2

Vital Signs

1
Blood Pressure
Blood Pressure (mmHg)
160

140

120

100

80 Systolic
Diastolic
60

40

20

0
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 Pulse Rate
Pulse rate (beats/ min)
120

100

80

60

40

20

0
D1 D2 D3 D4 D5 D6 D7 D8
Pulse rate (beats/ min)
 Respiratory Rate
Respiratory Rate (breath/min)
25

20

15

10

0
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Respiratory Rate (breath/min)

 Temperature
Temperature (◦C)
37.4

37.2

37

36.8

36.6

36.4

36.2

36
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Temperature (◦C)
Pain Score
Pain Score
6.2
6
5.8
5.6
5.4
5.2
5
4.8
4.6
4.4
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Pain Score
 SpO2 (%)
SpO2 (%)
99.2
99
98.8
98.6
98.4
98.2
98
97.8
97.6
97.4
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SpO2 (%)
 Pain Score
6.2 D2 :
• Diagnosis: Acute flare-up of UC
Patient appeared comfortable,
6 • reduced cramping but BO ~ 7-8
times today
• bloody in nature, pain score still
6/10
5.8 • Plan: Methotrexate to induce
remission then restart cap. D7 :
Asacol©. • Increased BO > 10x
today with malaena and
5.6 abdominal cramps. D8 :
D1 :
• Arrived in ED at 7:00 with bloody Patient claimed pain score •No change in condition.
and watery diarrhoea > 10 x for 6/10 and appeared pale •Diagnosis: Severe UC
5.4 1/7 and lethargic. refractory to
• Appeared lethargic and having • Plan: Restart IV HCT, corticosteroids
abdominal pains, cramping in start SRMD prophylaxis •Plan: To discuss with
nature, pain score 6/10 ward pharmacist on
5.2 Admitted to 7B by 10:00 under
Gastroenterology.
starting Ciclosporin.
Provisional diagnosis: Acute flare-
up of UC
Started IV HCT 100 mg OD, PR HCT
5 ON and S/C Enoxaparin
Ix: FBC, RP, LFT, CRP, Stool C&S D4 :
• Patient is ambulating
4.8 D3 : • have improved appetite D5 :
Patient appeared • BO ~ 5-6 times • No improvement in UC
improving, reduced •pain score 5/10. • BO still > 5 x day, bloody & watery
cramping, BO ~ 5-6 times • Monitor and KIV D/C CM if BO < 5 • abdominal cramps still persistent
4.6 today, pain score 5/10 x and no more cramps. • K+ = 3.1, Hb borderline
•To trace stool C & S. To oralize to • stool C & S no growth
oral prednisolone.

4.4
D1 D2 D3 D4 D5 D6 D7 D8
 Pain Score
6.2 D2:
• Patient appeared
comfortable
• Reduced cramping (BO
6 ~7-8)
• Still bloody in nature

Plan:
5.8 • MTX to induce remission
then restart Cap. D7:
Mesalazine • Increased BO > 10x
5.6 with malaena &
Started on: abdominal cramps D8:
D1: • Cap. Mesalazine 1 g TDS • Pale & lethargic • No change in
• Arrived in ED with CC • Tab. Methotrexate 20 condition
5.4 bloody and watery mg/week Plan: • Diagnosis: Severe
diarrhoea >10x for 1/7. • Tab. Folic Acid 5 • Start SRMD UC refractory to
• Lethargic, abdominal mg/week prophylaxis corticosteroids
pains, cramping  PS:
5.2 6/10. Started on: Plan:
• Provisional diagnosis: • IV HCT 100 mg OD • Discuss on starting
Acute flare-up of UC. • IV Ranitidine 50 mg IV Ciclosporin
TDS
5 Started on:
• IV HCT 100 mg OD D4:
• PR HCT 100 mg in 100 • Improved appetite
ml ON D3: • No more cramps D5:
4.8 • Symptoms improved • No improvements.
• Reduced cramping Discontinued: • Still BO >5x, bloody
• BO ~5-6x • IV HCT, PR HCT, S/C & watery
Enoxaparin • Hb level = borderline
4.6 • K+ = 3.1 mmol/L
Started: • Stool C&S no growth
• Supp. Mesalazine 1 g ON
4.4 • Tab. Prednisolone 40 mg
OD
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