{"reference":"Hi.\n\n Hello.\n\n Hi, hi I'm Maria.\n\n Hello, I'm Doctor Jacob and welcome to Babylon.\n\n How are you doing?\n\n I'm all right, thank you. Well I feel a little weird today, to be honest.\n\n Yeah, so just before we we start, is it all right if you could confirm your full name for me please?\n\n Yes. Maria Trabalotsa.\n\n OK, day and your date of birth?\n\n That is the first of October, ninety-nine.\n\n OK, and your email address for me please?\n\n Yes, M Traba at Gmail dot com.\n\n OK, and just to confirm that you're in a secure location and we can have a confidential conversation?\n\n Yes I think I am, yeah.\n\n Good, right, you've mentioned in in, in your patient notes that you're having some sort of lip swelling, and you after you had a sandwich. Is that correct?\n\n Yeah that is, well, I don't think, I don't think it was, it it wasn't a sandwich but it was, it was something with prawn so.\n\n Basically, I, I sometimes go with my friends to, to this place called .\n\n And, we, we regularly have like usually I have like a normal vegetarian soup or something.\n\n Mm-hmm.\n\n And yeah, and, then I wanted to try something new.\n\n Mm-hmm.\n\n Um, so what happened was, I, I ordered a prawn soup it it's it it's called laksa, it's like a soup, I ordered a prawn one this time.\n\n Yeah.\n\n And, yeah and then my feel like my lips started feeling a little weird just in the in the corner sort of on the left first.\n\n Mm-hmm.\n\n And then, I don't know and then, we went back we had little bit of chat, of banter I wasn't really, paying attention.\n\n Uh, now I feel the that there is a swelling, there is like a swelling on my, on my upper lip and it's kind of getting bigger. I don't know what to do.\n\n Yeah.\n\n Right.\n\n All right. So when did you have the prawn soup? What time?\n\n That was, that must have been just after work, so maybe like around seven.\n\n OK, around seven o'clock, and um how long did it take to develop the swelling?\n\n Well I wasn't really paying attention so, it must have been like, must have been like, I don't know half an hour maybe.\n\n OK in half an hour you developed the swelling yeah?\n\n Yeah.\n\n OK, and it's getting bigger and bigger?\n\n Yeah it's it it still feel it like, really pumping blood and it's kinda getting bigger it feels like it's getting worse.\n\n OK. So, just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up, any feeling like that?\n\n Yeah actually, I, I feel like I can't breathe that well right now.\n\n OK.\n\n And do you feel like, like your chest is tight?\n\n And I don't know if it's the chest it just generally feels a little difficult, but yeah it might be, I'm not sure.\n\n OK.\n\n OK, right.\n\n And just a few have you ever these any kind of lip swelling in the past? After eating any food?\n\n Yeah, well, maybe, I remember like a year ago.\n\n A year ago I was, out with my friends.\n\n Mm-hmm.\n\n And I think we went like, to a late night kinda Chinese place, and I remember that I was quite drunk to be honest.\n\n Sure, OK.\n\n And I remember that after like having that very late.\n\n I've woke up the next morning quite swollen up and had also I, felt really bad and quite difficult breathing, but I don't know what it was I had it was like a curry or something I think.\n\n OK.\n\n Right.\n\n OK. Uh, and what did you take at that time? Did you use anything like antihistamine or anything, when you had that last time?\n\n But I generally have asthma so, I took I, I take, ohh what's it called? Salbutamol inhalers?\n\n Yeah.\n\n Yeah, so I do take that regularly but I've always taken it. I generally have asthma.\n\n And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n\n Ohh I, no I don't think so, no.\n\n OK right and um so, do you use antihistamines like Cetirizine, Loratadine, Piriton, any of those, kind of things?\n\n Hmm, no. I, I got no I do sometimes but I don't know which ones, but I have a peanut allergy as well, like always had it.\n\n Yeah.\n\n Yeah.\n\n I, think I do get antihistamines for that but I'm not sure which ones.\n\n And any point because you had peanut allergy, any time you have to ever use like an injection?\n\n When I was a kid I think I remember my mom told me about it, but I don't know what it was 'cause I was small and I've changed doctors since.\n\n Right, so has your mum ever said that you had to go to hospital because you had an severe allergic reaction?\n\n Yeah is that well I was like six or something I, I, I think. Ohh sorry, the swelling is getting, ohh my god ohh, yeah I think when I was six.\n\n Oh.\n\n You all right? Are you OK now?\n\n Ohh, I feel a little dizzy right now to be honest, ohh.\n\n Are you .\n\n You're feeling dizzy. OK, right do you have any kind of, uh, antihistamines with you at the moment?\n\n No, I don't think I have no.\n\n OK, right OK, so.\n\n Right, uh, all right I, I'm really a bit worried about you at the moment, Maria. Um I think we need to call an ambulance, because, um, from what history you've been telling me. It sounds like you could be going into what we say an a, an anaphylactic reaction. That's when your throat and your chest, you know closes in and you might need an injection like what your mum's.\n\n Um, you know what your mum told you as you were a young child. OK, all right so is there any, anyone with you at the moment or are you alone?\n\n I'm alone at the moment, yeah.\n\n Ohh no so hang on the line, while I'll call the ambulance OK, and I'll send them right to you, OK and .\n\n Hey ohh somebody just came, somebody just came yes, I'm not alone any more. Thank.\n\n All right, OK somebody just came. So just call the ambulance make sure that person's with you till the ambulance comes, yeah. Uh and because we are worried about an anaphylactic reaction so you need go straight away. Could you ask the person whether they have any antihistamines around, in the interim, while we're waiting.\n\n Yes, uh Mum, Mum do we have any antihistamines around? Yes.\n\n Yes K. Do that straight away and if mum can call. Mum, if you can call the uh nine nine , nine nine nine yeah, and say that your there is a suspected anaphylactic reaction and they need to come straight away. OK.\n\n Ohh yeah yeah we do .\n\n Yes she said she will yes, yes.\n\n All right, so straight away take the antihistamines in the meantime all right.\n\n OK, OK. Yes, thank .\n\n And after you come out from the hospital do give us a ring back we might need to sort you out, um, with your injections and things like that OK?\n\n Yes, yes will do, yes, thank .\n\n All .\n\n OK then, take care.\n\n Thank you very much thank bye bye.\n\n Bye bye, bye.","products":{"hanah":[{"label":"Run 1","wer":14.37648927720413,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you.\n\n  I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza.\n\n  Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please?\n\n  Yes.\n\n  mtraba@gmail.com.\n\n  Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think— I don't think it was— it wasn't a sandwich, but it was— it was something with prawns. So basically, I— I sometimes go with my friends to— to this place called Fat Fat, and we— we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hmm.\n\n  Um, so what happened was I— I ordered a prawn soup. It's— it's— it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— like, my lips started feeling a little weird, just in the— in the corner sort of on the left first.\n\n  Mm-hmm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. It wasn't really paying attention.\n\n  Mm-hmm.\n\n  Uh, now I feel the— that there is a swelling.\n\n  Yeah.\n\n  There is, like, a swelling on my— on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7:00.\n\n  Okay. Around 7 o'clock. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know, half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— it's— it's— I still feel it, like, really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in— in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I— I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like— like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell— I— I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, piritin, any of those kind of things?\n\n  Um, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah, exactly. Well, I was like 6 or something. I— I— I think, oh, sorry, the swelling is getting—\n\n  Okay.\n\n  Oh, okay. Oh, yeah, I think when I was—\n\n  All right. Are you okay now?\n\n  Uh, yeah, I'm busy right now, to be honest.\n\n  You feel busy? Okay.\n\n  Yeah.\n\n  Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  No, I don't think I have. No.\n\n  Okay. Right. Okay. So right. Oh, all right. I— I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction.\n\n  Mm-hmm.\n\n  That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child.\n\n  Mm-hmm.\n\n  Okay. Right. So is there any— anyone with you at the moment, or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Oh, no. So hang on the line while I call the ambulance, okay? And I'll send them right to you.\n\n  Okay.\n\n  Okay? And I'll probably just— somebody just came, yes. I'm not alone anymore.\n\n  All right.\n\n  Thank you. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes, yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes.\n\n  Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the, uh, 9999, yeah?\n\n  Mm-hmm.\n\n  And say that you're— there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she says she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And ask if you come up from the hospital. Do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Yes. Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye.\n\n  Bye-bye.","marks":[[17,20,"",false],[308,327,"Trabalotsa. OK day",false],[367,370,"first",false],[382,395,"ninety-nine. OK",true],[446,472,"M Traba at Gmail dot com. OK",false],[864,871,"prawn",false],[945,952,".",false],[1046,1046,"Mm-hmm.",false],[1170,1174,"it",false],[1251,1255,"Yeah.",false],[1286,1293,"",false],[1534,1541,"",false],[1847,1859,"OK",false],[2186,2199,"it it",false],[2252,2259,"kinda",false],[2675,2679,"it",false],[2819,2822,"",false],[2871,2874,"",true],[3037,3055,"late night kinda",false],[3197,3198,"I've",false],[3581,3585,"took",false],[3598,3600,"ohh",false],[3835,3837,"Ohh I",false],[3948,3955,"Piriton",false],[3997,4001,"I I got",false],[4106,4110,"",false],[4239,4245,"you",false],[4279,4282,"have",false],[4408,4415,"'cause",false],[4433,4434,"I've",false],[4477,4480,"mum",false],[4575,4583,"is that",false],[4632,4634,"Ohh",false],[4671,4692,"ohh my god ohh",false],[4718,4718,"six. 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OK",false],[6794,6802,"thank",false],[6822,6830,"Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Prawn laksa consumed at ~19:00\"; food correctly identified as a prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"lip symptoms began within ~30 min.\""],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressive upper-lip swelling; feels increasingly enlarged.\""],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing; unsure if chest tightness.\""],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned anywhere in the note."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode ~1 yr ago after late Chinese meal/curry: woke swollen... had breathing difficulty.\""],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"PMH asthma; uses salbutamol inhaler regularly.\""],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"hospital attendance/injection for severe allergic reaction at ~6 yrs.\""],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"; \"require emergency assessment.\""],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Advised emergency ambulance attendance urgently for suspected anaphylaxis.\""],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","\"mother arrived during call\"; mother instructed to call and remain with pt."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised pt to take available antihistamine immediately while awaiting ambulance.\""],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Advised pt to contact service after hospital attendance; may need review regarding emergency injections.\""]],"claims":[],"note":"Subjective\nPrawn laksa consumed at ~19:00; lip symptoms began within ~30 min.\nInitial abnormal sensation at left lip corner → progressive upper-lip swelling; feels increasingly enlarged with “pumping” sensation.\nReports difficulty breathing; unsure if chest tightness.\nSimilar episode ~1 yr ago after late Chinese meal/curry: woke swollen, felt unwell and had breathing difficulty; trigger unclear.\nPMH asthma; uses salbutamol inhaler regularly. No other inhaler reported.\nKnown peanut allergy; intermittently uses unspecified antihistamines.\nRecalls mother reporting hospital attendance/injection for severe allergic reaction at ~6 yrs.\nInitially alone; mother arrived during call. No antihistamines immediately available on patient, but mother reported antihistamines at home.\nObjective\nNo objective examination findings documented during remote consultation.\nAssessment\nSuspected anaphylactic reaction, given likely food trigger (prawns), progressive lip swelling and reported breathing difficulty, with background of peanut allergy, asthma and previous possible severe allergic reactions.\nEscalating upper-lip swelling and respiratory symptoms require emergency assessment.\nPlan\nAdvised emergency ambulance attendance urgently for suspected anaphylaxis.\nMother instructed to call 9999, state suspected anaphylactic reaction and request urgent ambulance.\nAdvised mother remain with pt until ambulance arrival.\nAdvised pt to take available antihistamine immediately while awaiting ambulance.\nAdvised pt to contact service after hospital attendance; may need review regarding emergency injections.","review":79.05263157894737,"saved":200.44736842105263,"clean":false,"effort":7.6923076923076925,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during a suspected anaphylaxis suggests circulatory compromise, a key severity feature; omitted entirely."]]},{"label":"Run 2","wer":14.535345512311359,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you. I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza. Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please?\n\n  Yes.\n\n  mtraba@gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think— I don't think it was— it wasn't a sandwich, but it was— it was something with prawns. So basically, I— I sometimes go with my friends to— to this place called Fat Fat, and we— we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hmm.\n\n  Um, so what happened was I— I ordered a prawn soup. It's— it's— it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— like, my lips started feeling a little weird just in a— in a corner sort of on the left first.\n\n  Mm-hmm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. It wasn't really paying attention, uh, now I feel the— that there is a swelling.\n\n  Yeah.\n\n  There is, like, a swelling on my— on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7:00.\n\n  Okay. Around 7 o'clock. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know, half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— it's— I still feel it, like, really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in— in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I— I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like— like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell— I— I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, piritin, any of those kind of things?\n\n  Um, no. Well, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah, exactly. Well, I was like 6 or something. I— I— I think, oh, sorry, the swelling is getting—\n\n  Okay.\n\n  Oh, my God. Oh, yeah, I think when I was—\n\n  All right. Are you okay now?\n\n  Uh, yeah, I'm busy right now, to be honest.\n\n  You feel busy? Okay.\n\n  Yeah.\n\n  Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  No, I don't think I have. No.\n\n  Okay. Right. Okay. So right. Oh, all right. I— I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction.\n\n  Mm-hmm.\n\n  That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child.\n\n  Mm-hmm.\n\n  Okay. Right. So is there any— anyone with you at the moment, or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Um, so hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay?\n\n  Mm-hmm.\n\n  And I'll probably just— somebody just came, yes. I'm not alone anymore.\n\n  All right.\n\n  Oh, okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes, yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes.\n\n  Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the, uh, 99999, yeah?\n\n  Mm-hmm.\n\n  And say that you're— there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And ask if you come up from the hospital. Do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Mm-hmm. Yes. Yes. Will do. Yes.\n\n  Okay.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye-bye.\n\n  Bye-bye.","marks":[[17,20,"",false],[305,321,"Trabalotsa. OK day",false],[361,364,"first",false],[376,389,"ninety-nine. OK",true],[440,463,"M Traba at Gmail dot com. 