{"case":"After Care Dictation","title":"ICU handover dictation","tags":["Complex Medical Terminology","Detail heavy"],"reference":"[Speaker 1]: Rouzan al-Najjar has septic shock from aspiration pneumonitis versus cholangitis, with AF with RVR, AKI on CKD, hyperkalemia, lactate 4.3, pH 7.26, potassium 6.1, sats 91% on 6 L Hudson, BP 92/58, CBD dilatation, cholestatic LFTs, recent apixaban, and possible euglycemic ketoacidosis from empagliflozin.","audio":"/au/trust/transparency/audio/After%20Care%20Dictation/audio.mp3","prompts":[{"prompt":"Write an assessment summary","items":[{"id":"1.1","text":"The output states septic shock","clinical":true},{"id":"1.2","text":"The output describes the likely sources as aspiration pneumonitis versus cholangitis","clinical":true},{"id":"1.3","text":"The output states AF with RVR is included as a concurrent issue","clinical":true},{"id":"1.4","text":"The output states AKI on CKD is included as a complication","clinical":true},{"id":"1.5","text":"The output states hyperkalaemia is included as clinically significant","clinical":true},{"id":"1.6","text":"The output states possible euglycaemic ketoacidosis is included with empagliflozin attribution","clinical":true},{"id":"1.7","text":"The output reasons about the findings rather than only listing them","clinical":false}]}],"products":{"hanah":{"name":"Hanah","wer":{"value":0.017543859649122806,"substitutions":1,"insertions":0,"deletions":0,"referenceWords":57,"method":null},"language":null,"transcript":"[Speaker 1]: Rawzan Al-Najjar has septic shock, from aspiration pneumonitis versus cholangitis, with AF with RVR, AKI on CKD, hyperkalemia lactate 4.3, pH 7.26, potassium 6.1, sats 91% on 6 L Hudson, BP 92/58, CBD dilatation, cholestatic LFTs, recent apixaban, and possible euglycemic ketoacidosis from empagliflozin.","notes":[{"prompt":1,"available":true,"text":"Septic shock with BP 92/58, lactate 4.3 and pH 7.26. Source is aspiration pneumonitis vs cholangitis; CBD dilatation and cholestatic LFTs support cholangitis. Sats 91% on 6 L Hudson. Concurrent AF with RVR, AKI on CKD and hyperkalemia (K 6.1). Possible euglycemic ketoacidosis from empagliflozin. Recent apixaban.","items":[{"id":"1.1","verdict":"yes","why":""},{"id":"1.2","verdict":"yes","why":""},{"id":"1.3","verdict":"yes","why":""},{"id":"1.4","verdict":"yes","why":""},{"id":"1.5","verdict":"yes","why":""},{"id":"1.6","verdict":"yes","why":""},{"id":"1.7","verdict":"yes","why":"links CBD dilatation + LFTs to cholangitis"}],"flags":[]}],"defaultNote":null,"capturedAt":"2026-10-05T22:40:05.203Z","significantTranscriptErrors":[],"significantPerRun":[0]},"heidi":{"name":"Heidi","wer":{"value":0.07017543859649122,"substitutions":3,"insertions":1,"deletions":0,"referenceWords":57,"method":null},"language":{"mode":"manual","requested":{"code":"en","label":"English"},"input":"English","output":"English","verified":true,"verification":"Saved session reloaded; persisted input and output language labels checked"},"transcript":"Rausan al-Najar has septic shock from aspiration pneumonitis versus cholangitis with AF with RVR, AKI on CKD, hyperkalemia, lactate four point three.\n\npH 7.26, potassium 6.1, SATS 91% on six liters Hudson, BP 92 over 58, CBD dilatation, cholestatic LFTs, recent epixaban, and possible euglycemic ketoacidosis from empagliflozin.","notes":[{"prompt":1,"available":true,"text":"# Assessment Summary\n\n\n\n\nPatient: Rausan al-Najar\n\n\n\n\n## Presenting Problem\n\n- Septic shock secondary to aspiration pneumonitis versus cholangitis\n\n\n\n\n## Comorbidities / Contributing Factors\n\n- Atrial fibrillation with rapid ventricular response\n\n- Acute kidney injury on chronic kidney disease\n\n- Hyperkalaemia\n\n- Lactate 4.3\n\n- pH 7.26\n\n- Potassium 6.1\n\n- CBD dilatation\n\n- Cholestatic LFTs\n\n- Recent apixaban use\n\n- Possible euglycaemic ketoacidosis secondary to empagliflozin\n\n\n\n\n## Observations\n\n- SpO2 91% on 6L via Hudson mask\n\n- BP 