And on this paul hover 769777 77 year old gentleman medications list lanzoprazole 50 mg once in the morning amlodipine 5 mg once a day pixaban 5 mg twice a day past medical problems atrial fibrillation hypertension delirium in march 2025 ckd 3 ischemic heart disease 2004 hypercholesterolemia and angina in 2003 allergic to unclear no gp allergies recorded and if that's normal or if it was static normal so obviously ecg will be normal if there is no bone re occlusion yeah but what was the reason for that they they said ed team have discussed with surgery with no previous presentations with vague symptoms of delirium so recent admission admitted from the january 30 to the january 31 which is yesterday with non cardiac chest pain and incidental mass seen in the ct and been referred to endocrinology as an outpatient admitted with chest and epigastric pain with sudden onset he had a cta alter as well as some troponins which were negative investigations pc still pcr awaited cetium a 130, 134 creatinine a 121 from baseline of 88 potassium hemolyzed aki 1 liver function test bilirubin 31 note previously normal at 10 crp 204 from 56 and previously normal at 3 on the january 30 urea 13.2 when previously 6.6 and full blood count hemoglobin a 155 which is stable white cells are 20.5 and neutrals of 15 venous blood gas ph 7.34 with hypochloremia and hyponatremia ct thorax january 30 during recent admission for trauma negative chest pain study negative for dissection or other acute aortic syndromes incidental findings of a 4 cm heterogeneous lesion in the left superior retrosternal region causing mass effect which may relate to inferior retrosternal goiter or other superior mediastinal mass subcarinal and mediastinal lymph nodes noted 12 millimeter left adrenal nodule and measuring 30 hounsfield 12 pre contrast may require further image imaging mild fat stranding near the pancreatic tail correlation should be made with serum amylase left adrenal nodule is an adenoma adrenal mri and endocrinology referral are recommended she's got primarily respiratory tissue discussed with clinical team referral to the adrenal team for potential adenoma investigation 1 stop thyroid clinic for thyroid nodule investigation me yes or no are too small and may require 6 month interval scanning to this new lens of proceeding cool does that work yeah yeah so that's the plan adrenal team for potential adenoma investigation number next referral to 1 stop thyroid clinic for thyroid nodule investigation number next next investigation is chest x-ray widened cardiac salivary normal clear lung fields is it mister abar yes I'm rob I'm 1 the medical registrars pleasure to meet you sir how are you I'm alright good well that's great then can you take your head sorry I'm feeling comedic at this time right I'm sorry to see you in hospital I heard of you were in hospital over the last few days with chest pain no I'm not place not in the place you tell me more then not in the same place I snarl at the sun I say indigestion indigestion a burning pain behind your breastbone sort of yeah sort of yeah okay fine fine and has the pain gone or is it still there no it's gone it's gone that's good and what's brought you back to hospital now then you're obviously quite poorly and feeling unwell but tell me about it I'm just going go on my greg just a quick hand over thank you there were bone but he's a tissue and I'm trying to fill to recondylate him that's cool thank you so much I'll be back can you go on lisa alright I've I've got some things I'm sorry I'm sorry sorry I'm I can't allow you to go to bed how is this condition yeah I'm just gonna go to bed I'm just gonna go I'm I'm what brought you to to hop on this side gonna I'll go ahead and say I'm gonna hop a little drip in so that you can give me some the indigestion effect the indigestion that was last time and how about this time sorry sorry for that same thing more indigestion yeah so you're back in that discomfort with the indigestion have you got the indigestion now no that's good and tell me about your life more generally who lives at home with you no not really you live by yourself sorry I I live with with I don't quite quite define it I live with my mother the year of your mom yeah and how old is your mom about 60 70 60 70 fine and does she look after you do you look after her is it okay I sort of look after her yeah fine lovely so you look after your mom like a nice son that you are yeah and who does the shopping you oh no I'm sorry I'm asking yes okay and do you so you get out of the house because you're shopping and is alcohol a part of your life no not really no not really tell me about it not really do you drink alcohol no not at all you're tea is that right the you're t tape yeah do you smoke no vices that's a shame isn't it none whatsoever ready for the blood test mhmm so you're back in this indigestion pain and any other symptoms at all no no symptoms at all just the indigestion any fevers at all no any pain passing water no any tummy pain no but you do have that indigestion feeling I suppose you suppose so but I'm talking you into it don't I and has anyone told you where you are at the moment yeah I mean go on what a lovely cannula it is so you don't know where you are do you know what month it is so I think I'm alright alright tell me then january k it was recently january it's true but today is the february 1 that's okay and tell me okay any headache at all no change to your vision do you feel thirsty no any passing water cough or cold no no can I touch your tummy no alcohol is not really a thing for you smoking is not really a thing for you drugs not really a thing for you what do with your time then when you're out with your mom yeah at work that's what I say yeah what do do for a living what sore is it good don't really work for any of it now you don't really work for any no I'm not so what do you do for a living not being a legal executive you're a legal executive why was I that sounds serious you work for a big firm no work for yourself no okay how do you find work done there's a leak if I just take a restasis turn this around so that we can get some of the medicine from you you're looking for the toilet yeah yeah I'm looking for the toilet have a look what in the store cupboard yep let's see I'm just gonna do it just tying this round here so we can just get a blood test on this side with me haven't really got any symptoms I don't think about any symptoms any symptoms really have you no no nothing to speak of can I borrow his arm for you thanks okay just put me on the other side of the and blood test does anyone know you're here should I tell anyone that you're here oh yeah yeah sorry yeah she's working here who knows you're here yeah she's do working here who who knows knows you're you're here who yeah knows secret police the who the secret police secret police immediately who are the secret police I've not had it done and I guess they are secret so do you think they're following you the secret please unlikely unlikely why unlikely no I just do ready for the blood test sorry where are you I'm in yellow no sorry tests from you these are the main ones so it seems like you've got an infection somewhere this is a hernia by the look of your blood tests yeah there's the possibility of inflammation in your pancreas as well based on your previous scan so I was hoping for a few more blood tests just to have a look at that okay blood test coming on just keep you on that still very close 1 second still we got some notice so that's good we got any of those in there we'll get we'll do a couple of tests okay we'll take an x-ray of your chest scan of your head some strong antibiotics through your vein we'll tell you you've got an infection somewhere we'll look for 1 we'll do lots of tests we'll do an x-ray of your chest we'll do some samples of the urine if you cough anything up we'll take a sample of it and send it to the laboratory we'll get a scan of your head to see whether there's anything there causing you to feel a bit off and funny I'll get these blood tests including an amylase to make sure that there's no evidence of pancreatitis pancreatic inflammation that can happen and we'll have a look at the rest of the liver we'll take it from there I think and we'll take you to our acute medical unit that sound alright sounds like a plan then any questions anything I've forgotten no that's good can you tune them no there is blood transfusion but if I quickly examine you is that okay alright to your heart k so the heart sounds are normal we'll a quick follow-up very successful very good and then can I see your tummy I see your okay that's good tough tummy tuck nothing carefully moving all 4 limbs abdominal examination impression overwhelming infection with possibility of urinary tract infection versus peripancreatic inflammation like pancreatitis based upon pre recent ct thorax possibilities plan blood tests including mlas and recheck remaining hemolyzed tests chest x-ray already undertaken confusion screen bloods ct head antibiotics to cover urine with stat of gentamicin iv fluids in light of aki input output monitoring daily and aki urine dip mainly catheterization depending upon suggest urinary catheter to measure and given patient is confused and won't be able to mobilize out of bed tep full escalation