Clinical Decision Support
Consult
Consult (Clinical Reference Q&A) is the platform’s default response mode. When clinicians ask a question, Glass interprets their intent, searches authoritative literature, and returns a direct, evidence‑grounded answer; consult responses include the following components:
Evidence-based
Each answer cites current research and consensus guidelines inline.
Evidence-based
Each answer cites current research and consensus guidelines inline.
Evidence-based
Each answer cites current research and consensus guidelines inline.
Organized context
Responses include related insights and guideline pearls, arranged for rapid scanning.
Organized context
Responses include related insights and guideline pearls, arranged for rapid scanning.
Organized context
Responses include related insights and guideline pearls, arranged for rapid scanning.
What is the target SpO2 range in bronchiolitis?
The target SpO2 for bronchiolitis varies between guidelines, with the American Academy of Pediatrics recommending ≥90% and UK guidelines recommending ≥92-94%.
Guideline Recommendations
American Academy of Pediatrics (AAP) 2014: SpO2 ≥90% threshold for supplemental oxygen, consistent with WHO recommendations for lower respiratory tract infections.
UK NICE Guidelines 2015: SpO2 ≥92% threshold for supplemental oxygen.
Scottish Intercollegiate Guidelines Network (SIGN) 2006: SpO2 ≥94% threshold.
Canadian Pediatric Society 2014: SpO2 ≥90% threshold.
Evidence Supporting Lower Thresholds
The BIDS trial demonstrated that managing infants with bronchiolitis to an SpO2 target of ≥90% was equivalent to ≥94% for cough resolution (primary outcome) and was associated with shorter hospital stays and less oxygen use.
Infants managed to the 90% target had faster return to adequate feeding (19.5 vs 24.1 hours) and were fit for discharge sooner (30.2 vs 44.2 hours).
No significant differences in serious adverse events were observed between the two oxygen saturation targets.
What is the target SpO2 range in bronchiolitis?
The target SpO2 for bronchiolitis varies between guidelines, with the American Academy of Pediatrics recommending ≥90% and UK guidelines recommending ≥92-94%.
Guideline Recommendations
American Academy of Pediatrics (AAP) 2014: SpO2 ≥90% threshold for supplemental oxygen, consistent with WHO recommendations for lower respiratory tract infections.
UK NICE Guidelines 2015: SpO2 ≥92% threshold for supplemental oxygen.
Scottish Intercollegiate Guidelines Network (SIGN) 2006: SpO2 ≥94% threshold.
Canadian Pediatric Society 2014: SpO2 ≥90% threshold.
Evidence Supporting Lower Thresholds
The BIDS trial demonstrated that managing infants with bronchiolitis to an SpO2 target of ≥90% was equivalent to ≥94% for cough resolution (primary outcome) and was associated with shorter hospital stays and less oxygen use.
Infants managed to the 90% target had faster return to adequate feeding (19.5 vs 24.1 hours) and were fit for discharge sooner (30.2 vs 44.2 hours).
No significant differences in serious adverse events were observed between the two oxygen saturation targets.
What is the target SpO2 range in bronchiolitis?
The target SpO2 for bronchiolitis varies between guidelines, with the American Academy of Pediatrics recommending ≥90% and UK guidelines recommending ≥92-94%.
Guideline Recommendations
American Academy of Pediatrics (AAP) 2014: SpO2 ≥90% threshold for supplemental oxygen, consistent with WHO recommendations for lower respiratory tract infections.
UK NICE Guidelines 2015: SpO2 ≥92% threshold for supplemental oxygen.
Scottish Intercollegiate Guidelines Network (SIGN) 2006: SpO2 ≥94% threshold.
Canadian Pediatric Society 2014: SpO2 ≥90% threshold.
Evidence Supporting Lower Thresholds
The BIDS trial demonstrated that managing infants with bronchiolitis to an SpO2 target of ≥90% was equivalent to ≥94% for cough resolution (primary outcome) and was associated with shorter hospital stays and less oxygen use.
Infants managed to the 90% target had faster return to adequate feeding (19.5 vs 24.1 hours) and were fit for discharge sooner (30.2 vs 44.2 hours).
No significant differences in serious adverse events were observed between the two oxygen saturation targets.
Differential Diagnosis
When a clinician requests a differential—or signals uncertainty—Glass drafts a structured response that begins with a succinct case discussion and concludes with next‑step recommendations; the response includes:
Differential Diagnosis
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Case Discussion
This 65-year-old woman with cardiovascular risk factors (diabetes and hyperlipidemia) presents with acute-onset chest pain and diaphoresis, with ECG showing hyperacute T-waves without ST elevation. This constellation strongly suggests acute coronary syndrome (ACS), specifically non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Hyperacute T-waves represent a very early sign of myocardial ischemia, often preceding ST elevation, and can indicate impending complete coronary occlusion. Given her risk factors and presentation, acute myocardial infarction is highly concerning, though other cardiac and non-cardiac etiologies including aortic dissection, pulmonary embolism, and pericarditis must be considered.
