C09991732 / invoice 10000

History:See previous. Multiple episodes of fever and being unwell. Since Tuesday has been very week, not eating, heavy breathing. Able to walk for about 10 metres then sits down and doesnt want to move. Sitting down to urinate. Not eating. Hasnt pood for 2 days. Examination:QAR/flatCVS: Heart muffled, unable to hear clearly. Mm pink, tacky, CRT 2sResp: Intermittent panting, increased BV sounds bilaterally. Tracheal ausc NAD. Abdo: NAD and comfortable on palpation. LN's unremarkable. Temp 40.8Neuro: Cranial nerves NAD. No ataxia but quite weak behind. Once up can waddle along before choosing to lay down. AFAST:No free fluidHeterogenous mass mid spleen noted. TFAST: Multiple A lines, no free fluid, no pericardial effusion. Radiographs:Abdomen: Omnipaque has moved through well, no dilated loops, stomach appears normal. Thorax: Interstitual pattern evident. Cardiac silhouette rounded. Assessment:Pulmonary disease- pneumonia vs metastatic disease vs cardiac failure... Comms:Discussed with O, ideally referral for medicine work up and CT scan... Otherwise can consider medical trial for either or both CHF and pneumonia. Did also approach QOL discussion with O and considr pts INI    Vital Signs    Weight: 62.50;