Physician's Assistant

Patient Details

Issues review (191 days ago 21:40)

Issues review Sat 27 September 2025 21:40

Last Modified: 191 days ago

MRN:

Content:

Issues:
1. Thrombocytopenia with active epistaxis
- Platelets dropped from 35-40 to 21
- Currently experiencing nosebleed
- Recurrent epistaxis secondary to thrombocytopenia
- Previous notes indicated not for platelet transfusion unless severe bleeding, but to discuss with haematology if platelets drop to low 20s

2. Acute kidney injury (AKI) - worsening
- Urea rising
- Patient biochemically dry
- Currently on 1 litre Hartmann's over 10 hours
- Still passing urine
- Potassium has improved

3. Raised inflammatory markers with unknown source of infection
- CRP doubled to 400
- Blood cultures negative
- Stool sample negative
- Urine sample negative
- Chest clinically clear
- Awaiting chest X-ray
- No clear source of infection identified

Background:
Patient has heart failure with reduced ejection fraction (HFrEF). Previous COVID infection in February. Patient is comfortable apart from being annoyed about nosebleed. Patient is not oedematous and chest remains clear. Haemoglobin stable despite epistaxis.

Impression:
1. Thrombocytopenia with active bleeding (epistaxis)
2. Acute kidney injury - worsening
3. Hospital-acquired infection of unknown source with raised inflammatory markers
4. Background HFrEF

Plan:
1. Contact haematology regarding platelet transfusion given active bleeding in context of platelets at 21
2. Increase fluid resuscitation - change Hartmann's to run over 4 hours instead of 10 hours
3. Catheterise patient and commence input/output monitoring with fluid chart
4. Commence tazocin tonight to cover hospital-acquired pneumonia and potential aspiration
5. Await chest X-ray results
6. Send repeat urine sample and cultures
7. Monitor renal function and electrolytes

Field Clipboard (for EPR paste)

Builds copy buttons from the headings currently in the note, and also lets you copy the entire note.

Summary:

Investigations:

Patient Details

Issues review Sat 27 September 2025 21:40

Field Clipboard (for EPR paste)

Tasks

Feedback