Next patient monica ashton 1 257382 blood cultures negative so far ast hemolyzed renal function sodium a 131 from a 133 but has previously been as low as a 123 back in january creatinine 56 from a baseline of 41 open brackets pre ki close brackets trp 14 when previously has been a 109 in september urea 6.2 inr 0.9 full blood count normal calcium normal venous blood gas reassuring echocardiogram january 2025 bedside echo systolic motion of the amvl noted resulting in significant lvot obstruction with a velocity reaching 4.41 meters per second at least moderate mr dilated la dynamic lv systolic function normal lv wall thickness reduced lv internal dimension query underfilled lv rv non dilated with normal function investigations I was gonna come say hi but I can come back later sorry I was gonna come say hi but I guess I can come back later yes I'm just her her tablet has bypassing so I need to do good cataract so she has a 12 I'm gonna put 16 on amazing and that's where we are at the moment that's good and just change the present when she's ready awesome thank you hi are you michael hi hello hello hello hello hello how are you not good oh well good tell me all about it too much too much know you're a sort of both but I'm not gonna make it appear on you here in torbet in the emergency room in aed fair enough what can I do to make you feel better why do you feel crap what are your symptoms well I was told my symptoms were actually low blood pressure low blood pressure yeah which is apparently why I have had pneumonia mhmm but I've just been dumped in this side bin mhmm it is a lovely room though isn't it a lovely room yeah I just so love it it's beautiful isn't it just there's leaves on the wall where's the outside world I think it's out past these fake leaves that's nice isn't it it's dark to be fair outside the sun has not come up yet in another 8 minutes you'll be able to see the wonderful outside world well that isn't the issue I was told that changing the cash reserve would be too risky and they just changed it alright what would be risky about it risk of infection alright fair enough I think that the catheter was blocked it was blocked but I don't want the catheter I see I've always said I don't want a catheter I use it for my phone mhmm and and what made you gain the catheter then they just said you have to have the catheter oh and I said I don't want these they said you have to have it oh that sounds quite didactic that's what I find so I don't don't want me getting that option it's just being very dismissive evening no it's not very nice at all is it I know horrible agreed I can't go home with a big bag here then because the only way I'm mobile is in a wheelchair mhmm and it's like you just get stuck in a wheel you know here and over there of course and where do you live when you're not at the community hospital in tottenhams lovely live in darlington just up the road yeah I used to live I love the oh I love the cot too so nice isn't it they're doing delivery now so you don't even have to leave your house I had a cottage and I had a lovely cottage in top there did you I did oh well week did I I love week it's I'd want to live in week I'd love to live in week I always love to coach in week in higher week or week near the field which bit of week week yeah lovely higher week up the hill not really okay anyway that's beside the? Well I think you're right I hear from the team in newton abbott community hospital that you had low blood pressure and they were worried about a very severe infection which is why they sent you to hospital and you had some antibiotics when you got it that's changed my catheter that's why why changed your catheter well that and the fact that it was blocked yeah I know but there's a risk of infection and they've ignored that and just changed it anyway wow I think changing I personally think that changing something that could be infected is probably good oh but that wasn't what the doctor told me not a doctor okay my last doctors were terrible at we all say different things yeah yeah so I've never got this thing stuck in my bladder say again I've never got this thing stuck in my bladder mhmm which I don't want which you don't want and and I don't did you go into urinary retention is that why you needed to have the catheter put in I thought I had but I don't think I had fair enough so your catheter was originally set for retention but you're not we're not sure whether that actually occurred and now you'd like it taken out so we can try and take it out if you like oh you can if you won't but is there anything else taking it out well there's a risk that we'll have to put it back in again if you get back into retention because obviously urinary retention can be very dangerous I don't want you to think about if you take it out I'll need to have a pneumonia but yeah that's fine we'd want you to drink some good wheeze anyway and so did you have any symptoms apart from the low blood pressure did you have any symptoms in the lovely community hospital that you wanna get you back to any symptoms of what anything at all did you what apart from having the low blood pressure in the community hospital did you have any symptoms I had low blood pressure here which is why they sent me to new england he just says you're getting low blood pressure you can't stay here over the weekend oh we are open on the weekend and he said there won't be any medical assistance I'll be here yeah well it was always the time but they did it anyway it sounds nice it sounds like you're pissed off is that fair to say he pissed like that I mean I've been moved I'm not having a job yeah 1 person doesn't moving's horrible isn't it and you have to start over again I spent all night in the car park I'm not getting much rest in recovery of course and that's what you need I don't need money yeah and do you think your pneumonia has come back I think what do you think your pneumonia might come back no fair enough but it's don't know what you mean when you have pneumonia your heart rate was going quite fast wasn't it there's an ecg here from the 20 sixth yesterday a quad pass 1 which shows atrial fibrillation with a rapid ventricular response with non sustained ventricular tachycardia I'm not sure about that but your heart was definitely going quite fast and that was probably what put your blood pressure low we just need to find out why and then we can fix the problem and get you back to rest and recovery because it's probably a bit dangerous to have a blood pressure 6 c systolic in neutena but probably and I can understand why they panicked and sent you here do you feel thirsty yeah can I see your tongue do you mind thank you it's a bit dry isn't it you look a bit thirsty can I put the bed up a bit and examine you do you mind tell me about your life before you were in the hospital in the community hospital you got around in a wheelchair you were saying know it's a steep hill it was just I fell off of the cars coming up and down yeah no good they need to pedestrianize it I think anyway you you fell off so you don't like going out too much