Next patient theresa lawson 7 58089 investigations blood gas venous ph 7.34 full blood count normal coagulase screen inr 0.9 alcohol level 1,368 milligrams per liter lfts normal urea normal paracetamol undetectable kidney function at baseline with normal electrolytes including magnesium phosphate and calcium tsh normal salicylates less than 10 troponin 5 chest x-ray clear lung fields complain on response to leprosy is it theresa larson here yes hi hi there going to the name of the doctor nice to meet you so what what did happen what do you remember living at the yeah dinner with friends yeah at the top of the last week mhmm and I said my date time I just and then all of a sudden I just mean almost like like 2 3 really embarrassing goodness but or it wasn't breathing breathing I heard breathing at all it was just pain didn't come to for 15 20 minutes mhmm so mhmm and had some cpr I understand is that right did and had someone pushing up and down in your chest is that right yeah I feel that remember that yeah that was your first reaction when you first you weren't feeling fine yeah what's going on you suddenly felt very nauseated was sick no no I didn't feel nauseated I just put put my head back up awkward it wasn't very nice were you so don't know time to attack it was pretty pretty embarrassing never had anything like this before I said I well I think I've got this for you mhmm we did panic right yeah maybe blood tests have come back there pretty pristine to be honest with you you have all of your electrolytes in the blood tested all the salts in the blood in the thyroid pocket really which is excellent reassuring but it doesn't bring us closer to what's going on but it is very reassuring have my kidney checked every year because I only have 1 kidney okay so I had bloods done twice a year your renal function is good I have been rather anxious lately but any of this down to anxiety right but I don't think we know what's caused it yet so I think your perspective I guess your husband or so yes let's say tell me a bit about what it was from your perspective so you you remember being at the table rolling your head back or feeling very tired yeah erectile vomiting and then do you remember anything else no no until you woke up in the ambulance yes with someone jumping up your nose in the chest right and then I'd even forgotten that but I imagine that just okay follow-up yeah so you remember you remember that I do remember that yeah if you ask me I wouldn't remember that she collapsed onto the floor and then you said she was she wasn't breathing for some time very sure I didn't breathing and and then was it irritable that's why they had a pulse throughout you say yeah any of the limbs or a seizure no she wasn't very limb reflexes or anything just mhmm or when you were having dinner fine you felt very well there was lot of some joking and I mean and over the last few days and weeks do you feel unwell in any way I have not any been sleeping I haven't been sleeping well mhmm any any issues no I I just I was like I had some some sort some sort of a holiday like a fibroid yeah I think well the medicines I I just hit the telephone it was the very standard yeah I've had telephones okay allergic to anything not even a lot I've just come on this morning what was that last night just this morning guessing you it's fine it's 7 in the morning now like when you woke up you never felt like a little bit could you but roughly when do you think that was within the last 2 hours 4 times I think but well no it's helpful to know the timing so think my hands there I think I should blow my nose because I'm very sniffly I'm coking my hands and then I'll come back and examine is that okay I'll be back in a if I'm not sniffing maybe you can okay that's for real alright mhmm can I have a look at your hands okay okay like bugger on is interesting isn't it were you very cold I was cold were this this was blown up when you got here cool yeah it's almost like a warm yeah it is lacking in warm it's even warmer when they turn it on because it blows lots of hot air in here yeah last few years have you had episodes of palpitations or mhmm feeling like your heart's racing or chest pain everything so do you have painful sore hands yeah I wish I got 1 1 arthritic finger this 1 here I know this is a lot my brother had my brother had really bad arthritis but I don't have arthritis mhmm no appreciate it nobody else was sick from the feet so it wasn't a shoot was it no it would be very quick from the feet what was that viral illness that went around about 10 years ago that was projectile sickness norovirus that's a horrible we both had it norovirus we were living in switzerland at the time we were both and we woke up at midnight both themselves at the same time was all for us we'll see time will tell you don't hear much about norovirus anymore we still have it still around all the time there was a bit of an epidemic wasn't there I don't have a temperature all my vital signs are normal I really love that your blood pressure's 180 over 66 slightly better than the low side of your heart you're in the realm of normality your heart rate's 67 back up 96 your spirit's 11 all lovely numbers oh really nice alright actually you want to sit forward and have a listen to your back okay thank you you great so I'm gonna relax yeah see if saw enough just a cheers thank you