Differential Diagnosis
Edit
Case Discussion
This 65-year-old woman with cardiovascular risk factors (diabetes and hyperlipidemia) presents with acute-onset chest pain and diaphoresis, with ECG showing hyperacute T-waves without ST elevation. This constellation strongly suggests acute coronary syndrome (ACS), specifically non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Hyperacute T-waves represent a very early sign of myocardial ischemia, often preceding ST elevation, and can indicate impending complete coronary occlusion. Given her risk factors and presentation, acute myocardial infarction is highly concerning, though other cardiac and non-cardiac etiologies including aortic dissection, pulmonary embolism, and pericarditis must be considered.
Differential Diagnosis
Edit
Case Discussion
This 65-year-old woman with cardiovascular risk factors (diabetes and hyperlipidemia) presents with acute-onset chest pain and diaphoresis, with ECG showing hyperacute T-waves without ST elevation. This constellation strongly suggests acute coronary syndrome (ACS), specifically non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Hyperacute T-waves represent a very early sign of myocardial ischemia, often preceding ST elevation, and can indicate impending complete coronary occlusion. Given her risk factors and presentation, acute myocardial infarction is highly concerning, though other cardiac and non-cardiac etiologies including aortic dissection, pulmonary embolism, and pericarditis must be considered.
Case Discussion
Summarizes key positives, negatives, and contextual factors.
Case Discussion
Summarizes key positives, negatives, and contextual factors.
Case Discussion
Summarizes key positives, negatives, and contextual factors.
Diagnostic Next Steps
12-lead ECG: Obtain to evaluate for STEMI, ST-depression, T-wave inversions, or other signs of ischemia/infarction.
Dx:
Monitor BUN, creatinine, and electrolytes daily during diuresis
Urinalysis to assess for proteinuria
Calculate estimated GFR
Diagnostic Next Steps
12-lead ECG: Obtain to evaluate for STEMI, ST-depression, T-wave inversions, or other signs of ischemia/infarction.
Dx:
Monitor BUN, creatinine, and electrolytes daily during diuresis
Urinalysis to assess for proteinuria
Calculate estimated GFR
Diagnostic Next Steps
12-lead ECG: Obtain to evaluate for STEMI, ST-depression, T-wave inversions, or other signs of ischemia/infarction.
Dx:
Monitor BUN, creatinine, and electrolytes daily during diuresis
Urinalysis to assess for proteinuria
Calculate estimated GFR
Diagnostic Next Steps
Targeted labs, imaging, or monitoring to refine the list.
Diagnostic Next Steps
Targeted labs, imaging, or monitoring to refine the list.
Diagnostic Next Steps
Targeted labs, imaging, or monitoring to refine the list.
Most Likely Diagnoses
Acute Coronary Syndrome (ACS) - STEMI or NSTEMI)
Supporting Evidence: Typical anginal pain radiating to the left arm, shortness of breath on exertion, multiple cardiovascular risk factors (hypertension, type 2 diabetes, hyperlipidemia, smoking history), tachycardia, and hypertension. The patient's history of CAD, specifically with a prior angioplasty, significantly increases the likelihood of ACS. The S4 gallop suggests…
Dx:
Monitor BUN, creatinine, and electrolytes daily during diuresis
Urinalysis to assess for proteinuria
Calculate estimated GFR
Most Likely Diagnoses
Acute Coronary Syndrome (ACS) - STEMI or NSTEMI)
Supporting Evidence: Typical anginal pain radiating to the left arm, shortness of breath on exertion, multiple cardiovascular risk factors (hypertension, type 2 diabetes, hyperlipidemia, smoking history), tachycardia, and hypertension. The patient's history of CAD, specifically with a prior angioplasty, significantly increases the likelihood of ACS. The S4 gallop suggests…
Dx:
Monitor BUN, creatinine, and electrolytes daily during diuresis
Urinalysis to assess for proteinuria
Calculate estimated GFR
Most Likely Diagnoses
Acute Coronary Syndrome (ACS) - STEMI or NSTEMI)
Supporting Evidence: Typical anginal pain radiating to the left arm, shortness of breath on exertion, multiple cardiovascular risk factors (hypertension, type 2 diabetes, hyperlipidemia, smoking history), tachycardia, and hypertension. The patient's history of CAD, specifically with a prior angioplasty, significantly increases the likelihood of ACS. The S4 gallop suggests…
Dx:
Monitor BUN, creatinine, and electrolytes daily during diuresis
Urinalysis to assess for proteinuria
Calculate estimated GFR
Categorized Differential Diagnosis
Most Likely — High‑probability conditions with supporting and opposing evidence.
