Double bypass, respiratory failure, nose bleeds, selective embolization
Thank you for your query,
There are a few details which will help establish the preferred mode of treatment:
1. Is his epistaxis (bleeding from nose) one sided or from both sides? Is his blood pressure under control?
2. Has there been a drop in hemoglobin? What is his hematocrit (packed cell volume)? A coagulogram which includes a platelet count, bleeding time (BT), clotting time (CT), PT (Prothrombin Time) and PTTK (Partial Thromboplastin Time with Kaolin) must have been done. What are the latest values?
3. His coagulogram is bound to be deranged as he is on blood thinning and anti coagulation drugs secondary to his cardiac condition.
4. Does he bleed only from the nostrils or does blood come into his throat and mouth? The differentiation between an anterior and posterior bleed is important.
5. Is the blood bright red (arterial) or dark (venous bleed)? Does he expel clots from his nose or is the blood very thin?
Since you have tried most of the supportive medication and treatments, we need to look at specific medication to reduce bleeding such as ethamsylate, tranexamic acid , botropase and Vitamin K.
A nasal endoscopy to localize the bleed and to cauterize or ligate the bleeding points may be required. However, the above mentioned test results will be required to decide whether he is surgically fit to undergo the procedure.
Selective embolization is another option.
Hope I have answered your query. If you follow up with his test results, I will be available to answer any further questions.
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- Double bypass, respiratory failure, nose bleeds, selective embolization