You want to catch your leg up next patient cyril deuje 123836 past medical history dementia no package of care wife struggles blood pressure 120 over 68 respiratory rate 16 saturation is 98% heart rate 77 on 10 over 4 with 50% f I o 2 left loads of incravitations abdomen soft nontender no peripheral edema no rashes so 88 year old man past medical history investigated by cardiology for transient loss of consciousness with normal tilt table test and tape or implantable loop recorder showing episode of bradycardia down to 35 in af and 2 pauses in the early morning of 4 and 5 seconds both without symptoms reported also investigated by cardiology for ankle swelling and breathlessness echocardiogram showing an ejection fraction of 45% with severe tricuspid regurgitation other past medical history atrial fibrillation on edoxaban and cognitive impairment / dementia as well as hypertension knee osteoarthritis prediabetes small vessel cerebrovascular disease hip osteoarthritis medication history sertraline 100 mg in the morning amlodipine 5 mg once a day atorvastatin 20 mg at bedtime digoxin 62.5 micrograms once a day omeprazole 10 mg once a day rivaroxaban 20 mg once a day carvedilol 6.25 mg twice a day ibuprofen 5% gel by 3 times a day as required no known drug allergies according to gp record open brackets note adverse reaction to beats blockers however on a beats blocker so this seems unlikely close brackets investigations crp 48 creatinine 109 from a baseline of a 101 with normal electrolytes inr 1.9 crp 48 from 7 bilirubin 68 from 42 chronically raised urea 7.9 from 6.7 platelets a 124 from a 169 but the remainder of the blood count within normal limits blood gases venous blood gas on admission demonstrating ph of 7.42 worsening to 7.11 by 09:00 with lactate of 5.2 then rechecked 2 hours later improving to 7.3 with lactate 2.1 arterial blood gases undertaken demonstrating ph 7.35 and 7.37 with pco2 6.26 respectively note abg from 1 30 oxygen saturation 61.5% therefore unreliable most likely venous chest x-ray not yet performed hi it's rob from medical reg uk so chest x-ray awaited impression most likely urinary tract infection af with fast ventricular response episode of pulmonary edema secondary to iv fluid therapy in the context of af with fast ventricular response with itu team or with ed team I should say