Expanded Differential — Plausible alternatives warranting consideration.
Can’t Miss — Rare but critical diagnoses that must be excluded.
Assessment & Plan
When requested, Glass drafts an assessment & plan—ready for clinician review, revision, or incorporation into the official documentation. The output adheres to a clinical‑grade structure that combines a synthesized impression, problem‑oriented Dx / Tx bullets, actionable follow‑up items, and inline references linking every recommendation to its evidence base. The draft includes the following components:
Assessment and Plan
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Clinical Impression
71-year-old male with history of myocardial infarction presenting with progressive dyspnea on exertion, bilateral lower extremity edema, S3 heart sound, and jugular venous distention. Newly discovered reduced ejection fraction of 30%, consistent with heart failure with reduced ejection fraction (HFrEF). # Heart Failure with Reduced Ejection Fraction This patient presents with classic signs of heart failure including bilateral lower extremity edema, S3 heart sound, and JVD.
Assessment and Plan
Edit
Clinical Impression
71-year-old male with history of myocardial infarction presenting with progressive dyspnea on exertion, bilateral lower extremity edema, S3 heart sound, and jugular venous distention. Newly discovered reduced ejection fraction of 30%, consistent with heart failure with reduced ejection fraction (HFrEF). # Heart Failure with Reduced Ejection Fraction This patient presents with classic signs of heart failure including bilateral lower extremity edema, S3 heart sound, and JVD.
Assessment and Plan
Edit
Clinical Impression
71-year-old male with history of myocardial infarction presenting with progressive dyspnea on exertion, bilateral lower extremity edema, S3 heart sound, and jugular venous distention. Newly discovered reduced ejection fraction of 30%, consistent with heart failure with reduced ejection fraction (HFrEF). # Heart Failure with Reduced Ejection Fraction This patient presents with classic signs of heart failure including bilateral lower extremity edema, S3 heart sound, and JVD.
Clinical Impression
Concise synthesis of working diagnosis and priorities.
Clinical Impression
Concise synthesis of working diagnosis and priorities.
Clinical Impression
Concise synthesis of working diagnosis and priorities.
# Possible Renal Dysfunction
Patients with ADHF often have concomitant renal dysfunction, which may be pre-existing or acute due to cardiorenal syndrome.
Dx:
Tx:
Adjust medication doses based on renal function
Avoid nephrotic medications
Careful diuresis with close monitoring of renal function
# Possible Renal Dysfunction
Patients with ADHF often have concomitant renal dysfunction, which may be pre-existing or acute due to cardiorenal syndrome.
Dx:
Tx:
Adjust medication doses based on renal function
Avoid nephrotic medications
Careful diuresis with close monitoring of renal function
# Possible Renal Dysfunction
Patients with ADHF often have concomitant renal dysfunction, which may be pre-existing or acute due to cardiorenal syndrome.
Dx:
Tx:
Adjust medication doses based on renal function
Avoid nephrotic medications
Careful diuresis with close monitoring of renal function
Problem Section
Narrative rationale — links key findings.
Dx — recommended diagnostics.
Tx — evidence‑based treatments.
# Coronary Artery Disease
Continue aspirin 81 mg daily
Continue high-intensity statin therapy
Regular follow-up with cardiology
Annual influenza vaccination
Pneumococcal vaccination as per guidelines
M. M. Kittleson, M. S. Maurer et al.
# Coronary Artery Disease
Continue aspirin 81 mg daily
Continue high-intensity statin therapy
Regular follow-up with cardiology
Annual influenza vaccination
Pneumococcal vaccination as per guidelines
M. M. Kittleson, M. S. Maurer et al.
# Coronary Artery Disease
Continue aspirin 81 mg daily
Continue high-intensity statin therapy
Regular follow-up with cardiology
Annual influenza vaccination
Pneumococcal vaccination as per guidelines
M. M. Kittleson, M. S. Maurer et al.
Follow‑Up Plan
Outpatient follow‑ups, education points, and referrals.
Follow‑Up Plan
Outpatient follow‑ups, education points, and referrals.
Follow‑Up Plan
Outpatient follow‑ups, education points, and referrals.
References
Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association.
M. M. Kittleson, M. S. Maurer et al.
Circulation. 2020.
Review
High Impact
Highly Cited
References
Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association.
