Physician's Assistant

Patient Details

Rapidreview (167 days ago 17:34)

Rapidreview Tue 21 October 2025 17:34

Last Modified: 167 days ago

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Thank you for letting me know about this patient, Dr Prasad.

DIAGNOSIS:
Left lower zone community acquired pneumonia with raised CRP and increasing oxygen requirement

CLINICAL PRESENTATION:
CRP 266. Patient has developed increasing oxygen requirement from 4L nasal specs to requiring Hudson mask (at least, probably Venturi). CRP 200.

CURRENT TREATMENT:
On IV co-trimoxazole and oral clarithromycin as per guidelines. Early in this course of antibiotics so no indication to change at the moment.

EXAMINATION FINDINGS:
Alert, GCS 15. Sweaty and diaphoretic. Heart sounds normal. Chest: transmitted upper airway sounds throughout with left lower zone coarse crepitations. Abdomen soft and non-tender. No peripheral oedema.

PAST MEDICAL HISTORY:
Eosinophilic oesophagitis, noted previously on Jorveza dispersible budesonide. However, has not taken in the last 4 weeks and so I do not feel that adrenal insufficiency is a contributing factor here. Even if had been taking it recently, it is not absorbed well orally.

INVESTIGATIONS:
ECG: Sinus rhythm without evidence of ischaemia, rate 93 bpm

PLAN:
1. Move to resus
2. Nursing staff requesting Critical Outreach Team review
3. Titrate oxygen aiming for saturations 95%
4. Continue current antibiotics
5. Venous blood gas and repeat blood tests
6. Atypical pneumonia screen and HIV test
7. Sputum MC&S
8. New cannula

COMMENT:
Increasing oxygen requirement in the context of left lower zone pneumonia early in treatment.

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Rapidreview Tue 21 October 2025 17:34

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