92/58","items":[{"id":"1.1","verdict":"yes","why":""},{"id":"1.2","verdict":"yes","why":""},{"id":"1.3","verdict":"yes","why":""},{"id":"1.4","verdict":"yes","why":""},{"id":"1.5","verdict":"yes","why":""},{"id":"1.6","verdict":"yes","why":""},{"id":"1.7","verdict":"no","why":"pure list"}],"flags":[]}],"defaultNote":null,"capturedAt":"2026-10-05T22:40:50.249Z","significantTranscriptErrors":[{"id":"F4","category":"medication","reason":"Apixaban garbled to 'epixaban', ambiguous with edoxaban.","reference":"apixaban","transcribed":"epixaban"}],"significantPerRun":[1]},"freed":{"name":"Freed","wer":{"value":0.12280701754385964,"substitutions":5,"insertions":1,"deletions":1,"referenceWords":57,"method":null},"language":{"mode":"automatic","requested":{"code":"en","label":"English"},"manualOverride":false,"verification":"Recorder and Scribe preferences inspected; automatic multilingual workflow documented by vendor","source":"https://www.getfreed.ai/resources/ai-scribe-multilingual-visits","languageExplicitlyListed":true,"limitation":null},"transcript":"Rauzen al-Najjar has septic shock from aspiration pneumonitis versus cholangitis with AF with RvR, AKI on CKD, hyperkalemia, lactate 4.3, pH 7.26, potassium 6.1, SOTS 91% on 6 liters Hudson, BP92 over 58, CBD dilatation, cholestatic LFTs, recent apixaban, And possible U-glycemic ketoacidosis from empagliflozin.","notes":[{"prompt":1,"available":true,"text":"Assessment Summary\n\nSeptic shock: Hemodynamic compromise (BP 92/58), elevated lactate (4.3). Source unclear; aspiration pneumonitis vs. cholangitis considered due to CBD dilatation, cholestatic LFTs, and hypoxia. AF with RVR complicates instability.\nMetabolic acidosis: Severe (pH 7.26), likely multifactorial—lactic acidosis from shock, AKI on CKD, possible euglycemic DKA (empagliflozin).\nHyperkalemia: K+ 6.1, immediate cardiac risk in context of AKI/CKD and acidosis.\nHypoxic respiratory failure: SpO2 91% on 6L O2, likely aspiration pneumonitis.\nAF with RVR: Rate control complicated by instability; recent apixaban use increases bleeding/procedural risk.\nAKI on CKD: Superimposed AKI, contributing to hyperkalemia and acidosis.\n\nDisposition: Ongoing resuscitation, workup for septic source, frequent reassessment of hemodynamics, respiratory status, and labs. Monitor for complications (acidosis, hyperkalemia, multiorgan involvement).","items":[{"id":"1.1","verdict":"yes","why":""},{"id":"1.2","verdict":"yes","why":""},{"id":"1.3","verdict":"yes","why":""},{"id":"1.4","verdict":"yes","why":""},{"id":"1.5","verdict":"yes","why":""},{"id":"1.6","verdict":"yes","why":""},{"id":"1.7","verdict":"yes","why":""}],"flags":[{"claim":"Hypoxic respiratory failure ... likely aspiration pneumonitis","severity":"major","why":"new diagnosis not said; asserts one differential"},{"claim":"Disposition: ongoing resuscitation, workup for septic source, frequent reassessment, monitor for complications","severity":"major","why":"invented plan"},{"claim":"Metabolic acidosis likely multifactorial — lactic acidosis from shock, AKI on CKD","severity":"minor","why":"causal attribution not said"},{"claim":"AKI on CKD contributing to hyperkalemia and acidosis","severity":"minor","why":"causal attribution not said"},{"claim":"Hyperkalemia: immediate cardiac risk","severity":"minor","why":"risk statement not said"},{"claim":"Rate control complicated by instability; apixaban increases bleeding/procedural risk","severity":"minor","why":"reasoning/risk not said"}]}],"defaultNote":null,"capturedAt":"2026-10-06T01:39:13.242Z","significantTranscriptErrors":[],"significantPerRun":[0]},"lyrebird":{"name":"Lyrebird","wer":{"value":0.05263157894736842,"substitutions":2,"insertions":1,"deletions":0,"referenceWords":57,"method":null},"language":{"mode":"manual","requested":{"code":"en","label":"English"},"input":"English","output":"English","verified":true},"transcript":"Rousin al Najjar has septic shock from aspiration pneumonitis versus cholangitis with AF with RVR, AKI on CKD, hyperkalemia, lactate 4.3, pH 7.26, potassium 6.1, sat's 91 percent on 6 liters Hudson, BP 92 over 58, CBD dilatation, cholestatic LFTs, recent apixaban, and possible euglycemic ketoacidosis\n\nFrom empagliflozin.","notes":[{"prompt":1,"available":true,"text":"Assessment Summary\n\n\n\n\nPatient Name: Rousin al Najjar\n\nDate of Assessment: 06/10/2026\n\n\n\n\nClinical Presentation:\n\nThe patient presented with septic shock, with the source identified as either aspiration pneumonitis or cholangitis. The patient was haemodynamically unstable with a blood pressure of 92/58 mmHg and oxygen saturations of 91% on 6 litres via Hudson mask.