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-00095: Viggo Pemberton

60M · MRN40088787 · Cardiology · admitted Tue Nov 10, 2026 05:58 PM · in hospital · attending Dr. Cyrus Ellingham · resident Dr. Elena Nakashima · 160 cm, 105.8 kg

Documented diagnoses (current)

“class 3 obesity” · E66.813 Obesity, class 3
Principal: “acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“hypoxemia” · R09.02 Hypoxemia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 292 Heart failure and shock with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Criteria support Acute kidney injury (KDIGO stage 3) (N17.9); no corresponding diagnosis is documented.

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=3.589, t.ratio_s1=1.5, creat_rise_48h=0.98, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
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=True, creat_ratio=3.589, t.ratio_s3=3.0, creat_peak=4.45, 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	true
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=3.589, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=True, stage2=True, meets_definition=True	3
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.98, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=3, baseline_independent=True	true

Acute blood loss anaemia

Criteria met

No gap

Supported as documented (D62).

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=9.91, 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=3.2, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=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=290, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=69.9, egfr_late=66.6	69.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=69.9, t.g2=60, egfr_late=66.6	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=69.9, 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=69.9, egfr_late=66.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=69.9, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (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=1141.0, 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=23.0, 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=23.0, 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

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=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 (E66.813).

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=60, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=41.3, t.c3=40	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

Clinical judgement required

Clinical judgement required: Hypoxaemia without a charted sign of respiratory distress.

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=87.0, 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=87.0, 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=23.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=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=37.4, t.t_hi=38, temp_min_48h=36.8, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=90.0, 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=23.0, 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=10.83, t.wbc_hi=12, wbc_min_48h=6.37, 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=172.0	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=0.92	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=74.0	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=4.45	3
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=1.24	1
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=3, sofa_renal_baseline=1	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=2, 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 (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003227	Fri Nov 14, 2025 09:15 AM	creatinine	1.19 mg/dL
LAB-003228	Tue Sep 01, 2026 10:05 AM	creatinine	1.24 mg/dL
LAB-003229	Tue Nov 10, 2026 06:58 PM	creatinine	3.47 mg/dL
LAB-003233	Tue Nov 10, 2026 06:58 PM	bnp	1141.0 pg/mL
LAB-003234	Tue Nov 10, 2026 06:58 PM	sodium	137.0 mmol/L
LAB-003238	Tue Nov 10, 2026 06:58 PM	hemoglobin	13.16 g/dL
LAB-003242	Tue Nov 10, 2026 06:58 PM	wbc	10.43 x10^3/uL
LAB-003243	Tue Nov 10, 2026 06:58 PM	platelets	172.0 x10^3/uL
LAB-003250	Tue Nov 10, 2026 06:58 PM	bilirubin	0.92 mg/dL
LAB-003230	Wed Nov 11, 2026 05:00 AM	creatinine	4.45 mg/dL
LAB-003235	Wed Nov 11, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-003239	Wed Nov 11, 2026 05:00 AM	hemoglobin	11.21 g/dL
LAB-003244	Wed Nov 11, 2026 05:00 AM	wbc	10.83 x10^3/uL
LAB-003245	Wed Nov 11, 2026 05:00 AM	platelets	291.0 x10^3/uL
LAB-003231	Thu Nov 12, 2026 05:00 AM	creatinine	4.01 mg/dL
LAB-003236	Thu Nov 12, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-003240	Thu Nov 12, 2026 05:00 AM	hemoglobin	9.91 g/dL
LAB-003246	Thu Nov 12, 2026 05:00 AM	wbc	6.37 x10^3/uL
LAB-003247	Thu Nov 12, 2026 05:00 AM	platelets	203.0 x10^3/uL
LAB-003232	Fri Nov 13, 2026 05:00 AM	creatinine	3.34 mg/dL
LAB-003237	Fri Nov 13, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003241	Fri Nov 13, 2026 05:00 AM	hemoglobin	10.71 g/dL
LAB-003248	Fri Nov 13, 2026 05:00 AM	wbc	7.82 x10^3/uL
LAB-003249	Fri Nov 13, 2026 05:00 AM	platelets	277.0 x10^3/uL