M. M. Kittleson, M. S. Maurer et al.
Circulation. 2020.
Review
High Impact
Highly Cited
References
Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association.
M. M. Kittleson, M. S. Maurer et al.
Circulation. 2020.
Review
High Impact
Highly Cited
References
Inline numeric citations expand to a reference list.
References
Inline numeric citations expand to a reference list.
References
Inline numeric citations expand to a reference list.
Chart Summarization
Generate AI summaries of EHR data, including notes, history, medications, laboratory data, imaging data, and more.
Clinical Documentation
History & Physical Exam Note
Glass drafts a comprehensive H&P by combining EHR data with ambient dialogue. Only explicitly mentioned details are included—no inferences. If an A&P exists, it is preserved; otherwise, a new one is generated. The draft includes the following sections:
Chief Complaint
History of Present Illness
Past Medical & Surgical History
Medications
Allergies
Family History
Social History
Review of Systems
Vital Signs & Measurements
Physical Examination
Laboratory Data & Imaging
Chronic Problems
History & Physical Exam Note
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History & Physical Exam Note
Chief Complaint: "Winded walking to the mailbox." History of Present Illness: 54-year-old man presents with six weeks of progressively worsening dyspnea on exertion, dry hacking cough, unintended 10-lb weight loss, low-grade fevers to 100.8°F, night sweats, and fatigue. Denies hemoptysis, chest pain, orthopnea, peripheral edema, travel, sick contacts, or toxic exposures. Past Medical History: Hyperlipidemia Surgical History: Cholecystectomy 2015 Family History: Father myocardial infarction at age 67, mother rheumatoid arthritis, no malignancies Social History: 20 pack-year smoker (quit 9 years ago), approximately 2 beers per week, no illicit drugs, accountant, lives with wife, COVID-vaccinated Medications: Atorvastatin 40 mg at bedtime, ibuprofen as needed Exam: Vitals reviewed and notable for: Temperature 99.6°F, heart rate 96, blood pressure 132/74, respiratory rate 20, oxygen saturation 93% on room air General: Thin, mildly dyspneic at rest Head, Eyes, Ears, Nose, and Throat: Atraumatic, oropharynx moist, sclera anicteric Neck: Supple, no jugular venous distention or lymphadenopathy Cardiac: Regular rhythm, no murmurs, rubs, or gallops Pulmonary: Bibasilar fine "Velcro" crackles, no wheezes Abdomen: Soft, non-tender, non-distended, normoactive bowel sounds Genitourinary: No costovertebral angle tenderness, bladder non-palpable Musculoskeletal: Normal gait with full range of motion, no joint swelling Extremities: Warm, pulses 2+ bilaterally, no clubbing, cyanosis, or edema Skin: Warm, dry, intact Neurological: Alert and oriented ×3, strength 5/5 throughout, sensation intact Psychiatric: Cooperative with appropriate mood and affect
History & Physical Exam Note
Edit
History & Physical Exam Note
Chief Complaint: "Winded walking to the mailbox." History of Present Illness: 54-year-old man presents with six weeks of progressively worsening dyspnea on exertion, dry hacking cough, unintended 10-lb weight loss, low-grade fevers to 100.8°F, night sweats, and fatigue. Denies hemoptysis, chest pain, orthopnea, peripheral edema, travel, sick contacts, or toxic exposures. Past Medical History: Hyperlipidemia Surgical History: Cholecystectomy 2015 Family History: Father myocardial infarction at age 67, mother rheumatoid arthritis, no malignancies Social History: 20 pack-year smoker (quit 9 years ago), approximately 2 beers per week, no illicit drugs, accountant, lives with wife, COVID-vaccinated Medications: Atorvastatin 40 mg at bedtime, ibuprofen as needed Exam: Vitals reviewed and notable for: Temperature 99.6°F, heart rate 96, blood pressure 132/74, respiratory rate 20, oxygen saturation 93% on room air General: Thin, mildly dyspneic at rest Head, Eyes, Ears, Nose, and Throat: Atraumatic, oropharynx moist, sclera anicteric Neck: Supple, no jugular venous distention or lymphadenopathy Cardiac: Regular rhythm, no murmurs, rubs, or gallops Pulmonary: Bibasilar fine "Velcro" crackles, no wheezes Abdomen: Soft, non-tender, non-distended, normoactive bowel sounds Genitourinary: No costovertebral angle tenderness, bladder non-palpable Musculoskeletal: Normal gait with full range of motion, no joint swelling Extremities: Warm, pulses 2+ bilaterally, no clubbing, cyanosis, or edema Skin: Warm, dry, intact Neurological: Alert and oriented ×3, strength 5/5 throughout, sensation intact Psychiatric: Cooperative with appropriate mood and affect