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OK",false],[6760,6768,"thank",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after eating prawn laksa\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"onset approx. 30 min post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling \"reportedly enlarging\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing; unsure whether chest tightness present\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode ~1 year ago after ... Chinese meal/curry\" with swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"PMH: asthma; uses salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Known peanut allergy ...; hospital attendance for severe allergic reaction at ~6 years old\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Advised urgent ambulance attendance\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother arrived, asked to call emergency services and stay with patient."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact service after hospital attendance regarding need for emergency allergy injections\"."]],"claims":[],"note":"Subjective\nReports upper lip swelling after eating prawn laksa at ~19:00.\nLip symptoms began at left corner of mouth, onset approx. 30 min post-ingestion; swelling reportedly enlarging.\nReports difficulty breathing; unsure whether chest tightness present.\nSimilar episode ~1 year ago after eating an unspecified late-night Chinese meal/curry: woke with swelling, felt unwell and had difficulty breathing.\nPMH: asthma; uses salbutamol inhaler regularly. No other inhaler reported.\nKnown peanut allergy since childhood; reports hospital attendance for severe allergic reaction at ~6 years old, per mother.\nUnsure which antihistamines previously used for peanut allergy; no antihistamine initially available.\nInitially alone; mother arrived during call and confirmed antihistamines available.\nObjective\nNo physical examination or observations documented.\nPatient reported progressive upper-lip swelling and breathing difficulty during consultation.\nAssessment\nSuspected anaphylactic reaction following prawn ingestion.\nProgressive lip swelling with reported respiratory difficulty shortly after likely food exposure, with background of peanut allergy, prior severe allergic reaction and asthma, raises concern for anaphylaxis.\nPlan\nAdvised urgent ambulance attendance/emergency assessment.\nMother asked to call emergency services and state suspected anaphylactic reaction.\nAdvised to take available antihistamine while awaiting ambulance.\nAdvised not to remain alone; mother to stay with patient until ambulance arrival.\nAdvised to contact service after hospital attendance regarding need for emergency allergy injections.","review":81.57894736842105,"saved":197.92105263157896,"clean":false,"effort":7.6923076923076925,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis signals possible circulatory involvement; omitting it understates severity."]],"mb":10.2996,"latency":14.452,"signable":96.03094736842105},{"label":"Run 3","wer":13.97934868943606,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Rania.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you. I feel a little weird today, to be honest.\n\n  Yeah. So, just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza. Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please.\n\n  Yes.\n\n  mtraba@gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think— I don't think it was. It wasn't a sandwich, but it was— it was something with prawns. So basically, I— I sometimes go with my friends to— to this place called Fat Fat, and we— we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hmm.\n\n  Um, so what happened was I— I ordered a prawn soup. It's— it's— it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— like, my lips started feeling a little weird just in the— in the corners sort of on the left first.\n\n  Mm-hmm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. It wasn't really paying attention. Uh, now I feel the— that there is a swelling.\n\n  Yeah.\n\n  There is like a swelling on my— on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7:00.\n\n  Okay. Around 7:00. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know, half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— it's— I still feel it like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in— in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I— I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like— like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell— I— I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, Piriton, any of those kind of things?\n\n  Um, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah. When I was like 6 or something, I— I— I think, oh, sorry, the swelling is getting—\n\n  Okay.\n\n  Oh, I know. Oh, yeah, I think when I was—\n\n  You're right. Are you okay now?\n\n  Uh, I'm a little dizzy right now, to be honest.\n\n  Do you feel dizzy? Okay.\n\n  Yeah.\n\n  Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  Um, no, I don't think I have. No.\n\n  Okay. Right. Okay. So right. Oh, all right. I— I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in. And you might need an injection, like what your mom's— you know, what your mom told you as you were a young child.\n\n  Yeah.\n\n  Okay. Right. So is there any— anyone with you at the moment? Or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Um, so hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay? And if anybody just came— somebody just came, yes. I'm not alone anymore.\n\n  All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Yeah.\n\n  While we're waiting.\n\n  Yes. Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Get that straight away. And if mom can call, mom, if you can call the 9999, yeah?\n\n  Okay.\n\n  And say that you're— there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes.\n\n  Yes. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And if you come up from the hospital, do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Yes. Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye.\n\n  Bye-bye.","marks":[[31,33,"",false],[39,45,"Maria.",true],[306,322,"Trabalotsa. OK day",false],[362,365,"first",false],[377,390,"ninety-nine. OK",true],[441,464,"M Traba at Gmail dot com. 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Ohh no",false],[5526,5527,"I'll",false],[5597,5607,". Hey ohh somebody",false],[5658,5666,"any more. Thank.",false],[6026,6034,"Mum Mum",false],[6093,6105,"K.",false],[6113,6116,"",false],[6144,6147,"mum",false],[6158,6161,"Mum",false],[6183,6187,"uh nine nine nine nine nine",false],[6220,6226,"your",false],[6308,6312,"OK. Ohh yeah yeah we do .",false],[6353,6353,"All right",false],[6426,6437,"OK OK. Yes thank .",false],[6445,6447,"after",false],[6457,6459,"out",false],[6621,6631,"",false],[6641,6653,". All . OK",false],[6698,6706,"thank",false],[6726,6734,"Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after prawn laksa\" (prawn soup)."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"onset ~30 min post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressing to enlarging upper-lip swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports dyspnoea, possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"Reports dyspnoea, possible chest tightness, dizziness\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode ~1 year ago after late-night Chinese meal/curry\" with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"PMH: asthma; uses salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Known peanut allergy and \"childhood severe allergic reaction requiring injection/hospital attendance\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction following prawn ingestion\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Advised urgent ambulance attendance/emergency assessment\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother arrived, instructed to call emergency services and remain with pt."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised pt to take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact service after hospital assessment to discuss provision of injections\"."]],"claims":[],"note":"Subjective\nReports upper lip swelling after prawn laksa at ~19:00; onset ~30 min post-ingestion.\nInitial abnormal sensation at L lip corner, progressing to enlarging upper-lip swelling.\nReports dyspnoea, possible chest tightness, dizziness and worsening swelling.\nSimilar episode ~1 year ago after late-night Chinese meal/curry: woke with swelling, felt unwell and had difficulty breathing.\nPMH: asthma; uses salbutamol inhaler regularly. No other inhaler reported.\nKnown peanut allergy; intermittently uses antihistamines, type unknown.\nReports possible childhood severe allergic reaction requiring injection/hospital attendance; details unclear.\nInitially alone; mother arrived during call. No antihistamines initially available, then mother confirmed availability.\nObjective\nNo physical examination or observations documented.\nDuring consultation, pt reported progressive lip swelling, dyspnoea and dizziness.\nAssessment\nSuspected anaphylactic reaction following prawn ingestion.\nProgressive lip swelling with reported breathing difficulty, possible chest tightness and dizziness, in context of food allergy history and prior similar reaction, raises concern for airway/respiratory involvement.\nPlan\nAdvised urgent ambulance attendance/emergency assessment.\nMother instructed to call emergency services and report suspected anaphylactic reaction.\nAdvised pt to take available antihistamine while awaiting ambulance.\nAdvised mother to remain with pt until ambulance arrival.\nAdvised to contact service after hospital assessment to discuss provision of injections if required.","review":64.42105263157895,"saved":215.07894736842104,"clean":true,"effort":0.0,"sig":[],"mb":10.299203,"latency":15.534,"signable":79.95505263157895},{"label":"Run 4","wer":15.409054805401112,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon.\n\n  Mm-hm.\n\n  How are you doing?\n\n  I'm all right, thank you.\n\n  I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza.\n\n  Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please?\n\n  Yes.\n\n  mtraba@gmail.com.\n\n  Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is—well, I don't think—I don't think it was—it wasn't a sandwich, but it was—it was something with prawns. So basically, I—I sometimes go with my friends to—to this place called Fat Pub, and we—we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hm.\n\n  Um, so what happened was I—I ordered a prawn soup. It's—it's—it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel start—like, my lips start feeling a little weird, just in the—in the corner sort of on the left first.\n\n  Mm-hm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. I wasn't really paying attention.\n\n  Mm-hm.\n\n  Uh, now I feel the—that there is a swelling.\n\n  Yeah.\n\n  There is, like, a swelling on my—on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was—that must have been just after work, so maybe, like, around 7:00.\n\n  Okay. Around 7 o'clock. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe.\n\n  Okay. In half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's—it's—it's—I still feel it, like, really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions.\n\n  Mm-hm.\n\n  Um, so you mentioned about you swelling of your lips. Is there any feeling of swelling in—in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I—I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like—like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few—have you ever had these—any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell—I—I take—uh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, Piriton, any of those kind of things?\n\n  Mm, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point because you've had peanut allergy, any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah, exactly. Well, I was, like, six or something. I—I—I think after I had swelling is getting—ugh, ugh. Yeah, I think when I was.\n\n  All right. Are you okay now?\n\n  Uh, yeah, I'm busy right now, to be honest.\n\n  You feel busy? Okay. Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  Mm, no, I don't think I have. No.\n\n  Okay. Right. Okay. So.\n\n  Inhaler.\n\n  Right. Oh, all right. I—I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction.\n\n  Mm-hm.\n\n  That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child.\n\n  Mm-hm.\n\n  Okay. Right. So is there any—anyone with you at the moment, or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Um, so hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay? And I'll.\n\n  Okay.\n\n  Tell them what you just said. Somebody just came, yes. I'm not alone anymore.\n\n  All right.\n\n  Um, okay, somebody just came. So just call the am-ambulance. Make sure that person's with you till the ambulance comes, yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes.\n\n  Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the, uh, 99999, yeah?\n\n  Mm-hm.\n\n  And say that you're there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And if you come up from the hospital, do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Yes. Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then.\n\n  Okay.\n\n  Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye.\n\n  Bye-bye.","marks":[[91,97,"",false],[314,333,"Trabalotsa. OK day",false],[373,376,"first",false],[388,401,"ninety-nine. OK",true],[452,478,"M Traba at Gmail dot com. 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OK",false],[6780,6788,"thank",false],[6808,6816,"Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","partial","Prawn exposure captured, but named 'prawn laksa' where the transcript's dish name is unintelligible."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'progressive upper-lip swelling within ~30 min'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'swelling continuing to enlarge'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports difficulty breathing; unsure if chest tightness present.'"],["The note captures: Patient becomes dizzy during the consultation.","no","The patient's dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode ~1 year ago after Chinese food with swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'asthma; uses salbutamol inhaler'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Longstanding peanut allergy and possible childhood severe reaction requiring hospital/injection."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction'; emergency ambulance advised."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Advised emergency ambulance attendance urgently'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Remain with mother; 'Mother advised to contact emergency services'."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised immediate antihistamine use while awaiting ambulance'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'contact service after discharge regarding possible injection provision'."]],"claims":[],"note":"Subjective\nAfter prawn laksa at ~19:00, developed abnormal sensation at L lip corner followed by progressive upper-lip swelling within ~30 min.\nReports swelling continuing to enlarge; describes pulsating sensation.\nReports difficulty breathing; unsure if chest tightness present.\nSimilar episode ~1 year ago after eating an unspecified curry/Chinese food: woke with swelling, felt unwell and had breathing difficulty.\nPMH: asthma; uses salbutamol inhaler. Reports longstanding peanut allergy.\nReports possible childhood severe allergic reaction requiring hospital attendance/injection; details unclear.\nNo antihistamine initially available. Mother subsequently present and confirmed antihistamine available.\nObjective\nRemote consultation; no physical examination or vital signs documented.\nAssessment\nSuspected anaphylactic reaction following prawn-containing food, based on rapid-onset progressive lip swelling with reported dyspnoea after ingestion.\nIncreased concern given reported previous food-associated swelling/breathing difficulty, peanut allergy and asthma.\nPlan\nAdvised emergency ambulance attendance urgently for suspected anaphylaxis.\nAdvised patient remain with accompanying person/mother while awaiting ambulance.\nMother advised to contact emergency services and report suspected anaphylactic reaction.\nAdvised immediate antihistamine use while awaiting ambulance, if available.\nAdvised hospital assessment; patient to contact service after discharge regarding possible injection provision.","review":85.86842105263158,"saved":193.63157894736844,"clean":false,"effort":11.538461538461538,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call, a sign of systemic/cardiovascular involvement in anaphylaxis, is omitted."]],"mb":10.359148,"latency":23.48,"signable":109.34842105263158},{"label":"Run 5","wer":17.156473391580622,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you. I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza. Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please.\n\n  Yes.\n\n  mtraba@gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have— usually I have a normal vegetarian soup or something, and yeah, and then I wanted to try something new. So what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know, and then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention. Now I feel that there is a swelling.\n\n  Yeah.\n\n  There is like a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7.\n\n  Okay. Around 7 o'clock. And how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know— half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— you still feel it like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember like a year ago— a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went like to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after like having that very late I woke up the next morning quite swollen up and had also like—\n\n  Okay.\n\n  —felt really bad, and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Oh, no, I don't think so. No.\n\n  Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Piriton, any of those kind of things?\n\n  No. Well, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah. Well, I was like 6 or something. I think after I had swelling is getting— oh, yeah, I think when I was—\n\n  All right. Are you okay now?\n\n  I feel a little dizzy right now, to be honest.\n\n  You feel dizzy. Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\n  No. I don't think I have.\n\n  Okay. Right. Okay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's— what your mom told you as you were a young child. Right? So is there anyone with you at the moment? Or are you alone?\n\n  I'm alone at the moment.\n\n  Okay. So hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay?\n\n  Okay.\n\n  And if somebody just came— somebody just came, yes. I'm not alone anymore.\n\n  Okay.\n\n  All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes.\n\n  Okay.\n\n  Yeah? And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes. Mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\n\n  Okay.\n\n  And say that there is a suspected anaphylactic reaction, and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And ask if you come up from the hospital— do you give us a ring back? We might need to sort you out with your injections and things like that.\n\n  Okay.\n\n  Okay?\n\n  Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye-bye.\n\n  Bye-bye.","marks":[[17,20,"",false],[305,321,"Trabalotsa. OK day",false],[361,364,"first",false],[376,389,"ninety-nine. OK",true],[440,463,"M Traba at Gmail dot com. 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Um you know",false],[5044,5047,"mum",false],[5083,5083,"OK all",false],[5102,5102,"any",false],[5183,5188,"yeah. Ohh no",false],[5215,5216,"I'll",false],[5298,5300,". Hey ohh",false],[5360,5377,"any more. Thank.",false],[5741,5749,"uh Mum Mum",false],[5808,5820,"K.",false],[5858,5861,"mum",false],[5872,5875,"Mum",false],[5897,5901,"uh nine nine nine nine nine",false],[5933,5933,"your",false],[6015,6019,"OK. Ohh yeah yeah we do .",false],[6057,6057,"All",false],[6140,6151,"OK OK. Yes thank .",false],[6159,6165,"after",false],[6175,6177,"out",false],[6341,6351,"",false],[6361,6373,". All . OK",false],[6418,6426,"thank",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","partial","Prawn exposure captured, but named 'prawn laksa' where the transcript's dish name is unintelligible."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'upper lip swelling developed within ~30 min'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'progressively enlarging/pulsatile'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports dyspnoea, possible chest tightness'."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the call documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode ~1 year ago after Chinese meal with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'asthma; uses salbutamol inhaler regularly'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with possible childhood severe reaction requiring hospital/injection."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction'; urgent ambulance advised."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Advised urgent ambulance attendance via 999'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother present and to remain with patient, but her being asked to call emergency services is not documented."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised to take available antihistamine while awaiting ambulance.'"],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'Advised to contact service after hospital assessment regarding need for injections.'"]],"claims":[],"note":"Subjective\nAcute upper lip swelling after prawn laksa at ~19:00.\nLip tingling began at L corner of mouth; upper lip swelling developed within ~30 min and is progressively enlarging/pulsatile.\nReports dyspnoea, possible chest tightness, and dizziness.\nPrior similar episode ~1 year ago after late-night Chinese meal/curry: woke with swelling, felt unwell and had difficulty breathing.\nPMH: asthma; uses salbutamol inhaler regularly. Reports peanut allergy since childhood.\nPossible childhood severe allergic reaction requiring hospital attendance/injection; details unclear.\nNo antihistamine available initially. Mother subsequently present and confirmed antihistamines available.\nObjective\nNo physical examination or observations documented; remote consultation.\nDuring call, pt reported worsening lip swelling, breathing difficulty and dizziness.\nAssessment\nSuspected anaphylactic reaction following prawn-containing meal.\nProgressive lip angioedema with reported dyspnoea/possible chest tightness and dizziness shortly after food exposure is concerning for evolving anaphylaxis.\nBackground asthma, peanut allergy and prior possible severe food-related reaction increase concern.\nPlan\nAdvised urgent ambulance attendance via 999 for suspected anaphylaxis.\nMother to remain with pt until ambulance arrival.\nAdvised to take available antihistamine while awaiting ambulance.\nAdvised to contact service after hospital assessment regarding need for injections.","review":88.0,"saved":191.5,"clean":false,"effort":7.6923076923076925,"sig":[],"mb":10.267532,"latency":13.493,"signable":101.493}],"heidi":[{"label":"Run 1","wer":14.058776806989675,"text":"Hi. Hello? Hi. Hi.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fed Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxatives. It's like a soup. I ordered a prawn one this time. Yeah. And, yeah, and then my feel stuff like, my lips started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat of Bento. It wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nAnd a half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a lot difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to a late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take oh, what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nOh, no. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, peritone, any of those kind of things? No. No. I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh, I thought oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No. Right. Okay. So right. Al- all right. I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right. So is there any anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, yeah. So hang on the light while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yes. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll after you come up from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[274,296,"Trabalotsa. OK day",false],[351,369,"ninety-nine. OK",false],[414,420,"M Traba",false],[424,440,"Gmail dot com. OK",false],[597,601,"",false],[836,842,"prawn",true],[915,924,".",false],[1018,1023,"Mm-hmm.",false],[1074,1079,"Mm-hmm. 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Are",false],[4508,4524,". You're feeling dizzy. OK",true],[4649,4652,"uh",false],[4999,5004,"mum's.",false],[5030,5033,"mum",false],[5070,5075,"OK all",false],[5183,5183,"Ohh no",false],[5199,5204,"line",false],[5284,5284,". Hey ohh",false],[5344,5367,"any more. Thank. All right OK",false],[5683,5691,"uh Mum Mum",false],[5742,5757,"K. Do that",false],[5780,5783,"mum",false],[5793,5796,"Mum",false],[5948,5952,"OK. Ohh yeah yeah we do .",false],[5987,5987,"All right",false],[6047,6067,"all right. OK OK. Yes thank .",false],[6072,6076,"",false],[6092,6094,"out",false],[6227,6231,"will",false],[6241,6254,"thank . All . OK",false],[6293,6293,"thank",false],[6312,6312,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Lip swelling after consuming prawn laksa\"; prawn soup captured."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling began ... within 30 mins\"."],["The note captures: Upper lip swelling is progressively worsening.","partial","Progressive worsening captured, but swelling is placed at the \"left corner of mouth\"; the upper lip is not specified."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness recorded as \"a little busy\"; dizziness is not captured."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"similar lip swelling ~1 year ago after curry at Chinese restaurant, with difficult breathing\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Asthma: regular salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy plus \"childhood injection for severe allergic reaction (~age 6), per mother\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\" with urgent ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Urgent ambulance called for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother told to call emergency services, but the number is wrong (000 vs 999) and staying with the patient is not recorded."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately if available\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up after hospital discharge to discuss injections\"."]],"claims":[["Reports ... general chest tightness","Patient said she was unsure whether it was her chest (\"it might be, I'm not sure\"); stated as definite."],["Mother instructed to call emergency services (000)","Transcript specifies \"nine nine nine\"; 000 is a wrong number."]],"note":"Subjective\n\n- Reports feeling unwell today\n\n- Identity confirmed: Maria Travaloza, DOB 01/10/1999, email mtrava@gmail.com\n\n- Lip swelling after consuming prawn laksa at Fed Park ~7 PM\n\n- Swelling began at left corner of mouth within 30 mins, progressively worsening, pulsatile\n\n- Reports difficulty breathing and general chest tightness\n\n- PMHx: similar lip swelling ~1 year ago after curry at Chinese restaurant, with difficult breathing and waking swollen\n\n- Asthma: regular salbutamol inhaler; no other inhalers\n\n- Allergies: known peanut allergy\n\n- Not currently on antihistamines; believes taken in past for peanut allergy\n\n- Recalls childhood injection for severe allergic reaction (~age 6), per mother\n\n- Currently alone; feeling \"a little busy\"\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Suspected anaphylactic reaction\n\n\n\n\nPlan\n\n- Urgent ambulance called for suspected anaphylaxis\n\n- Advised to take antihistamines immediately if available\n\n- Mother instructed to call emergency services (000) and report suspected anaphylactic reaction\n\n- Follow-up after hospital discharge to discuss injections and further management","review":111.0,"saved":168.5,"clean":false,"effort":34.61538461538461,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness mis-transcribed as 'busy', losing a systemic anaphylaxis sign."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency action recorded with the wrong number (000 instead of 999), misstating the escalation given."]],"mb":39.629048,"latency":25.55,"signable":136.55},{"label":"Run 2","wer":14.455917394757744,"text":"Hi. Hello? Hi. Hi.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with prawn. So, basically, I I sometimes go with my friends to to this place called Fet Park.\n\nAnd we we regularly have like, usually I have like a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxa. It's like a soup. I ordered a prawn one this time. Yeah. And yeah. And then my feel stuff like, my lids started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat, a bent. It wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Alright. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I'm not sure what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nOh, no. No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, peritone, any of those kind of things? No. Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh, I know. Oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No, right. Okay. So- Right. All, all right. I, I am really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an, anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection, like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Mm-hmm. Right? So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, no. So hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah we do. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah. And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll after you come up from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[274,296,"Trabalotsa. OK day",false],[351,369,"ninety-nine. OK",false],[414,420,"M Traba",false],[424,440,"Gmail dot com. OK",false],[597,601,"",false],[915,924,".",false],[1016,1021,"Mm-hmm.",false],[1072,1077,"Mm-hmm. 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OK",false],[6320,6320,"thank",false],[6339,6339,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Lip swelling after consuming prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"~30 min post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressively worsening\" upper lip swelling."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Difficulty breathing\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"~1 year ago after curry at Chinese restaurant ... swollen with difficulty breathing\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"asthma (salbutamol inhaler)\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"severe allergic reaction ~age 6 requiring hospitalisation, ?injection\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\" with ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Ambulance called\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother arriving and being instructed to call captured, but the number is given as \"000\" instead of 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact clinic after hospital discharge to discuss adrenaline auto-injector\"."]],"claims":[["mother instructed to call 000","Transcript says to call \"nine nine nine\"; 000 is a wrong emergency number."]],"note":"Subjective:\n\n- Feeling \"a little weird\" today\n\n- Lip swelling after consuming prawn soup (laksa) at Fet Park, ~7 pm\n\n- Swelling initially left corner of upper lip, ~30 min post-ingestion, progressively worsening, \"pumping blood\"\n\n- Difficulty breathing, general discomfort\n\n- Similar episode ~1 year ago after curry at Chinese restaurant (alcohol involved) - woke next morning swollen with difficulty breathing\n\n- PMHx: asthma (salbutamol inhaler); peanut allergy (antihistamines)\n\n- Hx severe allergic reaction ~age 6 requiring hospitalisation, ?injection (per mother)\n\n- No antihistamines on hand at time of consult\n\n- Initially alone, mother arrived during consult\n\n\n\n\nObjective:\n\n- Telehealth consultation\n\n- Reports progressive lip swelling and breathing difficulty\n\n\n\n\nAssessment:\n\n- Suspected anaphylactic reaction\n\n\n\n\nPlan:\n\n- Advised to take antihistamines immediately\n\n- Ambulance called; mother instructed to call 000, report suspected anaphylaxis\n\n- Advised to remain with mother until ambulance arrives\n\n- Advised to contact clinic after hospital discharge to discuss adrenaline auto-injector and further management","review":86.02631578947368,"saved":193.4736842105263,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during suspected anaphylaxis signals possible circulatory compromise and is absent."]],"mb":35.987198,"latency":24.819,"signable":110.84531578947369},{"label":"Run 3","wer":14.138204924543288,"text":"Hi. Hello? Hi. Hi.