THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILBLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[10:05 am, 20/01/2026] PPM 1: This PaJR starts with an innocuous SMS on a Saturday evening (I've removed the identifiers):
Aarogyasri Emergency Approval: NWH: KIMS-NLG, CALLER: DR abc, TID: 1234, TIME: 07:08 PM, PATIENT: AGE: 65/F, PROCEDURE: M8.6, MITHRA: xyz.
AHCT, Govt. of Telangana
That's it! The system assumes whoever is the doctor is on call 24x7 or it really doesn't matter because that doctor has other doctors working for him/her and also there's no more information other than the above SMS and the doctor can figure it out and ask the doctors who work in his team.
Fair enough!
[10:15 am, 20/01/2026] PPM 1: She was admitted under pulmonology in the same hospital in October 2023 and they found she had old TB since 15 years and also had a damaged lung that they treated symptomatically and also found out she had diabetes.
Following is their EMR summary from 2023 @CR patient consent form is sent to you in pm
@PPM3 it may be a good idea to run an LLM audit on the symptomatic management she received in 2023 detailed below?
Age/Gender: 63 Years/Female
Address:
Discharge Type: Relieved
Admission Date: 26/10/2023 03:54 PM
Discharge Date: 30/10/2023 10:09 PM
Diagnosis
RIGHT FIBROCAVITARY DISEASE WITH RIGHT MIDDLE LOBE BRONCHIECTASIS
SECONDARY TO? CAP, WITH TYPE 1 RESPIRATORY FAILURE WITH DENOVO DIABETES
MELLITUS TYPE 2
Case History and Clinical Findings
PATIENT CAME WITH COMPLAINTS OF SOB SINCE 2 DAYS
COMPLAINS OF FEVER SINCE 4 DAYS
HISTORY OF PRESENT ILLNESS:
PATIENT WAS APPARENTLY NORMAL UNTIL 4 DAYS BACK AFTER WHICH SHE Developed
FEVER HIGH GRADE, ASSOCIATED WITH CHILLS AND RIGORS, INTERMITTENT IN NATURE, NO EVENING RISE,
C/O SOB GRADE II MMRC SINCE 2 DAYS, AGGRAVATED IN LYING DOWN POSITION,
RELIEVED IN SITTING POSITION, NOT ASOCIATED WITH WHEEZE, NO SEASONAL VARIATION
NO C/O COUGH, CHEST TIGHTNESS, CHEST PAIN, HEMPOTYSIS, PALPITATIONS.
PAST HISTORY:
H/O TB 15 YEARS BACK? SPUTUM POSITIVE AND USED ATT FOR 3 MONTHS
NO H/O LOSS OF WEIGHT.
LOSS OF APPETITE SINCE 4 DAYS
NOT A K/C/O DM, HTN, EPILEPSY, THYROID, CAD DISORDERS.
FAMILY H/O: NOT SIGNIFICANT.
PERSONAL HISTORY:
DIET - MIXED
APPETITE- DECREASED SINCE 4 DAYS
SLEEP- ADEQUATE
BOWEL AND BLADDER MOVEMENTS- REGULAR
ADDICTIONS-NONE
GENERAL EXAMINATION:
PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE.
NO PALLOR, ICTERUS, CYANOSIS, LYMPHADENOPATHY, CLUBBING AND GENERALISED
EDEMA.
VITALS AT ADMISSION
TEMP- 100 F
PULSE RATE - 85 BPM
RESP RATE- 24 CPM
BP- 120/80 MM HG
SPO2 -85 % AT RA
GRBS- 276 MG%
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM:
ON ASCULTATION -BAE+, VBS+
BILATERAL ISA FINE INSPIRATORY CREPTS
ABSENT BREATH SOUNDS AT RIGHT IAA, MA, DECREASED INTENSITY AT RIGHT ISA
VR INCREASED AT ICA, SSA
GENERAL MEDICINE REFERRAL WAS DONE ON 28/10/23 I/V/O HIGH SUGAR LEVELS
Page-3
KIMS HOSPITALS
TREATMENT ADVISED: TAB. GLIMI- M1 PO/OD
BRONCHOSCOPY DONE ON 30/10/23
PATIENT AND HIS ATTENDANTS WERE EXPLAINED ABOUT THE PROCEDURE AND
INFORMED CONSENT WAS TAKEN UNDER STRICT ASEPTIC CONDITIONS, 2% XYLOCAINE WAS SPRAYED OVER POSTERIOR PHARYNGEAL WALL AND FOB WAS PASSED UNDER VISUALISATION INTO RIGHT NOSTRIL AFTER LOCAL XYLOCAINE GEL APPLICATION BRONCHIAL WASHINGS WAS DONE.
