Ward

Morning rounds

Priority is trajectory, not diagnosis. Order each list, commit, and compare your round order against the expert's reasoning.

Four patients, forty minutes

Overnight summaries below. Put the list in the order you would physically see them, most urgent first, then commit.

1 · Bed 7
62M, day 2 after NSTEMI, medically managed pending angiography.
One episode of chest tightness at 05:30, settled with nitrate spray. Nurse notes he looks 'a bit grey'.
HR 92, BP 104/66 (from 128/80), SpO2 96%.
Repeat troponin pending. Morning ECG done, not yet reviewed.
2 · Bed 4
79F, day 5 of pneumonia, planned discharge today.
Slept well. No events.
T 36.8, HR 78, BP 128/74, SpO2 95% on air.
CRP falling, eating, walked with physio yesterday.
3 · Bed 9
58M, admitted with hyperkalemia and AKI, potassium 5.6 after treatment.
No events. Urine output 40 mL/hr overnight.
HR 76, BP 122/78.
06:00 potassium pending. Ramipril and naproxen held.
4 · Bed 12
70F, day 3 of cellulitis on IV antibiotics.
New temperature 38.4 at 04:00. Nurse reports leg looks 'about the same'.
T 38.4, HR 96, BP 118/70.
Blood cultures from admission still negative.

Overnight summaries below. Put the list in the order you would physically see them, most urgent first, then commit.

1 · Bed 5
71F post-op day 3, went into fast atrial fibrillation overnight, rate controlled by 04:00.
AF at 142 at 01:30; beta-blockade and electrolyte replacement brought her to 96. No chest pain.
HR 96 irregular, BP 118/70.
Potassium replaced to 4.2. Anticoagulation documented as a pending decision for the day team with the surgeons.
2 · Bed 8
82F admitted with a UTI, day 2, became acutely confused overnight.
Found climbing over the bedrail at 03:00, settled with reorientation and a family phone call. No fall, no injury.
T 37.2, HR 88, BP 132/80, SpO2 96%.
New zopiclone was given at 22:00 'to help her sleep'. Sodium 133 stable.
3 · Bed 12
68F with cellulitis, day 4, afebrile 48 hours, discharge planned.
No events. Asking to go home.
T 36.7, HR 74, BP 128/78.
Margin receding well inside the marked line. Oral switch done yesterday.
4 · Bed 2
64M with cirrhosis, admitted with ascites, diuretics uptitrated yesterday.
Nurse reports one black, tarry stool at 05:40. He mentions feeling 'washed out'.
HR 104 (from 82), BP 106/64 (from 124/78), SpO2 97%.
Hemoglobin yesterday 112. Known varices on last year's endoscopy.
5 · Bed 10
55M with community-acquired pneumonia, day 3, weaning oxygen.
Uneventful. Oxygen down to 1 L overnight, sats holding.
T 37.0, HR 78, BP 122/76, SpO2 95% on 1 L.
CRP falling, mobilizing with physio, switch to oral antibiotics due today.

Overnight summaries below. Put the list in the order you would physically see them, most urgent first, then commit.

1 · Bay 1
24F with DKA, on an insulin infusion since 02:00.
Gap closing; last pH 7.24 from 7.09. Potassium 3.6 on replacement.
HR 98, BP 112/68, RR 22.
06:00 potassium and glucose pending. Infusion protocol needs its next titration decision within the hour.
2 · Bay 4
58M with an exquisitely painful, hot first MTP joint.
Settled with analgesia. Afebrile overnight.
T 37.1, HR 80, BP 130/82.
Admission bloods: urate 480, creatinine 145, CRP 84. Joint not yet aspirated.
3 · Bay 3
77M admitted confused with sodium 118.
On fluid restriction after the emergency assessment; 04:00 sodium 121.
HR 82, BP 138/84, GCS 14 (confused speech).
Correction rate on the edge of the safe daily limit. Urine studies from admission not yet chased.
4 · Bay 6
45F with pyelonephritis, first antibiotic dose given in the ED.
Fevers to 38.6 with rigors at 03:00, settled. Tolerating oral fluids since.
T 37.8, HR 92, BP 116/72.
Cultures pending. Creatinine normal. Rigors within the first day of treatment.