Physician's Assistant

Refined ultra rapid review Thu 08 January 2026 02:51

Last Modified: 88 days ago

MRN:

Content:

Medical ST5 Miller Review

Reason:
Acute deterioration with agitation, confusion and breathing difficulties in patient with newly diagnosed abdominal mass

History:
Patient became acutely agitated and confused this evening with difficulty breathing requiring large amounts of oxygen. Working diagnosis of aspiration secondary to Parkinsonian crisis, likely precipitated by missing medication due to gastric compression from lymphoma.

Examination:
Sats 75% on 15 litres non-rebreather mask, GCS 6, peri-arrest state

Impression:
14cm upper quadrant mass consistent with lymphoma with central necrosis and possible vascular invasion. Significant aspiration event, possibly secondary to Parkinsonian crisis and gastric distortion from intra-abdominal malignancy. ITU consultant assessment: intubation and ventilation not beneficial due to poor prognosis and unlikely ventilator weaning.

Plan:
1. Establish BiPAP ventilation
2. Transfer to Midglee ward (respiratory ward)
3. Site Ryles tube
4. Follow-up chest X-ray post Ryles tube insertion
5. Allow time for rotigotine patch to work for Parkinsonian crisis
6. Family updated and understand current situation

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Summary:

Investigations:

Refined ultra rapid review Thu 08 January 2026 02:51

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