History & Physical Exam Note
Edit
History & Physical Exam Note
Chief Complaint: "Winded walking to the mailbox." History of Present Illness: 54-year-old man presents with six weeks of progressively worsening dyspnea on exertion, dry hacking cough, unintended 10-lb weight loss, low-grade fevers to 100.8°F, night sweats, and fatigue. Denies hemoptysis, chest pain, orthopnea, peripheral edema, travel, sick contacts, or toxic exposures. Past Medical History: Hyperlipidemia Surgical History: Cholecystectomy 2015 Family History: Father myocardial infarction at age 67, mother rheumatoid arthritis, no malignancies Social History: 20 pack-year smoker (quit 9 years ago), approximately 2 beers per week, no illicit drugs, accountant, lives with wife, COVID-vaccinated Medications: Atorvastatin 40 mg at bedtime, ibuprofen as needed Exam: Vitals reviewed and notable for: Temperature 99.6°F, heart rate 96, blood pressure 132/74, respiratory rate 20, oxygen saturation 93% on room air General: Thin, mildly dyspneic at rest Head, Eyes, Ears, Nose, and Throat: Atraumatic, oropharynx moist, sclera anicteric Neck: Supple, no jugular venous distention or lymphadenopathy Cardiac: Regular rhythm, no murmurs, rubs, or gallops Pulmonary: Bibasilar fine "Velcro" crackles, no wheezes Abdomen: Soft, non-tender, non-distended, normoactive bowel sounds Genitourinary: No costovertebral angle tenderness, bladder non-palpable Musculoskeletal: Normal gait with full range of motion, no joint swelling Extremities: Warm, pulses 2+ bilaterally, no clubbing, cyanosis, or edema Skin: Warm, dry, intact Neurological: Alert and oriented ×3, strength 5/5 throughout, sensation intact Psychiatric: Cooperative with appropriate mood and affect
Progress Note
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Progress Note
Interval Events/Subjective: Not provided Exam: Vital Signs reviewed and notable for: Afebrile, HR 88, BP 132/78, SpO₂ 94% on 2 L NC General: Alert, no acute distress Head, Eyes, Ears, Nose, and Throat: Not provided Neck: Not provided Cardiac: RRR, no murmurs Pulmonary: Bibasilar fine crackles, no wheezes Abdomen: Soft, NT/ND Genitourinary: Not provided Musculoskeletal: Not provided Extremities: No edema, no clubbing Skin: No rash Neurological: A&O ×3, no focal deficits Psychiatric: Not provided Labs reviewed and notable for: ANA positive (1:160, speckled) Imaging reviewed and notable for: HRCT chest showing basilar-predominant reticulation and ground-glass opacities without discrete mass
Progress Note
Edit
Progress Note
Interval Events/Subjective: Not provided Exam: Vital Signs reviewed and notable for: Afebrile, HR 88, BP 132/78, SpO₂ 94% on 2 L NC General: Alert, no acute distress Head, Eyes, Ears, Nose, and Throat: Not provided Neck: Not provided Cardiac: RRR, no murmurs Pulmonary: Bibasilar fine crackles, no wheezes Abdomen: Soft, NT/ND Genitourinary: Not provided Musculoskeletal: Not provided Extremities: No edema, no clubbing Skin: No rash Neurological: A&O ×3, no focal deficits Psychiatric: Not provided Labs reviewed and notable for: ANA positive (1:160, speckled) Imaging reviewed and notable for: HRCT chest showing basilar-predominant reticulation and ground-glass opacities without discrete mass
Progress Note
Edit
Progress Note
Interval Events/Subjective: Not provided Exam: Vital Signs reviewed and notable for: Afebrile, HR 88, BP 132/78, SpO₂ 94% on 2 L NC General: Alert, no acute distress Head, Eyes, Ears, Nose, and Throat: Not provided Neck: Not provided Cardiac: RRR, no murmurs Pulmonary: Bibasilar fine crackles, no wheezes Abdomen: Soft, NT/ND Genitourinary: Not provided Musculoskeletal: Not provided Extremities: No edema, no clubbing Skin: No rash Neurological: A&O ×3, no focal deficits Psychiatric: Not provided Labs reviewed and notable for: ANA positive (1:160, speckled) Imaging reviewed and notable for: HRCT chest showing basilar-predominant reticulation and ground-glass opacities without discrete mass
Progress Note
Glass drafts a daily progress note that captures interval changes and fills gaps with a “Not provided” placeholder. The draft includes the following elements:
Interval Events / Subjective
Objective
Vital signs & nursing data
Focused physical exam
Laboratory results
Imaging & procedures
Assessment & Plan — Updated or newly drafted as needed.
