Handover 27 June 2025 :: PA

Friday 27 June 2025

Scott Powell requiring cardiology admission for rate control with stepped approach using bisoprolol then digoxin if needed.
meeting - 283 days ago 14:17
Scott Powell, young male with atrial flutter since May 2025, presenting with inadequate rate control despite optimal beta-blockade, requiring admission for rate control and cardiology review.
clerking - 283 days ago 14:21
Patient with atrial flutter causing heart failure symptoms, currently on bisoprolol with good symptom control but medication side effects, planned for hospital admission for cardioversion and electrophysiology assessment.
custom - 283 days ago 14:50
35-year-old male with atrial flutter since May 2025, persistent tachycardia (146 bpm) despite Bisoprolol 5mg OD, now with hypotension and ankle oedema.
sdec - 283 days ago 14:03

36-year-old lady at 25 weeks gestation presenting with 3-week history of pleuritic chest pain and dyspnoea, being investigated for possible pulmonary embolism with VQ scan.
sdec - 283 days ago 08:51

Patient presenting with 3-4 day history of mixed rectal bleeding and morning malaise, requiring urgent investigation for lower GI bleeding.
sdec - 37 weeks ago 16:00
This appears to be a correspondence regarding training day organisation rather than a patient consultation.
email - 283 days ago 12:29
Gentleman with Type 3 diabetes presenting with DKA following insulin supply interruption, also requiring diabetic foot team assessment for right big toe ulcer.
issues review - 130 days ago 20:01
7- - 130 days ago + 7+

Restart Lantus insulin prescription

7- - 130 days ago + 7+

Monitor DKA resolution and consider stopping IV insulin

7- - 129 days ago + 7+

Urgent diabetic foot team referral
89-year-old gentleman presenting with acute onset worst-ever headache, collapse, confusion, and tendency to lean right - requiring urgent neurological assessment.
refined clerking - 129 days ago 19:06
7- - 129 days ago + 7+

Request urgent CT head scan

7- - 129 days ago + 7+

Request blood tests - FBC, U&E, CRP, urinalysis

7- - 129 days ago + 7+

Arrange medical ward admission
Patient with lower gastrointestinal bleeding presenting with 3-4 day history of dark stools with blood and significant haemoglobin drop from 94 to 79 g/L, likely secondary to colonic angiodysplasia.
sdec - 37 weeks ago 16:16
Anthony presented with collapse in bank this morning. Previous similar episode 2 years ago. Plan for Holter monitor, CT head and postural BP measurements.
sdec - 258 days ago 17:03
Middle-aged gentleman with type 2 diabetes and previous coronary stents presenting with 4-day history of left shoulder and chest wall pain, likely musculoskeletal in origin.
sdec - 256 days ago 18:00
Adult female with Turner syndrome and hypothyroidism presented with left-sided abdominal pain following a recent viral-type illness, with mild breathlessness and transient dizziness. Blood tests showed mild cholestatic liver derangement, with differential including reactive viral hepatitis versus biliary pathology.
refined clerking - 2 days ago 20:48
Patient with severe gastroenteritis presenting with profuse watery diarrhoea and abdominal pain, currently taking Mounjaro, with reactive lymphadenopathy on imaging but no acute surgical pathology identified.
referral - 208 days ago 11:33
Turner syndrome patient with hypothyroidism and recent viral gastroenteritis, now presenting with left-sided abdominal pain, breathlessness and mildly abnormal liver function tests. Impression is post-viral transaminitis versus biliary pathology, with plan for repeat LFTs, viral screen and ultrasound.
refined clerking - 2 days ago 20:49
43-year-old woman with recent viral prodrome, left lower abdominal pain and breathlessness, found to have mildly abnormal liver function tests with raised ALP. Differential includes transient viral hepatitis versus biliary pathology, and she was planned for repeat bloods, viral serology and abdominal ultrasound.
refined clerking - 2 days ago 20:55
Multiple gastroenterology follow-up consultations covering iron deficiency investigations, IBD management, and complex diagnostic cases requiring endoscopic and imaging follow-up.
meeting - 115 days ago 16:20
7- - 108 days ago + 7+

Request CT imaging for Anne Evans

7- - 108 days ago + 7+

Arrange fecal calprotectin for Mr Sutton

7- - 107 days ago + 7+

Send referral to Derriford IR for Anne Evans

7- - 101 days ago + 7+

Arrange colonoscopy for Aaron Valko

7- - 25 days ago + 7+

Arrange colonoscopy for Andrew when returns from Gibraltar
Adult female with Turner syndrome and hypothyroidism presented with left lower abdominal pain after a recent viral illness, with mildly abnormal liver function tests. Clinical picture was felt most likely to represent a post-viral hepatobiliary process, with gallstones/choledocholithiasis and viral hepatitis as differentials.
refined clerking - 2 days ago 21:02
Adult patient re-presented with hypotension and diagnostic uncertainty following abdominal pain, likely biliary infection or cholangitis with pancreatic inflammation.
Refined Ultra Rapid Review - 64 days ago 23:23
7- - 64 days ago + 7+

Flag patient to night registrar

7- - 9 weeks ago + 7+

Repeat blood tests

7- - 9 weeks ago + 7+

Consider MRCP if no improvement
Turner syndrome, hypothyroidism and prior hysterectomy, presenting with left lower abdominal pain and breathlessness following a recent viral illness. Bloods showed mild liver function derangement with raised alkaline phosphatase, with differential of transient viral hepatitis versus biliary pathology.
refined clerking - 2 days ago 21:07
Young patient with newly diagnosed aggressive ulcerative colitis presenting with disease flare following infliximab discontinuation due to severe allergic reaction, requiring IV steroid therapy.
refined clerking - 137 days ago 22:50
7- - 501 days ago + 7+

