Physician's Assistant

Clerking Fri 30 January 2026 19:40

Last Modified: 66 days ago

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Medical ST5 Miller Clerking
30/01/26 19:00

Presenting Complaint:
Hypertension perioperatively

History of Presenting Complaint:
Planned for shoulder surgery today however became hypertensive with blood pressure over 200 perioperatively. Blood pressure well controlled in the department with readings of 184/117 initially, then 146 systolic subsequently.

Past Medical History:
• Hypertension
• Subarachnoid haemorrhage 2018
• Asthma 2017

Medication History:
• Lisinopril 5mg PO OD
• Amlodipine 5mg PO OD
• Fostair 100/6 dose inhaler 2 puffs BD
• Omeprazole 20mg PO OD

Allergic History:
NKDA

On Examination:
Temperature 37.2°C, heart rate 82, respiratory rate 19, oxygen saturations 94%. 
Heart sounds normal. 
Chest clear. 
No peripheral oedema.

Investigations:
Albumin 51, remainder of bone profile normal. 
LFTs normal. 
Troponin 9. 
CRP 2. 
Urea normal. 
AST normal. 
Phosphate and magnesium normal. 
Full blood count normal. 
Venous blood gas normal. 
ECG shows high voltages but no evidence of ischaemia.

Impression:
Hypertension perioperatively, possibly due to missed medications, anticipation, or nil by mouth state

Plan:
1. Add bendroflumethiazide 2.5mg PO OD to antihypertensives
2. Monitor blood pressure at home
3. Copy orthopaedic team into discharge summary
4. CXR

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Clerking Fri 30 January 2026 19:40

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