anymore so you said most of the time around the house is that fair to say I I was able to I was just doing my own method of transferring mhmm what's your own method I was taught it in rehab mhmm months ago when I first had the brain fetuses and do you have no you have a stairlift no you live downstairs I live on live on is your whole house on a level or is it just that you live on house it's 1 of these independent living flats mhmm which I really don't like with this sorry you had a brain abscess didn't you yeah you had to be drained lost your business how did you get that the exciting travel what's that the exciting travel before the brain abscess no what's your main excitement you've been to africa or southeast asia switching to pick up weird bugs that created the brain there oh I went to science oh god very well I don't know it's gonna happen no I don't think so either do mind if I get this hair out of your eye yeah looks a bit more comfortable do you mind if I listen to your chest is that okay you so now I'm gonna listen to your front okay there it is great do need to go to it no you're the most normal heart sounds you're quite thin aren't you yeah you lost some weight or has you always been this sore I'm always skinny of course I don't think of any food anymore no and then when this covid heals no not really in sorry in in the in hospital in hospital sorry in the kidney test sorry they don't bring food well I have never I went long term without food yesterday and any diarrhea or anything like that do get diarrhea sometimes yeah not every day just they never eat food is it do you not ordering food or is it not providing food yeah I'm talking around in office now in you never no or here yeah okay fine sorry yeah it would be nice to be off this time okay I need to have other herpes zoster mhmm I I don't wanna eat sandwiches oh it's sandwiches which is very difficult isn't it need to put it in a position where I can use 1 of the simple things mhmm alright goodness under your arms it's painful sorry no they're not really my regular medication which is my anti seizure meds what do you take for your seizures good shepherd shepherd and and something else the valproate you did something else as well sodium valproate valproate I thought so oh I remembered reading that your chest sounds fine to me from the front but it will be worth getting a chest x-ray to make sure that pneumonia that you had in the hospital hasn't recurred you've already had 1 just a little bit I might get you another 1 if that's okay just to see if that pneumonia has got worse which may explain why you have low blood pressure and a fast heart rate have you had any blood tests looks like you probably did none good I've seen most of them anyway I asked if you've seen more I've done a few tests for the electrolytes in the blood to see if there's anything else that's made you go fast yeah I've done I'll ask them to send a sample of your urine to see whether there's any infection there there was a uti was that fine in that you were treated for in new nether no it was it was here of course so that's the way they said that they should remove the catheter but they have done that mhmm I think getting an infected thing out is good but you know I think it'll be fine how can I use it for my dad it needs to come next to the bed of course it needs to come next to the bed then you need to be able to transfer onto it we use the flip out ones mhmm but we can try and get that for you once we've got that can take the catheter out okay yeah the red 1 would like to come down would like it down now I've still got the catheter yeah well you still got the catheter not the catheter pick them up yeah 2 ac loads yes any questions anything I've gotten not mainly okay I understand you've got overloaded but you know I take the pressure off you guys we cover it as best I can you can go home of course I can do this I'm in particular rush to go home but why I need to be set up for leaving here and last time I left off the wall they set me up and funded me and they won't care yeah and they said they won't do that this time but they haven't done anything also I need to know how to when the carers come around they'll have to clean me up and wash me and they'll need me to know how to treat that open wound on my bum mhmm so they said they'd give me a printout of it what about the sleeping wound on your bum might that be infected yeah probably can I have a look at it how can I have a look at it I mean well and all that is that okay thank you say again in this sweet nasty place really and this left sided weakness is what you've been left with after the operation not not no apart the seizures apart from the seizures okay how can I help you roll over get the covers off you to start with does that make it easy can I help you with your main thing is the first thing for me how's that is that okay yeah yeah I'm gonna you down on your lap okay are you able to go over any further I can't really see okay dry dress it's painful sorry it's difficult to fill the vein this way from the painful only valve no it's painful now that's fine I've had a look at it it's a little bit red on the outside but it's got a nice dressing on it yeah we'll ask them when they next change you you can change the dressing yeah to take a little picture of it so you can have a look at it okay so I need to have some instructions of course and some spare adjustments mhmm of course yeah it's gonna be difficult for you to reach isn't it I can't we need someone to help you so I have to stand up and do it it could stand up and do it well that's how I've been washing them now mhmm at the moment let's get you feeling better medically and then we can sort all those things out for you okay so I've said my impression is that you've got a fast heart rate atrial fibrillation with a fast ventricular response probably because of a urine infection we've changed the catheter which I think is good we're starting on some antibiotics to treat the urine infection am I supposed to be getting them through the yeah I think you have had some I've been told I haven't given them too much today no but he's only 7 yeah okay we'll get some more antibiotics through get sample of your urine get a chest x-ray to make sure you haven't the ammonia hasn't got worse I'll ask them to take a swab from the area around your back passage where the around your lower back where the sore is and we'll make sure that's not infected and I'll get you a little slow drip of fluid just because you're a bit dry yeah that that's fine wonderful any questions anything at home no I need to check if I need to go to place before I leave the hospital mhmm because I have to be independent about it of course yeah I know you don't want to be dependent on anyone you're gonna need I told that kind of stuff to do yeah of course that's it cool you've got everything you need right here in the cool bell yeah your cool bell's up here I'm just gonna bring you a water closer to you that is that okay yeah okay thanks doctor alright thanks lovely to meet you see you next time yeah that's all