Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

ENC-00022: Pilar Ravensworth

80M · MRN61270312 · Hospital Medicine · admitted Sun Nov 01, 2026 02:27 PM · discharged Fri Nov 06, 2026 10:31 AM · attending Dr. Isaac Abernath · resident Dr. Keira Upfield · 171 cm, 95.2 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“urinary tract infection” · N39.0 Urinary tract infection, site not specified
“class 1 obesity” · E66.811 Obesity, class 1
“systolic heart failure” · I50.20 Unspecified systolic (congestive) heart failure
“hypoxemia” · R09.02 Hypoxemia
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 872 Septicemia or severe sepsis without MV >96 hours without MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 871.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.044, t.ratio_s1=1.5, creat_rise_48h=0.04, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	false
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=False, creat_ratio=1.044, t.ratio_s3=3.0, creat_peak=0.95, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=unknown, t.uo_s3_h=24, anuria_hours=unknown, t.anuria_h=12	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=1.044, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.04, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=M, hgb_nadir=13.98, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.3, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=False, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.98, anaemic=False	true

Chronic kidney disease

Clinical judgement required

No gap

Not documented; egfr 60 or above; ckd g1-g2 requires markers of kidney damage, which are not assessed here.

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=368, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=81.9, egfr_late=85.2	85.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=81.9, t.g2=60, egfr_late=85.2	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=85.2, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=81.9, egfr_late=85.2, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=85.2, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “systolic heart failure” (I50.20); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=1607.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=True	3
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=30.0, t.ref=40, t.pres=50	systolic
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=30.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=3, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on chronic	true

Hyponatraemia

Criteria not met

Clinical validation gap

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 137).

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=137.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=137.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=137.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=137.0, t.low=135	true

Malnutrition

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=unknown, wt_loss_pct=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

Obesity

Criteria met

No gap

Supported as documented (E66.811).

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=80, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=32.6, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.6, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.6, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria met

Specificity gap

Documented “hypoxemia” (R09.02); criteria support the more specific Acute respiratory failure with hypoxia (J96.01).

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=83.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=83.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=34.0, t.rr_distress=28, wob_increased=True, adv_resp_support=False	true
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=True	true

Sepsis

Criteria met

No gap

Supported as documented (A41.9).

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=39.2, t.t_hi=38, temp_min_48h=38.5, t.t_lo=36	true
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=117.0, t.hr=90	true
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=34.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=17.78, t.wbc_hi=12, wbc_min_48h=15.17, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	true
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=True, sirs_hr=True, sirs_rr=True, sirs_wbc=True	4
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=87.0	2
derived: sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`	bili_max_48h=0.51	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=64.0	1
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=0.93	0
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.91	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=2, sofa_liver=0, sofa_cardio=1, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	3
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=3, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=4, t.sirs_min=2	true
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.0, lactate_max_48h=2.9, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=True, sepsis2=True	true

Structured data

Labs (35)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-000740	Fri Sep 19, 2025 09:15 AM	creatinine	0.94 mg/dL
LAB-000741	Tue Sep 22, 2026 10:05 AM	creatinine	0.91 mg/dL
LAB-000742	Sun Nov 01, 2026 03:27 PM	creatinine	0.9 mg/dL
LAB-000748	Sun Nov 01, 2026 03:27 PM	bnp	1607.0 pg/mL
LAB-000749	Sun Nov 01, 2026 03:27 PM	sodium	141.0 mmol/L
LAB-000755	Sun Nov 01, 2026 03:27 PM	hemoglobin	14.19 g/dL
LAB-000761	Sun Nov 01, 2026 03:27 PM	wbc	17.69 x10^3/uL
LAB-000762	Sun Nov 01, 2026 03:27 PM	platelets	95.0 x10^3/uL
LAB-000773	Sun Nov 01, 2026 03:27 PM	bilirubin	0.51 mg/dL
LAB-000774	Sun Nov 01, 2026 03:27 PM	lactate	2.9 mmol/L
LAB-000743	Mon Nov 02, 2026 05:00 AM	creatinine	0.91 mg/dL
LAB-000750	Mon Nov 02, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-000756	Mon Nov 02, 2026 05:00 AM	hemoglobin	14.01 g/dL
LAB-000763	Mon Nov 02, 2026 05:00 AM	wbc	17.78 x10^3/uL
LAB-000764	Mon Nov 02, 2026 05:00 AM	platelets	87.0 x10^3/uL
LAB-000744	Tue Nov 03, 2026 05:00 AM	creatinine	0.93 mg/dL
LAB-000751	Tue Nov 03, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-000757	Tue Nov 03, 2026 05:00 AM	hemoglobin	14.27 g/dL
LAB-000765	Tue Nov 03, 2026 05:00 AM	wbc	15.17 x10^3/uL
LAB-000766	Tue Nov 03, 2026 05:00 AM	platelets	87.0 x10^3/uL
LAB-000745	Wed Nov 04, 2026 05:00 AM	creatinine	0.95 mg/dL
LAB-000752	Wed Nov 04, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-000758	Wed Nov 04, 2026 05:00 AM	hemoglobin	14.28 g/dL
LAB-000767	Wed Nov 04, 2026 05:00 AM	wbc	9.24 x10^3/uL
LAB-000768	Wed Nov 04, 2026 05:00 AM	platelets	262.0 x10^3/uL
LAB-000746	Thu Nov 05, 2026 05:00 AM	creatinine	0.92 mg/dL
LAB-000753	Thu Nov 05, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-000759	Thu Nov 05, 2026 05:00 AM	hemoglobin	13.98 g/dL
LAB-000769	Thu Nov 05, 2026 05:00 AM	wbc	7.83 x10^3/uL
LAB-000770	Thu Nov 05, 2026 05:00 AM	platelets	207.0 x10^3/uL
LAB-000747	Fri Nov 06, 2026 05:00 AM	creatinine	0.93 mg/dL
LAB-000754	Fri Nov 06, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-000760	Fri Nov 06, 2026 05:00 AM	hemoglobin	14.45 g/dL
LAB-000771	Fri Nov 06, 2026 05:00 AM	wbc	5.73 x10^3/uL
LAB-000772	Fri Nov 06, 2026 05:00 AM	platelets	302.0 x10^3/uL

