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-00128: Esme Northam

68F · MRN17549030 · Hospital Medicine · admitted Sat Nov 07, 2026 04:54 PM · in hospital · attending Dr. Wes Merriweather · 154 cm, 67.8 kg

Documented diagnoses (current)

Principal: “upper GI bleed” · K92.2 Gastrointestinal hemorrhage, unspecified
“acute kidney injury” · N17.9 Acute kidney failure, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 378 GI hemorrhage with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 378.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

Clinical validation gap

Documented “acute kidney injury” (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=1.041, 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=1.041, t.ratio_s3=3.0, creat_peak=0.77, 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=1.041, 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 met

Specificity gap

Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.

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=9.93, 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=2.8, 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=246, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=91.0, egfr_late=88.1	91.0
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=91.0, t.g2=60, egfr_late=88.1	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=91.0, 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=91.0, egfr_late=88.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=91.0, t.g2=60	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=False	0
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=0, 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=0	false

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=68, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=28.6, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=28.6, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=28.6, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=28.6, 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 not met

No gap

Not documented and not supported.

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=94.0, 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=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	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=37.5, t.t_hi=38, temp_min_48h=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=85.0, 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=19.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
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=10.92, t.wbc_hi=12, wbc_min_48h=7.7, 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=False, sirs_wbc=False	0
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=230.0	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=0.63	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=76.0	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=0.77	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=0.74	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=0, 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 (38)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004344	Wed Nov 19, 2025 09:15 AM	creatinine	0.72 mg/dL
LAB-004345	Fri Jul 24, 2026 10:05 AM	creatinine	0.74 mg/dL
LAB-004346	Sat Nov 07, 2026 05:54 PM	creatinine	0.77 mg/dL
LAB-004353	Sat Nov 07, 2026 05:54 PM	sodium	137.0 mmol/L
LAB-004360	Sat Nov 07, 2026 05:54 PM	hemoglobin	12.71 g/dL
LAB-004367	Sat Nov 07, 2026 05:54 PM	wbc	10.47 x10^3/uL
LAB-004368	Sat Nov 07, 2026 05:54 PM	platelets	275.0 x10^3/uL
LAB-004381	Sat Nov 07, 2026 05:54 PM	bilirubin	0.63 mg/dL
LAB-004347	Sun Nov 08, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-004354	Sun Nov 08, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004361	Sun Nov 08, 2026 05:00 AM	hemoglobin	11.04 g/dL
LAB-004369	Sun Nov 08, 2026 05:00 AM	wbc	10.92 x10^3/uL
LAB-004370	Sun Nov 08, 2026 05:00 AM	platelets	270.0 x10^3/uL
LAB-004348	Mon Nov 09, 2026 05:00 AM	creatinine	0.73 mg/dL
LAB-004355	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-004362	Mon Nov 09, 2026 05:00 AM	hemoglobin	9.93 g/dL
LAB-004371	Mon Nov 09, 2026 05:00 AM	wbc	7.7 x10^3/uL
LAB-004372	Mon Nov 09, 2026 05:00 AM	platelets	230.0 x10^3/uL
LAB-004349	Tue Nov 10, 2026 05:00 AM	creatinine	0.77 mg/dL
LAB-004356	Tue Nov 10, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004363	Tue Nov 10, 2026 05:00 AM	hemoglobin	10.73 g/dL
LAB-004373	Tue Nov 10, 2026 05:00 AM	wbc	10.79 x10^3/uL
LAB-004374	Tue Nov 10, 2026 05:00 AM	platelets	180.0 x10^3/uL
LAB-004350	Wed Nov 11, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-004357	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004364	Wed Nov 11, 2026 05:00 AM	hemoglobin	11.03 g/dL
LAB-004375	Wed Nov 11, 2026 05:00 AM	wbc	5.72 x10^3/uL
LAB-004376	Wed Nov 11, 2026 05:00 AM	platelets	206.0 x10^3/uL
LAB-004351	Thu Nov 12, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-004358	Thu Nov 12, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004365	Thu Nov 12, 2026 05:00 AM	hemoglobin	11.13 g/dL
LAB-004377	Thu Nov 12, 2026 05:00 AM	wbc	8.78 x10^3/uL
LAB-004378	Thu Nov 12, 2026 05:00 AM	platelets	221.0 x10^3/uL
LAB-004352	Fri Nov 13, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-004359	Fri Nov 13, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-004366	Fri Nov 13, 2026 05:00 AM	hemoglobin	11.13 g/dL
LAB-004379	Fri Nov 13, 2026 05:00 AM	wbc	9.97 x10^3/uL
LAB-004380	Fri Nov 13, 2026 05:00 AM	platelets	200.0 x10^3/uL

Vitals (108)

