Do with that kid now actually she's not very well so you look after her more than anything yeah it doesn't matter well I'm sorry to hear that you fell over yesterday day before yesterday now because it's now saturday morning over always you fall over a lot do you yeah how many times a week do you fall over how many times a week do you fall over a lot more how many times a month do you fall over I've got of questions what did you do for a living do you know that you've come to work with those hands I take that tablet apart I take it in 2 weeks all that every 6 weeks okay and what did you do for a living you're an architect well doesn't look like you just have pencils with those hands no pens too no no do you smoke or drink I do no you drink quite have you ever smoked together how old did you smoke for fine sorry brilliant you're going like this I just wanna see you so that they can stop and walk around and see you in 10 minutes alright great how old do you smoke for not yet born hello your lungs bigger than than hands isn't it okay so about 16 and a pack a day for that time and no alcohol a little bit of alcohol a couple of drinks a week kind of thing how do you get around the house no you walk do you use anything to help you walk said it was walk and do you get out of the house much no you can't do you apply the stairs 100 yeah better 200 fine alright can I a quick look at you fine no no your legs look a bit swollen up how long have they been swollen up for so it is bilaterally proficiency is hard pain in there at all no no great alright got your numbers on the screen your blood pressure's a 150 over a 100 so that's good I will get everything sorted to bring you to hospital start you into antibiotics start all your regular medicines and all of that stuff you've had a scan she's got a nasty pneumonia chest infection is there anyone I should talk to and let know let them know that you're here I'll give her a call she lives at the same place you do hawley sorry she'll think I'm calling your mistress yeah I'm glad you shower lastly cough you've got when did you get that 5 thank you any chest pain or anything like that do you have diabetes no no when people come into hospital it's important to talk about resuscitation and what we would do if you were to deteriorate in hospital the course of days and weeks to the? Where your heart were to stop has anyone talked to you about that before I didn't I haven't talked about it all no no perspective think if you were to continue to deteriorate in hospital despite medical treatment over the course I say days and weeks despite all of our best efforts still deteriorating don't think push go sorry thought you were coughing a bit how's that not good no didn't get it how was that no I'm not gonna do that I'm not I'm do gonna as I say I I think if you were to get worse and worse in hospital jumping up and down on your chest would be the right thing to do is there anything to add to that I think doing everything up to that. Was fine is that okay yeah great k it was nice to meet you thank you so he presented complaint for history presented complaint 2 days ago fell at home with family unclear as to the circumstances of fall full stop <\n\n> For the few days prior to this, had been developing a cough productive of white sputum full stop <\n\n> Yesterday, following the fall, family noticed increased infusion and shortness of breath and which led to admission full stop reviewed by the ed team for ed trauma ct head thorax abdomen and pelvis revealed consolidation consistent with chest infection and treated for that full stop the investigations ct head neck and thorax no acute traumatic injury identified anterior wedge compression fracture of t 5 unchanged no acute bone injury multiple old bilateral rib fractures no pneumothorax or hemothorax bibasal patchy consolidation with nodularity again noted in keeping with infective / inflammatory changes no pneumo or hemothorax coronary artery calcification noted an 81 year old man past medical history gastritis gallstones prediabetes bronchiectasis osteoporosis ocular hypertension atrial fibrillation mild copd migraine medication history carbocetin 750 mg 3 times a day gabapentin 600 mg 3 times a day digoxin 62.51 to be taken each day fluticasone 50 micrograms nasal spray 2 puffs twice per day omeprazole 20 mg twice a day rivaroxaban 20 mg once a day spiolto respimat 2.5 / 2.5 micrograms per dose 2 puffs once a day codeine 30 mg as required omeprazole 20 mg twice a day rivaroxaban 20 mg once a day spiolto respimat again ecg past atrial fibrillation at a 112 beats per minute impression infectious estimation of bronchiectasis leading to fall or recurrent falls likely secondary to peripheral edema for further investigation oh yeah and on examination he has edema up to the knees bilaterally normal heart sounds with no murmurs and bilateral coarse crepitations to the mid zones soft nontender abdomen no rashes so yeah impression is recurrent for secondary to fluid overload and frailty and weight loss unqualified for today secondary to infective exacerbation of bronchiectasis for treatment plan number 1 antibiotics iv number 2 iv fluids actually stop that not number not iv fluids number 2 echocardiogram number 3 add probnp number 4