latest obs 1m ago

Patient intelligence · showcase: multisystem-deterioration

R. Okafor · 78M

Bed 04 · sepsis · hospital day 4 · Urosepsis; cultures pending, antibiotics escalated day 2.

Context: Piperacillin-tazobactam from day 2 · No regular antihypertensives

VYZR Care RPP Engineconnecting…

Urgent · Rapidly worsening

Oxygen requirement 0.7 → 3.7 → 4.5 L/min over 40h; respiratory rate 18 → 25 → 27 /min over 44h; systolic pressure 128 → 100 → 97 mmHg over 44h; heart rate 85 → 103 → 106 /min over 48h; creatinine 0.90 → 1.20 → 1.50 mg/dL over 47h. 7 signals across 3 systems (respiratory, circulatory, renal) are moving in the adverse direction within the same window. Individually each change is modest; together they describe one trajectory. If the current slope continues: SBP ≈ 89 (84–93 mmHg) at 6h, crossing SBP 90 mmHg in ~5h; O₂ ≈ 5.8 (5.2–6.4 L/min) at 6h, crossing 6 L/min in ~8h; RR ≈ 29 (28–30 /min) at 6h, crossing RR 30/min in ~8h. 4 related patterns also active (rising respiratory burden, systemic infection trajectory, falling perfusion reserve, evolving renal injury).

Preparing narrative…

01 · Recognized · last 2 d

Urgent · Rapidly worsening

Multisystem deterioration

Pattern strength84/100 · higher evidence

Experimental explainable index, not a probability. 7 of 10 expected signals available 99 measurements across supporting signals

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Measured · 18 points · last 4h agoProjected · shaded = uncertainty band

4.5 L/min (+0.8 L/min since previous), above range, rising · +4.2 L/min/24h · 7 consecutive rises.

Supplemental oxygen

4.5 L/min · rising · +4.2 L/min/24h · 7 consecutive rises

Respiratory rate

27 /min · rising · +10 /min/24h · 7 consecutive rises

Oxygen saturation

93 % · stable

Systolic blood pressure

97 mmHg · falling · −24 mmHg/24h · 2 consecutive falls

02 · Predicted

6hhigher evidence confidence

If the current slope continues: SBP ≈ 89 (84–93 mmHg) at 6h, crossing SBP 90 mmHg in ~5h; O₂ ≈ 5.8 (5.2–6.4 L/min) at 6h, crossing 6 L/min in ~8h; RR ≈ 29 (28–30 /min) at 6h, crossing RR 30/min in ~8h.

Next in line if this continues: Progression toward multi-organ failure requiring organ support.

Higher evidence quality: several concordant, fresh, repeated measurements. Still a linear extrapolation, not a forecast of outcome.

Projections · 5 made · 0 withheld

Systolic blood pressureols-recent · fitted on 7 points · slope -1.29 mmHg/h

+6h · Sep 25 21:41

89 (84–93)

+12h · Sep 26 03:41

81 (76–86)

+24h · Sep 26 15:41

66 (60–71)

SBP 90 mmHg in ~5h if the current slope continues (at Sep 25 20:41).

Supplemental oxygenols-recent · fitted on 5 points · slope +0.13 L/min/h

+6h · Sep 25 21:41

5.8 (5.2–6.4)

+12h · Sep 26 03:41

6.6 (5.9–7.3)

6 L/min in ~8h if the current slope continues (at Sep 25 23:41).

Respiratory rateols-recent · fitted on 6 points · slope +0.39 /min/h

+6h · Sep 25 21:41

29 (28–30)

+12h · Sep 26 03:41

32 (30–33)

+24h · Sep 26 15:41

36 (35–38)

RR 30/min in ~8h if the current slope continues (at Sep 25 23:41).

Creatinineols-recent · fitted on 3 points · slope +0.01 mg/dL/h

+6h · Sep 25 21:41

1.59 (1.48–1.69)

+12h · Sep 26 03:41

1.67 (1.56–1.78)

+24h · Sep 26 15:41

1.82 (1.7–1.94)

Urine outputols-recent · fitted on 6 points · slope -1.53 mL/h/h

+6h · Sep 25 21:41

14 (9–20)

+12h · Sep 26 03:41

5 (0–12)

+24h · Sep 26 15:41

0 (0–0)

<20 mL/h in ~2h if the current slope continues (at Sep 25 17:41).

Alternative explanations

· Coincident but unrelated changes (e.g. post-procedure oxygen weaning plus a diuretic-driven creatinine bump).
· Observation frequency or recording artefact clustering changes at one round.
· A single reversible driver (pain, dehydration) explaining all changes at once.