Vitals (105)

Vitals
Row	When	Kind	Value	Detail
VIT-002118	Sun Nov 01, 2026 02:47 PM	spo2	83.0	room air
VIT-002119	Sun Nov 01, 2026 02:47 PM	rr	34.0
VIT-002163	Sun Nov 01, 2026 02:47 PM	temp_c	38.9
VIT-002164	Sun Nov 01, 2026 02:47 PM	hr	111.0
VIT-002165	Sun Nov 01, 2026 02:47 PM	map	68.0
VIT-002166	Sun Nov 01, 2026 02:47 PM	gcs	15.0
VIT-002120	Sun Nov 01, 2026 02:57 PM	o2_lpm	5.0	nasal cannula
VIT-002121	Sun Nov 01, 2026 10:47 PM	spo2	95.0	nasal cannula
VIT-002122	Sun Nov 01, 2026 10:47 PM	rr	25.0
VIT-002123	Sun Nov 01, 2026 10:47 PM	o2_lpm	3.0	nasal cannula
VIT-002167	Sun Nov 01, 2026 10:47 PM	temp_c	38.6
VIT-002168	Sun Nov 01, 2026 10:47 PM	hr	112.0
VIT-002169	Sun Nov 01, 2026 10:47 PM	map	64.0
VIT-002170	Sun Nov 01, 2026 10:47 PM	gcs	15.0
VIT-002124	Mon Nov 02, 2026 06:47 AM	spo2	95.0	nasal cannula
VIT-002125	Mon Nov 02, 2026 06:47 AM	rr	22.0
VIT-002126	Mon Nov 02, 2026 06:47 AM	o2_lpm	4.0	nasal cannula
VIT-002171	Mon Nov 02, 2026 06:47 AM	temp_c	38.5
VIT-002172	Mon Nov 02, 2026 06:47 AM	hr	117.0
VIT-002173	Mon Nov 02, 2026 06:47 AM	map	67.0
VIT-002174	Mon Nov 02, 2026 06:47 AM	gcs	15.0
VIT-002127	Mon Nov 02, 2026 02:47 PM	spo2	91.0	nasal cannula
VIT-002128	Mon Nov 02, 2026 02:47 PM	rr	26.0
VIT-002129	Mon Nov 02, 2026 02:47 PM	o2_lpm	2.0	nasal cannula
VIT-002175	Mon Nov 02, 2026 02:47 PM	temp_c	39.2
VIT-002176	Mon Nov 02, 2026 02:47 PM	hr	104.0
VIT-002177	Mon Nov 02, 2026 02:47 PM	map	67.0
VIT-002178	Mon Nov 02, 2026 02:47 PM	gcs	15.0
VIT-002130	Mon Nov 02, 2026 10:47 PM	spo2	92.0	nasal cannula
VIT-002131	Mon Nov 02, 2026 10:47 PM	rr	20.0
VIT-002132	Mon Nov 02, 2026 10:47 PM	o2_lpm	2.0	nasal cannula
VIT-002179	Mon Nov 02, 2026 10:47 PM	temp_c	39.2
VIT-002180	Mon Nov 02, 2026 10:47 PM	hr	103.0
VIT-002181	Mon Nov 02, 2026 10:47 PM	map	64.0
VIT-002182	Mon Nov 02, 2026 10:47 PM	gcs	15.0
VIT-002133	Tue Nov 03, 2026 06:47 AM	spo2	91.0	nasal cannula
VIT-002134	Tue Nov 03, 2026 06:47 AM	rr	24.0
VIT-002135	Tue Nov 03, 2026 06:47 AM	o2_lpm	2.0	nasal cannula
VIT-002183	Tue Nov 03, 2026 06:47 AM	temp_c	38.8
VIT-002184	Tue Nov 03, 2026 06:47 AM	hr	103.0
VIT-002185	Tue Nov 03, 2026 06:47 AM	map	65.0
VIT-002186	Tue Nov 03, 2026 06:47 AM	gcs	15.0
VIT-002136	Tue Nov 03, 2026 02:47 PM	spo2	95.0	nasal cannula
VIT-002137	Tue Nov 03, 2026 02:47 PM	rr	26.0
VIT-002138	Tue Nov 03, 2026 02:47 PM	o2_lpm	3.0	nasal cannula
VIT-002187	Tue Nov 03, 2026 02:47 PM	temp_c	37.6
VIT-002188	Tue Nov 03, 2026 02:47 PM	hr	71.0
VIT-002189	Tue Nov 03, 2026 02:47 PM	map	82.0
VIT-002190	Tue Nov 03, 2026 02:47 PM	gcs	15.0
VIT-002139	Tue Nov 03, 2026 10:47 PM	spo2	94.0	nasal cannula
VIT-002140	Tue Nov 03, 2026 10:47 PM	rr	23.0
VIT-002141	Tue Nov 03, 2026 10:47 PM	o2_lpm	4.0	nasal cannula
