"EPISTAXIS"
A 78 years male patient C/O nasal bleeding past 2hrs (left nostril), associated with burning sensation in abdomen.heart , 3-4 episodes of vomiting, headache.. Onset- sudden onset,no h/o injury & all... No h/o HTN,DM BP- 132/84mm hg PR- 80b/m Spo2- 96% Appetite,sleep,micturition,Stool are all normal. Plz suggest conservative treatment...
Firstly for nasal bleeding haemostasis - Intranasal packing lt nostril with gauge soaked in adrenaline for atleast 24hrs to 48 hrs then remove. Liquid antacid and bootroclot drops intranasaly after packing removal. TAB Tranexa 1×3.×5days. Further investigate for peptic ulcer and bleeding diasthesis.
If there is active bleeding,pinch the nose with thum & index finger, cold sponging around nose i.e.forehead& Face Antiemetic ,& coagulant i.e.stemetil,&trenexa Orally or injection according to condition If required nasal packing to done If bleeding stops &post pharyngeal wall is clear .give pantaprazole&domperidone , Trenexa & mefenamic acid combination, Along with a good antibiotics, at least for 3-4 days . packing should be removed after 3-4days according to the condition During this period investigation done Hb CBC BT CT
does vomitus contain fresh or altered blood? ascertain whether epistaxis anterior or posterior.previous episodes?nasal pack,blood investigation.smoker? liver disease?drugs?nasal endoscopy to R/O nasal,post nasal cause.UGI scopy where relevant.rhinosporidiosis?epistaxis management is best left to an Otolaryngologist as in certain cases aggressive packing will aggravate bleeding.my advice is not to proceed blindly.
Check for nasal polyp sinus or polyp Get ECG done Botroclot nasal package Tranexa injection and Antiemetics
Watch for any antiplatelet he is on, Examine both nostril. To ruleout local cause of bleeding.
Ask pt regarding any drug like aspirin
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