rtNow called 11/24/25@0310 from RN at small community hospital*. Patient ******* *****, DOB: 1/1/1973, MR#********. Patient arrived with sob. BS: Wheezy. On room air O2 sats 89-91%. Placed on Bipap with the v6o for increased work of breathing. Initial settings: 10/5 rate 10 fio2 60%. Settings increased to 18/8 rate 10 40%. Lasix given by RN. Recently seen 10/21/25 through 10/27/25 for hepatic encephalopathy. She has a history of ETOH, CVA, liver cirrhosis, methamphetamine use, neuromuscular disease, atrial flutter, copd, hypertension, opioid dependence, heart failure and hyperammonemia. Patient will be heading to CT on Bipap. Plan: Continue on BiPAP, collect ABG/VBG to monitor pH/Co2,HcO3, await result of CT and labs. Call ended at 0400
rtNow follow-up call to small community ER @0432 and patient still @ radiology. vbg @ 0400. 7.37,44,81,25 Plan: Continue BiPAP on current settings and possible transfer to higher level of care due to increased LFTs and pending result of CT scan. Continue to monitor on current settings.
rtNow follow-up call at 0528 on ******* *****, DOB: 1/1/1973, MR#********. Patient back from CT. Continuous albuterol started. Repeat vbg: 7.31, 50, 62,25.2. Oxygen weaned down to 30%. Backup rate on Bipap increased to 14. Patient stable and still able to answer questions appropriately and follow commands. Current Bipap settings: 18/8 rate 14, 30%. Patient measured values: rr 21, vt: 651 13.6.
Plan: continue to monitor on these settings. Repeat vbg in an hour. Patient is stable and will be transported to higher level of care. Continue continuous albuterol for now. Call ended at 0540 a.m.
rtNow follow-up call at @6:47 a.m with RN at small community hospital.Following up on VBG for ******* *****, DOB: 1/1/1973, MR#********. Repeat VBG: 7.30,49,60,24. Continuous albuterol stopped at 6:45 a.m. Oxygen weaned down to 25%. Current Bipap settings: 18/8 rate 14 25%. Patient measured values: rate20, vt: 752,MV:14.6. Plan: Patient stable and being transported to higher level of care. Continue on current settings. RN will call rtNOW as needed. Call ended at 0653.
*Hospital name and patient data redacted.