🩺 Record Detail

Patient Info

Name: Unknown
Age: Unknown
Date: 2025-07-21 05:02:47

Transcript

[00:00 → 00:13] The patient is having fever with seizures and is a known case of C-A-D and rest advice for one week.
[00:15 → 00:23] The fever is responding to paracetamol and the patient is also having headache and severe
[00:23 → 00:24] pain in the back.

Clinical Notes

Subjective

  • Patient: Known case of Coronary Artery Disease (C-A-D).

  • Primary Concern: Fever with seizures, headache, and severe back pain.

  • Symptoms:

    • Fever responding to paracetamol.
    • Headache.
    • Severe back pain.

Objective

  • Medical History:
    • Known case of Coronary Artery Disease (C-A-D).

Assessment

  1. Fever with Seizures: Presenting symptom, responding to paracetamol.
  2. Headache: Reported by the patient.
  3. Severe Back Pain: Significant symptom mentioned by the patient.

Plan

  1. Medication:

    • Continue paracetamol for fever management.
    • Consider additional pain management for headache and severe back pain.

  2. Rest Advice:

    • Advise continued rest for one week to support recovery.

  3. Further Evaluation:

    • Monitor fever and seizures closely.
    • Evaluate the need for additional investigations or specialist consultations if symptoms persist or worsen.
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