Colin penn 88 year old man 120 81 4 9 medications list theolaz duo eye drops 1 drop to both eyes 4 times a day allopurinol 100 mg once a day rivaroxaban 15 mg once a day doxazosin 2 mg at night amlodipine 10 mg once a day busoprolol 5 mg once a day death of spouse march 2025 hydronephrosis is renal and trill calculus obstruction july 2024 leading to nephrostomy asbestos induced pleural plaques pulmonary fibrosis related to that ckd 3 gout atrial fibrillation gilbert's syndrome hypertension cholecystectomy investigations test arterial blood gas ph 7.28 with p c o 2 4.3 and p o 2 7.5 despite 15 liters of oxygen sodium a 126 calcium 1.06 glucose 11.1 lactate 4.8 oxygen saturation is 86.3% on this gas that's an arterial gas about I should have phoned you were just doing the ultrasound code unlikely to be an arterial gas yeah oh no actually he's on scale 2 probably is an arterial gas base excess - 10.6 full blood count hemoglobin 120 has been anemic since at least december 2025 normal hemoglobin in august platelets 221 normocytic neutrophils 9.98 from 5.12 and white cells 11.2 from 7.2 ast hemolyzed troponin t 24 however hemolyzed blood so difficult to interpret eosinase creatinine 113 at patient's baseline electrolytes normal lfts alp 136 from 118 and a 112 respectively bilirubin 68 from a baseline of 30 no patient has gilbert syndrome crp of 6 no previous crp on record urea 9.2 quad swab negative arterial blood gas on presentation ph 7.42 with p c o 2 3.7 p o 2 7.2 base excess - 5 chest x-ray bilateral calcified pleural plaques consistent with asbestos exposure new bilateral pleural effusions with fluid along the right horizontal fissure and airspace consolidation in the right middle zone and both lower zones cardiac silhouette enlarged findings suggestive of pulmonary edema coexisting is possible and 12 lead ecg atrial fibrillation with pvcs qtc 464 no evidence of ischemia clearly but some biphasic t waves in v 5 and v 6 stable on repeat ecg is it mister penn is it mister penn hi can I help you at all are you alright I'm rob I'm 1 of the medical registrars nice to meet you how do you do I don't know it's going to catch you look ever so uncomfortable can I help you more be more comfortable and then we can have a discussion no I can't what's happening then what's been happening with you tell me all about it don't like 3 or 4 can I help you get more comfortable you look like a song comfortable where are you trying to get to where are trying to go up here can I have a look at you is that alright can I examine you is that okay alright thanks alright I was just about to go so you sat through tonight and got some tracing on your feet yeah that's alright muscle the fluid up to your hips on both sides got polyphonic expiratory wheeze throughout and some crepitations to the midrails I'll put this under here think you can pull out here a little bit coming forward for me left alright then can I see your tongue quite dry right and who lives at home with you who lives at home with you no 1 does anyone live with you at home no what do you where do you live anyone I should talk to no family oh really sam who's sam oh your son sorry who's your son I'm trying to use that and the mother one's often but they're you know tend to use that so we've got a letter from our hospital about testing and I'm partner okay let me get to you we've got you pulled do you smoke no have you smoked in the past 7 years ago you smoked fair enough I go take this phone call I'll come back alright oh thanks I thought someone was with you margaret's not with you well do you think oh I'll be there for you what do you want to do hi is that robert penn hi I'm robert miller I'm 1 of the medical registrars 1 of the doctors here at torbay hospital I'm I'm calling about your dad colin penn he's in with us in hospital I didn't know if you knew that oh I'm sorry to be the 1 breaking the knees to you I didn't know whether he'd let let you know he's he's he came into hospital with us about a few hours ago and I he's he's come in with difficulty with his breathing we're he's had some treatment with us at the moment he's on a bit of oxygen to help to support him but I we've only just managed to get his phone plugged in to get your number because he wasn't able to tell us or his what your number was so I can get in contact with you jim okay and do you mind if I ask you a bit about him no no have you been in contact with him recently or I will get this phone checked only by phone do you live a fair