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-00055: Pilar Upfield

73F · MRN23245859 · Hospital Medicine · admitted Wed Nov 11, 2026 08:30 AM · in hospital · attending Dr. Odette Galloway · resident Dr. Greta Kowalczyk · 166 cm, 74.1 kg

Documented diagnoses (current)

Principal: “upper GI bleed” · K92.2 Gastrointestinal hemorrhage, unspecified
“AKI” · N17.9 Acute kidney failure, unspecified
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 377 GI hemorrhage with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 377.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

Clinical validation gap

Documented “AKI” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.

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=1.029, t.ratio_s1=1.5, creat_rise_48h=0.03, 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=1.029, t.ratio_s3=3.0, creat_peak=0.72, 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=1.029, 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=0.03, 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

Clinical judgement required

Clinical judgement required: Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL).

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=F, hgb_nadir=9.42, t.hb_m=13, t.hb_f=12	true
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=1.4, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=1.4, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=9.42, anaemic=True	false
outcome: no_source	`anaemic and acute_fall`	anaemic=True, acute_fall=False	false
outcome: borderline	`anaemic`	anaemic=True	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=244, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=91.3, egfr_late=91.3	91.3
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=91.3, t.g2=60, egfr_late=91.3	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=91.3, 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=91.3, egfr_late=91.3, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=91.3, t.g2=60	true

Heart failure

Clinical judgement required

No gap

Not documented; only one acute indicator; acuity needs clinical judgement.

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=unknown, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=True	1
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=unknown, t.ref=40, t.pres=50	unknown
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=unknown, 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=1, hf_history=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=1	true

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

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=136.0, 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=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, 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 not met

No gap

Not documented and not supported.

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=73, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=26.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=26.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=26.9, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=26.9, 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

No gap

Supported as documented (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=82.0, 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=82.0, 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=33.0, 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 not met

No gap

Not documented and not supported.

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=37.6, t.t_hi=38, temp_min_48h=36.7, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=89.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=33.0, 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=7.54, t.wbc_hi=12, wbc_min_48h=5.61, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=True, sirs_wbc=False	1
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=206.0	0
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=0.49	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=75.0	0
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=0.72	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=0.7	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (18)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001853	Thu Dec 04, 2025 09:15 AM	creatinine	0.7 mg/dL
LAB-001854	Thu Aug 06, 2026 10:05 AM	creatinine	0.7 mg/dL
LAB-001855	Wed Nov 11, 2026 09:30 AM	creatinine	0.72 mg/dL
LAB-001858	Wed Nov 11, 2026 09:30 AM	sodium	136.0 mmol/L
LAB-001861	Wed Nov 11, 2026 09:30 AM	hemoglobin	10.82 g/dL
LAB-001864	Wed Nov 11, 2026 09:30 AM	wbc	6.05 x10^3/uL
LAB-001865	Wed Nov 11, 2026 09:30 AM	platelets	206.0 x10^3/uL
LAB-001870	Wed Nov 11, 2026 09:30 AM	bilirubin	0.49 mg/dL
LAB-001856	Thu Nov 12, 2026 05:00 AM	creatinine	0.69 mg/dL
LAB-001859	Thu Nov 12, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001862	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.02 g/dL
LAB-001866	Thu Nov 12, 2026 05:00 AM	wbc	5.61 x10^3/uL
LAB-001867	Thu Nov 12, 2026 05:00 AM	platelets	275.0 x10^3/uL
LAB-001857	Fri Nov 13, 2026 05:00 AM	creatinine	0.72 mg/dL
LAB-001860	Fri Nov 13, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001863	Fri Nov 13, 2026 05:00 AM	hemoglobin	9.42 g/dL
LAB-001868	Fri Nov 13, 2026 05:00 AM	wbc	7.54 x10^3/uL
LAB-001869	Fri Nov 13, 2026 05:00 AM	platelets	218.0 x10^3/uL

Vitals (56)

