Abnormal narrative bank — focused / at-risk
Six focused abnormal narratives carrying the full necessity chain — finding, severity, comparison, risk, action, notification, and reassessment.
A1 Airway-threatening oral swelling / angioedema | Skilled assessment of rapid swelling of the lips and tongue with drooling and difficulty managing secretions shortly after a new medication — an airway threat concerning for angioedema. EMS was activated immediately and the patient positioned to protect the airway; epinephrine was given per order where anaphylaxis features were present; the provider was notified at 15:45. The airway and vital signs were monitored continuously pending transport (cross-reference Allergic/Immunologic). |
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A2 Deep-space infection / epiglottitis | Skilled assessment of severe throat pain with drooling, muffled voice, and an inability to swallow secretions, with a fever of 102°F — findings concerning for a deep-space infection or epiglottitis. EMS was activated for emergent evaluation and the patient kept upright and calm without oral intake; the provider was notified at 13:20. The airway was monitored closely pending transport and nothing placed in the mouth. |
A3 Candidiasis limiting intake | Skilled assessment of new white curd-like plaques over the tongue and buccal mucosa that wipe to a raw base, with soreness limiting oral intake — new from baseline and consistent with candidiasis reducing intake. The provider was notified at 11:10; an antifungal order was received and initiated. Oral care and intake monitoring were taught, and the lesions and intake will be reassessed next visit; the intake impact was coordinated with Nutrition (cross-reference Nutrition). |
A4 Non-healing oral lesion | Skilled assessment of a firm, ulcerated lesion on the right lateral tongue that the patient reports has been present for more than two weeks and has not healed — a non-healing lesion requiring evaluation to exclude malignancy. The provider was notified at 09:45 and a referral for evaluation requested; the lesion was measured for tracking. The patient was educated on the reason for evaluation and to avoid irritating the area; the lesion will be reassessed next visit. |
A5 Oral bleeding on an anticoagulant | Skilled assessment of gingival bleeding that is moderate and slow to stop in a patient on warfarin — new and significant given the anticoagulant. Gentle pressure was applied and the bleeding controlled; the provider was notified at 14:05 and bleeding-risk review initiated. The patient was taught atraumatic oral care and to seek care for bleeding that will not stop; the gingiva and the coagulation status will be monitored and the Anticoagulation overlay applied. |
A6 Severe dental infection | Skilled assessment of a severe dental infection with facial swelling, significant pain, and a low-grade fever, with early tenderness of the floor of the mouth — findings requiring urgent evaluation given the risk of airway involvement. The provider was notified at 10:30; orders for urgent dental evaluation and antibiotics were received. The patient was educated on the warning signs of airway compromise (floor-of-mouth swelling, tongue elevation, difficulty swallowing) and to activate EMS for them; the swelling and temperature will be reassessed. |