So diana horrill 86 year old lady 733010 observations temperature 37 heart rate 89 respiratory rate 20 blood pressure 150 over 82 satzima is 7% on air recent medications course of doxycycline and prednisolone for 10 30 mg started on the march 30 right I'm putting pain down now for 5 days and course of amoxicillin started on the march 23 for 5 days repeat medication adderall d3 1 twice per day paracetamol is required easyhaler salbutamol 100 microgram per dose dry powder inhaler 2 puffs to be taken when required up to the maximum of 4 times a day oral morph solution is required ibuprofen gel is required trelegy ellipta 92 / 55 micrograms per day / 22 micrograms per dose inhaler 1 dose to be inhaled each day past medical history osteoporosis having zoledronic acid infusions depression pancreatic atrophy total hip replacement 2022 diverticular disease in the sigmoid 2021 metabolic associated fatty liver disease 2021 copd 2015 bronchiectasis 2015 fibromyalgia 2012 mixed anxiety and depression 1993 so on review of the gp record you can see that she had her copd review on the january 22 declined pulmonary rehabilitation he had 2 exacerbations in the last year and then feverish and myalgic drinking water but not much else to the gp on the march 23 was treated for an infectious exacerbation of copd with amoxicillin and prednisolone subsequently representing on the march 30 with ongoing aches and pains so we're seeing on the march 30 I'm going get some pains productive cough predicted completed 5 days of prednisolone and amoxicillin 3 days ago so did get up and showered so some improvement and the plan was for repeat rescue pack with a switch to doxy and then 2 days later still having a cough dark green sweater short of breath wheezy malaise despite 2 lots of antibiotics and 2 lots of prednisolone hello therefore impression is effective exacerbation of copd plan viral swab sputum mcns treat with antibiotics and steroids given failed 2 courses in the community admits overnight to ensure improving with current regimen tep for base care needs to be discussed pharmacological vt prophylaxis pulmonary rehabilitation repeat blood tests including crp given previous results hemolyzed current investigations using his crp and urea to hemolyzed covid swab not being performed at this time full blood count white cells 12.6 neutrophils 11.66 and lymphopenia 0.79 recent ct thorax 18 since september 2025 in complete resolution of inflammatory change in the upper lobes bilateral lower lobe atelectasis very easy yeah I'm sitting down here yeah yeah okay so you've been struggling with your breathing now for some time I can see you've been back and forth with your gp since for about a couple of weeks I've been in bed 10 days and then I've had 2 lots of steroids yeah 2 lots of whatever antibiotics yeah if mark hadn't rung my doctor that is he hadn't rung the they were both in bed my husband got caught mhmm now so bad and the pain and perspirations at night mhmm now 3 nights is last night really it's like when you're really feeling really cold just stir up oh yeah I'm sorry I just and still got a cough I I've I've not today but at night it's and yeah a bit green mhmm I don't know why I can't why the cough haven't gone and at night when I go to bed it's terrible mhmm sorry I I can't stop I get to a liter of water a night mhmm every night in the day I have a liter as well because I can't you know I can't tell you on your how how I feel I feel poorly you feel poorly yeah I don't wanna come in here I mean I said to mark this morning I don't wanna go back in he knows if I I haven't bothered him if you know what I mean because he's bully as well yeah we're frailty everything ran out your steroids and your and stuff days with nothing and then monday I thought I was gonna blow up I I was so bad I had to wait until 03:00 mhmm to pick up the steroids of course I took 6 straight away mhmm like they told me and 2 antibiotics yeah the doxycycline yeah oh they were and did it make you feel better it was a nightmare I was in agonies mhmm and it's painful in your chest painful chest and perspiration I was soaking mhmm and I said to my daughter the last lot they said take 2 2 2 of steroids yeah why did they tell me to take 6 all at once we usually do say to say the 6 all at once oh you really yeah we say have 30 mg at once oh wow it stays that's a lot man I shouldn't do that but I did that's the right dose 30 mg of steroids I told but I got terrible pain in your back oh my kidneys are here because of this sudden you kick kick me horrid yeah I mean I don't wanna take up your time no it's fine if I can cure myself at home that's why I stayed home yeah I do feel bad and since coming in you've had some blood tests which showed raised markers of infection as we might see are you bringing stuff up with your cough yes fine horrible green stuff yeah have you done any coughing today I have yes fine I've only got 1 that's okay maybe if we get you a pop you could give us some we could see what it grows on the left that'll be good okay and I guess from my perspective from looking at your numbers there's nothing that needs to keep you in the hospital however you should need some different antibiotics definitely and probably an x-ray of your chest have you had an x-ray of your chest yet yeah no we should do that I think okay and check your blood test to make sure they are normalised they're okay because a few of the blood tests that were sent the lab couldn't process them because they were broken down slightly by the time they arrived so you just need to repeat your blood test and have a chest x-ray you've tried a couple of antibiotics and we would usually use a different antibiotic if you failed the first 1 I've had 2 different ones haven't I exactly so usually what we would do in hospital in gp they have different guidelines but in hospital we'd give you amoxicillin or doxycycline yeah love that yeah and if you fail 1 of those we use a different antibiotic something called cotrimoxazole okay have you got any allergies to any medicines no I don't think so that's fine I have just had amoxicillin last week mhmm exactly and the ones I've been taking are a little turquoise ones doxycycline exactly but we think that if your chest infection hasn't responded to amoxicillin it's unlikely to respond to doxycycline so in hospital we would use something different but the gps have different guidelines but we would use a medicine called cotrimoxazole which works really well against atypical infections things that aren't normally covered by amoxicillin does that make sense and this pain in your chest it would good to get a chest x-ray to make sure you've got that when I was seeing you last time I had that for a long time and I know they did 1 minute they said it was this then they said it was something else and I was here 4 days I wasn't as bad as I am now so I don't know why I just want it gone want it gone of course I completely understand yeah well let's get you on some antibiotics let's get you on some more steroids let's get a chest x-ray and see what repeating your blood test shows up because a few of them were broken down and then we should have an answer or so in an hour with the blood tests and and chest x-ray repeat and whether you're feeling a little bit better with those antibiotics and we'll see and we're happy to keep you that's absolutely fine but if we can get you out of here it'd probably be nicer to sleep in your own bed but if you don't feel better and we still don't have all the answers then we should keep you in hospital is that okay yeah anything I've forgotten or anything like that no no that's okay no fine cool gonna have a quick look if you bring your mind I'm gonna look at your hands and listen to your chest is that okay yeah you don't have to take anything off or anything like okay I I am a little bra on anyway that's fine yeah I know have to take anything off it's fine thank you just for a quick listen to your back and just have a big breath whenever you're ready oh my goodness sorry is that painful oh my goodness big breath for me very nice 1 breathe better say again she's better now yeah you have some wheezy backaches nope never been I've never been wheezy it's just been like tight and I I couldn't breathe and did the steroids make the tightness better I do I I don't know not sure mhmm I'm not I can fit 1 I don't know they might add because they've only had them for 2 days now and I was I didn't have any for 2 days when you were being poorly made me drop back because I it was 3 days that I went without of anything and then I started getting poorly on monday afternoon mhmm and I had to phone up my I was so bad and I was sick I brought all my food up mhmm so I've been pretty poorly I wouldn't have wanted to come in yeah if you weren't poorly needed to yeah of course completely and you live in a in a house with your husband is or your partner you said yeah he's gone into bed he's got 4 not very well yeah that's fine so I said like if I had to go my love to get a taxi yeah I didn't mind yeah yeah we can sort all of that out if required but you couldn't stay you only stayed an hour you drink or smoke is that kind of do you drink alcohol or smoke cigarettes or anything like that no no nothing like that no and this is what I wanted to ask you because when I was living in london I had the same mhmm about 10 years ago I think they rushed me in with in the hospital and they said that yesterday the chemist said I should have a pack a resting pack yes that would be I've never had 1 15 years with copd my mother-in-law has yeah fine I'll ask your gp to get you 1 that would be helpful wouldn't it I never even knew I could have 1 yeah yeah we often do those for people if you're having you're having a couple of exacerbations a year aren't you but yeah 2 or 3 every twice a year yeah so it'd be good to have that if you yeah buy you if you need ears wouldn't it well it would be nicer for you to be able to treat at home for a bit and see yeah because better to be home yeah of course yeah yeah well let's get those few things sorted and we'll see if we can get your antibiotics on the different antibiotics does that sound alright okay you want me to go home tonight well we'll see depends what your chest x-ray and your blood test show okay is that alright yeah cool alright now we'll get those is that okay can I give you the hand no you're fine okay thanks thank you we're give a little chat I'm not sure what did you do for a living I'm 87 87% what did I do yeah we run our stainless steel company mhmm for 25 years nice a hospital with heart transplant yeah I got tiny oh my purse stool cool that was my I I adored when great my husband and I and we traveled the country brilliant yeah good night and then I'll bring all my weight to yeah just so plan to actually switch antibiotics to cotamoxazole restart steroid course of 5 days chest x-ray repeat blood tests including crp and uni to ensure normal if blood test reassuring and chest x-ray demonstrating clear effective cause for chest pain then could go home with course of antibiotics on examination right lower zone crepitations no clear wheeze speaking in full sentences able to mobilize independently from the waiting room to the examination room heart sounds normal no tremor see evidence of ct retention