VIT-002191	Tue Nov 03, 2026 10:47 PM	temp_c	37.3
VIT-002192	Tue Nov 03, 2026 10:47 PM	hr	91.0
VIT-002193	Tue Nov 03, 2026 10:47 PM	map	87.0
VIT-002194	Tue Nov 03, 2026 10:47 PM	gcs	15.0
VIT-002142	Wed Nov 04, 2026 06:47 AM	spo2	92.0	nasal cannula
VIT-002143	Wed Nov 04, 2026 06:47 AM	rr	26.0
VIT-002144	Wed Nov 04, 2026 06:47 AM	o2_lpm	3.0	nasal cannula
VIT-002195	Wed Nov 04, 2026 06:47 AM	temp_c	36.6
VIT-002196	Wed Nov 04, 2026 06:47 AM	hr	91.0
VIT-002197	Wed Nov 04, 2026 06:47 AM	map	87.0
VIT-002198	Wed Nov 04, 2026 06:47 AM	gcs	15.0
VIT-002145	Wed Nov 04, 2026 02:47 PM	spo2	91.0	nasal cannula
VIT-002146	Wed Nov 04, 2026 02:47 PM	rr	21.0
VIT-002147	Wed Nov 04, 2026 02:47 PM	o2_lpm	4.0	nasal cannula
VIT-002199	Wed Nov 04, 2026 02:47 PM	temp_c	37.4
VIT-002200	Wed Nov 04, 2026 02:47 PM	hr	91.0
VIT-002201	Wed Nov 04, 2026 02:47 PM	map	76.0
VIT-002202	Wed Nov 04, 2026 02:47 PM	gcs	15.0
VIT-002148	Wed Nov 04, 2026 10:47 PM	spo2	94.0	nasal cannula
VIT-002149	Wed Nov 04, 2026 10:47 PM	rr	26.0
VIT-002150	Wed Nov 04, 2026 10:47 PM	o2_lpm	3.0	nasal cannula
VIT-002203	Wed Nov 04, 2026 10:47 PM	temp_c	36.9
VIT-002204	Wed Nov 04, 2026 10:47 PM	hr	77.0
VIT-002205	Wed Nov 04, 2026 10:47 PM	map	77.0
VIT-002206	Wed Nov 04, 2026 10:47 PM	gcs	15.0
VIT-002151	Thu Nov 05, 2026 06:47 AM	spo2	94.0	nasal cannula
VIT-002152	Thu Nov 05, 2026 06:47 AM	rr	25.0
VIT-002153	Thu Nov 05, 2026 06:47 AM	o2_lpm	2.0	nasal cannula
VIT-002207	Thu Nov 05, 2026 06:47 AM	temp_c	36.8
VIT-002208	Thu Nov 05, 2026 06:47 AM	hr	92.0
VIT-002209	Thu Nov 05, 2026 06:47 AM	map	84.0
VIT-002210	Thu Nov 05, 2026 06:47 AM	gcs	15.0
VIT-002154	Thu Nov 05, 2026 02:47 PM	spo2	91.0	nasal cannula
VIT-002155	Thu Nov 05, 2026 02:47 PM	rr	23.0
VIT-002156	Thu Nov 05, 2026 02:47 PM	o2_lpm	2.0	nasal cannula
VIT-002211	Thu Nov 05, 2026 02:47 PM	temp_c	37.0
VIT-002212	Thu Nov 05, 2026 02:47 PM	hr	77.0
VIT-002213	Thu Nov 05, 2026 02:47 PM	map	81.0
VIT-002214	Thu Nov 05, 2026 02:47 PM	gcs	15.0
VIT-002157	Thu Nov 05, 2026 10:47 PM	spo2	95.0	nasal cannula
VIT-002158	Thu Nov 05, 2026 10:47 PM	rr	24.0
VIT-002159	Thu Nov 05, 2026 10:47 PM	o2_lpm	3.0	nasal cannula
VIT-002215	Thu Nov 05, 2026 10:47 PM	temp_c	36.7
VIT-002216	Thu Nov 05, 2026 10:47 PM	hr	77.0
VIT-002217	Thu Nov 05, 2026 10:47 PM	map	79.0
VIT-002218	Thu Nov 05, 2026 10:47 PM	gcs	15.0
VIT-002160	Fri Nov 06, 2026 06:47 AM	spo2	93.0	nasal cannula
VIT-002161	Fri Nov 06, 2026 06:47 AM	rr	24.0
VIT-002162	Fri Nov 06, 2026 06:47 AM	o2_lpm	3.0	nasal cannula
VIT-002219	Fri Nov 06, 2026 06:47 AM	temp_c	37.1
VIT-002220	Fri Nov 06, 2026 06:47 AM	hr	83.0
VIT-002221	Fri Nov 06, 2026 06:47 AM	map	86.0
VIT-002222	Fri Nov 06, 2026 06:47 AM	gcs	15.0

