Eileen lewis +1 83754 83 year old lady many thanks for asking me to see this lady doctor miller 83 year old lady admitted with fresh fresh red pr bleeding on patient left for loading and display january 30 am currently looking at the patient admitted to eyewall past medical history hip osteoarthritis on the left with recurrent dislocation diagnosed with anemia 20 23 managed with ferrous sulfate hypercholesterolemia hyperlipidemia to the patient's hypertension osteopenia any current diet order details all food allergies and bad luck at school medications at home amlodipine leperamide naproxen for the last 6 weeks mebeverine ramipril tovastatin pentoxifylline functional background by clicking the patient's room lives in a house alone independently does own shopping has no care does own housework click david's room in the on admission to the emergency department blood pressure a 113 over 58 with a pulse rate of 79 investigated by the surgical team for lower gi bleeding with a ct abdomen and pelvis with contrast which demonstrates very full bladder needs catheter catheterized successfully no bowel related mass tortuous bowel mildly stool filled no features to suggest obstruction no mass bone lesions mild compression fracture of l1 this will open up the patient tab along the top allowing you to quickly navigate other investigations I will now demonstrate this full blood count today hemoglobin 55 from 69 on admission and a 113 on the january 27 a 123 on august 12 55 currently neutomies with creatinine 50 urea 7.8 from 3.4 at baseline increasing to 12.7 and 11.3 crp of 9 another activity which you may find useful is the ward housekeeper dennis to see hello I'm developed melina put the patient on the list a few hours ago last night and episode of hematemesis today at approximately 1,600 small volume fresh red pr examination by surgical f 1 doctor miller many thanks demonstrating melina venous blood gas taken demonstrating hemoglobin of 47 note urea falling slightly which is reassuring in regard of hopefully majority of bleeding has stopped now on examination airway patent breathing clear chest anteriorly bilaterally no oxygen sats 98% circulation pale pale increased capillary refill time centrally and peripherally dry mucous membranes melina smell obvious at bed space small volume of fresh red hematemesis in bowl at patient's bedside heart sounds normal blood pressure reassuring at 140 over 61 heart rate's 98 note during initial part of admission was 73 no peripheral edema abdomen soft and nontender catheterized draining clear urine good volumes discuss with patient disorientated to place but orientated to time and person likely mild delirium related to anemia and critical illness discussed with patient regarding resuscitation however unable to really engage in this conversation although would be happy to be considered for everything discussion with angie hicks who is adopted daughter and has known patient since she was 5 full stop lives in warden controlled flat but does not have a package of care mobilizes independently gets out to the shops to do her own shopping as well as her own cleaning and cooking only problems are caused by occasional dislocation of prosthetic hip but no medical no significant medical comorbidity impression upper gi bleed most likely secondary to 6 weeks of naproxen for osteoarthritis leading to peptic ulceration no stigmata of chronic liver disease tep form full escalation move to allerton ward venous blood gas wide bore cannula iv ppi continue transfusions but if further episode of hematemesis or hypotension increased rate of blood transfusion to stat and consider activation of major hemorrhage cross match further 5 units post transfusion hemoglobin takeover of care by the medical team urgent upper gi endoscopy aiming tomorrow following resuscitation intravenous fluids alongside blood stop in a proximate