\n\n\n\n\nCardiovascular:\n\nAtrial fibrillation with rapid ventricular response was documented.\n\n\n\n\nRenal Function:\n\nAcute kidney injury on a background of chronic kidney disease was present. Significant hyperkalemia was noted with a potassium level of 6.1 mmol/L.\n\n\n\n\nMetabolic Status:\n\nMetabolic acidosis was evident with a pH of 7.26 and lactate of 4.3 mmol/L. There was concern for possible euglycemic ketoacidosis, likely related to empagliflozin therapy.\n\n\n\n\nHepatobiliary:\n\nCholestatic liver function tests were present with common bile duct dilatation identified on imaging.\n\n\n\n\nCurrent Medications:\n\nThe patient was on apixaban (recently commenced) and empagliflozin.\n\n\n\n\nImpression:\n\nThis patient presented with multisystem compromise including septic shock (aspiration pneumonitis versus cholangitis), atrial fibrillation with rapid ventricular response, acute on chronic kidney injury with severe hyperkalemia, metabolic acidosis, cholestatic liver dysfunction with biliary dilatation, and possible euglycemic diabetic ketoacidosis secondary to SGLT2 inhibitor therapy.\n\n\n\n\nTreating Clinician","items":[{"id":"1.1","verdict":"yes","why":""},{"id":"1.2","verdict":"yes","why":""},{"id":"1.3","verdict":"yes","why":""},{"id":"1.4","verdict":"yes","why":""},{"id":"1.5","verdict":"yes","why":""},{"id":"1.6","verdict":"yes","why":""},{"id":"1.7","verdict":"partial","why":"synthesising impression, otherwise restated"}],"flags":[{"claim":"apixaban (recently commenced)","severity":"minor","why":"'recent apixaban' ≠ recently commenced"},{"claim":"severe hyperkalemia","severity":"minor","why":"intensifier not said"},{"claim":"euglycemic diabetic ketoacidosis","severity":"minor","why":"implies diabetes, never said"}]}],"defaultNote":null,"capturedAt":"2026-10-05T22:40:52.353Z","significantTranscriptErrors":[],"significantPerRun":[0]},"patientnotes":{"name":"PatientNotes","wer":{"value":0.12280701754385964,"substitutions":3,"insertions":0,"deletions":4,"referenceWords":57,"method":null},"language":{"mode":"manual","requested":{"code":"en","label":"English"},"input":"English","verified":true,"verification":"Selected language confirmed after reopening recording settings"},"transcript":"Rousan al najjar has septic shock from aspiration. Pneumonitis versus cholangitis with af with rvr AKI on CKD hyperkalemia lactate 4.3, ph Potassium 6.1 sots 91% on 6l hudson bp 92 58, cbd dilatation, cholestatic lfts, recent Apixaban and possible euglycemic ketoacidosis from Dapagliflozin","notes":[{"prompt":1,"available":true,"text":"Subjective\nChief Complaint (CC)\n\nPatient has septic shock from aspiration.\n\nHistory of Present Illness (HPI)\n\nPneumonitis versus cholangitis is being considered.\n\nAtrial fibrillation with rapid ventricular response is present.\n\nAcute kidney injury on chronic kidney disease is noted.\n\nHyperkalaemia with potassium 6.1 mmol/L is documented.\n\nLactate is elevated at 4.3 mmol/L.\n\nOxygen saturation is 91% on 6 L Hudson mask.\n\nBlood pressure is 92/58 mmHg.\n\nCommon bile duct dilatation observed.\n\nCholestatic liver function test pattern present.\n\nHistory\n\nNot discussed\n\nReview of Systems (ROS)\n\nNot discussed\n\nCurrent Medications, Allergies\n\nApixaban (recently administered).\n\nDapagliflozin (possible cause of euglycaemic ketoacidosis).\n\nObjective\n\nOxygen saturation 91% on 6 L Hudson mask.\n\nBlood pressure 92/58 mmHg.\n\nLactate 4.3 mmol/L.\n\nPotassium 6.1 mmol/L (hyperkalaemia).\n\nElevated cholestatic liver function tests.\n\nCommon bile duct dilatation on imaging.