William wells 471q83 89 year old man investigation crp 11 ct head no acute intracranial pathology tsh naught 0.16 with free t 4 normal white blood cells 17.1 neutrophils 9.31 and lymphocytes 6.38 ferritin of 507 beta 1 folate normal calcium normal use is normal lfts bilirubin 25 note has been intermittently raised in the past in keeping with gilbert's crp 11 inr 1.1 magnesium normal urea normal venous blood gas normal past medical history gout osteoporosis atrial fibrillation prediabetes cll sleep apnea 2004 hypothyroidism hypertension no known drug allergies medications list levothyroxine hundred and 25 micrograms allopurinol 100 mg once a day accretin d3 twice a day allergenic acid 70 mg once each week bisoprolol 1.25 mg tablets once a day ramipril 2.5 mg once a day apixaban 5 mg twice a day your down as a bit of a reading always always always yeah yeah that's good I know I use a different music oh alright I've got the kids I'm rob I'm 1 of the medical records how's he doing fine he's sleepy and tired but yeah we were just wondering so robert any any conclusions yeah no I saw him when he first came into hospital we were acutely worried about about a stroke yeah and he's had a scan of his head which hasn't shown any signs of stroke which is good admittedly if there was a very early stroke we wouldn't see him so early on that ct scan but assessing him in some detail with some of my stroke team colleagues we don't think that it is a stroke he's not weak in any part of his body he's had some blood tests which show slightly might raise markers of infection and there's the possibility of an infection somewhere whether it's in his chest in in his urine somewhere else got a fever don't coughing has he I don't know and his grandson's up yeah yeah and your grandson's up yeah a whole 3 generations yeah we're all here great yeah lovely and you were working in a garden where he and you saw him at the window or something is that right yeah yeah and he looked alright at that time I wouldn't say he looked alright but I just assumed he was just sleeping and whatever yeah fine and then a couple hours later I'm on a bed check on him yeah and what happened you went inside and found him on the floor the floor yeah in the bed yeah mhmm and he says that he'd fallen down because his legs felt weak is that what he said to you I'm sorry I didn't tell you to that's why and then he said he couldn't reach the radiator to pull himself back up or something like that no that's I don't know sounds about right with what would have happened but yeah he wasn't really got really sick consistent yeah yeah fair enough and that gets I was hoping to give him a bit of time a bit of a rest and then see if he became a bit more consistent he was walking around between our bed and the ct scanner and things like that so that's all he couldn't get from reassuring he couldn't get from the trolley on the could he not yeah because the girl said that he'd seemed a lot about there yeah he looked good when he got here he was struggling a bit okay alright and I had a read of his gp record it seems like he's quite fit yeah he's got gout and hypertension high blood pressure he takes a few medicines he hasn't been taking tablets for his blood thinning he's apixaban for 2 days I I understand because of a bruise on his there's a bruise on his arm yeah alright but he takes the blood thinner because of an irregular heartbeat that's right yeah get trifle pollution I'm rob 1 of the doctors we met earlier in the scanner how are you feeling little bit I haven't got a bit as far as you go a little bit better pardon yeah a little bit better yeah have you got any symptoms at all to speak of any cough or cold got a cough bit of a cough anything coming up pardon anything coming up no nothing dry and how about your the waterworks how are they no I don't get a lot didn't I of I haven't heard anything yeah about your waterworks yeah yeah yeah funny when did you last go for a wee pardon when did you last go for a wee just trying to say I did say that I'm I'm hanging on because I know you're you're wanting a wee and I mhmm a of hours I would say a couple of hours couple of hours okay and when you went for a wee was it painful no no you look very uncomfortable if I lay the bed down a bit flatter I can you can a bed off can squidge up the bed a bit and be slightly more comfortable as comfortable as you can be on this trolley sorry as comfortable as you can be on this trolley you're quite tall now aren't you our beds aren't big enough for you they fit me but not you I've had nothing I don't know well fair enough alright and and so when you came into hospital there was concern about a stroke a lot about a stroke yeah because you had some weakness on the right hand side of your body I was told because I and I'd been I'd been taking my naughty boy naughty boy I was afraid because thing the had been bleeding yeah goodness it looks like it's a nasty bruise I can understand right want any under in my arm so until the nurse told me just to mhmm yeah the risk of of stroke with atrial fibrillation is measured over years you know your risk is maybe 5% a year so stopping it for 2 days you'd have to be very unlucky to have stroke and I don't think you have had a stroke no your scan's fine which is good it will your scan of your head is fine alright you've got a lovely brain no problem with it alright because I I do get quite a bit a headache and it seems like in there have you got 1 now no but you've got had like that in the past yeah and I was like you know is it anything or is it not well yeah of course it's difficult isn't it without having the headache now for me to ask you about it yeah the vast majority of headaches unless they come on very suddenly and