REPORTS: PROCEDURE WENT UNEVENTFUL WITH PATIENT
CONSCIOUS, COHERENT, COOPERATIVE.
VOCAL CORDS - NORMAL
CARINA- NORMAL
RIGHT MAIN BRONCHUS - NORMAL
LEFT MAIN BRONCHUS - NORMAL
POST PROCEDURE VITALS:
BP-120/70 MMHG
PR-104 BPM
RR-26 CPM
SPO2 - 98% @ 1 L O2
PATIENT IS ADVISED TO G.S ON 31/10/23 I/V/O CHOLELITHIASIS
PATIENT IS DIAGNOSED WITH CHOLELITHIAIS BY G.S DEPARTMENT
PATIENT IS ADVISED FOR SURGERY REFERRAL ON 31/10/23 I/V/O CHOELLITHIASIS
Investigation
DATE-27/10/23
FBS- 146 MG/DL
PLBS- 216 MG/DL
HBA1C- 6.8%
LIVER FUNCTION TEST (LFT) 26/10/23
Total Bilurubin 0.59 mg/dl
Direct Bilurubin 0.16 mg/dl
SGOT(AST) 52 IU/L
SGPT(ALT) 51 U/L
ALKALINE PHOSPHATE 275 IU/L
Page-4
KIMS HOSPITALS
TOTAL PROTEINS 7.3 gm/dl
ALBUMIN 3.6 gm/dl
A/G RATIO 1.02
CUE :26/10/23
COLOUR Pale yellow APPEARANCE Clear
REACTION ACIDICSP.GRAVITY 1.010ALBUMIN +++SUGAR Nil BILE SALTS Nil BILE PIGMENTS
Nil PUS CELLS 4-5EPITHELIAL CELLS 2-4 RED BLOOD Nil
CUE :29/10/23
COLOUR Pale yellow APPEARANCE Clear
REACTION ACIDIC SP.GRAVITY 1.010ALBUMIN +SUGAR Nil BILE SALTS Nil BILE PIGMENTS
Nil PUS CELLS 3-4EPITHELIAL CELLS 1-2RED BLOOD Nil
SEROLOGY- NEGATIVE [ HIV, HBSAG, HCV]
CRP- POSITIVE (2.4 MG/DL)
DENGUE NS1 ANTIGEN, IGG, IGM- NEGATIVE
ESR- 80 MM/1ST HR
URINE FOR KETONE BODIES- NEGATIVE
COMPLETE BLOOD PICTURE 27/10/23
HAEMOGLOBIN 10.9 gm/dl TOTAL COUNT 8600 cells/cumm NEUTROPHILS 74 LYMPHOCYTES, 18EOSINOPHILS 02MONOCYTES 06 BASOPHILS 00
COMPLETE BLOOD PICTURE 29/10/23
HAEMOGLOBIN 11.9 gm/dl TOTAL COUNT 7300 cells/cumm NEUTROPHILS 55 LYMPHOCYTES, 40EOSINOPHILS 02 MONOCYTES 03 BASOPHILS 00
PLATELETS 2.0 LAKH
SMEAR-Normocytic normochromic
RFT on 26/10/23
BLOOD UREA -25 MG/DL
SERUM CREATININE- 0.8 MG/DL
URIC ACID- 2.7 MG/DL
Page-5
KIMS HOSPITALS
CALCIUM - 9.5 MG/DL
SODIUM 138 MEQ/L
POTASSIUM 3.6 MEQ/L
CHLORIDE 98 MEQ/L
RFT on 30/10/23
BLOOD UREA -19 MG/DL
SERUM CREATININE- 0.9 MG/DL
URIC ACID- 3.0 MG/DL
CALCIUM - 9.5 MG/DL
SODIUM 137 MEQ/L
POTASSIUM 3.4 MEQ/L
CHLORIDE 102 MEQ/L
APTT- 30 SEC
BT- 2 MIN 00 SEC
CT- 4 MIN 30 SEC
PT- 16 SEC
INR-1.11
SERUM MAGNESIUM- 2.0 MG/DL
2D ECHO :26/10/23
NO AR, TRIVIAL MR/TR
NO RWMA. NO AS/MS. SCLEROTIC AV
GOOD LV SYSTOLIC FUNCTIONS
DIASTOLIC DYSFUNCTION, NO PAH/PE.
