The next patient is richard kv 688444 79 year old gentleman investigations lp 54 neutrophils 8.2 with white cells 8.8 griatin 106 from baseline 84 electrolytes normal bilirubin 26 from baseline 19 lactate 1.7 recent ct thorax noted stable appearances of left lower lobe nodule vestous pleural disease changes with mild right lower lobe effusion remains static nodular soft tissue thickening in the right lung base probably due to some early round asis remains the same adult medical emergency 10 line of work with level 5 adult alright cool so we've done already we've done the machine done already done we've the 1 so I'm gonna go and do machine investigations chest x-ray right lower zone hazy opacification as well as left lower zone small bilateral pleural effusions evidence of asbestos related lung disease a possibility however aggressive consolidation compared to previous ct thorax scout film hello is it mister kv that's right hello there and then I'm 1 of the medical experts oh nice to meet you how are you I'm happy about it I'm good I'm glad tell me all about it what brings you to hospital well I took my neighbor up to see her I see and drop it off and then yeah it but then but then about 4 4 ly really all today all today and before that you felt fine uh-huh okay yeah that's good fine so you felt fine before today and then today you suddenly felt poorly and in what way did you feel poorly well I was I had to stand up was shaking got weak mhmm yeah do I feel mhmm what any other symptoms no no very strange isn't it it is strange yeah so very weak all over lethargic and tired any and aching an aching dry foot any fevers that you've you've noticed you feel quite warm to the touch at the moment yeah I was I was quite warm quite a lot mhmm and is that just today as well or is that been more than just today just today yeah mhmm what caused it well any pain anywhere just just you know just on my stomach in the tummy I'm on steroids a course of steroids for your chest or for something else for arthritis polymyalgia rheumatica yeah when did you start that course get on your repeat medicines but it must be a different thing that your gp's prescribed to you came from down here from the arthritis clinic that's why yeah fine and how much are you on no I'm sure steroids that's okay I'll try and find the letter I'm sure we'll to dig it out from somewhere yeah yeah okay alright so you're on some steroids for your pulmonary artery massacre you've got a bit of tummy discomfort but no pain anywhere else no no no that's not was very worried I know now the better find the a and e team have sorted you out then yeah yeah good couple with ambulance good I'm glad and then then you'd see 1 of the a and e consultants here who I think has started on some antibiotics and things like that and has kept a close eye on you and then he's asked me to come and see you and 1 of the medical doctors to think about bringing you into hospital overnight yes to keep an infection somewhere we think probably in your chest yeah yeah yeah when the urine was a funny color according to was it according to paramedics yes what color was it how dark like coca cola dark yeah that dark yeah dark really and how are your stools any change there no no no no change there at all when you change the smell of your wee does it smell particularly pungent pungent not a little bit yeah mhmm and you're a bit itchy down there is that fair to say yeah yeah fine sometimes they can be a bit uncomfortable is it painful passing water not really no no are you going more often than normal not really not really okay fair enough alright cough or cold nope nope fine any pain in the back at all headache visual changes rashes anywhere no no wonderful can I have a quick look at you do you mind okay should I see your hands to start with thank you let's see lovely what did you do for a living I was a electrician right how long did you do that for most of my work and life lovely great what kind of stuff did you do anything really domestic commercial everything everything yeah wonderful fine let's do it you don't have to do anything or anything I'm walking on my phone I'll have a sneeze and then listen to your back and I saw you've been investigated by the respiratory team because of some asbestos like lung changes is that right that's right yeah and that from being a sparky crawling around in asbestos and attics and things like that sorry that's chris whenever you're ready so I'm just gonna a please lovely thank you very much any trouble with your bowels at all any loose stools nope nope nope fine great can I touch your tummy do you want me to take that bowing again sure can you don't look particularly comfortable can I do anything to make you more comfortable yeah looks alright because you're off the bed you're quite tall now yeah and you want to lie down flat yeah because you want to go to bed because it's 02:00 in the morning so shall I lie down flat and then you can squidge your head a bit further up then release all the bed it looks like you've wet yourself a little bit yes do you want some we can get you a change of if you like can you yeah yeah we can get you some pants they're very no one's fetching at these no unfortunately and the discomfort in your tummy is it anywhere in particular not really not really any trouble with the waterworks the prostate stuff is coming for all of us do you get up in the night to go for a week yes trouble with your spleen at all not well not not not not particularly not from re age yeah and any dribbling after you've got it yeah you get a bit of dribbling and a bit of leakage for chirps yeah okay sorry about that have you have you had your prostate blood test done at all yes you haven't you had some yeah good and an exam fine very good yeah fine so that one's on top of that that's good yeah I'll get you a new gown I'll ask them to get you a new gown and some pants I'll ask them to scan your bladder and just see whether there's any stiff stuff left in there right because sometimes when you're ill for other reasons can retain urine and leak a little bit like that without realizing it because you've got lots of water stuck inside you want some antibiotics which is good and we'll continue those on I it's possible you've got a chest infection it sounds as though you might have a chest infection and your chest x-ray looks like it so we'll continue to treat the chest but it raises the possibility of having a urine infection and we'll test some test some of your urine to make sure we haven't got a bug there anything else I've missed I don't think so what are you allergic to I'm giving you a red wrist band only gluten gluten fine okay well yeah yeah fine you're not allergic to any medicines no no wonderful can I see your tongue is that alright lovely nice nice that's great you know our numbers on the screen were really nice when they tested them earlier yeah you're very wonderful any questions anything I've forgotten don't think so good that's fine we oh I should ask do you drink or smoke no no who do you live at home with wife do you help each other yes do you need any more help than her I'm the 1 for yourself I need more help okay than her do you do everything for yourself at home or do you have carers come to help you no no I'm exhausted all the time oh I'm sorry but nobody seems to know what's causing it I'll look I'll add on some blood tests to look for a cause of being exhausted all the time hope you'll find something to replace just to make you feel better and fine and do you you walk around by yourself at home yeah with a stick yeah yeah with stick fine and who does the shopping yeah everything's good you do it together wonderful fine when you come into hospital we should always talk about escalation about what we'd do if you were to become so unwell that your heart were to stop I have I have no problem with doing everything including jumping up and down on your chest to try and restart your heart no is that okay with you of course it is wonderful great alright thanks for talking to me thank you sorry for disturbing you do you want me to turn the lights off to go to sleep or are you okay it's alright it's there do want me to turn it off no I'm happy you're happy okay thank you very much lovely to meet you see you later okay yeah you're okay yeah thank you sounds good okay busy emily yeah yeah you don't feel like this just an alternative suffering for us and again it'd be nice to say it doesn't matter you never finish so why bother worrying for the bed that is true not a bed at the moment yeah impression right to community acquired pneumonia on a background of asbestos related lung disease episode of urinary incontinence raises the possibility of urinary retention or even urinary tract infection given dark and offensive urine plan number 1 antibiotics to cover chest and urine number 2 medical admission number 3 iv fluids number 4 bladder scan + or - catheter number 5 add on bloods for fatigue screen number 6 sputum mcns if produces number 7 u number 8 blood cultures number 9 for full escalation