So robert blunton 535077 medical emergency call at 14 48 in attendance doctor chris nova I m t 3 doctor miller s t 5 itu registrar ailey reminder of medical emergency team 71 year old gentleman admitted under the orthopedic team on the 20 third of the first with pain in the right knee on the background of parkinson's disease type 2 diabetes ckd renal transplant managed with steroids and tacrolimus initially concerned about prosthetic knee infection given recent total knee replacement in december and therefore aspirated that but aspirate sterile subsequently transferred to the medical team were treated for urinary tract infection with e coli cultured in urine paragraph sensitive to meropenem gentamicin but resistant to beta lactamases blood cultures negative throughout renal ultrasound demonstrating no evidence of perinephric collection or in transplanted kidney episode of rsv during inpatient admission as well as delirium and autonomic dysfunction which led to switching of parkinson's medicines to reticotine patch checked online and appropriate dose of reticotine patch on arrival patient in bed responsive to voice sweaty and diaphoretic airway patent hello I'm there on the doctor's call sorry did the primary so bad yeah and he was like hot and clammy sorry no no it's fine yeah his lungs are airway patent yeah lungs clear to aspirate to auscultation sats a 100% on air circulation initially concerned about hypotension however blood pressure a 105 systolic after machine cycled tachycardic with a rate of 160 prior to blood pressure circulation initially concerned about hypotension given tachycardia and concerns from ccu about fast heart rate about a 180 likely fast atrial fibrillation based upon rhythm and previous ecgs demonstrating fast atrial fibrillation therefore pads applied but subsequent blood pressure demonstrated normal therefore pads later removed note episode of fast atrial fibrillation yesterday managed with magnesium and digoxin dis in terms of disability he it was gcs 14 on assessment glucose on gas normal abdomen is often nontender prefebrile on temperature assessment impression initially concerned about hypertension secondary to fast af however blood pressure normal secondary concern about potential for hyper parkinsonian crisis however ritigatine patch appropriate given levels of given given on admission medication therefore likely diagnosis of fast atrial fibrillation secondary to septic shower or or secondary to febrile episodes secondary to urinary tract infection + or - right knee infection given hot to touch compared to other knees, slightly red and recently instrumented plan bolus of iv fluid digoxin reloading for managed fast atrial fibrillation portable chest x-ray venous blood gas onto computer system full panel of blood tests family updated throughout stat of gentamicin as bug sensitive to this and continue regular gentamicin if further febrile episode consider discussion with microbiology at that juncture discuss with orthopedics I tried to bleep however no answer