feel like you've been hit in the head are usually quite benign yeah and so have you had any fevers or shivers and shakes or anything like that yeah you have tell me about that well just sort of shivers and shakes okay fair enough when when the ambulance crew came to see you you had a fever yeah so apparently so yeah so I still got 1 not on your last set of tests no no but they do tend to come and go yeah there could be loads of things going on given your cough your fever and feeling generally weak and falling over wondering if you've got the flu or something like that yeah it's certainly going around at the moment yeah it's very we're seeing a lot of people with it the alternative could be whether you've got a urine infection or whether you've got a nasty chest infection like a pneumonia yeah they're all possibilities right your markers of infection in the blood are up but not very much yeah so I guess the question is what should we do about it I'd like to examine you if it's all fine we've got lots of options can try and see how you are on your feet and see if we can get you out of here at 11:00 at night or I can try and get you a bed for the night and we can keep an eye on you overnight I think it's unlikely that you'll need any invasive hospital treatments for this I I think I'll be better to stay in with the toilet yeah I can try and find you a bed yeah with the look of the hospital it's a strong possibility that you stay in this room on this trolley overnight yeah that would be alright yeah okay fair enough can I have a quick look at you is that alright done ms harvey can I see your tongue can I see your tongue lovely that's great can I have a look at your legs and they say oh you're rushing you're rushing rushing so your tongue is okay is it okay in your tummy no no fair enough alright so why don't we get an x-ray of your chest and see if it shows anything in terms of a nasty chest infection I think if if that's fine then we should try you on your feet and try and get you out of here I think it I don't think you'd need to stay in here this horrible room overnight I think you'd sleep much better in your bed at home and get less risk of getting a horrible pressure sore from lying on this very uncomfortable trolley I think I was in there staying at night yeah what worries you about going home what worries me about going home nothing really okay there's nobody over yeah fine fair enough don't wanna be by yourself got it yeah I understand what do you guys think about him going in if the x-ray is fine he's going on you're standing later yeah yeah I obviously if he needs we need to see him standing him up you you'll see him you'll see him okay if he's the same no that's fine fair enough no I've not seen him up no that's fine the only time I saw him after you were walking fine it wasn't 1 person out but it was 2 people I was having yeah if you're struggling on your feet then you won't be able to manage at home will you okay so we'll I'll book you a chest x-ray I'll ask them to try and see if they can get you up and see how you go yeah but if we can't manage it then that's fine we can keep you in overnight no alright lovely so we've got a bit of a plan pardon we've a bit of a plan a bit of a plan about what we do next you have x-ray of your chest won't start you on any antibiotics or anything at the moment no mate if it shows a big pneumonia I'll start you on the sun we'll see if we can get you up on your feet if we can't then we'll keep you in 1 of our beds hopefully if not in this room overnight yeah and try and get you out to new york okay yeah great any questions from you guys anything I've forgotten happy no we had to go small good great well it was nice to see you again bill yeah alright see you soon can I tuck you back in you're kinda smooth are you more comfortable than when I came yeah you sure yeah okay so what are gonna do then about what I'll arrange you an x-ray of your chest oops I'll do over there got it I'll arrange you an x-ray of your chest yeah yeah because of your cough alright got it great okay see you soon what do you think stay go or well you will stay if you want we'll also have the bathroom it's it's fine I honestly don't think you'll you should come out no no what we've seen tonight food can really knock you for 6 when you're in your eighties no no no glasses that make you feel I mean you you know when we get the flu you get achy muscles and feel crap imagine if you've got 89 and there's a muscles that are already feeling 80 and crap then you get humbling you'll tear up when they come in you're on the right side wood is like is it yeah it was down isn't it did it no no couldn't stand up straight because he was bent over sideways and that's why they ask people like me who set up the senior doctors on overnight to come and see people quickly when they come in because there's been loads of things that mimic strokes and so having a couple of specialist people look at the person and see whether they think it is a stroke or not and by the time he came to see us his facial droop was gone he wasn't weak on the right should I no no no he was different yeah exactly we when we came in this room was different but he was taking yeah yeah off his feet it took 2 of the ambulance guys to maneuver him mhmm yeah but mhmm we're gonna go on I think I feel like he can do anything he he's not a baby yeah got of physiotherapy he's gonna come around in morning and some support have you got oh so you've got a name for the cayman number cayman cayman number number so you've the I think it's yeah just a question incredibly below your pay grade where do the notes of lamisep look our 70 stop in the when I'm putting the notes on the card before just put the on the screen sorry