Vitals
Row	When	Kind	Value	Detail
VIT-012479	Sat Nov 07, 2026 05:14 PM	spo2	99.0	room air
VIT-012480	Sat Nov 07, 2026 05:14 PM	rr	16.0
VIT-012515	Sat Nov 07, 2026 05:14 PM	temp_c	37.4
VIT-012516	Sat Nov 07, 2026 05:14 PM	hr	81.0
VIT-012517	Sat Nov 07, 2026 05:14 PM	map	87.0
VIT-012518	Sat Nov 07, 2026 05:14 PM	gcs	15.0
VIT-012481	Sun Nov 08, 2026 01:14 AM	spo2	95.0	room air
VIT-012482	Sun Nov 08, 2026 01:14 AM	rr	19.0
VIT-012519	Sun Nov 08, 2026 01:14 AM	temp_c	36.6
VIT-012520	Sun Nov 08, 2026 01:14 AM	hr	74.0
VIT-012521	Sun Nov 08, 2026 01:14 AM	map	76.0
VIT-012522	Sun Nov 08, 2026 01:14 AM	gcs	15.0
VIT-012483	Sun Nov 08, 2026 09:14 AM	spo2	96.0	room air
VIT-012484	Sun Nov 08, 2026 09:14 AM	rr	15.0
VIT-012523	Sun Nov 08, 2026 09:14 AM	temp_c	37.4
VIT-012524	Sun Nov 08, 2026 09:14 AM	hr	82.0
VIT-012525	Sun Nov 08, 2026 09:14 AM	map	79.0
VIT-012526	Sun Nov 08, 2026 09:14 AM	gcs	15.0
VIT-012485	Sun Nov 08, 2026 05:14 PM	spo2	94.0	room air
VIT-012486	Sun Nov 08, 2026 05:14 PM	rr	18.0
VIT-012527	Sun Nov 08, 2026 05:14 PM	temp_c	36.8
VIT-012528	Sun Nov 08, 2026 05:14 PM	hr	85.0
VIT-012529	Sun Nov 08, 2026 05:14 PM	map	91.0
VIT-012530	Sun Nov 08, 2026 05:14 PM	gcs	15.0
VIT-012487	Mon Nov 09, 2026 01:14 AM	spo2	96.0	room air
VIT-012488	Mon Nov 09, 2026 01:14 AM	rr	17.0
VIT-012531	Mon Nov 09, 2026 01:14 AM	temp_c	37.5
VIT-012532	Mon Nov 09, 2026 01:14 AM	hr	68.0
VIT-012533	Mon Nov 09, 2026 01:14 AM	map	89.0
VIT-012534	Mon Nov 09, 2026 01:14 AM	gcs	15.0
VIT-012489	Mon Nov 09, 2026 09:14 AM	spo2	96.0	room air
VIT-012490	Mon Nov 09, 2026 09:14 AM	rr	19.0
VIT-012535	Mon Nov 09, 2026 09:14 AM	temp_c	37.2
VIT-012536	Mon Nov 09, 2026 09:14 AM	hr	82.0
VIT-012537	Mon Nov 09, 2026 09:14 AM	map	89.0
VIT-012538	Mon Nov 09, 2026 09:14 AM	gcs	15.0
VIT-012491	Mon Nov 09, 2026 05:14 PM	spo2	98.0	room air
VIT-012492	Mon Nov 09, 2026 05:14 PM	rr	20.0
VIT-012539	Mon Nov 09, 2026 05:14 PM	temp_c	36.5
VIT-012540	Mon Nov 09, 2026 05:14 PM	hr	78.0
VIT-012541	Mon Nov 09, 2026 05:14 PM	map	76.0
VIT-012542	Mon Nov 09, 2026 05:14 PM	gcs	15.0
VIT-012493	Tue Nov 10, 2026 01:14 AM	spo2	96.0	room air
VIT-012494	Tue Nov 10, 2026 01:14 AM	rr	18.0
VIT-012543	Tue Nov 10, 2026 01:14 AM	temp_c	37.1
VIT-012544	Tue Nov 10, 2026 01:14 AM	hr	74.0
VIT-012545	Tue Nov 10, 2026 01:14 AM	map	87.0
VIT-012546	Tue Nov 10, 2026 01:14 AM	gcs	15.0
VIT-012495	Tue Nov 10, 2026 09:14 AM	spo2	98.0	room air
VIT-012496	Tue Nov 10, 2026 09:14 AM	rr	19.0
VIT-012547	Tue Nov 10, 2026 09:14 AM	temp_c	36.6
VIT-012548	Tue Nov 10, 2026 09:14 AM	hr	88.0
VIT-012549	Tue Nov 10, 2026 09:14 AM	map	85.0
VIT-012550	Tue Nov 10, 2026 09:14 AM	gcs	15.0
VIT-012497	Tue Nov 10, 2026 05:14 PM	spo2	95.0	room air
VIT-012498	Tue Nov 10, 2026 05:14 PM	rr	17.0
VIT-012551	Tue Nov 10, 2026 05:14 PM	temp_c	37.4
VIT-012552	Tue Nov 10, 2026 05:14 PM	hr	70.0
VIT-012553	Tue Nov 10, 2026 05:14 PM	map	88.0
VIT-012554	Tue Nov 10, 2026 05:14 PM	gcs	15.0
VIT-012499	Wed Nov 11, 2026 01:14 AM	spo2	99.0	room air
VIT-012500	Wed Nov 11, 2026 01:14 AM	rr	20.0
VIT-012555	Wed Nov 11, 2026 01:14 AM	temp_c	37.1
VIT-012556	Wed Nov 11, 2026 01:14 AM	hr	80.0
VIT-012557	Wed Nov 11, 2026 01:14 AM	map	83.0
VIT-012558	Wed Nov 11, 2026 01:14 AM	gcs	15.0
VIT-012501	Wed Nov 11, 2026 09:14 AM	spo2	94.0	room air
VIT-012502	Wed Nov 11, 2026 09:14 AM	rr	17.0