Vitals (62)

Vitals
Row	When	Kind	Value	Detail
VIT-009293	Tue Nov 10, 2026 06:18 PM	spo2	87.0	room air
VIT-009294	Tue Nov 10, 2026 06:18 PM	rr	23.0
VIT-009319	Tue Nov 10, 2026 06:18 PM	temp_c	37.1
VIT-009320	Tue Nov 10, 2026 06:18 PM	hr	89.0
VIT-009321	Tue Nov 10, 2026 06:18 PM	map	75.0
VIT-009322	Tue Nov 10, 2026 06:18 PM	gcs	15.0
VIT-009295	Wed Nov 11, 2026 02:18 AM	spo2	94.0	nasal cannula
VIT-009296	Wed Nov 11, 2026 02:18 AM	rr	18.0
VIT-009297	Wed Nov 11, 2026 02:18 AM	o2_lpm	2.0	nasal cannula
VIT-009323	Wed Nov 11, 2026 02:18 AM	temp_c	37.1
VIT-009324	Wed Nov 11, 2026 02:18 AM	hr	79.0
VIT-009325	Wed Nov 11, 2026 02:18 AM	map	82.0
VIT-009326	Wed Nov 11, 2026 02:18 AM	gcs	15.0
VIT-009298	Wed Nov 11, 2026 10:18 AM	spo2	96.0	nasal cannula
VIT-009299	Wed Nov 11, 2026 10:18 AM	rr	20.0
VIT-009300	Wed Nov 11, 2026 10:18 AM	o2_lpm	2.0	nasal cannula
VIT-009327	Wed Nov 11, 2026 10:18 AM	temp_c	37.3
VIT-009328	Wed Nov 11, 2026 10:18 AM	hr	70.0
VIT-009329	Wed Nov 11, 2026 10:18 AM	map	78.0
VIT-009330	Wed Nov 11, 2026 10:18 AM	gcs	15.0
VIT-009301	Wed Nov 11, 2026 06:18 PM	spo2	95.0	nasal cannula
VIT-009302	Wed Nov 11, 2026 06:18 PM	rr	23.0
VIT-009303	Wed Nov 11, 2026 06:18 PM	o2_lpm	2.0	nasal cannula
VIT-009331	Wed Nov 11, 2026 06:18 PM	temp_c	37.4
VIT-009332	Wed Nov 11, 2026 06:18 PM	hr	90.0
VIT-009333	Wed Nov 11, 2026 06:18 PM	map	74.0
VIT-009334	Wed Nov 11, 2026 06:18 PM	gcs	15.0
VIT-009304	Thu Nov 12, 2026 02:18 AM	spo2	94.0	nasal cannula
VIT-009305	Thu Nov 12, 2026 02:18 AM	rr	19.0
VIT-009306	Thu Nov 12, 2026 02:18 AM	o2_lpm	2.0	nasal cannula
VIT-009335	Thu Nov 12, 2026 02:18 AM	temp_c	36.8
VIT-009336	Thu Nov 12, 2026 02:18 AM	hr	75.0
VIT-009337	Thu Nov 12, 2026 02:18 AM	map	77.0
VIT-009338	Thu Nov 12, 2026 02:18 AM	gcs	15.0
VIT-009307	Thu Nov 12, 2026 10:18 AM	spo2	94.0	nasal cannula
VIT-009308	Thu Nov 12, 2026 10:18 AM	rr	23.0
VIT-009309	Thu Nov 12, 2026 10:18 AM	o2_lpm	2.0	nasal cannula
VIT-009339	Thu Nov 12, 2026 10:18 AM	temp_c	37.4
VIT-009340	Thu Nov 12, 2026 10:18 AM	hr	75.0
VIT-009341	Thu Nov 12, 2026 10:18 AM	map	80.0
VIT-009342	Thu Nov 12, 2026 10:18 AM	gcs	15.0
VIT-009310	Thu Nov 12, 2026 06:18 PM	spo2	96.0	nasal cannula
VIT-009311	Thu Nov 12, 2026 06:18 PM	rr	18.0
VIT-009312	Thu Nov 12, 2026 06:18 PM	o2_lpm	2.0	nasal cannula
VIT-009343	Thu Nov 12, 2026 06:18 PM	temp_c	37.4
VIT-009344	Thu Nov 12, 2026 06:18 PM	hr	85.0
VIT-009345	Thu Nov 12, 2026 06:18 PM	map	91.0
VIT-009346	Thu Nov 12, 2026 06:18 PM	gcs	15.0
VIT-009313	Fri Nov 13, 2026 02:18 AM	spo2	92.0	nasal cannula
VIT-009314	Fri Nov 13, 2026 02:18 AM	rr	21.0
VIT-009315	Fri Nov 13, 2026 02:18 AM	o2_lpm	2.0	nasal cannula
VIT-009347	Fri Nov 13, 2026 02:18 AM	temp_c	37.4
VIT-009348	Fri Nov 13, 2026 02:18 AM	hr	84.0
VIT-009349	Fri Nov 13, 2026 02:18 AM	map	83.0
VIT-009350	Fri Nov 13, 2026 02:18 AM	gcs	15.0
VIT-009316	Fri Nov 13, 2026 10:18 AM	spo2	92.0	nasal cannula
VIT-009317	Fri Nov 13, 2026 10:18 AM	rr	19.0
VIT-009318	Fri Nov 13, 2026 10:18 AM	o2_lpm	2.0	nasal cannula
VIT-009351	Fri Nov 13, 2026 10:18 AM	temp_c	37.0
VIT-009352	Fri Nov 13, 2026 10:18 AM	hr	72.0
VIT-009353	Fri Nov 13, 2026 10:18 AM	map	87.0
VIT-009354	Fri Nov 13, 2026 10:18 AM	gcs	15.0