cheers about having 2 clothes it's of my clothes yeah I wish I could alter that for you I don't know do do you know I don't think that was sorry I haven't signed on no worries sorry if you spent time yes I might I can go see someone else okay I've got 1 last time haven't we yeah yeah that'd be lovely thank you so much cool just 1 of my colleagues who's gonna put me the spot you yeah I don't know where your gloves are sorry but we can try and track them down well I know they cut my sweat off but I but my pants are okay that's fine so in terms of what what's going on it's difficult to say at the moment as I say I've none of your tests have pushed us towards what's going on yeah but I think it's worth investigating a few more things just tracing of your heart is entirely fine but I think it'll be worth getting a monitor of your heart just to make sure that you're not flipping into and out of a fund that you're monitored at the moment still so we can keep an eye on it and we should keep monitoring you while you're in the hospital I'll book you a scan of your head given the headache you're having so rarely small bleeds on the brain can happen that can drop people off completely and that can they can lead to a headache and the reason I was keen to entitle is within 6 hours of you having the headache we're much more likely to detect something on the scan however if we don't detect something it may be that the headache is a delayed presentation of something going on in the head it may be something else and hopefully we'll see something on the scan I suggest we do a jelly scan of your heart just to make sure that the heart valves are a problem I think this it can either be neurological or cardiac in nature what you described it sounds it sounds more like likely to be cardiac than the vomiting to me so we'll investigate that but I don't think yeah we'll investigate the brain as well maybe that we don't find anything but we'll certainly exclude loads of worrying things and I think given you've had some cpr and clearly had a fundus episode that's worth investigating on because we obviously don't want it happening yet and we can't fix it unless we know why but it could have just been a 1 off I guess I guess it could be but I think it would be really nice it'll be nice to find out wouldn't it and have something to to not staying in though am I well so you've you've been in last night I think you should see the consultant this morning like my boss mhmm and I think you should have some more tests and some monitoring whether that can be done all today or whether you need to whether we suggest staying in just until monday can't stay in I've got a big party because I'm in charge of it oh goodness mhmm okay I I have to go home for that well I've got to do it I see what sorry doris I've got to be there at 08:00 for the food to arrive I'll do that oh no yeah I think I think you definitely need to see the consultant in the morning I've got some pain and then I'll come back on tuesday I I don't think I should send you out a hospital till we find out what's going on because what if this happens again you could die you're going to do I just get it present you know I can't hold you here against joelle you can do whatever you want no no I but she just she has a very heavy sense of responsibility yeah well it's handled she's got a card from the queen yesterday so well best to get you out of here but I do think it would be yeah it would be nice if sunday's gone yeah probably lots of things yeah yeah mostly definitely get a scan of your head this morning okay you you got switched up here said you it may be cardiac related though isn't it certainly yeah okay think that's hard yeah it's it's difficult to say nothing points us 1 way or the other at the moment but it's worth investigating think heart is alright now then so the tracing of your heart is good and your marker of heart damage is also good it's very reassuring but flipping into a funny rhythm that made you pass out and then flipping back into a normal rhythm it could be normal those tests could still be normal so you may have been flipping into and out of a funny rhythm at school stage sometimes bothersome can I have questions for a headache yeah of course you could do I some prazosin to start with I think I'll see you first okay I was told not to have too much anti quinapril in fact you know the sake of my kidney yeah yeah I look like that but but my dad had 1 kidney he lived to 92 great yeah that's fine 59 on it yeah yeah you probably don't you probably don't need to but it's nice to have a working 1 yeah so yeah we'll get this paracetamol and I'll pop you off a small dose of morphine if it's dangerous I've got to know that I'm not gonna yeah I'm gonna do this any questions from you in the department for me drew no I'll on examination heart sounds normal chest clear abdomen's soft and on tender no peripheral edema neurologically intact but complaining of severe headache pupils equal and reactive to light gcs 15 impression unresponsive episode and possible with associated vomiting of unclear cause <\n> Severe headache concerning for underlying neurological cause plan number 1 ct head number 2 continue cardiac monitoring number 3 second troponin number 4 analgesia for headache number 5 hold off pharmacological vt prophylaxis and manage for potential subarachnoid hemorrhage number 6