So shirley murrell '7 57231 8 8 year old lady cranon 61 at baseline potassium 3.9 sodium 134 lft's normal crp 1 urea normal ast normal full blood count mildly raised white cells with predominantly neutrophils and microcytosis without anemia note previously anemic in august venous blood gas ph 7.31 with sodium 129 note formal sodium a 134 so note recently assessed at her care home on the eleventh of the eighth following discharge from toulouse admitted on the august 7 several episodes of vomiting dark brown vomit 3 episodes similar admission october 2024 no signs of bleeding on assessment treated for aspiration pneumonia past medical history hypertension diverticular disease ckd alzheimer's dementia seizures or epilepsy frailty medications list levetiracetam 500 mg twice a day liquid preparation omeprazole 20 mg twice a day laxido 1 or 2 daily as needed atenolol 25 mg once a day folic acid 5 mg once daily thyroxine 100 micrograms once in the morning paracetamol 1 to 2 g up to 4 times a day as required the ical d 3 1000 mg / 880 units 1 to be taken per day no known drug allergies social history care home advanced alzheimer's dementia note tep form completed to improve his admission august 7 focus of care at home but hospital admission may be required for management of symptoms mobilizes with a frame barrett's esophagus in the past medical history chest x-ray reviewed linear atelectasis in the right middle zone parking no focal consolidation tiny left third effusion observations heart rate 131 ecg fast atrial fibrillation sats 94% on face mask 4 l blood pressure a 178 over 85 respiratory rate 27 afebrile ecg is atrial fibrillation with fast ventricular response irregular narrow complex tachycardia history presented complaint known to have seizures last seen by staff well at 09:00 visited by staff at midnight and found to be seizing vomit around the mouth unresponsive on arrival of the crew has been seizing for at least 30 minutes prior to arrival managed by managed by the ambulance crew for seizures with benzodiazepines unresolved plan now about that let's just say on examination hi shirley I'm I'm rob 1 of the doctors just having a quick look at you okay I'm just talking to someone while I do it auregular peripheral pulses very strong cool peripheries no tremor or asterixis noted hi shirley can you open your eyes can you open your eyes for me can you squeeze my hand can you give my hand a squeeze can you push me away just give you a little squeeze shirley can you feel me squeezing your shoulder shirley hello opening her eyes to pain so that's e 3 e 2 hello shirley how are you feeling voice some noises that's a v 2 m 5 localizing pain so gcs 9 remembrance empty airway in situ she's got fine crepitations in the left base clear right chest can I look at your tongue do you mind thank you bilateral laparotomy scars but soft and not clearly tender abdomen she's got a pad in situ no catheter no peripheral edema no rashes but there is a healing pretibial flap laceration and a tibial bruise look at my finger on the left where on my blood possibly okay impression is prolonged postictal phase following convulsive status epilepticus managed with benzodiazepines episode of desaturation most likely aspiration pneumonia in context of recent seizure last atrial fibrillation not previously noted to be naf but hemodynamically stable plan number 1 iv fluids is clinically dry number 2 antibiotics to treat aspiration pneumonia or pneumonitis number 3 rate control atrial fibrillation with digoxin 500 micrograms iv input output monitoring neuro observations if not improved by morning brain imaging ct head let's do a ct head now add tsh to blood tests as well as magnesium calcium and phosphate next of kin kindly updated by the nursing staff tep already discussed no plan no change