Emergency Hipertension

A 33 year old man came to the emergency room with complaints of nosebleeds since this afternoon. The patient also complained of moderate intensity headache. Headaches appear persistent and continuous. Apart from that, the patient complained of fluctuating fever since 1 day ago. there was a lot of nausea, there was vomiting when I was in the emergency room. Currently the patient complains of weakness and tends to be lethargic.

Shortness of breath (-), cough (-), runny nose (-)

RPD: Hypertension (+) Amlodipine 5 mg, history of upper GI bleeding in 2021

RPO: Amlodipine 5 mg, history of blood transfusion +

 

GCS E4M6V5 TD:200/130 mmHg N: 86x/m

RR: 22x/m, S: 36.5C, SpO2: 98% on RA

 

Physical examination:

Head: normocephali

Eyes: CA (+/+), SI (-/-), oblique eyes (-/-)

Mouth: dry oral mucosa

Thorax: symmetrical, retracted (-/-) Pulmo: ves (+/+), rh (-/-), wh (-/-)

Cor: BJ I-II reg, murmur (-) gallop (-)

Abdomen: supple, BU + normal, NTE (+)

Extremities: Warm accral +/+, CRT <2 sec

 

A:Hypertension Emergency,,Anterior Epitaxis, Thrombocytopenia ec DHF (?), Bleeding Anemia,Hyponatremia

P: Inf. NaCl 3% 500 ml/24 hours, Nicardipine drip 5 mg/hour --> currently 140/80 mmHg, Inj. Tranexamic Acid 500 mg, Inj. Omeprazole 40 mg, Inj. Ondansetron 4 mg, Inj. Paracetamol 1 gr

 

Please advise and further management, thank you.