Physician's Assistant

Patient Details

Referral (299 days ago 18:24)

Referral Wed 11 June 2025 18:24

Last Modified: 299 days ago

MRN:

Content:

Investigations:
CT scan: Shows chest infection and pneumonia, also demonstrates significant constipation

I reviewed this gentleman in hospital who is recovering from recent surgery (6 operations mentioned). He presents with a productive cough and shortness of breath. Post-operatively he developed respiratory symptoms with fever yesterday, which has since settled. He reports difficulty expectorating despite feeling the need to bring something up.

On examination, he appears unwell with tachycardia. Chest examination reveals end-expiratory wheeze bilaterally with quiet air entry in the left lower zone consistent with pneumonia. Abdominal examination demonstrates significant distension with tympanic percussion consistent with severe constipation and bowel stasis.

His bowel function has been severely impacted following multiple operations, with significant constipation requiring regular Laxido and Senna. The constipation is contributing to his respiratory compromise by limiting diaphragmatic excursion.

Past medical history includes obstructive sleep apnoea and psoriasis. He is an ex-smoker, stopped 20 years ago.

Current medications include Clopidogrel, Aspirin, Laxido and Senna daily.

Impression:
Hospital-acquired pneumonia (left lower lobe)
Severe post-operative constipation with bowel stasis
Post-operative respiratory compromise

Suggest:
1. Continue current strong antibiotics for pneumonia
2. Throat swab to exclude viral infection (COVID/influenza)
3. Sputum sample if productive expectoration occurs
4. Nebulised saline/mucolytic therapy to aid expectoration
5. Aggressive bowel management with increased laxatives including stimulant preparation
6. Early mobilisation to improve both respiratory function and bowel motility
7. Consider physiotherapy input for chest clearance techniques
8. Monitor for fever recurrence which may indicate viral co-infection

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Rapidreview (299 days ago 17:24)

Rapidreview Wed 11 June 2025 17:24

Last Modified: 299 days ago

MRN:

Content:

Post-operative consultation following recent spinal surgery.

HISTORY:
Patient underwent right L4/L5 decompression and discectomy, plus L5/S1 midline sparing decompression and discectomy on 30/05/25.

CURRENT ISSUES:
1) Post-operative lumbar stenosis management
2) Sepsis of unknown origin (presumed chest source)

INVESTIGATIONS:
- CTAP: Negative for surgical cause
- CTPA: Negative for pulmonary embolism but suggests pneumonia
- Chest examination: Patient requiring supplemental oxygen, not dramatically increased work of breathing

FINDINGS:
- Fecal loading noted on imaging with fecalisation of terminal ileum contents
- Significant constipation secondary to opiate analgesia
- Atelectasis present
- Patient on dual antiplatelet therapy for cardiac history

CURRENT TREATMENT:
- IV Levofloxacin for presumed pneumonia
- Laxido for constipation
- Supplemental oxygen as required
- Opiate analgesia post-operatively

PLAN:
- Continue current antibiotic therapy
- Optimise bowel management with additional laxatives
- Consider prokinetic agent to combat opiate-induced gut sluggishness
- Monitor respiratory status
- Cardiology review completed
- Nursing staff to monitor for clinical deterioration

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Summary:

Investigations: