Patient I'm just gonna have to for investment yeah I'm I'm really busy at home I'm really nervous every not where we are so we're here for the we're for the medical hello mister caldwell so alright I don't know we don't know him then what what he's saying it's a young gentleman okay came in seventh of early june with some chest symptoms was admitted as a case of bilateral pneumonia okay and also some aka on ckd and sepsis and also some physical osteoclasts for pneumonia got it yeah I think I was able to go an x-ray when he was just called me earlier he seems to have some kind of pulmonary edema going on almost the left side of his chest is almost done he's currently she's he's finally on a fosamide deficient at 40 mg thank you check out the 40 mg boluses okay blood pressure is 98 56 yep so I know yes I think yesterday just just in case we have to have prescribed over the night I I gave him his call been here with him finally about possible complication because he may be suffering from this I think at this moment we're now still not here but I've not met him today surviving yeah they're we need to listen to other videos really that right thank you okay she's pop up tomorrow okay he's not for it as so okay yes escalation just for the base care is it oh yeah I think it's just more of like can you tell me like like we decide any for yeah understand official yeah yeah it's obviously the middle of the day there are there are there any amu registers that lay in or yeah yeah I'm just gonna do it I just thought you were malcolm just look in your eyes can you squeeze my hands please out of the way squeeze my hands hand I'll do 1 alright there we are that's actually what towel works yeah great I'll release them that's fine silicone we'll use some of these new tools station didn't know if you would do it okay can we grab any gcn no gcn abuse is there both of and you could if you think you're gonna win but I it depends if we really think it is pulmonary or we think it is pulmonary so there's more vesicular bronchial signs towards the upper zones there's there entry a slight expiratory wheeze is well discernable on the right face okay and some associated crepitations so it could be some degree of pulmonary edema any peripheral edema don't know there's no peripheral edema here it's capillary refill time it's about yeah 2 to 3 seconds and I'll just try and just membranes gcs about 14 mhmm okay we'll have a look at the x-ray and see what it looks like so you didn't look at cold or fever so you start those you know she's like you know sore throat the hips it's just another morning so you don't want to go to 4 hours which is no infusion 2 2 I'm so bullish on him and he's got some on boluses did you last have a bolus of 3 he's on a 38 infusion he had the 1 40 mg about 10:00 10:10 o'clock your outpatient is well within the end of the year actually okay he's at still 76 mg so 76 6 score rate for the alcohol they're going down to 50 and then they're 50 and so we see a significant deterioration on the left don't we but no large effusion on the right yeah it doesn't really fit the cartilage no peripheral edema no effusions unilateral changes this is most recent 1 yeah no fluid in the fissure when there was fluid in the fissure but but there's still so there's a fissure line there's a fissure line okay no just moved in side dish I will do that left side of the line bnp is also too low yeah oh no that's fine okay fine and then yeah no could be some congestion there might as well just provide me some rest of my cup of tea yeah yeah he's doing a lot and but I just by not saying I don't know if it's gonna be something that we're gonna transformatively fix his oxygen requirement or bruise I think that's what it does actually look like obviously that was a couple of days ago and then another 2 year old boy's chair and that'll help us inhalers anything like that do they sound wheezing it's a bit wheezing but I don't know if he's got any obstructive lung disease on top of that as well the wheeze could be attributed to some to ghn too but so what is the ex smoker well that's it do you have a no it's probably got a extra potassium drip in her that's not really not happy so oxygenate aren't we so what we want that's what we really want effects is the oxygenation oxygenation so the only thing we can give is some fruit bite really to fix the oxygenation this is just a very large left sided pneumonia with significant desaturation it's all something really clear with the cranium isn't it so I didn't see the chest x-ray what you saw chest x-ray shows yeah constipation for long time okay no signs of confusion it's on the right just a tiny bit bitsy movement so let's get a hold of the chest to make sure he hasn't developed a pneumothorax driving this significant deterioration it's unlikely but it's possible his blood pressure on the is the side effect if it's okay we can give him a bit of food like so that's the only 1 that's literally every 1 what have the sats been like over the course of the day is this much worse than normal or just normal mass there informed is on 65% oxygen this morning it's never been good no it went down to 50 as lowest yeah so you've never been waiting I think 22 liters I think it's 22 2 l think a longer in green oh is this that's 5 l nasal spec and a normal ring that's 20 liters of ring yeah play much isn't it it's an insignificant oxygen requirement with no improvements in saturations it's not a record deterioration in anything like that for some time despite maximum medical therapy I think we'll get them all to just make sure there's nothing grossly to change if there's a big effusion then we'll give them a statin freeze I don't think it's the same as before then I think we we we're we're family yeah yeah yeah trunk is that is that alright if anyone have any concerns about the physical plan anything I've missed or forgotten no okay and we'll start with that just in case you missed just in stressed isn't it it is but think I have some black black beer to keep the big cholesterol that's fine it's alright for now isn't it we can help him keep prescribing he's sensible if you order the port address he'll let you know oh absolutely yeah so we'll get that we'll go do some writing on how to pass the family is that alright and then we'll see the port address okay I'll just go back to port yeah what's happening at the port well the the so the surgical registrar's not gonna have you on it for you oh why not why not I don't know pierre will have to find out okay well don't know mean she doesn't she doesn't need it now she just need it if we give it more yeah yeah that's fine so if she hasn't met her abdominal okay that's that's you know that's it yeah yeah yeah yeah this one's every 12 hours I'll go look downstairs doctor I've never known how people know how to ring them when the number isn't at thumb does somebody's voice have a message oh no they were talking about massage weren't they naming meds does diabetic having low blood sugar for a minute no fuck your oxygenation k have you had a nap yet no not yet hasn't any lumped either no have you no we were halfway through that gutting you're probably having sorry a little of what was that wow trauma lies for a stroke do you go to a god no at night at night you're on a stroke crutch but in the day it's a proper stroke crutch thankfully that's scary she doesn't a vision I hate you really I thought yeah I mean you you don't do that much it's completely opposite of how I think yeah like in terms of structures and that's like just a big globular mess yeah mhmm yeah bit more it's all that much but it's simple really do a sensible assessment cool good not quite great this is malcolm duig mhmm it's malcolm daub yeah duig duig duig yeah there's no next of kin on here fine we'll speak to where the network how long the story is so thank you pneumonia yeah I think we've called that and most of them was an additional element of like fluid in the body okay so that's why I started to talk about giving diuretics today yes in terms of his inability to respond yes okay he's not doing well we know that the saturation didn't pick up so yes I mean how may I get new to make the decision john I don't mind so been trying to talk quite a bit about the acl and he didn't pick up at all the the pneumonia is severe yeah and I'm happy to stop the active treatment if you are happy on this I'll explain his brother the twin his twin brother okay okay alright the twins the next the kin you see he's given us permission completely right cope with what you think okay he's at the same age and the same age does anyone have any lasting power of atorvastatin or no okay you can contact him you can say that he's not improving despite after treatment like the last 3 to 4 days yeah and if if if he's happy to keep him only comfortable yeah we will give him the oxygen yeah because this doesn't help respiratory distress but we will stop all the the rest of the actual treatment okay this is all alright yeah that's what can do no appreciate you I'm still in that accept talking I agree I am okay and and is she okay okay I'm okay so she has you have to send me check like so it's it's really bad all of the english okay it is a severe cough I didn't have high expectations for that but we have found here I was really okay with this patient what are they in the sound of they can understand enough totally and I'm okay I can stop and that's why I but I'm sorry about the matter they're even very happy to come that's the same thing nice to come he was very to go you know of course sorry even I decided to keep him here so no 1 will be bothered about the words sorry did that earlier alright that's fine we we have written I told them I'm I'm on the top of the I I mean you the the 1 was the last time no I'm okay you you you can write whatever you want you can just text me yeah okay brilliant brilliant brilliant brilliant brilliant yeah this is number I need to call oh that's brother this is the brother's older yeah so I don't know if you can do anything yeah if you're the other way you are available here right now for friday night they call it then next call I call okay yeah so you I mean are we saying okay so if you're out and ready for a yeah yeah yeah so the plan is look at it it's gonna say should we just see the x-ray now and then I think we're talking in agreement no no more med schools no more replacements and then stop anything that we have and then to to switch to palliation as from tomorrow or from midnight if you don't have 1 24 hours yes I will put you in for minute I mean but if we have the decision now we'll stop him now okay it's up to the family I'm sorry I'm not giving him anything I don't know putting her out very much just that you know yeah yeah yeah to her out need to figure out you know if they can tell you it can try yes yes but the thyroid are are you able to try that I mean if you did like 1 hour here you go back in so I don't think you're done oh you're just not taking that till the I'm showing you that the numbers are fine they're okay you said that they don't work immediately I think