way away is that you're in north devon fine understood is there anyone else anyone else nearby that might have seen him more recently no fine there's someone in his phone called cam pen oh I'm so sorry I didn't know that sorry to be rude I'm fine understood so he's a bit he's by himself doesn't see anyone very informant yeah but obviously you're there on the phone has he have you been speaking to him recently has he been okay when was the last time you you spoke to him if you don't mind me asking when was the last time you spoke to him if you don't mind me asking fine and he was okay then mhmm and what kind of things does he does he do for himself I understand he lives in a house is that right is this like a assisted living mhmm mhmm yeah and what's his life like what kind things does he do I saw some keys for a land rover in his his bag but that's not his land rover fun but he doesn't drive it yes I saw that yeah he had a lens put in didn't he like a catch back treatment mhmm sorry I'm trying to piece it all together because he's a bit he's got this mask on to give him oxygen he's quite sleepy so he's not really able to tell us too much so he walks a couple of times a day he doesn't drive his land rover he's recently had his cataracts done but you from as far as you know he's been completely well recently yeah fine okay good fine cool and in terms of these apartments would would there be someone there that might see him more regularly do you think there may be not I'll give them a call and see that's fair enough will so I just wondered if you'd mentioned anyone just trying to get an impression of how long he's been 44 or maybe he's said anything to anyone else but I can try and piece it together and speak to the people in the mcarthur's home that's really helpful in terms of you and things like that you obviously would be more than welcome to come and see him if you wanted he's in our recess area here in a and e at the moment then from there we'll be hoping to get him to a ward quite soon shortly after that he's needing quite a bit of oxygen yeah is he's having a good amount of oxygen through through some high flow nasal oxygen that we use he's seems as though his fluid is building up in his chest for either that's because of an infection or because of his heart not working fantastically you need to work out what your dose is but for the meantime he's needing a bit of oxygen to support him well you'd be always welcome anytime I guess from I always sleep either in my bed thinking that I've told people to come and see their relatives when they're poorly so yeah no just yeah he'd be obviously more than welcome to come sooner if yeah he'll he'll be very likely to be on anything more clear yeah can indeed exactly ask about it and if any this this is torbay hospital exactly yeah not not exeter yeah it's pretty big I don't know that but yeah it's in it's in chippy just outside of toki just on the outskirts of toki I'm sure I can find it for you I can Google it it's tq27aa 27aa don't miss us yeah you're welcome anytime if if anything gets if anything if he deteriorates and we wanted any more information you're happy for me to call you again I've got your number exactly fantastic that's good to know thank you very much brilliant thanks for talking to me a bit bye bye it's right you're right sure hi it's robynne dorscht hi doctor taylor how are you good I'm very fine good fantastic what brings you up mhmm mhmm all those risk factors yeah brilliant yeah you can see oh can the end of it closes the the sternum it's fine yeah thank you so much so on examination expiratory polyphonic wheeze throughout with coarse crepitations to the mid zones bilaterally pitting edema to the hips bilaterally dry tongue low volume regular peripheral pulses heart rate 60 blood pressure 90 blood pressure 101 over 53 respiratory rate 28 and saturation is 90% on air so impression is acute decompensated heart failure likely secondary to missed myocardial infarction approximately 10 days ago his patient has collateral history from paramedics reports has been feeling generally unwell for the last 10 days and with biphasic t waves laterally ecg show atrial fibrillation with pvcs pulse rate 66 that's 92% respiratory rate 26 and blood pressure a 101 over 53 initially sat 85% at the beginning of my review but optiflow pressure optiflow settings increased to 90% f I o 2 and 50 l per minute flow further salbutamol prescribed given polyphonic wheeze throughout and further furosemide