Physician's Assistant

Patient Details

Met call (299 days ago 13:20)

Met call Wed 11 June 2025 13:20

Last Modified: 299 days ago

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Content:

Reason for Call:
Emergency review of patient with bilateral pneumonia admitted 7th June, showing deterioration with significant oxygen requirements and possible pulmonary oedema.

A-E Assessment:
A - Airway: Patent

B - Breathing: Significant respiratory compromise requiring 65% oxygen via 5L nasal specs and 20L via mask (22L total). Saturations dropping to 50% at lowest. Vesicular breath sounds in upper zones with slight expiratory wheeze discernible on right side. Associated crepitations suggestive of pulmonary oedema. No improvement despite maximum medical therapy.

C - Circulation: BP 98/56. Capillary refill time 2-3 seconds. No peripheral oedema present. Currently on Furosemide 40mg boluses with infusion running.

D - Disability: GCS 14. Hand grip strength intact bilaterally.

E - Exposure: No fever reported. Mucous membranes assessed.

Investigations:
Chest X-ray: Shows significant deterioration on left side with large left-sided pneumonia. No large effusion on right. Some fluid previously noted in fissure. BNP reported as low.

Impression:
Severe bilateral pneumonia with significant left-sided changes and respiratory failure. Possible superimposed pulmonary oedema. Patient showing no improvement despite maximum medical therapy over 3-4 days.

Plan:
1. Repeat chest X-ray to exclude pneumothorax given significant deterioration
2. Continue current oxygen therapy for comfort
3. Family discussion completed with twin brother (next of kin) regarding prognosis
4. Decision made to transition to palliative care approach
5. Cease active medical interventions
6. Focus on comfort measures and symptom control
7. Maintain oxygen therapy for respiratory distress relief

Team Leader: Malcolm Duig
Documentation Date: 25/06/11 13:20

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Patient Details

Met call Wed 11 June 2025 13:20

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