Physician's Assistant

Rapidreview Thu 06 November 2025 21:23

Last Modified: 151 days ago

MRN:

Content:

Further review at 20:30.

On arrival:
- Pulse rate: 88 bpm
- Oxygen saturation: 92% on 15 litres non-rebreather oxygen
- Respiratory rate: 29/min
- Blood pressure: 130/55 mmHg

O/E Chest: Bilateral crepitations to mid-zones. Bilateral lower limb oedema to knees.

Investigations:
Reviewed blood tests from earlier which were not originally available. CRP significantly raised with AKI (most likely), although no baseline available for comparison.

Discussion:
Explained to patient and wife how unwell he is with this significant oxygen requirement and evidence of bilateral infection on chest X-ray. There may be an element of fluid overload given his cardiac background leading to worsening oxygenation, so suggested trial of furosemide to see if this improves things.

He is currently on 15 litres oxygen and uncertain how long he will be able to maintain this level. He might benefit from intensive care support and this was discussed.

He has strong Christian faith and does not wish to be for CPR, which is entirely reasonable and what I would suggest clinically. However, despite his comorbidities of diabetes, ischaemic heart disease, CKD, prostatic hypertrophy and mild Alzheimer's dementia, he was well enough to travel by coach for a planned holiday. His functional baseline is therefore not too poor.

Considered whether he might benefit from intensive care for single organ support (increased oxygen demand) with clearly reversible cause such as pneumonia, and he would be agreeable to this. DNAR form completed to that effect.

Plan:
1. Catheterise
2. IV furosemide
3. Repeat ECG
4. ITU review
5. Arterial blood gas

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Summary:

Investigations:

Rapidreview Thu 06 November 2025 21:23

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