Alright it's it's you saw me when I checked your antibiotics I feel out of breath yeah he may have and that's what is it you have bronchiectasis bronch bronchitis bronchitis I think it's right okay I I that's okay they started off but you've been short of breath now for 2 days or so more short of breath for 2 days but it's it's happened before I haven't taken a full course yet mhmm it usually clears it up coughing a with this I've been coughing been coughing for a while now mhmm because then it's not last night night before but I could I could have any chest pain going along with it I I just wore an ache an ache yeah I don't know you mean shaky and hot and cold there's nothing out of water or heavy it's just told me to said years ago it's it's peripheral neuralgia peripheral neuralgia well this week I've actually got + yeah okay worse over the last few days my breathing is down your breathing is but how about your legs like my legs are always like this always like this give some dry cold here to say no more because I'm better than I'm ready for you tell me about your life generally do you exercise much no not now not now we is that you and your wife maybe my wife old is she ah so many she's old I'm age you said yeah it's a cradle snatch yeah I am I'm old did you meet 4 minutes oh sorry I'm a the 1 as long as you know yeah as long as you can remember at least so I can change it 13 years ago oh yeah maybe 14 maybe 14 and it's good and so no she's not here I won't tell don't worry can you take a back or take it back she's 4 years later yeah she knows and what's that I'm barber but I had 1 I had a couple of yesterday yesterday oh really you're still working well yeah you know probably I've got I've doing it when you're I've doing it to really he's always on the move hello ray okay you're you're comfortable little bit of plastic don't worry yeah yeah drink or smoke I don't smoke I have a glass of wine and I okay sometimes too not so lice not lice yeah not very have you ever smoked before no you can sit still for me if you can because you were just checking your blood pressure you have a snake no no that's fine you can leave it alright fine no wonder you're on call we'll be once they're finished with you I think and I think the only doctor has explained to you what's going on not really not really just I've got a little there was something to do in the heart is that it's going quite slowly yeah a bit too slow uh-huh probably we we have some medicines that we could give you to speed your heart that medicine doesn't work we've got another medicine we could use to speed your heart up but we probably don't need to because you're feeling okay and it does come with risks so you need that medicine to speak heart up for the moment if your blood pressure's low or things are different we can start med system and treat it with the heart these things don't work we can do better over in the lab it really is have you got plans imagine I think it's time to do that it's high don't do that good not low yeah that's it it's good okay you've got a nice regular rhythm coming from up at the heart but it's just not conducting down to the bottom every few beats so your heart's trying to go faster but it's not getting through to the bottom so you need both up the top and the bottom you get lots of chest pain that's your job tell us if you're having chest pain no no no no pressure yeah oh I'm gonna check-in a second okay you have a small heart sounds big back in there already much water it backs up on your lungs you've got crepitations up to the mid zone you've lots of fluid in your body but thankfully it's not affecting your oxygen we could give you a medicine to try and get blood pressure on the x I'd rather leave that going if that's okay for a bit of time although yeah no matter approved I mean the last day is what yes so my insulin is fluid there alright well I didn't know the plan look look look as soon as we can alright look any questions no worries no look fine I think if someone is quite active at home in terms of still cutting people's hair and things that although you do it the same way well they usually come to me yeah so I sign and do it but I think mhmm I was due to be done you know but but I didn't feel up to it so you've been feeling not right for a bit of time I think when people are in hospital we would like to make a plan to what would happen if people were to deteriorate and their heart were to stop I think for you given we've got a clear reversal of course it's worth doing everything including jumping up and down on your chest if we need to to get your heart restarted because there's a clear reason why it would have stopped if it was going very very slowly if that makes sense so I think that's a fine thing to do as long as that's okay with you and what was the message talking about cpr and resuscitation yeah I think that as I say think given we've got a clear reversible cause it'll be worth doing everything yeah hospital with multi organ failure think it'd be a different matter in your eighties back at the moment is that okay yeah good I'll get all of that sorted oh I'll you when you get upset and we don't want alright no no you want me to talk to her about why you're in hospital do want me to call her and update her it's 11:00 at night I'm more than happy to talk you're fine tomorrow fine k and she's at home with you we've got probably got your home phone number if you want me to call her and tell her what's going on yeah if you could yeah fine alright alright if she calls we'll let her know but I'll let her I'll let her sleep because there's I'm more than happy to call her if you're the team she's not she's I don't mind she's on the sheet don't you're going to call her just saying alright alright yeah any questions anything I've forgotten no okay do want me to spit that out do you want me to spit it out okay mobilizers with a stick has been on amoxicillin for a month for a cough on prophylactic doxycycline for recurrent uti previous stroke and has been on antibiotics for a month dizzy and breathless for the last 3 days very persistent cough with wheeze heart rate of 36 on saturations probe today 5 doses atropine administered with the ambulance crew at 5 minute intervals to no effect ecg secondary heart block 2 to 1 mobitz type 2 this is a clocking for john austin 262359 86 year old man patient's list 500 mg 3 times a day as a rescue pack for bronchiectasis flares doxycycline 100 mg 3 times per week as prophylaxis lanzoprazole a simvastatin 40 mg at night doxycycline no known drug allergies on examination heart rate 36 on monitor blood pressure a 180 systolic respiratory rate 22 saturation is 96% on air on examination looks short of breath horse crepitations to the mid zones bilaterally on auscultation heart sounds normal abdomen mildly distended and tympanic bowels last opened yesterday no ankle edema jvp raised moist mucous membranes gcs neurologically intact impression symptomatic bradycardia secondary to mobitz type 2 beta 1 block plan number 1 tap form for full escalation despite past medical history as clearly reversible cause number 2 coronary care unit number 3 cardiac monitor number 4 if hypotensive consider medical management with isoprenaline given previous atropine doses ineffective and further discussion with cardiology avive clear fluids from now and nil by mouth from 2 in the morning number next aim pacemaker tomorrow