Vitals
Row	When	Kind	Value	Detail
VIT-005311	Wed Nov 11, 2026 08:50 AM	spo2	82.0	room air
VIT-005312	Wed Nov 11, 2026 08:50 AM	rr	33.0
VIT-005335	Wed Nov 11, 2026 08:50 AM	temp_c	37.2
VIT-005336	Wed Nov 11, 2026 08:50 AM	hr	68.0
VIT-005337	Wed Nov 11, 2026 08:50 AM	map	75.0
VIT-005338	Wed Nov 11, 2026 08:50 AM	gcs	15.0
VIT-005313	Wed Nov 11, 2026 09:00 AM	o2_lpm	4.0	nasal cannula
VIT-005314	Wed Nov 11, 2026 04:50 PM	spo2	93.0	nasal cannula
VIT-005315	Wed Nov 11, 2026 04:50 PM	rr	20.0
VIT-005316	Wed Nov 11, 2026 04:50 PM	o2_lpm	4.0	nasal cannula
VIT-005339	Wed Nov 11, 2026 04:50 PM	temp_c	36.7
VIT-005340	Wed Nov 11, 2026 04:50 PM	hr	84.0
VIT-005341	Wed Nov 11, 2026 04:50 PM	map	90.0
VIT-005342	Wed Nov 11, 2026 04:50 PM	gcs	15.0
VIT-005317	Thu Nov 12, 2026 12:50 AM	spo2	94.0	nasal cannula
VIT-005318	Thu Nov 12, 2026 12:50 AM	rr	21.0
VIT-005319	Thu Nov 12, 2026 12:50 AM	o2_lpm	2.0	nasal cannula
VIT-005343	Thu Nov 12, 2026 12:50 AM	temp_c	37.1
VIT-005344	Thu Nov 12, 2026 12:50 AM	hr	78.0
VIT-005345	Thu Nov 12, 2026 12:50 AM	map	85.0
VIT-005346	Thu Nov 12, 2026 12:50 AM	gcs	15.0
VIT-005320	Thu Nov 12, 2026 08:50 AM	spo2	92.0	nasal cannula
VIT-005321	Thu Nov 12, 2026 08:50 AM	rr	23.0
VIT-005322	Thu Nov 12, 2026 08:50 AM	o2_lpm	3.0	nasal cannula
VIT-005347	Thu Nov 12, 2026 08:50 AM	temp_c	37.3
VIT-005348	Thu Nov 12, 2026 08:50 AM	hr	81.0
VIT-005349	Thu Nov 12, 2026 08:50 AM	map	77.0
VIT-005350	Thu Nov 12, 2026 08:50 AM	gcs	15.0
VIT-005323	Thu Nov 12, 2026 04:50 PM	spo2	95.0	nasal cannula
VIT-005324	Thu Nov 12, 2026 04:50 PM	rr	26.0
VIT-005325	Thu Nov 12, 2026 04:50 PM	o2_lpm	3.0	nasal cannula
VIT-005351	Thu Nov 12, 2026 04:50 PM	temp_c	37.6
VIT-005352	Thu Nov 12, 2026 04:50 PM	hr	89.0
VIT-005353	Thu Nov 12, 2026 04:50 PM	map	85.0
VIT-005354	Thu Nov 12, 2026 04:50 PM	gcs	15.0
VIT-005326	Fri Nov 13, 2026 12:50 AM	spo2	93.0	nasal cannula
VIT-005327	Fri Nov 13, 2026 12:50 AM	rr	24.0
VIT-005328	Fri Nov 13, 2026 12:50 AM	o2_lpm	4.0	nasal cannula
VIT-005355	Fri Nov 13, 2026 12:50 AM	temp_c	37.2
VIT-005356	Fri Nov 13, 2026 12:50 AM	hr	70.0
VIT-005357	Fri Nov 13, 2026 12:50 AM	map	91.0
VIT-005358	Fri Nov 13, 2026 12:50 AM	gcs	15.0
VIT-005329	Fri Nov 13, 2026 08:50 AM	spo2	93.0	nasal cannula
VIT-005330	Fri Nov 13, 2026 08:50 AM	rr	21.0
VIT-005331	Fri Nov 13, 2026 08:50 AM	o2_lpm	2.0	nasal cannula
VIT-005359	Fri Nov 13, 2026 08:50 AM	temp_c	37.0
VIT-005360	Fri Nov 13, 2026 08:50 AM	hr	86.0
VIT-005361	Fri Nov 13, 2026 08:50 AM	map	75.0
VIT-005362	Fri Nov 13, 2026 08:50 AM	gcs	15.0
VIT-005332	Fri Nov 13, 2026 04:50 PM	spo2	94.0	nasal cannula
VIT-005333	Fri Nov 13, 2026 04:50 PM	rr	20.0
VIT-005334	Fri Nov 13, 2026 04:50 PM	o2_lpm	2.0	nasal cannula
VIT-005363	Fri Nov 13, 2026 04:50 PM	temp_c	37.3
VIT-005364	Fri Nov 13, 2026 04:50 PM	hr	80.0
VIT-005365	Fri Nov 13, 2026 04:50 PM	map	75.0
VIT-005366	Fri Nov 13, 2026 04:50 PM	gcs	15.0

Medications, orders, echo, history (0)

Notes

History and physical · DOC-000191 · Dr. Greta Kowalczyk (resident) · Wed Nov 11, 2026 11:30 AM

Cited facts from this note (2)

bleeding_source: coffee-ground emesis · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… ce: Hospital Medicine Attending: Dr. Odette Galloway History of present illness: 73-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy. Past medical history: hypertension, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… ays of coffee-ground emesis; GI consulted for endoscopy. Past medical history: hypertension, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Upper GI bleed: PPI, GI following.

Source document DOC-000191: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Pilar Upfield   MRN: MRN23245859   Admitted: 2026-11-11 08:30
Service: Hospital Medicine   Attending: Dr. Odette Galloway

History of present illness: 73-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy.
Past medical history: hypertension, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Upper GI bleed: PPI, GI following.

Progress note · DOC-000192 · Dr. Greta Kowalczyk (resident) · Fri Nov 13, 2026 11:55 AM · awaiting cosign

Source document DOC-000192: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Pilar Upfield   MRN: MRN23245859   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Upper GI bleed: continue current management.
2. AKI: trend creatinine, hold nephrotoxins, strict intake and output.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Greta Kowalczyk   Attending cosign: pending