Medications, orders, echo, history (12)

MED-000078 11-01 15:27 ceftriaxone per protocol IV
MED-000079 11-02 05:00 cefepime per protocol IV
MED-000080 11-03 05:00 ceftriaxone per protocol IV
MED-000081 11-01 08:00 furosemide 40 mg IV
MED-000082 11-01 20:00 furosemide 40 mg IV
MED-000083 11-02 08:00 furosemide 40 mg IV
MED-000084 11-02 20:00 furosemide 40 mg IV
MED-000085 11-03 08:00 furosemide 40 mg IV
MED-000086 11-03 20:00 furosemide 40 mg IV
ORD-000018 11-01 14:57 blood_culture: blood cultures x2
ECH-000009 2026-11-02 echo LVEF 30.0%
HX-000006 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000072 · Dr. Keira Upfield (resident) · Sun Nov 01, 2026 05:27 PM

Cited facts from this note (2)

infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… rvice: Hospital Medicine Attending: Dr. Isaac Abernath History of present illness: 80-year-old man admitted with sepsis. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Past medical history: heart failure with reduced ejection fraction, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… infection with cefepime. Past medical history: heart failure with reduced ejection fraction, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Sepsis: antibiotics, fluids. 2. Urinary tract infection: antibiotics.

Source document DOC-000072: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Pilar Ravensworth   MRN: MRN61270312   Admitted: 2026-11-01 14:27
Service: Hospital Medicine   Attending: Dr. Isaac Abernath

History of present illness: 80-year-old man admitted with sepsis. Urinalysis with pyuria; treated for urinary tract infection with cefepime.
Past medical history: heart failure with reduced ejection fraction, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Sepsis: antibiotics, fluids.
2. Urinary tract infection: antibiotics.

Progress note · DOC-000073 · Dr. Keira Upfield (resident) · Tue Nov 03, 2026 03:27 PM

Source document DOC-000073: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Pilar Ravensworth   MRN: MRN61270312   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.
2. Class 1 obesity: counsel on weight.
3. Systolic heart failure: diuresis and daily weights; monitor electrolytes.
4. Hypoxemia: supplemental oxygen, wean as tolerated.
5. Hyponatremia: trend sodium.

Resident: Dr. Keira Upfield   Attending cosign: completed

Discharge summary · DOC-000074 · Dr. Isaac Abernath (attending) · Fri Nov 06, 2026 10:31 AM

Source document DOC-000074: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Pilar Ravensworth   MRN: MRN61270312
Admitted 2026-11-01; discharged 2026-11-06.

Discharge diagnoses:
- sepsis
- urinary tract infection
- class 1 obesity
- systolic heart failure
- hypoxemia
- hyponatremia
- hyperlipidemia

Disposition: home with follow-up.