HRCT CHEST :26/10/23
COLLAPSE OF RIHT LUNG UPPER LOBE AND MIDDLE LOBE WITH BRONCHIECTASIS IN
RIGHT MIDDLE LOBE
MULTIPLE THIN WALLED COALESCENT CAVITIES IN RIGHT LUNG LOWER LOBE
F/S/O CHRONIC INFECTION
GROUND GLASS NODULES IN LEFT UPPER LOBE AND LOWER LOBE- ACTIVE INFECTION
CHOLELITHIASIS
BLOOD C/S - NO GROWTH AFTER 24 HRS OF AEROBIC INCUBATION
SPUTUM C/S - NORMAL ORAL FLORA GROWN
URINE C/S- NO GROWTH
BAL CULTURE 26/10/23
NO GROWTH
Treatment Given (Enter only Generic Name)
1. INJ. AUGMENTIN 1.2GM IV/TID X5 D
2. INJ. PAN 40 MG IV OD BBF
3. T. PCM 650 MG PO SOS IF TEPERATURE >99 F
4.INJ NEOMOL 1GM IV SOS IF TEMP >101 F
5.TAB CUPROFLOX X 500 MG PO BDX 4 D
6.INJ ZOFER 8 MG IV TID
7.T. GLIMI M1 PO/OD
8.SYP GRILLINCTUS PO TID 2 TSP
9.SYP MUCKCAINE GEL 15 ML PO TID BEFORE FOOD
Advice at Discharge
1.T CIPROFLOX 500 MG PO BD X 1 D
2.T CYRA-D PO BD
3.T .ZOFER 8 MG PO TID
4.SYP GRILLINCTUS DX 2 TSP PO TID
5.SYP MUCINE GEL 15 ML PO TID
6.T.GLIMI M1 PO OD
7.T UDILIV 300 MG PO BD
Follow Up
REVIEW TO PULMONOLOGY OPD AFTER 1 WEEKS /S.O.S
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
Procedures
Consultants
Drugs
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE, DONOT MISS MEDICATIONS. In case of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendant Declaration: - The medicines prescribed
and the advice regarding preventive aspects of care, when and how to obtain urgent care have been
explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date
Date:31/10/23
Ward: RICU
S.No Date Procedure Name
1 26-10-2023 04:54:PM E.C.G
2 29-10-2023 09:41:AM X-Ray Chest PA
3 29-10-2023 09:39:PM X-Ray Chest PA
4 31-10-2023 07:55:AM E.C.G
Drug-Dosage Drug-Dosage Drug-Dosage
ADRENALINE - 1 M L- ATROPINE SULPHATE - INJ IML- AZIRIN 500MG TABBIOLIV
- 300MG - TAB
(URSODEOXYCHOLIC)-
BIOXAMIC - 5ML INJ(TRANEXAMIC)- CORTIBEST -100MG
INJ(HYDROCORTISONE)-
DISPOSABLE SYRINGE 10ML-
(DISPOVAN)-
DISPOVAN SYRINGE - 20 CC- DISPOVAN SYRINGES - 2 MLDUOLIN
- 2.5 ML RESPULES- ECG LEADS (MEDICO)- FECET - TAB (CETIRIZINE)-
FUNIDE - RESPULES (budesonide0- GLUCOWIN - M1 - TAB (GLIMEPRIRID
METFORMIN)-
GUILD - M -TAB (LEVOCET -MONTELUKAST)-
I.V. CANNULA - NO:20 [POLYMED]- IV DNS -500ML (PUNISKA)- IV NS - 500ML (PUNISKA)-
IV SETS [POLYMED)- LIGNONEXT -2% INJ 30ML(LIGNOCAINE)- MALIDENS- IV 100ML(PARACETAMOL)-
MEDICAINE - 200 ML- METRONIDAZOLE - 100ML -PUNISKA- MOXYNIC -1.2GM - INJMUCUS
EXTRACTOR - NAPRO-MIDA 10ML INJ(MIDAZOLAM)- NEBULIZER MASK(AIRWAYS) ADULTNILOGRAM
500MG TAB (CIPROFLOX)- NS 100ML -ACCULIFE - ONTASYN - 2ML INJ (ONDASETRON)-
OXYGEN MASK ADULT - (LIFE O LINE)- OXYGEN MASK ADULT - LIFE O LINE- PANCOLY - 40MG INJPANTOPRAZOLE)-
PANRAS - 40MG TAB(PANTOPRAZOLE)- PAQVITA - 650 MG [PARACETAMOL]- QUADRIS - 7- TABSETIMED
- 10MG TAB (CETIRIZINE)- SPINAL NEEDLE - NO:23G [ROMSONS]- SPORLAC DS TABSUCTION
CATHETER - NO:14
[ROMSONS]-
SURGICAL GLOVE - NO - 7-5
[SURGICARE]-
SURGICAL GLOVE - NO:6-0
[SURGICARE]-
SURGICAL GLOVE -6.5 -(AQMAX)- SURGICAL GLOVE -7.0 -(AQMAX)- SYRINGES - 5 ML [ROMOJET]-
TUCIN -BR SYRUP- VOMIAMP -4MG
TABLET(ONDANSETRAN)-
ZINKOVITA - SYP 200ML
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