Keel

Floviken
Keel
Worklist
Scrooge, Ebenezer

Scrooge, Ebenezer [TEST]

MRN7892135

71 M

DOB21-Mar-1955

CodeFull

AllergiesNKDA

AttendingDr. Bergström

AdmitMay 19

LocMed · 7 ICU-SD · 712

AI activity for this patient.

Margin

Radiology incidental findings agent

Reviews radiology reports for incidental findings not on the active problem list. Findings are surfaced as structured proposals for clinician verification, which become entries on the problem list when verified.

Reviewed 1 imaging study. 1 verified, 6 pending review.

Margin · CT Abdomen/Pelvis with contrast · 2026-05-19

Incidental 8 mm solid pulmonary nodule in the medial right lower lobe with smooth borders

From the report:

8 mm solid pulmonary nodule in the right lower lobe. Recommend follow-up per Fleischner Society guidelines

Suggested problem: Incidental solitary pulmonary nodule, right lower lobe (R91.1)

Suggested code, verify before adding.

Radiologist recommendation: Recommend follow-up per Fleischner Society guidelines (dedicated chest CT at 6-12 months given intermediate risk)

Margin · CT Abdomen/Pelvis with contrast · 2026-05-19

Indeterminate 1.4 cm hypodensity in hepatic segment VII, too small to fully characterize

Reduced extraction confidence — radiologist used tentative language.

From the report:

1.4 cm hepatic hypodensity, indeterminate. Recommend dedicated abdominal MRI or contrast-enhanced ultrasound for further characterization.

Hedging language:

too small to fully characterize on this study

Suggested problem: Indeterminate hepatic lesion, requires further characterization (R93.2)

Suggested code, verify before adding.

Radiologist recommendation: Recommend dedicated abdominal MRI or contrast-enhanced ultrasound for further characterization

Margin · CT Abdomen/Pelvis with contrast · 2026-05-19

1.8 cm right adrenal lesion, ~15 HU, most likely lipid-poor adenoma

Reduced extraction confidence — radiologist used tentative language.

From the report:

1.8 cm right adrenal lesion, most likely adenoma. Dedicated adrenal protocol CT can confirm if clinically warranted.

Hedging language:

most likely representing a lipid-poor adenoma

Suggested problem: Incidental right adrenal nodule, likely adenoma (D35.00)

Suggested code, verify before adding.

Radiologist recommendation: Dedicated adrenal protocol CT can confirm if clinically warranted

Margin · CT Abdomen/Pelvis with contrast · 2026-05-19

Small bilateral pleural effusions, right greater than left

From the report:

Small bilateral pleural effusions, right greater than left.

Suggested problem: Small bilateral pleural effusions (J90)

Suggested code, verify before adding.

Margin · CT Abdomen/Pelvis with contrast · 2026-05-19

Atherosclerotic calcification of the abdominal aorta, no aneurysm

From the report:

Atherosclerotic calcification of the abdominal aorta without aneurysm.

Suggested problem: Atherosclerosis of aorta (I70.0)

Suggested code, verify before adding.

Margin · CT Abdomen/Pelvis with contrast · 2026-05-19

Multilevel degenerative changes of the lumbar spine

From the report:

Multilevel degenerative change of the lumbar spine.

Suggested problem: Lumbar spondylosis (M47.816)

Suggested code, verify before adding.

Audit log

May 22, 2026 20:29 UTC · Margin reviewed CT Abdomen/Pelvis with contrast from May 19, 2026. 6 findings proposed.

Lowfire

Neutropenic-fever empiric coverage agent

Deterministic IDSA / ASCO empiric coverage. When an ANC below 500 pairs with a temperature at or above 38.3 °C, the agent proposes a class-level antibiotic bundle for the clinician to sign or override. The algorithm is the source of truth; Claude only voices the recommendation.

Triggered. Bundle proposed for sign / override.

Lowfire · Neutropenic Fever · 2026-06-12

ANC 200, T 38.6°C — neutropenic fever criteria met.

ANC: 200 cells/µL
Temperature: 38.6 °C
Systolic BP: 146 mmHg
Hemodynamically stable: yes
MDR history: none
Indwelling catheter / line: no

Antibiotics

β-lactam-1 · IV · X g every Y hours

Cultures

Blood cultures × 2 — two separate peripheral sites
Urinalysis with culture

Ancillary

CBC with differential — repeat in 6 hours
Comprehensive metabolic panel
Lactate

Nursing

Vital signs every 1 hour × 4 hours, then every 4 hours
Reverse isolation precautions — neutropenic patient

Pharmacy

Verify renal dosing on empiric antibiotics

Decisions

Trigger met: ANC 200 cells/mm³ (<500) and temperature 38.6°C (single ≥38.3°C).
Risk stratification: high-risk inpatient IV pathway (v1 default for the simplified algorithm).
Empiric antipseudomonal β-lactam-1 monotherapy with β-lactam-1.

Out of scope

Local antibiogram and unit-specific resistance patterns are not in the algorithm; consider when finalizing coverage.
Pediatric dosing is not covered by this algorithm (adults only).
MASCC scoring and full risk-stratification beyond hemodynamic stability are not implemented in v1.

Second opinion

Simulated colleague voice; class-level antibiotic names only. No real drug names are sent to the model.

Sign writes class-level antibiotics + "Neutropenic fever" problem. Override writes nothing.