04 · Consider now

Consider a single unifying driver — sepsis, hypovolaemia/bleeding, cardiogenic failure, or a drug effect — rather than treating 7 separate problems.

The engine judges this pattern strong, fresh and fast enough to justify interrupting a clinician.

Decision support only · no order has been placed · engine rpp-0.4.0 · latest supporting value 1 min ago

03 · Connected

What may be causing what

Mechanistic chain assembled from the recognised features. Each link is a hypothesis for bedside verification, not an established cause.

Rising O₂ need + RRhypoxaemia and work of breathingCardiac strain

Falling SBPreduced organ perfusionFalling urine output, rising creatinine

Combined organ stressloss of compensatory reserveRapid decompensation

Evidence · 29 raw observations

Timestamps are real and irregular · click an observation to focus its trace above

04 · Prevention prompts

Consider, investigate, monitor, escalate

Clinician-support prompts derived from the pattern — not prescriptions. Status is persisted so the team sees what has been planned or judged not appropriate.

Consider causes

Consider a single unifying driver — sepsis, hypovolaemia/bleeding, cardiogenic failure, or a drug effect — rather than treating 7 separate problems.

Missing information

Fluid balance, mentation, capillary refill and a full metabolic panel would confirm the extent of organ involvement.

Investigate

Consider repeat lactate, blood gas, full blood count, renal profile and cultures; consider ECG and chest imaging.

Monitor

Consider increasing observation frequency to hourly and hourly urine output while the pattern is active.

Medication review

Review sedatives, antihypertensives, diuretics, nephrotoxins and fluid prescriptions together.

Level of care

Consider early critical-care awareness — several systems moving together is the strongest case for a senior bedside review.

Other active patterns · 4

Rising respiratory burden

Oxygen requirement 0.7 → 3.0 → 3.7 → 4.5 L/min over 40h; respiratory rate 18 → 24 → 25 → 27 /min over 44h. SpO₂ is being held at 93 % only by escalating oxygen. Two or more respiratory signals are moving together — a work-of-breathing trajectory, not a single reading.

Urgent · Rapidly worsening

Pattern strength85/100 · higher evidence

Systemic infection trajectory

Heart rate 85 → 103 → 106 /min over 48h; respiratory rate 18 → 25 → 27 /min over 44h; white cells 14.1 → 15.8 ×10⁹/L over 24h; CRP 190 → 230 mg/L over 24h; lactate 2.1 → 2.8 mmol/L over 18h; systolic pressure 128 → 100 → 97 mmHg over 44h. Inflammatory markers are moving with a physiological response — the pattern is systemic, not just a lab value. Occurring despite current antibiotic therapy (recorded context).

Urgent · Rapidly worsening

Pattern strength78/100 · higher evidence

Falling perfusion reserve

Systolic pressure 128 → 106 → 100 → 97 mmHg over 44h; heart rate 85 → 100 → 103 → 106 /min over 48h; lactate 2.1 → 2.8 mmol/L over 18h; urine output 61 → 36 → 29 → 24 mL/h over 44h. Falling pressure with rising rate is a compensation pattern — reserve is being consumed before the numbers look critical.

Urgent · Rapidly worsening

Pattern strength76/100 · higher evidence

Evolving renal injury

Creatinine 0.90 → 0.90 → 1.20 → 1.50 mg/dL over 2.5 d (1.7× admission baseline 0.90 mg/dL); urine output 61 → 36 → 29 → 24 mL/h over 3 d; potassium 4.1 → 4.3 → 4.6 mmol/L over 2 d. Rising creatinine with falling urine output is a concordant renal trajectory.

Concerning · Rapidly worsening

Pattern strength63/100 · higher evidence

Changed since last review · 8 meaningful

Respiratory rate · 21 /min → 27 /min (+6 /min, 1 min ago)rising

Supplemental oxygen · 3.0 L/min → 4.5 L/min (+1.5 L/min, 4h ago)rising

Systolic blood pressure · 114 mmHg → 97 mmHg (−17 mmHg, 19 min ago)falling

Heart rate · 92 /min → 106 /min (+14 /min, 18 min ago)rising

Temperature · 37.3 °C → 37.5 °C (+0.2 °C, 4h ago)rising

Urine output · 42 mL/h → 24 mL/h (−18 mL/h, 17 min ago)falling

Creatinine · 1.20 mg/dL → 1.50 mg/dL (+0.30 mg/dL, 1h ago)rising

Lactate · 2.1 mmol/L → 2.8 mmol/L (+0.7 mmol/L, 2h ago)rising

Reassuring signals · 1

Temperature · 37.5 °C — in range and steady.

Synthetic demonstration · engine output requires clinical correlation and is not a diagnosis