George clay 1471002 further review at 20 30 stop on arrival pulse rate 88 saturation is 92% respiratory rate 29 blood pressure a 130 over 55 on 15 liters of non rebreathe oxygen chest examination reveals bilateral crepitations to the mid zones and edema to the knees bilaterally full stop paragraph reviewed blood tests from earlier which were not available originally crp circa march with aki most likely although we don't have a baseline stop paragraph I've explained to him his wife how unwell he is with this significant oxygen requirement and evidence of bilateral infection on his chest x-ray full paragraph there may it may be that an element of overload given his cardiac background is leading to worsening oxygenation so I suggest we try some freeze mind to see if that improves things full stop paragraph he's on 15 liters of oxygen now and I'm not sure how long he will be able to maintain this full stop he might benefit from intensive care and we discussed this full stop paragraph he has a strong christian faith and does not wish to be for cpr and I think this is entirely reasonable and what I would suggest clinically full stop paragraph however, despite his comorbidities of diabetes ischemic heart disease ckd prostatic hypertrophy and his mild alzheimer's dementia he was well enough to get on a coach and travel down here and was planning to have a holiday and so his in terms of his functional baseline it's not too bad full stop I wonder whether he might benefit from intensive care for single organ support I e increased oxygen demand with a clearly reversible cause such as this pneumonia and he would be happy with this full stop paragraph I've completed a tetiform to that effect full stop paragraph plan number 1 catheterize number 2 iv furosemide number 3 repeat ecg number next it review number next arterial blood gas