Discharge Summary
Glass drafts a structured discharge summary that encapsulates the hospitalization and supports a safe transition. The draft includes the following sections:
Header Information — Admission and discharge dates.
Final Diagnoses — Primary and secondary.
Hospital Course
Exam on Discharge
Significant Labs / Imaging
Operations / Procedures
Consultations
Discharge Medications
Required Outpatient Follow‑Up
Disposition
Embedded A&P
Patient‑Facing Documentation
Discharge Instructions
Glass drafts plain‑language instructions summarizing the stay and outlining next steps. The instructions include the following components:
Evidence‑grounded
Hospital Summary Paragraph
Medication Changes — Begin, continue, stop.
Follow‑Up
Warning Signs
Reassuring Closing
Discharge Instructions
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Discharge Instructions
Dear Patient, You were admitted to the hospital with breathing problems and concern for lung disease. While in the hospital, you had CT scans and breathing tests that showed scarring in your lungs (fibrotic interstitial lung disease). A bronchoscopy procedure was done to look for infection or cancer, which came back negative. Your breathing improved with oxygen therapy and learning about pulmonary rehabilitation. On Discharge: BEGIN: Use oxygen 1-2 liters as needed with activity and exertion Continue your home medications as prescribed STOP: No medications were stopped during this admission Continue taking your other medications as before. Follow Up With: ILD (Interstitial Lung Disease) clinic as scheduled Rheumatology clinic as scheduled Outpatient lung biopsy (cryobiopsy) as scheduled Please call your doctor, call 911, or return to the emergency department if you have worsening shortness of breath, chest pain, fever, or any other concerning symptoms. It was a pleasure taking care of you.
Discharge Instructions
Edit
Discharge Instructions
Dear Patient, You were admitted to the hospital with breathing problems and concern for lung disease. While in the hospital, you had CT scans and breathing tests that showed scarring in your lungs (fibrotic interstitial lung disease). A bronchoscopy procedure was done to look for infection or cancer, which came back negative. Your breathing improved with oxygen therapy and learning about pulmonary rehabilitation. On Discharge: BEGIN: Use oxygen 1-2 liters as needed with activity and exertion Continue your home medications as prescribed STOP: No medications were stopped during this admission Continue taking your other medications as before. Follow Up With: ILD (Interstitial Lung Disease) clinic as scheduled Rheumatology clinic as scheduled Outpatient lung biopsy (cryobiopsy) as scheduled Please call your doctor, call 911, or return to the emergency department if you have worsening shortness of breath, chest pain, fever, or any other concerning symptoms. It was a pleasure taking care of you.
Discharge Instructions
Edit
Discharge Instructions
Dear Patient, You were admitted to the hospital with breathing problems and concern for lung disease. While in the hospital, you had CT scans and breathing tests that showed scarring in your lungs (fibrotic interstitial lung disease). A bronchoscopy procedure was done to look for infection or cancer, which came back negative. Your breathing improved with oxygen therapy and learning about pulmonary rehabilitation. On Discharge: BEGIN: Use oxygen 1-2 liters as needed with activity and exertion Continue your home medications as prescribed STOP: No medications were stopped during this admission Continue taking your other medications as before. Follow Up With: ILD (Interstitial Lung Disease) clinic as scheduled Rheumatology clinic as scheduled Outpatient lung biopsy (cryobiopsy) as scheduled Please call your doctor, call 911, or return to the emergency department if you have worsening shortness of breath, chest pain, fever, or any other concerning symptoms. It was a pleasure taking care of you.