Monitor inflammatory markers

7- - 501 days ago + 7+

IBD team review for alternative biologics

7- - 501 days ago + 7+

Dermatology review of facial lesion
Patient with Turner syndrome and hypothyroidism presented with left lower abdominal pain following a recent self-limiting febrile vomiting illness. Bloods showed mildly abnormal liver tests and alkaline phosphatase, with differential including post-viral change versus biliary pathology.
refined clerking - 2 days ago 21:08
Mrs Harry presenting with dysphagia requiring positional changes to swallow, associated weight loss and anxiety, undergoing upper GI endoscopy to investigate swallowing difficulties and exclude coeliac disease.
endoscopy report - 129 days ago 14:26
7- - 129 days ago + 7+

Complete upper GI endoscopy procedure

7- - 122 days ago + 7+

Review histology results from duodenal biopsies

7- - 115 days ago + 7+

Follow up endoscopy results with patient
Patient with iron deficiency and rectal bleeding, background of spinal stenosis, underwent upper GI endoscopy and planned for CT colonography to exclude colorectal malignancy.
clinic letter - 104 days ago 15:29
7- - 103 days ago + 7+

Follow up endoscopy results

7- - 97 days ago + 7+

Arrange CT colonography with contrast

7- - 90 days ago + 7+

Send results letter to GP
Colin Penn is an 88-year-old gentleman presenting with acute hypoxic respiratory failure in the context of a 10-day history of general deterioration, with clinical, biochemical and ECG findings consistent with acute decompensated heart failure likely secondary to a missed myocardial infarction. He has significant background comorbidities including atrial fibrillation, CKD stage 3, asbestos-induced pleural disease, and pulmonary fibrosis.
refined clerking - 40 days ago 19:02
Colin Penn is an 88-year-old male who presented to Torbay Hospital ED with acute breathlessness, found to have acute decompensated heart failure with pulmonary oedema, likely secondary to a missed myocardial infarction approximately 10 days prior, complicated by significant background cardiorespiratory comorbidities including atrial fibrillation, asbestos-related pulmonary fibrosis, and CKD stage 3.
refined clerking - 40 days ago 19:05
69-year-old man with a previous lacunar basal ganglia stroke in August 2025 presented with overnight worsening bilateral weakness and gait difficulty on a background of coryzal symptoms, urinary frequency, and hyperglycaemia. Presentation was felt most consistent with recrudescence of old stroke symptoms triggered by intercurrent infection and raised blood glucose, rather than a new stroke.
refined clerking - 5 days ago 10:05

Patient initially planned for discharge has developed cholangitis requiring inpatient antibiotics and urgent ERCP consideration.
email - 283 days ago 12:43
Jacqueline Venn - update required for Dr Vine regarding patient status.
notes - 285 days ago 16:40
Jacqueline Venn requires follow-up communication with Dr Vine regarding OGD results for potential ERCP consideration.
notes - 283 days ago 12:25
Patient initially well for discharge but developed cholangitis requiring inpatient antibiotics and urgent ERCP consideration.
email - 283 days ago 12:44

80-year-old man presenting with acute left leg swelling and pain, suspected ruptured Baker's cyst or Achilles tendon injury, referred for orthopaedic assessment.
sdec - 283 days ago 16:17
80-year-old man presenting with 24-hour history of left leg swelling and pain below the knee, suspected Baker's cyst rupture.
sdec - 283 days ago 16:26

Mr Dodds is a gentleman with ulcerative colitis diagnosed in 1977, recently returned to Plymouth, experiencing mild flare symptoms managed by increasing Balsalazide dose, requiring routine colonoscopy surveillance and annual follow-up.
clinic letter - 311 days ago 09:59
Results letter for Dennis Dodds regarding blood test monitoring while on Colazide - kidney and liver function normal with borderline low potassium.
refined results letter - 283 days ago 07:45

Patient with ileal Crohn's disease post ileocaecal resection 1997, now with neoterminal ileal stricture and bile acid malabsorption, presenting with 10x daily loose stools and right-sided abdominal pain.
clinic letter - 311 days ago 10:53
Results letter for Angela Palford regarding blood tests showing low vitamin D (58 nmol/L) with normal thyroid function and other parameters.
refined results letter - 283 days ago 07:35

Mr Jones, a bus driver with previous ileocaecal resection, has bile acid malabsorption causing loose stools 2-3 times daily, well controlled with colesevelam which can be increased to effect.
clinic letter - 311 days ago 08:38
Barry Jones (MRN: 800278) - colonoscopy results showing scattered small bowel ulcers with mild inflammation but no evidence of IBD.
refined results letter - 283 days ago 07:55

Mr Trevathan presented with concerns of right leg DVT which was excluded on ultrasound. Bilateral lower limb oedema secondary to congestive cardiac failure, switching diuretic therapy.
sdec - 283 days ago 11:20

33-year-old lady with ADHD and asthma presenting with 3-day history of fever, haemoptysis, and acute asthma exacerbation, diagnosed with lower respiratory tract infection.
sdec - 283 days ago 11:52
33-year-old lady with fever, haemoptysis and back pain. Normal inflammatory markers suggest viral URTI rather than bacterial pneumonia.
sdec - 283 days ago 13:12