Next patient is norman smith 709458 89 year old man presenting complaint tripped through a door past medical history paget's disease of the bone ckd 3 peptic ulcer 02/2007 radial ulcer 2000 investigations ct head established lacunar infarcts mild small vessel disease atrophic changes multiple extracranial densities bilateral overlying the bilateral occipital bone that likely represent multiple extracranial foreign bodies query glass creatinine 117 at baseline electrolytes normal alp stable at a 198 full blood count anemia with lymphocytosis lymphocytes 4.5 white cells 9.6 hemoglobin a 125 blood gas reassuring so while walking towards his back door at 11:00 this morning with a frame tripped forward head through a double glazed door no loss of consciousness, vomiting, headache, chest pain, shortness of breath 2 lacerations to the back of head no nausea or vomiting social history lives alone without a package of care his family support him he walks in the frame observations respiratory rate 20 sat's 96% blood pressure a 119 over 82 pulse 80 temperature 36.2 degrees centigrade single episode of presyncope in the x-ray corridor the ed team were planning to send him home impression trip forward with head laceration secondary to frailty and use of walking frame norman I'm norman nice to meet you I'm rob I'm 1 of the doctors hi norman I'm sorry to hear about what happened to your head double glazed window I know window when it's over yeah awful and what happened when did you wait to put your head through it well I turned around and put the door out of the room to go into the toilet and then I had to open the door I see front door is it no back door back door oh so toilet's next to the back door yeah so you're going to the toilet you and you went into the toilet your hand slipped off the handle you think and then you fell into the door and you normally walk with a frame is that right yeah so I was in the frame I I had a frame tried yeah do you had any other slips and trips in this no have I can see you haven't come to hospital no I say you must be doing alright oh no and then this head you had a scan and everything looks fine but they said there's lots of glass in your head did they pick it out no did they did they take it out in a and e they did good I'm glad but it it doesn't hurt but it could be some there yeah fine and then of course it come out on its own too right put his way through fine okay we could do an x-ray of your head and make sure I've done that yeah you had a ct scan before you had the glass taken out probably we should do an x-ray to make sure all the glass is out because it'll be changing he's like that you've had another x-ray after yeah oh fine I'll have a look I haven't seen the result of that I couldn't see it on the computer but sometimes they have I think you're fine I've had 1 fine and they said it will make it normally out fine oh well it sounds like they've sorted everything then yeah and I just need to find out why you fell over yeah have you been feeling okay in yourself lately not ill in any way good fine my boyfriend just on his front garden and he's my front garden on the driveway mhmm and he was coming in and they heard children screaming he said no side and I just look I must have looked around the door mhmm I see door so it's there for us come back I slept fine oh no damn kids alright and you live by yourself at home is that right I have to live in the home and your family help a bit I understand who does this my daughter comes down quite a lot mhmm and my son comes up a lot how often is a lot every day well no they comes up on tuesdays mhmm I do it in bed and I've been yeah housework stuff housework and stuff who does the shopping and and do the shopping she does okay well then ken comes on thursdays well he was he asked well I want anymore shopping mhmm there's milkshakes I have and he he was he brought so so they help you with the shopping they help you with stuff around the house but everything else you do yourself you wash and dress yourself I dress myself yeah great brilliant fantastic and you walk around with a crane when's the last time you got out of the house I've been outdoors sometimes I go to the back door that's nice and I go down the bar and I go to bench and I sit on there for an hour lovely and listen to the birds and listen to the birds I've got a cat I've got stitches in my head I've got a cat that puts on to protect me from the sun from the sun you're gonna need a bigger hat I can umbrella I can umbrella why I put on right have a good listen to your heart big breastfeeding if you're ready and tummy currently no any pain passing for you passing at all you're not fine I usually last it I don't know bit of room to fill up and then some fill ups longer and I'll undo them fine to go for a week no but it's not painful or anything like that no and you've got a bit of a cough is that a long standing thing or is that over the last couple of days I dropped my teeth in oh see of course sorry can you help me take them out no no I'm taking my don't wanna lose them I don't wanna lose them fair enough can I have a look at your legs aren't you yeah how tall are you 6 foot 6 foot 6 foot a bit of leg swelling haven't you yeah have you had that for a while yeah I've been tory tory didn't wanna cause you pain I'm okay have you take do you take things before yeah I'm taking part some bruits don't I'm talking about choking a lot you know because having big heavy legs it won't help you move in your neck because they're big and heavy and you're more likely to catch them or things because you can't lift them enough which may be a potential cause for why you fell but I think obviously the kids do have most of the blame no they're alright good I'm glad so you were in hospital overnight because you had a bit of a funny episode when you were waiting for your x-ray your chest x-ray and you felt a bit unwell I understand I don't remember it you don't remember it my daughter told me I did and that's why she was dead here with her was fine we're very happy to look after you overnight make sure it doesn't happen again and then I can get someone to keep have a look at you and check and get you on your feet and see how you walk tomorrow does that sound okay very thank you I'll have a look at your water medicine and I'll increase it slightly to try and get some water off your legs if that's okay yeah great just gonna make all the changes and stuff like that okay yes do you want some painkillers for your head no I'm alright do need a bit of paracetamol no I haven't I like some okay don't want anymore I can give you a little bit of oral morphine or something just to take the edge off you'll sleep well I won't sleep well if you had a bit of oral morphine you would you reckon yeah you want to well just a low dose just to take the edge off I'll try it then give it a try I think I'll just try it that won't be great it was nice to meet you gentleman as well lovely to meet you you gentlemen see you in the morning nice to meet you see you doctor morning mate well oh no don't worry I'm usually not able to no I don't yeah don't worry well then impression multifactorial full with glass injury laceration to scalp secondary to peripheral edema and use of frame plan number 1 increase furosemide number 2 well actually he's not on furosemide we'll start furosemide number 2 lying standing blood pressure number 3 ot and pt review number 4 ecg number 5 and then in investigations normal sensation in legs and grossly normal power however not formally assessed as 02:00 in the morning and patient in bed disconcerned following mobilization marnet for repeat examination