Patient Handout
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Patient Handout
Fibrotic Interstitial Lung Disease What Is It? Fibrotic interstitial lung disease (ILD) is a group of conditions that cause inflammation and scarring (fibrosis) in the lung tissue between the air sacs. This scarring makes it harder for oxygen to pass from your lungs into your bloodstream, leading to breathing difficulties. In the US, ILD affects approximately 650,000 people and causes approximately 25,000 to 30,000 deaths per year. Common Signs/Symptoms The most common symptom is shortness of breath during activity (dyspnea on exertion). Approximately 30% of patients with ILD report a dry cough. Other symptoms may include fatigue, unintended weight loss, and reduced ability to exercise. As the disease progresses, you may experience breathlessness even at rest. Causes or Risk Factors Some forms of ILD are associated with environmental or occupational exposures, certain medications, or connective tissue disorders like rheumatoid arthritis or scleroderma. However, many cases have no known cause and are called "idiopathic." Risk factors include older age, with IPF being more common in men than women, and smoking history. Possible Complications A 5% decline in lung function (forced vital capacity) over 12 months is associated with approximately a 2-fold increase in mortality compared with no change. Up to 85% of individuals with end-stage fibrotic ILD develop pulmonary hypertension (high blood pressure in the lungs). Some patients may experience acute worsening episodes that can be life-threatening
Patient Handout
Edit
Patient Handout
Fibrotic Interstitial Lung Disease What Is It? Fibrotic interstitial lung disease (ILD) is a group of conditions that cause inflammation and scarring (fibrosis) in the lung tissue between the air sacs. This scarring makes it harder for oxygen to pass from your lungs into your bloodstream, leading to breathing difficulties. In the US, ILD affects approximately 650,000 people and causes approximately 25,000 to 30,000 deaths per year. Common Signs/Symptoms The most common symptom is shortness of breath during activity (dyspnea on exertion). Approximately 30% of patients with ILD report a dry cough. Other symptoms may include fatigue, unintended weight loss, and reduced ability to exercise. As the disease progresses, you may experience breathlessness even at rest. Causes or Risk Factors Some forms of ILD are associated with environmental or occupational exposures, certain medications, or connective tissue disorders like rheumatoid arthritis or scleroderma. However, many cases have no known cause and are called "idiopathic." Risk factors include older age, with IPF being more common in men than women, and smoking history. Possible Complications A 5% decline in lung function (forced vital capacity) over 12 months is associated with approximately a 2-fold increase in mortality compared with no change. Up to 85% of individuals with end-stage fibrotic ILD develop pulmonary hypertension (high blood pressure in the lungs). Some patients may experience acute worsening episodes that can be life-threatening
Patient Handout
Edit
Patient Handout
Fibrotic Interstitial Lung Disease What Is It? Fibrotic interstitial lung disease (ILD) is a group of conditions that cause inflammation and scarring (fibrosis) in the lung tissue between the air sacs. This scarring makes it harder for oxygen to pass from your lungs into your bloodstream, leading to breathing difficulties. In the US, ILD affects approximately 650,000 people and causes approximately 25,000 to 30,000 deaths per year. Common Signs/Symptoms The most common symptom is shortness of breath during activity (dyspnea on exertion). Approximately 30% of patients with ILD report a dry cough. Other symptoms may include fatigue, unintended weight loss, and reduced ability to exercise. As the disease progresses, you may experience breathlessness even at rest. Causes or Risk Factors Some forms of ILD are associated with environmental or occupational exposures, certain medications, or connective tissue disorders like rheumatoid arthritis or scleroderma. However, many cases have no known cause and are called "idiopathic." Risk factors include older age, with IPF being more common in men than women, and smoking history. Possible Complications A 5% decline in lung function (forced vital capacity) over 12 months is associated with approximately a 2-fold increase in mortality compared with no change. Up to 85% of individuals with end-stage fibrotic ILD develop pulmonary hypertension (high blood pressure in the lungs). Some patients may experience acute worsening episodes that can be life-threatening
Patient Handout
Glass drafts condition‑specific handouts that explain diagnoses and self‑care in accessible language. The handout includes the following sections:
Condition Overview
Signs / Symptoms
Causes / Risk Factors
Complications
Treatment Options
When to Seek Help
Additional Advice / Follow-Up
Disclaimer
Advanced Functionality
Workspace
A unified dashboard for viewing, organizing, and editing all files generated during an encounter; the Workspace offers the following capabilities:
File Tabs — Browse and switch between generated files within a tabbed interface
Inline Editing — Make real‑time changes with tracked modifications.
Version History — Review, compare, and restore prior versions.
DDX
A&P
H&P
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Case Discussion
This 65-year-old woman with diabetes and hyperlipidemia presents with acute chest pain, diaphoresis, and hyperacute T-waves without ST elevation - a constellation highly concerning for acute coronary syndrome. Hyperacute T-waves represent the earliest ECG manifestation of acute coronary occlusion and often precede ST elevation, making this presentation equivalent to STEMI despite the absence of frank ST elevation. Women with diabetes are at particularly high risk for atypical presentations of ACS and may have delayed recognition of symptoms. The combination of traditional cardiovascular risk factors (diabetes, hyperlipidemia, age >65) with acute symptoms and hyperacute T-waves creates a very high pretest probability for acute myocardial infarction requiring emergent intervention.
Most Likely Diagnoses
Acute ST-Elevation Myocardial Infarction (STEMI equivalent): Hyperacute T-waves represent the earliest ECG sign of acute coronary occlusion and often precede frank ST elevation. This patient's presentation with acute chest pain, diaphoresis, and hyperacute T-waves warrants immediate reperfusion therapy despite absence of ST elevation.
