So sylvia lingu foxtrot 08/7656 year old name lady presenting complaint hemoptysis and shortness of breath history of presenting complaint 2 day history of hemoptysis and progressive dyspnea full stop fresh red hemoptysis multiple times over the last 2 days full stop associated with this, has noticed right leg swelling and tenderness to palpation full stop <\n\n> Known hemodialysis patient with end stage renal failure undergoes dialysis 3 times a week most recent dialysis session 2 days ago open brackets friday close brackets full stop <\n\n> On examination comfortable at rest vital signs blood pressure a 155 over 98 heart rate 87 respiratory rate 18 oxygen saturation is 97% on air temperature 36.6 heart sounds normal bibasal crepitations on lung auscultation midline sternotomy scar midline laparotomy scar I should say no abdominal tenderness pitting edema to the knees bilaterally ecg sinus rhythm at night 6 beats familiar with slightly prolonged qt interval no evidence of st elevation or ecg signs of hyperkalemia investigations creatinine 894 with urea 24.3 and potassium 7.1 open brackets hemodialysis patient close brackets alp 169 alt 68 d 1.3 elevated hemoglobin 113 stable anemia past medical history past medical past medical history burnt out tubular interstitial nephritis on renal biopsy open brackets august 2020 close brackets current hemodialysis 2 failed fistulas on left arm right sided fistula appears to be functioning previous uremic pruritus hep b core antibody positive bilateral salpingo oophorectomy supracholic omentectomy for benign ovarian serous cyst adenofibroma march 2023 allergies flucloxacillin and vancomycin listed for renal transplantation impression concerning for pulmonary embolism evidence of fluid overload hyperkalemia despite recent dialysis plan number 1 therapeutic low molecular weight heparin number 2 ct pulmonary angiogram number 3 green cannula multiple attempts including with ultrasound guidance by myself nursing staff however unable to be cited at 1 attempt we were successful however subsequent abg revealed this to be subsequent blood gas revealed this to be an arterial cannula removed discussed with renal team regarding admission admit until scan performed medications list atorvastatin 20 mg once per night renavit 1 tab once per day warfarin as per inr alpha calcidol 250 nanograms 3 times a week calcitu 2 tablets 3 times a day rinne gel 800 mg 3 times a day inhixa 40 mg on dialysis days venofer 100 mg once per fortnight iv amlodipine 10 mg once per day pramipexole 88 micrograms at night orally eprex 4000 units 3 times a week intravenously