\n\nAssessment\n\nPatient is in septic shock secondary to aspiration with multi‑organ dysfunction including respiratory compromise, acute kidney injury on chronic kidney disease, hyperkalaemia, and possible euglycaemic ketoacidosis.\n\nSeptic shock secondary to aspiration.\n\nPossible pneumonitis versus cholangitis.\n\nAtrial fibrillation with rapid ventricular response.\n\nAcute kidney injury on chronic kidney disease.\n\nHyperkalaemia.\n\nPossible euglycaemic ketoacidosis related to dapagliflozin.\n\nPlan","items":[{"id":"1.1","verdict":"yes","why":""},{"id":"1.2","verdict":"partial","why":"asserts aspiration as cause, then 'pneumonitis vs cholangitis'"},{"id":"1.3","verdict":"yes","why":""},{"id":"1.4","verdict":"yes","why":""},{"id":"1.5","verdict":"yes","why":""},{"id":"1.6","verdict":"no","why":"attributed to dapagliflozin"},{"id":"1.7","verdict":"partial","why":""}],"flags":[{"claim":"Septic shock secondary to aspiration","severity":"major","why":"asserts one cause; differential was left open"},{"claim":"Dapagliflozin (possible cause of euglycaemic ketoacidosis)","severity":"major","why":"wrong drug"}]}],"defaultNote":null,"capturedAt":"2026-10-05T22:42:03.975Z","significantTranscriptErrors":[{"id":"B2","category":"number","reason":"pH 7.26 dropped from the handover.","reference":"7.26","transcribed":""},{"id":"B5","category":"medication","reason":"Empagliflozin transcribed as dapagliflozin, a different drug.","reference":"empagliflozin.","transcribed":"Dapagliflozin"}],"significantPerRun":[2]},"cliniscripts":{"name":"CliniScripts","wer":{"value":0.017543859649122806,"substitutions":1,"insertions":0,"deletions":0,"referenceWords":57,"method":null},"language":{"mode":"default","requested":{"code":"en","label":"English"},"manualOverride":false,"selected":["English"]},"transcript":"Rawzan Al-Najjar has septic shock from aspiration pneumonitis versus cholangitis, with AF with RVR, AKI on CKD, hyperkalemia lactate 4.3, pH 7.26, potassium 6.1, sats 91% on 6 L Hudson, BP 92/58, CBD dilatation, cholestatic LFTs, recent apixaban, and possible euglycemic ketoacidosis from empagliflozin.","notes":[{"prompt":1,"available":true,"text":"The patient is assessed to be in septic shock, with a differential diagnosis considering aspiration pneumonitis versus cholangitis. They are also experiencing Atrial Fibrillation with Rapid Ventricular Response, Acute Kidney Injury on a background of Chronic Kidney Disease, hyperkalemia with a potassium level of 6.1, and possible euglycemic ketoacidosis potentially due to empagliflozin use.","items":[{"id":"1.1","verdict":"yes","why":""},{"id":"1.2","verdict":"yes","why":""},{"id":"1.3","verdict":"yes","why":""},{"id":"1.4","verdict":"yes","why":""},{"id":"1.5","verdict":"yes","why":""},{"id":"1.6","verdict":"yes","why":""},{"id":"1.7","verdict":"partial","why":"prose restatement with an assessed framing, no linking"}],"flags":[]}],"defaultNote":null,"capturedAt":"2026-10-06T01:39:10.228Z","significantTranscriptErrors":[],"significantPerRun":[0]},"preve":{"name":"Preve","wer":{"value":0.07017543859649122,"substitutions":3,"insertions":1,"deletions":0,"referenceWords":57,"method":null},"language":null,"transcript":"Rousin al Najjar has septic shock from aspiration pneumonitis versus cholangitis.\n\nWith AF with RVR, AKI on CKD, hyperkalemia, lactate four point three.\n\nPH 7.26, potassium 6.1, SOTS 91% on six liters Hudson.\n\nBP 92 over 58, CBD dilatation, cholestatic LFTs.\n\nRecent epixaban and possible euglycemic ketoacidosis from empagliflozin.","notes":[{"prompt":1,"available":false,"text":null,"items":[{"id":"1.1","verdict":"no","why":""},{"id":"1.2","verdict":"no","why":""},{"id":"1.3","verdict":"no","why":""},{"id":"1.4","verdict":"no","why":""},{"id":"1.5","verdict":"no","why":""},{"id":"1.6","verdict":"no","why":""},{"id":"1.7","verdict":"no","why":""}],"flags":[]}],"defaultNote":null,"capturedAt":"2026-10-05T22:42:05.616Z","significantTranscriptErrors":[{"id":"G5","category":"medication","reason":"Apixaban garbled to 'epixaban', ambiguous with edoxaban.","reference":"apixaban","transcribed":"epixaban"}],"significantPerRun":[1]}},"notCaptured":{}}