Medications, orders, echo, history (9)

MED-000373 11-10 08:00 furosemide 40 mg IV
MED-000374 11-10 20:00 furosemide 40 mg IV
MED-000375 11-11 08:00 furosemide 40 mg IV
MED-000376 11-11 20:00 furosemide 40 mg IV
MED-000377 11-12 08:00 furosemide 40 mg IV
MED-000378 11-12 20:00 furosemide 40 mg IV
ORD-000084 11-11 09:00 transfusion_prbc: transfuse PRBC
ECH-000045 2026-11-11 echo LVEF 23.0%
HX-000035 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000322 · Dr. Elena Nakashima (resident) · Tue Nov 10, 2026 08:58 PM

Cited facts from this note (1)

bleeding_source: bleeding from the surgical drain · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… tending: Dr. Cyrus Ellingham History of present illness: 60-year-old man admitted with acute on chronic systolic heart failure. Hospital course complicated by bleeding from the surgical drain. Past medical history: heart failure with reduced ejection fraction, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: scattered crackles at t …

Source document DOC-000322: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Viggo Pemberton   MRN: MRN40088787   Admitted: 2026-11-10 17:58
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 60-year-old man admitted with acute on chronic systolic heart failure. Hospital course complicated by bleeding from the surgical drain.
Past medical history: heart failure with reduced ejection fraction, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Progress note · DOC-000323 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 12:55 PM · awaiting cosign

Source document DOC-000323: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Viggo Pemberton   MRN: MRN40088787   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute on chronic systolic heart failure: continue current management.
2. Class 3 obesity: counsel on weight.
3. Hypoxemia: supplemental oxygen, wean as tolerated.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Elena Nakashima   Attending cosign: pending