Non-ST Elevation Myocardial Infarction (NSTEMI): Women with diabetes commonly present with acute coronary syndromes and may have non-specific symptoms leading to diagnostic delays. The hyperacute T-waves suggest significant coronary ischemia that may represent NSTEMI with impending progression to STEMI.
Expanded Differential
Wellens Syndrome (LAD Stenosis): Hyperacute T-waves can evolve into the characteristic biphasic or deeply inverted T-waves of Wellens syndrome, indicating critical proximal LAD stenosis. This represents a pre-infarction state requiring urgent intervention to prevent extensive anterior wall MI.
Posterior Wall STEMI: ST depression in anterior leads with hyperacute changes may represent posterior wall STEMI, particularly involving the left circumflex artery. Posterior leads (V7-V9) would be needed to confirm this diagnosis.
DDX
A&P
H&P
More…
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Case Discussion
This 65-year-old woman with diabetes and hyperlipidemia presents with acute chest pain, diaphoresis, and hyperacute T-waves without ST elevation - a constellation highly concerning for acute coronary syndrome. Hyperacute T-waves represent the earliest ECG manifestation of acute coronary occlusion and often precede ST elevation, making this presentation equivalent to STEMI despite the absence of frank ST elevation. Women with diabetes are at particularly high risk for atypical presentations of ACS and may have delayed recognition of symptoms. The combination of traditional cardiovascular risk factors (diabetes, hyperlipidemia, age >65) with acute symptoms and hyperacute T-waves creates a very high pretest probability for acute myocardial infarction requiring emergent intervention.
Most Likely Diagnoses
Acute ST-Elevation Myocardial Infarction (STEMI equivalent): Hyperacute T-waves represent the earliest ECG sign of acute coronary occlusion and often precede frank ST elevation. This patient's presentation with acute chest pain, diaphoresis, and hyperacute T-waves warrants immediate reperfusion therapy despite absence of ST elevation.
Non-ST Elevation Myocardial Infarction (NSTEMI): Women with diabetes commonly present with acute coronary syndromes and may have non-specific symptoms leading to diagnostic delays. The hyperacute T-waves suggest significant coronary ischemia that may represent NSTEMI with impending progression to STEMI.
Expanded Differential
Wellens Syndrome (LAD Stenosis): Hyperacute T-waves can evolve into the characteristic biphasic or deeply inverted T-waves of Wellens syndrome, indicating critical proximal LAD stenosis. This represents a pre-infarction state requiring urgent intervention to prevent extensive anterior wall MI.
Posterior Wall STEMI: ST depression in anterior leads with hyperacute changes may represent posterior wall STEMI, particularly involving the left circumflex artery. Posterior leads (V7-V9) would be needed to confirm this diagnosis.
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Edit
Case Discussion
This 65-year-old woman with diabetes and hyperlipidemia presents with acute chest pain, diaphoresis, and hyperacute T-waves without ST elevation - a constellation highly concerning for acute coronary syndrome. Hyperacute T-waves represent the earliest ECG manifestation of acute coronary occlusion and often precede ST elevation, making this presentation equivalent to STEMI despite the absence of frank ST elevation. Women with diabetes are at particularly high risk for atypical presentations of ACS and may have delayed recognition of symptoms. The combination of traditional cardiovascular risk factors (diabetes, hyperlipidemia, age >65) with acute symptoms and hyperacute T-waves creates a very high pretest probability for acute myocardial infarction requiring emergent intervention.
Most Likely Diagnoses
Acute ST-Elevation Myocardial Infarction (STEMI equivalent): Hyperacute T-waves represent the earliest ECG sign of acute coronary occlusion and often precede frank ST elevation. This patient's presentation with acute chest pain, diaphoresis, and hyperacute T-waves warrants immediate reperfusion therapy despite absence of ST elevation.
Non-ST Elevation Myocardial Infarction (NSTEMI): Women with diabetes commonly present with acute coronary syndromes and may have non-specific symptoms leading to diagnostic delays. The hyperacute T-waves suggest significant coronary ischemia that may represent NSTEMI with impending progression to STEMI.
Expanded Differential
Wellens Syndrome (LAD Stenosis): Hyperacute T-waves can evolve into the characteristic biphasic or deeply inverted T-waves of Wellens syndrome, indicating critical proximal LAD stenosis. This represents a pre-infarction state requiring urgent intervention to prevent extensive anterior wall MI.
Posterior Wall STEMI: ST depression in anterior leads with hyperacute changes may represent posterior wall STEMI, particularly involving the left circumflex artery. Posterior leads (V7-V9) would be needed to confirm this diagnosis.
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2025 Glass Health. All rights reserved.