VIT-012559	Wed Nov 11, 2026 09:14 AM	temp_c	36.5
VIT-012560	Wed Nov 11, 2026 09:14 AM	hr	86.0
VIT-012561	Wed Nov 11, 2026 09:14 AM	map	82.0
VIT-012562	Wed Nov 11, 2026 09:14 AM	gcs	15.0
VIT-012503	Wed Nov 11, 2026 05:14 PM	spo2	99.0	room air
VIT-012504	Wed Nov 11, 2026 05:14 PM	rr	18.0
VIT-012563	Wed Nov 11, 2026 05:14 PM	temp_c	36.7
VIT-012564	Wed Nov 11, 2026 05:14 PM	hr	81.0
VIT-012565	Wed Nov 11, 2026 05:14 PM	map	85.0
VIT-012566	Wed Nov 11, 2026 05:14 PM	gcs	15.0
VIT-012505	Thu Nov 12, 2026 01:14 AM	spo2	97.0	room air
VIT-012506	Thu Nov 12, 2026 01:14 AM	rr	14.0
VIT-012567	Thu Nov 12, 2026 01:14 AM	temp_c	37.0
VIT-012568	Thu Nov 12, 2026 01:14 AM	hr	72.0
VIT-012569	Thu Nov 12, 2026 01:14 AM	map	78.0
VIT-012570	Thu Nov 12, 2026 01:14 AM	gcs	15.0
VIT-012507	Thu Nov 12, 2026 09:14 AM	spo2	97.0	room air
VIT-012508	Thu Nov 12, 2026 09:14 AM	rr	18.0
VIT-012571	Thu Nov 12, 2026 09:14 AM	temp_c	37.2
VIT-012572	Thu Nov 12, 2026 09:14 AM	hr	83.0
VIT-012573	Thu Nov 12, 2026 09:14 AM	map	87.0
VIT-012574	Thu Nov 12, 2026 09:14 AM	gcs	15.0
VIT-012509	Thu Nov 12, 2026 05:14 PM	spo2	96.0	room air
VIT-012510	Thu Nov 12, 2026 05:14 PM	rr	20.0
VIT-012575	Thu Nov 12, 2026 05:14 PM	temp_c	37.0
VIT-012576	Thu Nov 12, 2026 05:14 PM	hr	68.0
VIT-012577	Thu Nov 12, 2026 05:14 PM	map	80.0
VIT-012578	Thu Nov 12, 2026 05:14 PM	gcs	15.0
VIT-012511	Fri Nov 13, 2026 01:14 AM	spo2	96.0	room air
VIT-012512	Fri Nov 13, 2026 01:14 AM	rr	19.0
VIT-012579	Fri Nov 13, 2026 01:14 AM	temp_c	37.4
VIT-012580	Fri Nov 13, 2026 01:14 AM	hr	73.0
VIT-012581	Fri Nov 13, 2026 01:14 AM	map	83.0
VIT-012582	Fri Nov 13, 2026 01:14 AM	gcs	15.0
VIT-012513	Fri Nov 13, 2026 09:14 AM	spo2	94.0	room air
VIT-012514	Fri Nov 13, 2026 09:14 AM	rr	18.0
VIT-012583	Fri Nov 13, 2026 09:14 AM	temp_c	37.3
VIT-012584	Fri Nov 13, 2026 09:14 AM	hr	69.0
VIT-012585	Fri Nov 13, 2026 09:14 AM	map	89.0
VIT-012586	Fri Nov 13, 2026 09:14 AM	gcs	15.0

Medications, orders, echo, history (1)

ORD-000109 11-08 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000433 · Dr. Wes Merriweather (attending) · Sat Nov 07, 2026 07:54 PM

Cited facts from this note (1)

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

Show source for bleeding_source

… e: Hospital Medicine Attending: Dr. Wes Merriweather History of present illness: 68-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy. Past medical history: GERD. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Assessment and p …

Source document DOC-000433: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Esme Northam   MRN: MRN17549030   Admitted: 2026-11-07 16:54
Service: Hospital Medicine   Attending: Dr. Wes Merriweather

History of present illness: 68-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy.
Past medical history: GERD.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Upper GI bleed: PPI, GI following.

Progress note · DOC-000434 · Dr. Wes Merriweather (attending) · Fri Nov 13, 2026 11:55 AM

Source document DOC-000434: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Esme Northam   MRN: MRN17549030   Hospital day 6

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Upper GI bleed: continue current management.
2. Acute kidney injury: trend creatinine, hold nephrotoxins, strict intake and output.

Attending: Dr. Wes Merriweather