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Investigations ultrasound lower limb doppler july 2025 yeah occlude acute non occlusive thrombus throughout the popliteal vein on the right this is mark berbery foxtrot70 8 0 1 7 dvt scan tenth and seventh 20 25 no above knee dvt but not possible to adequately visualize the calf veins due to swelling I haven't used that before to exclude calf propagation okay yeah yeah I found it on health toolbox on and you're in of the loitering in there how are you okay fine good alright isn't it yes steve I'm doctor nunak 1 of the medical instructors sorry to hear about your leg yeah did they tell you in the scan that there's a clot in your legs they did fine usually they do and you've had this before yeah is that right a clot on the lungs at that time was it or is it on your legs both legs before fine and when was that yeah I used to do heroin and do like injections that's what I want d alright so it's provoked by that before yeah but this time are you still doing that no no I haven't doing that I've been clean 10 years good for you great it's just no no no no sometimes you can damage the vessels and then it can be more at risk of that because I smoke as well my bad no yeah of course and do you have you had any weight loss recently you've been feeling a lately gaining that's good we've gained weight not really that yeah oh no yeah but we hate it when people lose weight we get worried about them but that's good fine and can I see your leg it's alright isn't it yeah is it you're hobbling a little bit on it is yeah it all the way down the whole thing very angry isn't it yeah and secondly swollen and tender on that right hand side now you can see the sites of previous injections yeah yeah fine fair enough okay so when you had it last time did you have some treatment for it I can't remember that's fine I did I probably did but I can't remember what what we do we usually start people on some anticoagulation so blood thinning tablets I'm on way what are you on the 1 that starts with an r rivaroxaban yeah you're still on that yeah fine have you been taking it every day yeah really taken till that time 1 at 1 in the morning 1 at night fine they they started you on it after the last scan yeah yeah fine you're on well they started it before I had my scan yeah I went to the doctors first and they put me on the fine fine but you haven't been on it for years since your last no no good good I was worried because sometimes people can have these clots when they've been on it for a long time yeah but you're on the treatment of it yeah it's not a it sounds like you're on apixaban which is twice a day no no you're on rivaroxaban yeah yeah okay that's fine so I'll get you some more rivaroxaban to continue yeah I ain't gonna walk all the way up there I'm watching that no think I've got some here oh you got some yeah think I've got some got a question no I've been out to school there last time for me really like forcing it's horrid isn't it yeah I haven't got a transport here I've got a bus here at all you got a bus home yeah we're gonna get to cornwall camp calington calington god so long walk to the bristol where I'll get up because of the work and the groomer frankly yeah alright thankfully you don't need to come back for any more appointments but you do need to have some blood thinning medicine yeah yeah for a good amount of time you know for at least 6 months yeah to clear all this up and then we can think about what we do about it I've brought a new pair of trainers a 100 pound pair of trainers you can't even get in them I can't even get in them oh I'm sorry yeah oh they'll last longer you'll be back in them soon yeah in a bit of time we'll be back in them make sure you've got the have a look at what you had last time and then I will yeah so basically I'll go in the room and get you some tablets to take home with you yes sure you said you've got a few yeah well I ain't got that many but there's some there there's some there great fine so I'll try and see if we've got some more if not can ask someone to run up to the pharmacy and get them for you oh yeah would be easier as well yeah and then we'll start you on those continue it for 6 months and take it from there yeah is that alright yeah that's fine yeah brilliant fine I'll ask my colleagues in dvt clinic they manage all patients with dvts to follow-up with you by phone at some time in those next sort of few months to make sure you're doing okay the important thing to remember is it does take time to get better as I'm sure you remember yeah it's not a magic fix unfortunately I know yeah yeah great I've got this which is from apixaban so it's a different drug that you had before but you're welcome to have it if you like it's a similar type of medicine it's all about how to the things you can do to reduce the risk of clots I think it's helpful rivaroxaban don't have any of that what do you think man you're the doctor yeah yeah no I think it's helpful information to have about what to do with the dvt I'll go and find you the medicine and you're welcome to hang out here I'll back in the waiting room and come it for you oh I'll wear it here you're wear it here yeah I'll prescribe it great come up to the lab hi hi hi hi hi hi

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Medical ST5 Miller Clerking
[Current Date] [Current Time]

Presenting Complaint:
[The reason for attendance in 1-3 words]

History of Presenting Complaint:
[Chronological narrative of current illness using short, clear sentences. Include:
- Onset, character, location, radiation, timing, exacerbating/relieving factors
- Associated symptoms
- Impact on daily activities
- Previous similar episodes
- Relevant collateral history from relatives/carers
- Any relevant background from other healthcare professionals
Do not repeat patient's name throughout. Be concise and tell a chronological story to the reader. Do not include subjective descriptions of the symptoms e.g. "severe" or use unnecessarily long words.]

Past Medical History:
[Bulleted list of significant medical conditions with relevant details:]
• [Condition with year if mentioned]
• Diabetes mellitus - latest HbA1c: [value] mmol/mol ([date])
• Asthma/COPD - latest spirometry: FEV1 [value], FVC [value] ([date])
• [Previous surgeries with dates]
• [Other significant medical history]

Drug History:
• [Drug name] [dose][units] [route] [frequency]
• [Example: Omeprazole 20mg PO OD]
• [Example: Clopidogrel 75mg PO OD]

Recently Stopped Medications: [If relevant]
• [Medication] - stopped [date/reason]

Allergy History:
[If allergies mentioned:]
• [Allergen] - [Reaction type] ([severity if mentioned])
• NKDA [if no known drug allergies stated]

Social History:
[Living situation. Who they live with, housing type, if mentioned]
[Mobility. Walking aids, stairs, transfers, if mentioned]
[Carers. Formal/informal care arrangements, if mentioned]
[Occupation. Current/previous if relevant, if mentioned]
[Smoking. Never/Ex-smoker/Current - pack years if mentioned]
[Alcohol. Units per week/Never/Ex-drinker - if mentioned]
[Functional Status: Impact on activities of daily living, if mentioned]

On Examination:
[General Appearance. Alert, well/unwell, distressed, if mentioned]
Observations:: [If mentioned - HR, BP, Temp, RR, O2 sats (do not use subscripts)]
• Abdomen: [Inspection, palpation, percussion, auscultation findings. If not commented upon, document as normal]
• Cardiovascular: [Heart sounds, murmurs, peripheral pulses, oedema. If not commented upon, document as normal]
• Respiratory: [Chest expansion, percussion, auscultation. If not commented upon, document as normal]
• Neurological: [If examined.]
• Other: [Any other relevant examination findings, if mentioned]

Investigations:
• [Test name] ([date, if mentioned, do not include include today's date on results, list without a date]): [Result without units]
• [Example: Hb 85]
• [Imaging type] ([date, if mentioned]): [Key findings]
• [Example: CT Abdomen/Pelvis (15/03/24): Sigmoid diverticulosis, no perforation]

Impression:
[Main diagnosis]
Differential Diagnoses: [Only if multiple possibilities discussed]
[Secondary issues. Relevant comorbidities affecting management. If mentioned]

Management Plan:
1. [A numbered list documenting the management plan to be undertaken, if mentioned, include:
- Immediate management/monitoring,
- Investigation requests,
- Treatment interventions - medications, procedures,
- Discharge planning/follow-up arrangements,
- Patient education/lifestyle advice,
- Referrals to other specialties if needed,
- Which ward or specialty the patient would be best admitted to e.g. "Respiratory Bed",
- Escalation plan that was discussed - whether the patient is suitable for CPR, ITU and/or NIV.]

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