowel and bladder movements-regular
General examination
Pt is conscious, coherent, and cooperative
Vitals
Temp-Afebrile
Pr-72bpm
Bp-170/110mmHG
Spo2-94% on RA
Systemic examination
Cvs-S1,S2 +
Rs-Decreased breath sounds in all areas
P/A-soft,non-tender
Cns-NAD
Provisional diagnosis
Epistaxis secondary to hypertension with hypokalemia under evaluation .? Chronic bronchitis
Investigations
Serum electrolytes
Sodium-141mEq/l
Potassium-2.9mEq/l
Chloride-101mEq/l
Serum creatinine-0.8mg/dl
Treatment
1. Tab.Nicardia 10mg PO /Stat- Tab. Telma-AM(40/5) PO/OD
2. Inj.Kcl 2 amp in 500 ml NS slow over 5hours
3. Saline nasal drops qid
4. Avoid nose blowing
5. Bp monitoring 2nd hourly
6. Stop Tab.Aten50mg
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