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtraba at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fet Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxa. It's like a soup. I ordered a prawn one this time. Yeah. And yeah. And then my feel stuff like, my lips started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat, a dental. It wasn't really\n\nPaying attention. And now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to a late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No. Right. And, um, so do you use antihistamines like, like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any p- point, because you had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting oh, oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. Oh, right. Okay. So- Right. Oh, all right. I, I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an, anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection, like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right. So is there any- anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, yeah. So hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And I'll Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we are waiting? Yes. Mom mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah. And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And after you come up from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[274,296,"Trabalotsa. OK day",false],[351,369,"ninety-nine. OK",false],[414,420,"M Traba",false],[424,440,"Gmail dot com. OK",false],[597,601,"",false],[833,839,"prawn",true],[912,921,".",false],[1015,1020,"Mm-hmm.",false],[1071,1076,"Mm-hmm. 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OK",false],[6323,6323,"thank",false],[6342,6342,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after consuming prawn soup'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'~30 mins post-ingestion'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'left corner of upper lip... progressively worsening'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","partial","Difficulty breathing recorded, but chest tightness wrongly stated as denied."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'Similar reaction ~1yr ago after Chinese food... swelling and difficulty breathing'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'Asthma - managed with salbutamol inhaler'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'Peanut allergy' and 'Childhood (~6yo) hospitalisation for severe allergic reaction'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction' with urgent ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Ambulance called for urgent transfer'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and staying with someone recorded, but 000 given instead of 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised to take antihistamines immediately'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after discharge 'including discussion of adrenaline auto-injector'."]],"claims":[["denies chest tightness","Patient said chest tightness 'might be, I'm not sure'; she did not deny it."],["Mother to call 000","The clinician said to call 'nine nine nine'; 000 is a different emergency number never stated."]],"note":"Subjective:\n\n- Lip swelling and difficulty breathing after consuming prawn soup (laksa) ~19:00\n\n- Swelling began in left corner of upper lip ~30 mins post-ingestion, progressively worsening\n\n- Reports sensation of blood pumping in lip\n\n- Difficulty breathing, generally difficult; denies chest tightness\n\n- No antihistamines available at time of call\n\n- Initially alone; mother arrived during consultation\n\n\n\n\nPast Medical History:\n\n- Asthma - managed with salbutamol inhaler regularly\n\n- Peanut allergy\n\n- Childhood (~6yo) hospitalisation for severe allergic reaction (per mother)\n\n- Similar reaction ~1yr ago after Chinese food (curry-like dish) while intoxicated - swelling and difficulty breathing next morning; no antihistamines taken\n\n\n\n\nMedications:\n\n- Salbutamol inhaler\n\n- Antihistamines for peanut allergy (type unknown)\n\n\n\n\nAllergies:\n\n- Peanuts\n\n- Possible prawn/shellfish allergy\n\n\n\n\nObjective:\n\n- Telehealth consultation\n\n- Reports worsening lip swelling and difficulty breathing\n\n\n\n\nAssessment:\n\n- Suspected anaphylactic reaction\n\n\n\n\nPlan:\n\n- Ambulance called for urgent transfer to hospital\n\n- Advised to take antihistamines immediately\n\n- Mother advised to call 000 and report suspected anaphylactic reaction\n\n- Advised to remain with someone until ambulance arrives\n\n- Follow up after hospital discharge for allergy management, including discussion of adrenaline auto-injector","review":123.86842105263158,"saved":155.63157894736844,"clean":false,"effort":30.76923076923077,"sig":[["partial","Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","Chest tightness recorded as denied when patient said it might be present."],["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis not recorded."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency number recorded as 000 instead of 999."]],"mb":35.726166,"latency":29.793,"signable":153.66142105263157},{"label":"Run 4","wer":14.297061159650518,"text":"Hi. Hello? Hi. Hi, I'm Maria.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety-nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location, and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your, in, in your patient notes that you're having some, uh, sort of lip swelling, and you-- after you had a sandwich? Is that correct? Yeah, that is... Well, I don't think, I don't think it was, it, it wasn't a sandwich, but it was, it was something with crawl. So basically, I, I sometimes go with my friends to, to this place called Fet Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxator. It's like a soup. I ordered a prawn one this time. Yeah. And yeah. And then my feel stuff like, my lids started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat, a bent. It wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Alright. So when did you have the prawn soup? What time? That was that must have been just after work. So maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if with the test. It's just generally feels a lot difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to a late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something, I think. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No. Right. And, um, so do you use antihistamines like, like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any point, because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I've been to doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting oh, I know. Oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No. Right. Okay. So right. Al- all right. I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child. Um, right? So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, so hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. We do. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She says she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll after you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[[285,307,"Trabalotsa. OK day",false],[425,431,"M Traba",false],[435,451,"Gmail dot com. OK",false],[609,613,"",false],[865,871,"prawn",true],[945,954,".",false],[1048,1053,"Mm-hmm.",false],[1104,1109,"Mm-hmm. 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OK",false],[6355,6355,"thank",false],[6374,6374,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after consuming prawn soup'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'Onset ~30 mins post prawn soup ingestion (~7pm)'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'Swelling progressive, currently affecting upper lip... worsening'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports difficulty breathing'."],["The note captures: Patient becomes dizzy during the consultation.","no","Records feeling 'busy' instead of dizzy; dizziness not captured."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'previous similar reaction ~1 year ago (swelling and difficulty breathing after curry...)'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma in background and salbutamol use recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'known peanut allergy' and 'hospital admission age 6 for severe allergic reaction'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction' with immediate ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Ambulance called for immediate transfer to hospital'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and staying with her recorded, but told to call 000 rather than 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised to take antihistamines immediately; mother confirmed availability'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after discharge 'including potential adrenaline auto-injector prescription'."]],"claims":[["Mother to call 000","The clinician said to call 'nine nine nine'; 000 is a different emergency number never stated."],["Chest tightness reported as present","Patient said 'I don't know if it's the chest... it might be, I'm not sure'; tightness was not confirmed."]],"note":"Subjective\n\n\n\n\n- Left-sided lip swelling after consuming prawn soup (Laksa) ~30 mins prior\n\n- Swelling progressive, currently affecting upper lip, feels like \"pumping blood,\" worsening\n\n- Reports difficulty breathing and chest tightness\n\n- Onset ~30 mins post prawn soup ingestion (~7pm)\n\n\n\n\nObjective\n\n\n\n\n- Telehealth consultation; no physical examination performed\n\n- Reports feeling \"busy\" during consult\n\n- Initially alone; mother arrived during consult\n\n\n\n\nAssessment\n\n\n\n\n- Suspected anaphylactic reaction given acute onset lip swelling, difficulty breathing and chest tightness following prawn ingestion\n\n- Background: known peanut allergy, asthma, previous similar reaction ~1 year ago (swelling and difficulty breathing after curry, used salbutamol), hospital admission age 6 for severe allergic reaction\n\n\n\n\nPlan\n\n\n\n\n- Ambulance called for immediate transfer to hospital\n\n- Advised mother to call 000\n\n- Advised to take antihistamines immediately; mother confirmed availability\n\n- Advised to remain with mother until ambulance arrives\n\n- Advised to contact clinic for follow-up re allergy management, including potential adrenaline auto-injector prescription, after hospital discharge","review":100.23684210526315,"saved":179.26315789473685,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis replaced by 'busy'; red-flag symptom lost."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency number recorded as 000 instead of 999."]],"mb":35.519823,"latency":25.474,"signable":125.71084210526315},{"label":"Run 5","wer":13.820492454328834,"text":"Hi. Hello? Hi. Hi. I'm Maria.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fed Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxator. It's like a soup. I ordered a prawn one this time. Yep. And, yeah, and then my feels like, my lids started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat event, and I wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work. So maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No kidding. Right. And, um, so do you use antihistamines like, like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any p- point, because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I've changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh, oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No. Right. Okay. So- Right. Al- all right. I, I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an, anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right. So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, no. So hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. Straight away. And if mom can call mom, if you can call the nine nine\n\nNine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction, and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. And I'll come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care. Thank you very much. Bye bye. Bye. Bye.","marks":[[285,307,"Trabalotsa. OK day",false],[362,380,"ninety-nine. OK",false],[425,431,"M Traba",false],[435,451,"Gmail dot com. OK",false],[608,612,"",false],[847,853,"prawn",true],[926,935,".",false],[1029,1034,"Mm-hmm.",false],[1085,1090,"Mm-hmm. 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OK",false],[6330,6330,"thank",false],[6349,6349,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Lip swelling following consumption of prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"~30 mins after eating\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Began left corner of upper lip, \"progressively worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Difficulty breathing; general tightness, possibly in chest."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Previous lip swelling ~1 year ago after curry at Chinese restaurant with difficult breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Asthma: uses Salbutamol inhalers regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Severe childhood reaction (~6yo) requiring hospitalisation."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"; ambulance called."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Ambulance called\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Another person arriving and being told to call is captured, but not that it was the mother or that she should stay; number given as 000 instead of 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately if available\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up required regarding EpiPen prescription\"."]],"claims":[["prawn soup (laxator)","The dish name is blank in the transcript (\"it's called it's like a soup\"); no dish name is stated, so this fills in missing speech."],["Advised to have person present call 000","Clinician said to call \"nine nine nine\"; 000 is never mentioned."]],"note":"Subjective\n\n\n\n\n- Reports feeling unwell today.\n\n- Lip swelling following consumption of prawn soup (laxator) at approx 7 PM.\n\n- Swelling began at left corner of upper lip ~30 mins after eating, progressively worsening.\n\n- Describes sensation of lip \"pumping blood.\"\n\n- Difficulty breathing.\n\n- General feeling of tightness, possibly in chest.\n\n- Initially alone; another person arrived during consult.\n\n\n\n\nPast Medical History\n\n\n\n\n- Asthma: uses Salbutamol inhalers regularly. Denies other inhalers (e.g. brown inhalers).\n\n- Peanut allergy: recalls antihistamines in past, unsure which. Severe allergic reaction in childhood (~6yo) requiring hospitalisation, per mother.\n\n- Previous lip swelling ~1 year ago after curry at Chinese restaurant while intoxicated, with difficult breathing next morning. No antihistamines used at that time.\n\n\n\n\nMedications\n\n\n\n\n- Salbutamol inhalers.\n\n- Denies regular antihistamine use. No antihistamines available at time of consult.\n\n\n\n\nAllergies\n\n\n\n\n- Peanuts.\n\n\n\n\nObjective\n\n\n\n\n- Telehealth consultation; no physical examination performed.\n\n\n\n\nAssessment\n\n\n\n\n- Suspected anaphylactic reaction based on lip swelling, difficulty breathing and general tightness, with rapid onset after consuming known allergen (prawns).\n\n- Previous similar reaction to unknown food substance ~1 year prior.\n\n- History of severe childhood allergic reaction.\n\n\n\n\nPlan\n\n\n\n\n- Ambulance called.\n\n- Advised to stay on line until ambulance arrival.\n\n- Advised to take antihistamines immediately if available.\n\n- Advised to have person present call 000 and report suspected anaphylactic reaction requiring immediate attention.\n\n- Follow-up required regarding EpiPen prescription.","review":119.5,"saved":160.0,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."]],"mb":37.159552,"latency":25.0,"signable":144.5},{"label":"Run 6","wer":14.614773629864972,"text":"Hi. Hello? Hi. Hi. Hello. I'm Doctor. Jacob, and welcome to Babylon.\n\nHow are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we we start, is it all right if you could confirm your full name for me, please? Yes. Maria Travaloza. Okay. Date and your date of birth? That is the first of October.\n\nNinety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fet Fuck.\n\nAnd we we regularly have like, usually I have like a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxa. It's like a soup. I ordered a prawn one this time. Yeah. And, yeah, and then my feel stuff, like, my lips started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back, we had a little bit of a chat, a bent. It wasn't really\n\nPaying attention. And now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. Right. I don't know what to do. Alright. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nAnd a half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping, but and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the test. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No. Right. And, um, so do you use antihistamines like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any p- point, because you had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh. Oh, I thought, oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. Oh, right. Okay. So- Right. All, all right. I, I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection, like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right? So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Okay. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And I'll Somebody just came. Somebody just came. Yes. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. We do. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll ask you come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[277,298,"Trabalotsa. OK day",true],[354,372,"ninety-nine. OK",false],[417,423,"M Traba",false],[427,443,"Gmail dot com. OK",false],[600,604,"",false],[839,845,"prawn",true],[918,927,".",false],[1019,1024,"Mm-hmm.",false],[1075,1080,"Mm-hmm. 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You're feeling dizzy. OK",true],[4637,4639,"no. OK",false],[4648,4657,"OK so.",false],[4665,4668,"uh",false],[5027,5032,"mum's.",false],[5058,5061,"mum",false],[5098,5103,"OK all",false],[5203,5208,"yeah. Ohh no",false],[5235,5236,"I'll",false],[5306,5310,". Hey ohh",false],[5370,5393,"any more. Thank. All right OK",false],[5709,5716,"uh Mum Mum",false],[5767,5785,"K.",false],[5812,5815,"mum",false],[5825,5828,"Mum",false],[5980,5984,"OK. Ohh yeah yeah we do .",false],[6019,6019,"All right",false],[6079,6099,"all right. OK OK. Yes thank .",false],[6104,6112,"after",false],[6122,6124,"out",false],[6257,6261,"will",false],[6271,6284,"thank . All . OK",false],[6323,6323,"thank",false],[6342,6342,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Lip swelling after consuming prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling onset ~30 mins post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressive upper lip swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing and general tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"previous lip swelling/difficulty breathing ~1 year ago post-curry\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"asthma (salbutamol inhaler)\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"peanut allergy, previous severe allergic reaction ~age 6 requiring hospitalisation\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Urgent ambulance (999) called\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother mentioned only confirming antihistamines; being alone, staying with patient and calling 999 are not recorded."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up call post-discharge to arrange adrenaline auto-injector\"."]],"claims":[],"note":"Subjective\n\n- Lip swelling after consuming prawn soup (~19:00)\n\n- Swelling onset ~30 mins post-ingestion, initially left corner of mouth, progressively worsening\n\n- Reports difficulty breathing and general tightness\n\n- No antihistamines available at time of consult\n\n\n\n\nObjective\n\n- Telehealth consultation\n\n- Reports progressive upper lip swelling, \"pumping\" sensation\n\n- SOB and chest tightness reported\n\n\n\n\nAssessment\n\n- Suspected anaphylactic reaction following prawn ingestion\n\n- Background: asthma (salbutamol inhaler), peanut allergy, previous severe allergic reaction ~age 6 requiring hospitalisation, previous lip swelling/difficulty breathing ~1 year ago post-curry\n\n\n\n\nPlan\n\n- Urgent ambulance (999) called for immediate transport to hospital\n\n- Advised to take antihistamines immediately; mother confirming availability and administering\n\n- Advised to remain on line until ambulance arrives\n\n- Follow-up call post-discharge to arrange adrenaline auto-injector and further management","review":68.02631578947368,"saved":211.4736842105263,"clean":false,"effort":11.538461538461538,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis signals possible circulatory involvement; omitting it understates severity."]],"mb":40.651581,"latency":28.264,"signable":96.29031578947368}],"freed":[{"label":"Run 1","wer":17.31532962668785,"text":"Hi! Hello! Hi! Hi, I'm Maria! Hello, I'm Doctor Jacob, and welcome to Babylon! How are you doing?\n  I'm alright, thank you. I feel a little weird today, to be honest.\n  Yeah, so just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, amtrabba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fat Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger? Yeah, you can still feel it, like. really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take, what's it called, salbutamol inhalers. Yeah, so I do take that regularly, but I've always taken it.\n  I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  No, I think sometimes, but I don't know which ones. So I have a peanut allergy as well, like I've always had it, and I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n  Yeah, when I was like 6 or something, I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was six. Are you okay now? I feel a bit dizzy right now, to be honest.\n  You feel dizzy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, all right, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection like what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes.\n  Yes.\n  Oh, yeah, we do. Go straight away, and if mom can call, mom, if you can call the 999, yeah? And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamine in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. All right.\n  Okay then, take care. Thank you very much. Bye-bye.","marks":[[104,111,"all right",false],[206,213,"all right",false],[277,293,"Trabalotsa. OK day",false],[331,334,"first",false],[347,355,"ninety-nine. OK",false],[401,409,"M Traba",false],[813,820,"prawn",false],[893,901,".",false],[991,991,"Mm-hmm.",false],[1043,1043,"Mm-hmm. Um",false],[1088,1088,"it it's it",false],[1180,1180,"my feel like",false],[1266,1266,"Mm-hmm.",false],[1454,1454,"on my",false],[1528,1528,"Yeah. Right. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Only 'Ensure companion remains with patient'; mother's arrival and her being asked to call 999 are not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["Living Situation: Lives alone","Patient only said she was alone at the moment; nothing states she lives alone."]],"note":"Subjective\nMaria Chabalotza presents with acute onset lip swelling and difficulty breathing after eating prawn soup. She reports going out with friends after work around 7 PM and ordering a prawn laksa soup at a restaurant. Approximately 30 minutes after eating, her lips started feeling \"a little weird,\" beginning at the left corner of her lip. She initially did not pay much attention to the symptoms but now reports progressively worsening swelling on her upper lip that continues to enlarge. She describes the sensation as feeling like it is \"pumping blood\" and getting worse. She also reports difficulty breathing and feeling dizzy.\n\nThe patient recalls a similar episode approximately one year ago after eating at a late-night Chinese restaurant, where she woke up the next morning with significant swelling and difficulty breathing. She was intoxicated at the time and is unsure of the exact food trigger but believes it may have been a curry. She has a known peanut allergy and reports that she was hospitalized at approximately age 6 due to a severe allergic reaction, though she does not recall the specific details as she was young and has since changed doctors. Her mother has told her she required an injection at that time.\n\nMedical History  \n- Asthma  \n- Peanut allergy, with history of hospitalization at approximately age 6 for a severe allergic reaction\n\nMedications and Supplements  \n- Salbutamol inhaler for asthma  \n- Antihistamines for peanut allergy\n\nAllergies  \n- Peanut allergy (swelling and difficulty breathing)\n\nSocial History  \n- Alcohol: Occasional use  \n- Living Situation: Lives alone\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with asthma and peanut allergy, presenting with lip swelling and breathing difficulty.\n\nAnaphylactic Reaction  \nAssessment: Acute onset lip swelling beginning approximately 30 minutes after consuming prawn soup at 7 PM. Swelling has progressively worsened and is now accompanied by breathing difficulty and dizziness. History of similar reaction approximately one year ago after eating curry, which also caused swelling and breathing difficulties. Known peanut allergy requiring hospitalization at age 6. Current symptoms of lip swelling with respiratory compromise and systemic symptoms are highly concerning for anaphylaxis requiring immediate emergency intervention.  \nPlan:  \n- Call 999 ambulance immediately for suspected anaphylactic reaction  \n- Take antihistamine medication immediately while awaiting emergency services  \n- Ensure companion remains with patient until ambulance arrival  \n- Follow up after hospital discharge for further allergy management and potential epinephrine auto-injector prescription\n","review":150.3421052631579,"saved":129.1578947368421,"clean":false,"effort":11.538461538461538,"sig":[],"mb":15.126379,"latency":44.855,"signable":183.05310526315787},{"label":"Run 2","wer":17.156473391580622,"text":"Hi. Hello. Hi, I'm Maria. Hello, I'm Doctor Jacob and welcome to Babylon. How are you doing?\n  I'm all right, thank you.\n  I feel a little weird today, to be honest. Yeah, so just before we start, is it all right if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, mtraba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yes. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fed Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger. Yeah, I still feel it, like, really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take what's called salbutamol inhalers.\n  Yeah, so I do take that regularly, but I've always taken it. I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. I've always had it. I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was, because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah.\n  When I was, like, 6 or something, I-I-I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was- Right. Are you okay now? I feel busy right now, to be honest.\n  You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, alright, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straightaway. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around?\n  Yes. Yes. Oh, yeah, we do.\n  Go straightaway, and if mom can call, mom, if you can call the 999, yeah? and say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamines in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. Thank you.\n  Okay, then. Take care. Thank you very much. Bye-bye.","marks":[[10,10,"Hi",false],[276,292,"Trabalotsa. OK day",false],[330,333,"first",false],[346,354,"ninety-nine. OK",false],[400,406,"M Traba",false],[809,816,"prawn",false],[889,897,".",false],[987,987,"Mm-hmm.",false],[1039,1039,"Mm-hmm. Um",false],[1084,1084,"it it's it",false],[1176,1176,"my feel like",false],[1262,1262,"Mm-hmm.",false],[1450,1450,"on my",false],[1524,1524,"Yeah. 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OK",false],[4419,4426,"uh all right I",false],[4756,4761,"mum's. Um",false],[4783,4786,"mum",false],[4823,4827,"OK all",false],[4847,4847,"any",false],[4920,4920,"yeah. Ohh no",false],[5011,5015,"OK and . Hey ohh",false],[5035,5035,"somebody just came yes",false],[5051,5073,"any more. Thank. All right OK",false],[5258,5271,"straight away.",false],[5382,5390,"uh Mum Mum",false],[5442,5454,"K.",false],[5461,5476,"that straight away",false],[5485,5488,"mum",false],[5499,5502,"Mum",false],[5524,5527,"uh nine nine nine nine nine",false],[5547,5547,"your",false],[5628,5632,"OK. Ohh yeah yeah we do .",false],[5760,5760,"thank . And",false],[5932,5943,". All . OK",false],[5983,5991,"thank bye bye. Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented anywhere in the note."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and patient remaining with another person are captured, but mother being asked to call 999 is not."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["Living Situation: Lives alone, mother recently arrived","Patient only said she was alone at the moment; nothing states she lives alone."],["Hospital evaluation and treatment for anaphylaxis, likely requiring epinephrine injection","No epinephrine treatment in hospital was stated; the doctor only mentioned sorting out injections after discharge."]],"note":"Subjective\nMaria Chabalotza, a patient with a history of asthma and peanut allergy, presents with acute lip swelling and difficulty breathing after eating prawn soup.\n\nThe patient reports that she went out with friends to a restaurant called Fed Park after work, around 7 PM, and ordered a prawn laksa soup. She notes that her lips started feeling \"a little weird,\" beginning on the left corner of her upper lip, approximately 30 minutes after eating the soup. She initially did not pay much attention to the symptoms but now reports a progressively worsening swelling on her upper lip that she describes as feeling like it is \"really pumping blood\" and \"getting bigger.\" She also reports difficulty breathing and a general feeling of tightness, though she is unsure if it is specifically in her chest. She states the swelling continues to worsen.\n\nThe patient reports a similar episode approximately one year ago after eating at a late-night Chinese restaurant, during which she woke up the next morning with significant swelling and difficulty breathing. She notes she was quite drunk at the time and had eaten a curry dish. She has a known peanut allergy and reports that her mother told her she required a hospital visit and an injection for a severe allergic reaction when she was around 6 years old. She changed doctors since that time and does not recall the specific details of the injection she received. She does not currently have antihistamines with her but her mother, who just arrived, confirmed they have antihistamines at home.\n\nMedical History\n- Asthma\n- Peanut allergy, with history of severe allergic reaction requiring hospitalization and injection at approximately age 6\n\nMedications and Supplements\n- Salbutamol inhaler for asthma\n- Antihistamines for peanut allergy, specific name unknown\n\nAllergies\n- Peanut allergy (swelling and difficulty breathing)\n\nSocial History\n- Alcohol: Occasional, including being quite drunk at a restaurant approximately one year ago\n- Living Situation: Lives alone, mother recently arrived\n- Social Activities: Regularly goes out to eat with friends at restaurants\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup at around 7 PM, with swelling progressively worsening and now involving the upper lip. She reports difficulty breathing and sensation of throat tightness. She has a history of similar reaction approximately one year ago after eating curry, which resulted in facial swelling and breathing difficulties. Patient has known peanut allergy since childhood and history of severe allergic reaction requiring hospitalization at age 6. Current presentation is highly concerning for anaphylaxis given the rapid onset of angioedema, respiratory symptoms, and patient's allergy history.  \nPlan:  \n- Emergency services activation: Call 999 immediately for suspected anaphylactic reaction  \n- Immediate antihistamine administration while awaiting emergency services  \n- Ensure patient remains with another person until ambulance arrives  \n- Hospital evaluation and treatment for anaphylaxis, likely requiring epinephrine injection  \n- Follow-up after hospital discharge for allergy management and epinephrine auto-injector prescription\n","review":212.65789473684208,"saved":66.84210526315792,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call, a sign of systemic anaphylaxis, is not documented."]],"mb":15.030984,"latency":44.913,"signable":244.4168947368421},{"label":"Run 3","wer":17.156473391580622,"text":"Hi. Hello. Hi, I'm Maria. Hello, I'm Doctor Jacob and welcome to Babylon. How are you doing?\n  I'm all right, thank you.\n  I feel a little weird today, to be honest. Yeah, so just before we start, is it all right if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, mtraba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yes. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fat Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger. Yeah, I still feel it, like, really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take what's called salbutamol inhalers.\n  Yeah, so I do take that regularly, but I've always taken it. I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. I've always had it. I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was, because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah.\n  When I was, like, 6 or something, I-I-I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was- Right. Are you okay now? I feel busy right now, to be honest.\n  You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, alright, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straightaway. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around?\n  Yes. Yes. Oh, yeah, we do.\n  Go straightaway, and if mom can call, mom, if you can call the 999, yeah? And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamines in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. Thank you.\n  Okay then. Take care. Thank you very much. Bye-bye.","marks":[[10,10,"Hi",false],[276,292,"Trabalotsa. OK day",false],[330,333,"first",false],[346,354,"ninety-nine. OK",false],[400,406,"M Traba",false],[809,816,"prawn",false],[889,897,".",false],[987,987,"Mm-hmm.",false],[1039,1039,"Mm-hmm. Um",false],[1084,1084,"it it's it",false],[1176,1176,"my feel like",false],[1262,1262,"Mm-hmm.",false],[1450,1450,"on my",false],[1524,1524,"Yeah. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"acute onset lip swelling and difficulty breathing after eating prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Within approximately 30 minutes of eating\" swelling developed."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"visible swelling of her upper lip ... the swelling is worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Difficulty breathing and throat tightness, \"unsure if her chest feels tight\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode one year ago at a late-night Chinese restaurant with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"She uses a salbutamol inhaler for her asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with hospitalisation for severe reaction at about age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"highly concerning for anaphylaxis requiring immediate emergency intervention\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call ambulance immediately for suspected anaphylactic reaction\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","\"mother present during the encounter\" and someone to remain with patient, but mother being asked to call emergency services and her arrival sequence not clearly captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take antihistamines while awaiting emergency services\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow up after hospital discharge ... potential epinephrine auto-injector prescription\"."]],"claims":[["similar reaction one year ago after eating curry, which required hospitalization as a child","The curry episode a year ago had no hospitalisation; hospital care at age 6 was a separate peanut reaction."]],"note":"Subjective\nMaria Chabalotza, a patient with a history of asthma and peanut allergy, presents with acute onset lip swelling and difficulty breathing after eating prawn soup.\n\nThe patient reports that approximately around 7 PM she ordered a prawn laksa soup at a restaurant. Within approximately 30 minutes of eating, she noticed a strange sensation at the left corner of her lip, which progressed to visible swelling of her upper lip. She reports the swelling is worsening and she can feel it \"pumping blood\" and getting bigger. She also reports difficulty breathing and a sensation of throat tightness, though she is unsure if her chest feels tight. She does not have any antihistamines with her at the time of presentation.\n\nThe patient recalls a similar episode approximately one year ago after eating food at a late-night Chinese restaurant, during which she woke up the next morning with significant swelling and difficulty breathing. She was intoxicated at the time and is unsure of the exact food trigger, though she believes it may have been a curry. She also has a known peanut allergy and reports that at approximately age 6, she required hospitalization for a severe allergic reaction, though she does not recall the specific treatment she received at that time. She uses a salbutamol inhaler for her asthma and does not use any other inhalers. She sometimes takes antihistamines for her peanut allergy but is unsure which ones.\n\nMedical History  \n- Asthma  \n- Peanut allergy, with history of hospitalization for severe allergic reaction at approximately age 6\n\nMedications and Supplements  \n- Salbutamol inhaler for asthma  \n- Antihistamines for peanut allergy, name unspecified\n\nAllergies  \n- Peanut allergy, with history of severe reaction requiring hospitalization at approximately age 6\n\nSocial History  \n- Living Situation: Lives alone at the time of presentation; mother present during the encounter\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup, with progressive worsening and associated breathing difficulty. She has a history of similar reaction approximately one year ago after eating curry, which required hospitalization as a child for severe allergic reaction. Patient has known peanut allergy and asthma managed with salbutamol inhaler. Current symptoms of lip swelling with respiratory compromise are highly concerning for anaphylaxis requiring immediate emergency intervention.  \nPlan:  \n- Call ambulance immediately for suspected anaphylactic reaction  \n- Take antihistamines while awaiting emergency services  \n- Ensure someone remains with patient until ambulance arrives  \n- Follow up after hospital discharge for management of allergies and potential epinephrine auto-injector prescription\n","review":178.23684210526318,"saved":101.26315789473682,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during a suspected anaphylaxis suggests circulatory involvement and is absent from the note."],["fabrication","similar reaction one year ago after eating curry, which required hospitalization as a child","It says the curry episode needed hospitalisation, but that episode had none; the only hospitalisation was the peanut reaction at age 6, so the severity history is wrong."]],"mb":15.138469,"latency":45.211,"signable":211.32584210526318},{"label":"Run 4","wer":17.156473391580622,"text":"Hi. Hello. Hi, I'm Maria. Hello, I'm Doctor Jacob and welcome to Babylon. How are you doing?\n  I'm all right, thank you.\n  I feel a little weird today, to be honest. Yeah, so just before we start, is it all right if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, mtraba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yes. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fed Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger. Yeah, I still feel it, like, really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take what's called salbutamol inhalers.\n  Yeah, so I do take that regularly, but I've always taken it. I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. I've always had it. I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was, because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah.\n  When I was, like, 6 or something, I-I-I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was- Right. Are you okay now? I feel busy right now, to be honest.\n  You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, alright, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straightaway. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around?\n  Yes. Yes. Oh, yeah, we do.\n  Go straightaway, and if mom can call, mom, if you can call the 999, yeah? and say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamines in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. Thank you.\n  Okay, then. Take care. Thank you very much. Bye-bye.","marks":[[10,10,"Hi",false],[276,292,"Trabalotsa. OK day",false],[330,333,"first",false],[346,354,"ninety-nine. OK",false],[400,406,"M Traba",false],[809,816,"prawn",false],[889,897,".",false],[987,987,"Mm-hmm.",false],[1039,1039,"Mm-hmm. Um",false],[1084,1084,"it it's it",false],[1176,1176,"my feel like",false],[1262,1262,"Mm-hmm.",false],[1450,1450,"on my",false],[1524,1524,"Yeah. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States \"ingesting prawn soup\"; food correctly identified as prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Within about 30 minutes of eating, she noticed a strange sensation\" progressing to swelling."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"visible swelling of her upper lip ... the swelling is worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Reports \"difficulty breathing and a sensation of throat tightness, though she is unsure whether her chest feels tight\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned anywhere."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode ~1 year ago at late-night Chinese restaurant with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma listed; \"used her salbutamol inhaler\" and salbutamol in medications."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with hospital visit and possibly an injection at around age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"highly concerning for anaphylaxis\" with emergency ambulance transport."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance transport to hospital for suspected anaphylactic reaction\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and her contacting emergency services noted, but instruction to stay with patient until ambulance arrives omitted."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Immediate antihistamine administration while awaiting emergency services\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up after hospital discharge ... possible epinephrine auto-injector prescription\"."]],"claims":[["Living Situation: Lives alone","Transcript only says \"I'm alone at the moment\"; living arrangements never discussed."]],"note":"Subjective\nMaria Chabalotza presents with acute onset lip swelling and difficulty breathing after ingesting prawn soup. She reports going out with friends after work and ordering a prawn laksa soup at approximately 7:00 PM. Within about 30 minutes of eating, she noticed a strange sensation at the left corner of her lip, which progressed to visible swelling of her upper lip. She reports the swelling is worsening and feels like it is \"really pumping blood\" and \"getting bigger.\" She also reports difficulty breathing and a sensation of throat tightness, though she is unsure whether her chest feels tight.\n\nThe patient recalls a similar episode approximately one year ago after eating at a late-night Chinese restaurant, where she woke up the next morning with significant lip swelling and difficulty breathing. She was intoxicated at the time and is unsure of the exact food that triggered the reaction, but believes it may have been a curry. She did not use any antihistamines at that time but used her salbutamol inhaler.\n\nShe has a known peanut allergy and reports that her mother told her she required a hospital visit and possibly an injection for a severe allergic reaction when she was around age 6. She changed doctors since that time and does not recall the specifics of the treatment she received. She does not currently have antihistamines with her but her mother, who just arrived, confirmed they have antihistamines at home.\n\nMedical History\n- Asthma\n- Peanut allergy, with history of severe allergic reaction requiring hospitalization at approximately age 6\n\nMedications and Supplements\n- Salbutamol inhaler\n- Antihistamines\n\nAllergies\n- Peanut allergy, with history of severe anaphylactic reaction requiring hospitalization at approximately age 6\n\nSocial History\n- Living Situation: Lives alone\n- Social Activities: Regularly goes out with friends to eat at restaurants\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic Reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup at 7 PM, with progressive worsening and associated breathing difficulty. History of similar reaction one year ago after eating curry, as well as known peanut allergy since childhood requiring hospitalization at age 6. Current symptoms of lip swelling with respiratory compromise are highly concerning for anaphylaxis given the rapid onset, progressive nature, and patient's allergic history.  \nPlan:  \n- Emergency ambulance transport to hospital for suspected anaphylactic reaction  \n- Immediate antihistamine administration while awaiting emergency services  \n- Emergency services to be contacted by patient's mother for urgent transport  \n- Follow-up after hospital discharge for anaphylaxis management and possible epinephrine auto-injector prescription\n","review":178.55263157894737,"saved":100.94736842105263,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during a suspected anaphylaxis suggests circulatory involvement and is absent from the note."]],"mb":15.579635,"latency":44.14,"signable":210.45163157894737},{"label":"Run 5","wer":17.31532962668785,"text":"Hi! Hello! Hi! Hi, I'm Maria! Hello, I'm Doctor Jacob, and welcome to Babylon! How are you doing?\n  I'm alright, thank you. I feel a little weird today, to be honest.\n  Yeah, so just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, amtrabba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fat Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger? Yeah, you can still feel it, like. really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take, what's it called, salbutamol inhalers. Yeah, so I do take that regularly, but I've always taken it.\n  I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  No, I think sometimes, but I don't know which ones. So I have a peanut allergy as well, like I've always had it, and I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n  Yeah, when I was like 6 or something, I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was six. Are you okay now? I feel a bit dizzy right now, to be honest.\n  You feel dizzy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, all right, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection like what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes.\n  Yes.\n  Oh, yeah, we do. Go straight away, and if mom can call, mom, if you can call the 999, yeah? And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamine in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. All right.\n  Okay then, take care. Thank you very much. Bye-bye.","marks":[[104,111,"all right",false],[206,213,"all right",false],[277,293,"Trabalotsa. OK day",false],[331,334,"first",false],[347,355,"ninety-nine. OK",false],[401,409,"M Traba",false],[813,820,"prawn",false],[893,901,".",false],[991,991,"Mm-hmm.",false],[1043,1043,"Mm-hmm. Um",false],[1088,1088,"it it's it",false],[1180,1180,"my feel like",false],[1266,1266,"Mm-hmm.",false],[1454,1454,"on my",false],[1528,1528,"Yeah. Right. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and companion staying are captured, but mother being asked to call 999 is not."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["Living Situation: Currently lives alone","Patient only said she was alone at the moment; nothing states she lives alone."]],"note":"Subjective\nMaria Chabalotza presents with acute onset lip swelling and difficulty breathing after eating prawn soup. She reports going out with friends to a restaurant called Fat Park after work, around 7:00 PM, and ordered a prawn laksa soup. She typically orders vegetarian soup at this establishment. Approximately 30 minutes after eating, she noticed a strange sensation at the left corner of her lip, which progressed to visible swelling of her upper lip. The swelling has been progressively worsening and feels like it is \"pumping blood.\" She also reports difficulty breathing and a sensation of throat tightness, though she is unsure if her chest feels tight. She currently feels dizzy.\n\nThe patient recalls a similar episode approximately one year ago after eating at a late-night Chinese restaurant, during which she woke up the next morning with significant swelling and difficulty breathing. She was intoxicated at the time and does not recall the exact food that triggered the reaction, but it was possibly a curry. She has a known peanut allergy and reports that she was hospitalized at approximately age 6 for a severe allergic reaction, during which she may have received an injection, though she does not recall the specifics as she was young and has since changed doctors. Her mother confirmed this hospitalization. She uses a salbutamol inhaler regularly for her asthma and denies using any other inhalers such as a brown preventer inhaler. She does not currently have antihistamines with her but her mother, who just arrived, confirmed they have antihistamines at home. She denies taking any specific antihistamine medication regularly, though she believes she may have been prescribed some in the past for her peanut allergy.\n\nMedical History\n- Asthma\n- Peanut allergy, with hospitalization at approximately age 6 for a severe allergic reaction\n\nMedications and Supplements\n- Salbutamol inhaler, used regularly for asthma\n- Antihistamines, taken occasionally in the past for peanut allergy, specific names unknown\n\nAllergies\n- Peanut (anaphylactic reaction with swelling and difficulty breathing; hospitalized at age 6)\n- Shellfish/prawn (lip swelling, difficulty breathing, throat tightness)\n\nSocial History\n- Alcohol: Occasional use; was intoxicated approximately one year ago at a restaurant\n- Living Situation: Currently lives alone; mother recently arrived\n- Social Activities: Regularly dines out with friends at restaurants\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup at around 7 PM, with progressive worsening of swelling on upper lip. She reports difficulty breathing and feeling dizzy, which are concerning signs of systemic allergic reaction. Patient has history of similar reaction approximately one year ago after eating curry, which caused lip swelling and breathing difficulties. She has known peanut allergy since childhood and required hospitalization at age 6 for severe allergic reaction. Current presentation with rapid onset lip swelling, respiratory symptoms, and dizziness following shellfish ingestion is highly suggestive of anaphylaxis requiring immediate emergency intervention.  \nPlan:  \n- Call ambulance immediately for suspected anaphylactic reaction  \n- Take antihistamine medication while awaiting emergency services  \n- Ensure companion stays with patient until ambulance arrives  \n- Follow up after hospital discharge for further management including potential epinephrine auto-injector prescription\n","review":195.81578947368422,"saved":83.68421052631578,"clean":false,"effort":11.538461538461538,"sig":[],"mb":15.111116,"latency":44.75,"signable":228.39278947368422}],"cliniscripts":[{"label":"Run 1","wer":17.871326449563146,"text":"Hi.\nHello? Hi. Hi, I'm Maria. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabalozza.\nOkay. And your date of birth?\nThat is the 1st of October 199. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first.\nAnd then I don't know, and then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late, I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I think sometimes but I don't know which ones. So I have a peanut allergy as well.\nI've always had it.\nAnd I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like 6 or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nI feel a little dizzy right now, to be honest. You feel dizzy?\nOkay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay.\nRight. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So hang on the line while I call the ambulance, okay? And I'll send them right to you.\nOkay? And if somebody just came somebody just came, yes. I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting.\nYes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes.\nShe said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. Yes. And ask if you come out from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nAll right. Okay, then. Take care.","marks":[[274,291,"Trabalotsa. OK day",false],[328,331,"first",false],[343,353,"ninety-nine. OK",true],[398,421,"M Traba at Gmail dot com. OK",false],[724,724,"I don't think",false],[781,788,"prawn",false],[855,862,".",false],[938,938,"Mm-hmm.",false],[988,988,"Mm-hmm. Um",false],[1034,1034,"it it's it",false],[1134,1141,"like",false],[1227,1227,"Mm-hmm.",false],[1405,1405,"on my",false],[1604,1613,"OK",false],[1912,1912,"it's it",false],[1922,1927,"feel it",false],[1964,1971,"kinda",false],[2358,2362,"it",false],[2492,2495,"",false],[2642,2642,"Mm-hmm.",false],[2668,2686,"late night kinda",false],[2754,2754,"Sure OK.",false],[2804,2805,"I've",false],[2978,2983,"I think. OK. Right. OK. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"lip swelling after consuming prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling began ... approximately 30 minutes after ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","partial","Progressive worsening captured, but upper lip location not stated (only \"left corner of the lip\")."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"difficulty breathing and generalized tightness, possibly in the chest\" matches uncertain characterisation."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"They also reported feeling dizzy.\""],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar lip swelling and difficult breathing one year prior at a Chinese restaurant."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"history of asthma, for which they use a Salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with childhood severe reaction requiring injection and hospital visit around age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Assessment: concern for potential anaphylactic reaction; ambulance called immediately."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"advised calling an ambulance immediately\"; mother to call 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother arrives and is told to call 999, but instruction to stay with the patient is omitted."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"advised to take any available antihistamines in the interim while waiting for the ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact the clinic after hospital discharge to discuss injections\"."]],"claims":[["born on October 1, 1990","Transcript gives date of birth as \"first of October, ninety-nine\" (1999), not 1990."]],"note":"S (Subjective):\n- The patient, Maria Trabalozza, born on October 1, 1990, presented with lip swelling after consuming prawn soup (laksa) around 7:00 PM.\n- Swelling began on the left corner of the lip approximately 30 minutes after ingestion and has been progressively worsening and feeling \"bigger\" and \"pumping blood.\"\n- The patient reports feeling difficulty breathing and generalized tightness, possibly in the chest. They also reported feeling dizzy.\n- They have a history of a similar lip swelling episode and difficult breathing one year prior after eating \"curry or something\" at a Chinese restaurant while intoxicated.\n- The patient has a known peanut allergy and a history of asthma, for which they use a Salbutamol inhaler regularly. They recall their mother mentioning a severe allergic reaction requiring an injection when they were a child (around 6 years old) and a hospital visit for swelling.\n\nO (Objective):\n- The patient confirmed their full name and date of birth as Maria Trabalozza, 1st October 1990, and email mtraba@gmail.com.\n- The patient confirmed being in a secure location for a confidential conversation.\n- The patient reported feeling \"a little weird today.\"\n- The patient initially stated they were alone, but a family member (mother) arrived during the consultation.\n\nA (Assessment):\n- The doctor expressed concern for a potential anaphylactic reaction based on the patient's reported symptoms of lip swelling, difficulty breathing, dizziness, and history of severe allergic reactions.\n\nP (Plan):\n- The doctor advised calling an ambulance immediately due to the suspected anaphylactic reaction.\n- The doctor instructed the patient's mother to call 999 and report a suspected anaphylactic reaction requiring immediate attention.\n- The patient was advised to take any available antihistamines in the interim while waiting for the ambulance.\n- The patient was asked to contact the clinic after hospital discharge to discuss injections and further management for allergies.\n","review":131.73684210526318,"saved":147.76315789473682,"clean":false,"effort":19.230769230769234,"sig":[["fabrication","born on October 1, 1990","DOB recorded as 1990 when the patient said 1999, a wrong patient identifier."]],"mb":25.289765,"latency":22.591,"signable":142.7568421052632},{"label":"Run 2","wer":18.109610802223987,"text":"Hi.\nHello? Hi. Hi. Hi, I'm Rania. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah.\nGood. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know. And then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like it must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah, it still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah, actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food?\nYeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something, I think.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI always had it. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like six or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nYeah, I'm busy right now, to be honest. Do you feel dizzy?\nYeah. Okay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay? Mm-hmm. Right? So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So\nhang on the line while I call the ambulance, okay? And I'll send them right to you.\nOkay? And if anybody just came somebody just came, yes, I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting.\nYes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes, she said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. Yes. And ask if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nAll right. Okay, then. Take care.\nThank you very much. Bye-bye. Bye. Bye-bye.","marks":[[19,21,"",false],[27,33,"Maria.",true],[278,294,"Trabalotsa. OK day",false],[331,334,"first",false],[346,357,"ninety-nine. OK",false],[402,425,"M Traba at Gmail dot com. OK",false],[728,728,"I don't think",false],[785,792,"prawn",false],[859,866,".",false],[942,942,"Mm-hmm.",false],[992,992,"Mm-hmm. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","partial","Breathing difficulty captured, but chest tightness is stated as definite ('tightness in the chest') though the patient was unsure."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother joining and patient staying with her are captured, but the mother being asked to call 999 is not."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["The patient reported difficulty breathing and tightness in the chest.","Patient said 'I don't know if it's the chest... it might be, I'm not sure'; chest tightness is asserted as definite."]],"note":"S (Subjective):\n- The patient, Maria Trabaloza, DOB 10/01/1999, presented with lip swelling after consuming prawn soup (laksa) at approximately 7:00 PM.\n- Swelling began on the left corner of the lip and progressed to the entire upper lip within half an hour, continuing to enlarge (\"getting bigger and bigger,\" \"pumping blood\").\n- The patient reported difficulty breathing and tightness in the chest.\n- They have a history of a similar lip swelling episode approximately a year ago after eating Chinese food (curry) while intoxicated, also accompanied by difficulty breathing.\n- The patient has a known peanut allergy and a history of asthma, for which they use a salbutamol inhaler regularly. They recall being told by their mother about an injection for an allergic reaction as a child and a hospital visit for severe swelling at age six.\n- The patient reported feeling dizzy during the consultation.\n\nO (Objective):\n- The patient confirmed their identity and location for a confidential conversation.\n- The patient's reported symptoms of increasing lip swelling, difficulty breathing, and dizziness were noted.\n- The patient was alone initially but was joined by their mother during the call.\n- The patient reported using salbutamol inhalers for asthma.\n- The patient does not currently have antihistamines on hand.\n\nA (Assessment):\n- The patient is presenting with symptoms highly suggestive of an acute allergic reaction, potentially anaphylaxis, given the rapid onset of progressive lip swelling, difficulty breathing, chest tightness, and dizziness following exposure to a new food allergen (prawns).\n- History of similar past reactions and known peanut allergy further supports the diagnosis of an allergic response.\n- The severity of symptoms, particularly respiratory distress and dizziness, indicates a potentially life-threatening condition requiring immediate medical intervention.\n\nP (Plan):\n- Immediate call to emergency services (ambulance/999) for suspected anaphylactic reaction.\n- Administration of antihistamines immediately, which the patient's mother located.\n- Patient advised to remain with their mother until emergency services arrive.\n- Follow-up call requested from the patient after hospital discharge to arrange for an epinephrine auto-injector prescription and further management of allergies.\n","review":150.28947368421052,"saved":129.21052631578948,"clean":false,"effort":15.384615384615385,"sig":[],"mb":25.377368,"latency":24.137,"signable":160.27247368421052},{"label":"Run 3","wer":18.7450357426529,"text":"Hi.\nHello? Hi. Hi. Hi, I'm Maria. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah.\nGood. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know. And then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like it must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late, I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI've always had it. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like six or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nYeah. I'm busy right now, to be honest. Do you feel dizzy?\nYeah. Okay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay? Mm-hmm. Right? So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So\nhang on the line. While I call the ambulance, okay? And I'll send them right to you.\nOkay? And if somebody just came somebody just came, yes. I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes.\nShe said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. And if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nOkay, then. Take care.","marks":[[11,14,"",false],[278,294,"Trabalotsa. OK day",false],[331,334,"first",false],[346,357,"ninety-nine. OK",false],[402,425,"M Traba at Gmail dot com. OK",false],[728,728,"I don't think",false],[785,792,"prawn",false],[859,866,".",false],[942,942,"Mm-hmm.",false],[992,992,"Mm-hmm. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","partial","Ambulance call documented but with wrong number '9999' instead of 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Another individual arrived and was told to call, but not identified as mother and staying with patient is not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[],"note":"S (Subjective):\n- The patient presents with a chief complaint of lip swelling, which began approximately 30 minutes after consuming prawn soup (laksa) around 7:00 PM.\n- The swelling started on the left corner of their lips, then progressed to the upper lip, and is reported to be getting \"bigger and bigger,\" \"pumping blood,\" and \"worse.\"\n- Associated symptoms include difficulty breathing, a general feeling of tightness or difficulty in the chest, and dizziness.\n- The patient has a history of asthma, for which they regularly use Salbutamol inhalers. They also report a long-standing peanut allergy and occasionally take unspecified antihistamines for it.\n- History includes a previous episode of swelling and difficulty breathing after consuming Chinese food approximately one year ago, and a severe allergic reaction requiring an injection and hospital visit as a child (around 6 years old), as reported by their mother.\n\nO (Objective):\n- The doctor expressed significant concern during the consultation, indicating worry for the patient's current state.\n- The patient's reported symptoms of progressively worsening lip swelling, difficulty breathing, and dizziness suggest an escalating clinical situation.\n- No explicit vital signs, laboratory results, or specific physical examination findings were documented during this teleconsultation.\n- The patient was initially alone but confirmed that another individual arrived during the consultation.\n\nA (Assessment):\n- The patient is assessed to be experiencing a suspected anaphylactic reaction.\n- This assessment is based on the acute onset and rapid progression of lip swelling, coupled with respiratory symptoms (difficulty breathing, chest tightness) and systemic symptoms (dizziness), following exposure to a new food allergen (prawns).\n- The patient's medical history of asthma, peanut allergy, and previous severe allergic episodes further supports the high index of suspicion for anaphylaxis.\n\nP (Plan):\n- An ambulance (9999) was immediately called for the patient due to the suspected anaphylactic reaction.\n- The patient was advised to take any available antihistamines without delay while awaiting emergency services.\n- The patient's accompanying individual was instructed to call 9999 and report a suspected anaphylactic reaction.\n- The patient was advised to contact the clinic again after their hospital visit for further management, including discussion of potential auto-injector prescriptions.\n","review":137.0263157894737,"saved":142.4736842105263,"clean":false,"effort":7.6923076923076925,"sig":[],"mb":25.553921,"latency":31.344,"signable":154.0673157894737},{"label":"Run 4","wer":18.665607625099284,"text":"Hi.\nHello? Hi. Hi, I'm Maria. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah.\nGood. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know. And then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past? After eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something, I think. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI've always had it.\nAnd I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah. Well, I was like 6 or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nYeah. Busy right now, to be honest. You feel busy?\nOkay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in. And you might need an injection like what your mom's what your mom told you as you were a young child. Okay?\nMm-hmm. Right? So is there anyone with you at the moment? Or are you alone? I'm alone at the moment. Okay. So hang on the line. While I call the ambulance, okay? And I'll send them right to you.\nOkay? And. I already just came. Somebody just came.\nYes. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting. Yes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes. She said she will. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. And ask if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay?\nYes. Yes.\nWill do. Yes. Thank you.\nOkay, then. Take care.","marks":[[274,290,"Trabalotsa. OK day",false],[327,330,"first",false],[342,353,"ninety-nine. OK",false],[398,421,"M Traba at Gmail dot com. OK",false],[724,724,"I don't think",false],[781,788,"prawn",false],[855,862,".",false],[938,938,"Mm-hmm.",false],[988,988,"Mm-hmm. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned anywhere in the note."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","'The person who arrived was asked to call 999' - not identified as mother and staying with patient is not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["following exposure to a known allergen (prawns)","Transcript describes prawn soup as something new she tried; prawns were never stated to be a known allergen."]],"note":"S (Subjective):\n- Patient, Maria Trabaloza, born October 1, 1999, presented with lip swelling after consuming prawn soup (laksa) around 7:00 PM.\n- Swelling started on the left corner of the upper lip approximately 30 minutes after eating and is progressively worsening.\n- Patient reports difficulty breathing and a general feeling of tightness, possibly in the chest.\n- History includes a similar episode of swelling and difficulty breathing a year prior after consuming Chinese food (curry), at which time they were quite intoxicated and woke up swollen with breathing difficulties.\n- Patient has a known peanut allergy and asthma, for which they use a Salbutamol inhaler regularly. They recall their mother mentioning a severe allergic reaction requiring an injection when they were a child (around 6 years old) and a hospital visit for swelling.\n\nO (Objective):\n- The patient's email address is mtraba@gmail.com.\n- Patient reported feeling \"a little weird\" and \"really pumping blood\" in the swollen area.\n- Patient initially alone but someone arrived during the consultation.\n- There are no other objective findings from a physical examination mentioned in the transcript.\n\nA (Assessment):\n- Suspected anaphylactic reaction due to rapidly progressing lip swelling, difficulty breathing, and chest tightness following exposure to a known allergen (prawns).\n- History of previous similar allergic reactions and known peanut allergy further supports the diagnosis of anaphylaxis.\n- The patient's current symptoms raise significant concern for airway compromise.\n\nP (Plan):\n- Immediate call to emergency services (ambulance/999) for suspected anaphylactic reaction.\n- Patient advised to take any available antihistamines immediately while waiting for emergency services.\n- The person who arrived was asked to call 999 and inform them of a suspected anaphylactic reaction.\n- Patient advised to contact the clinic back after discharge from the hospital to arrange for an adrenaline auto-injector (e.g., EpiPen) and further management.\n","review":134.9736842105263,"saved":144.5263157894737,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call signals systemic/cardiovascular involvement in anaphylaxis and is absent from the note."],["fabrication","following exposure to a known allergen (prawns)","Invents a pre-existing known prawn allergy when prawn was a new food, falsifying allergy history."]],"mb":25.331393,"latency":21.703,"signable":144.9536842105263},{"label":"Run 5","wer":18.34789515488483,"text":"Hi.\nHello? Hi. Hi. Hi, I'm Rania. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know, and then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like it must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI've always had it. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you have to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like six or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nI feel a little dizzy right now, to be honest. Do you feel dizzy? Yeah. Okay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay? Mm-hmm. Right? So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So\nhang on the line. While I call the ambulance, okay? And I'll send them right to you.\nOkay? And if somebody just came somebody just came, yes, I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting. Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes.\nShe said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. And if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nOkay, then. Take care.","marks":[[19,21,"",false],[27,33,"Maria.",true],[278,294,"Trabalotsa. OK day",false],[331,334,"first",false],[346,357,"ninety-nine. OK",false],[402,425,"M Traba at Gmail dot com. OK",false],[728,728,"I don't think",false],[785,792,"prawn",false],[859,866,".",false],[942,942,"Mm-hmm.",false],[992,992,"Mm-hmm. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy captured, but the severe childhood reaction requiring hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","partial","Ambulance call documented but with wrong number '9999' instead of 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mom arriving and being asked to call is captured, but instruction to stay with the patient is missing."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[],"note":"S (Subjective):\n- Patient, Maria Trabaloza, born October 1, 1999, presented with lip swelling after consuming prawn soup (laksa) around 7:00 PM.\n- Swelling started on the left corner of the upper lip approximately 30 minutes after eating and is progressively worsening.\n- Patient reports difficulty breathing and a general feeling of tightness, though unsure if it is chest tightness.\n- History of a similar swelling episode a year prior after eating Chinese food (curry or something) while intoxicated, which also involved swelling and difficulty breathing the next morning.\n- Patient has a known peanut allergy and asthma, for which they use a Salbutamol inhaler regularly. They sometimes take antihistamines for their peanut allergy but are unsure which type.\n\nO (Objective):\n- Patient confirmed their full name, date of birth, and email address (mtraba@gmail.com).\n- Patient initially stated they were alone but later confirmed someone (Mom) arrived.\n- Patient reported feeling dizzy during the consultation.\n\nA (Assessment):\n- Suspected anaphylactic reaction.\n- History of previous allergic reactions with swelling and breathing difficulties.\n- Patient has known peanut allergy and asthma, increasing risk for severe allergic responses.\n\nP (Plan):\n- Immediate call to ambulance (9999) by the doctor due to concern for anaphylaxis.\n- Patient's accompanying person (Mom) to call 9999 and report suspected anaphylactic reaction.\n- Patient instructed to take available antihistamines immediately while awaiting emergency services.\n- Post-hospitalization follow-up to arrange for an adrenaline auto-injector prescription and education.\n","review":113.44736842105263,"saved":166.05263157894737,"clean":false,"effort":11.538461538461538,"sig":[["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Prior severe childhood reaction needing hospital/injection is key anaphylaxis history relevant to the adrenaline auto-injector plan."]],"mb":25.332733,"latency":20.274,"signable":122.42536842105262}],"lyrebird":[{"label":"Run 1","wer":15.250198570293886,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was,\n\n6 or something. I I I think, oh, sorry. The swelling is getting Okay. Like that. Oh, yeah. I think when I was Are you right? Are you okay now? You're busy right now, to be honest. You're feeling busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Right. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[[19,26,"I'm Maria.",true],[99,107,"all right",false],[202,209,"all right",false],[273,290,"Trabalotsa. OK",false],[348,357,"ninety-nine. OK",false],[404,409,"Traba",false],[590,594,"",false],[830,838,"prawn",true],[911,921,".",false],[1016,1021,"Mm-hmm.",false],[1072,1077,"Mm-hmm. 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OK",false],[6232,6232,"thank",false],[6248,6255,"bye bye.",true]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"prawn soup (laksa) consumption at approximately 7:00 pm\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"approximately 30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressing to upper lip\"; \"Reported worsening swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea present\"; \"Possible chest tightness, patient uncertain\"."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"Patient reported feeling dizzy during consultation\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode approximately one year ago ... following late-night Chinese curry, with lip swelling and dyspnoea\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"History of asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Known peanut allergy ... required hospitalisation at age 6 for severe allergic reaction\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis\" with an emergency ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance requested via 999\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival noted, but not that she was asked to stay or to call emergency services."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Immediate antihistamine administration (available at home with mother)\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up post-discharge required to arrange adrenaline autoinjector prescription\"."]],"claims":[["Allergy testing and specialist referral to be considered following acute episode","No allergy testing or specialist referral was mentioned; the clinician only asked her to ring back about injections."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 21/09/2026\n\nTime of Consultation: 2:13 am\n\n\n\n\nSubjective:\n\nPresented with acute lip swelling following prawn soup (laksa) consumption at approximately 7:00 pm on 21/09/2026\n\nSwelling commenced in left corner of lip approximately 30 minutes post-ingestion, progressing to upper lip\n\nReported worsening swelling with sensation of blood pumping to area\n\nDyspnoea present at time of consultation\n\nPossible chest tightness, patient uncertain\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese curry, with lip swelling and dyspnoea, patient intoxicated at time\n\nKnown peanut allergy since childhood, required hospitalisation at age 6 for severe allergic reaction\n\nHistory of asthma, managed with salbutamol inhaler\n\nTakes antihistamine for peanut allergy (specific type unknown)\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive lip swelling observed during consultation\n\nPatient reported feeling dizzy during consultation\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown atopic history (asthma, peanut allergy)\n\nPrevious anaphylactic reaction in childhood\n\nPrevious similar reaction to unidentified food allergen\n\n\n\n\nPlan:\n\nEmergency ambulance requested via 999\n\nImmediate antihistamine administration (available at home with mother)\n\nEmergency department transfer for acute management\n\nHospital assessment and treatment\n\nFollow-up post-discharge required to arrange adrenaline autoinjector prescription\n\nAllergy testing and specialist referral to be considered following acute episode\n\n\n\n\nTreating Clinician\n\nGeneral Practitioner","review":98.55263157894737,"saved":180.94736842105263,"clean":false,"effort":15.384615384615385,"sig":[["fabrication","Allergy testing and specialist referral to be considered following acute episode","Allergy testing and specialist referral were never discussed; invented plan item."]],"mb":17.363224,"latency":21.792,"signable":120.34463157894737},{"label":"Run 2","wer":15.091342335186656,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called, we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's can you still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think, oh, sorry. The swelling is getting Okay. Like that. Oh, yeah. I think when I was Are you right? Are you okay now? You're busy right now, to be honest. You're feeling busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Right. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are work\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXhance","marks":[[19,26,"I'm Maria.",true],[99,107,"all right",false],[202,209,"all right",false],[273,290,"Trabalotsa. OK",false],[348,357,"ninety-nine. OK",false],[404,409,"Traba",false],[590,594,"",false],[830,838,"prawn",true],[910,910,". And",false],[1002,1007,"Mm-hmm.",false],[1058,1063,"Mm-hmm. 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Oh.",false],[4391,4391,"all",false],[4417,4428,"Ohh I feel a little dizzy",true],[4453,4453,"ohh. Are you .",false],[4469,4480,"dizzy. OK",true],[4605,4617,"uh all right",false],[4950,4955,"mum's. Um",false],[4977,4980,"mum",false],[5017,5022,"OK all",false],[5126,5126,"Ohh no",false],[5153,5154,"I'll",false],[5223,5223,". Hey ohh",false],[5284,5307,"any more. Thank. All right OK",false],[5440,5444,"worried",false],[5621,5629,"uh Mum Mum",false],[5679,5697,"K.",false],[5729,5732,"mum",false],[5742,5745,"Mum",false],[5767,5768,"uh",false],[5886,5890,"OK. Ohh yeah yeah we do .",false],[5925,5925,"All right",false],[5984,6004,"all right. OK OK.",false],[6015,6015,". And after you",false],[6157,6161,"will",false],[6177,6186,". All . OK",false],[6224,6224,"thank",false],[6240,6246,"bye bye.",true]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"acute lip swelling following prawn laksa consumption\" identifies prawn exposure."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"progressing to upper lip swelling over approximately 30 minutes\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Progressive worsening of swelling during consultation\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea and possible chest tightness reported\"."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"feeling unwell and dizzy during consultation\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"approximately one year ago ... following late-night Chinese curry, with lip swelling and breathing difficulty\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"peanut allergy with anaphylaxis requiring hospitalisation at age 6\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis\" with emergency ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance called for immediate transfer\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother arrived, instructed to call 999, patient to remain with her."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","partial","States \"Antihistamine administered immediately (provided by mother)\" as done rather than the advice given; also contradicts \"No antihistamines available at home\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up ... post-hospital discharge for consideration of adrenaline auto-injector\"."]],"claims":[["Antihistamine administered immediately (provided by mother)","Transcript only advises taking antihistamines; administration was never confirmed."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 5:27 am\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn laksa consumption at approximately 7:00 pm on 21/09/2026\n\nInitial tingling sensation left corner of mouth, progressing to upper lip swelling over approximately 30 minutes\n\nProgressive worsening of swelling during consultation\n\nDyspnoea and possible chest tightness reported\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese curry, with lip swelling and breathing difficulty\n\nKnown peanut allergy with anaphylaxis requiring hospitalisation at age 6 (injection administered)\n\nBackground of asthma, managed with salbutamol inhaler\n\nUses antihistamines for peanut allergy (specific type unknown)\n\nNo antihistamines available at home at time of consultation\n\nMother arrived during consultation and confirmed antihistamines available in home\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive upper lip swelling observed during consultation\n\nPatient reported feeling unwell and dizzy during consultation\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown history of food allergies (peanut) with previous anaphylaxis\n\nPrevious similar reaction to shellfish/seafood likely\n\nAsthma (comorbidity)\n\n\n\n\nPlan:\n\nEmergency ambulance called for immediate transfer to hospital\n\nAntihistamine administered immediately (provided by mother)\n\nMother instructed to call 999 and report suspected anaphylaxis\n\nPatient to remain with mother until ambulance arrival\n\nFollow-up appointment required post-hospital discharge for consideration of adrenaline auto-injector prescription and allergy management plan\n\nPatient advised to contact practice after hospital discharge","review":104.23684210526315,"saved":175.26315789473685,"clean":false,"effort":11.538461538461538,"sig":[["partial","Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","Records antihistamine as administered when it was only advised, misleading the receiving team about treatment given."]],"mb":17.519787,"latency":26.517,"signable":130.75384210526315},{"label":"Run 3","wer":15.170770452740271,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think, oh, sorry. The swelling is getting Okay. Like that. Oh, yeah. I think when I was Are you right? Are you okay now? You're busy right now, to be honest. You're feeling busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Right. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[[19,26,"I'm Maria.",true],[99,107,"all right",false],[202,209,"all right",false],[273,290,"Trabalotsa. OK",false],[348,357,"ninety-nine. OK",false],[404,409,"Traba",false],[590,594,"",false],[830,838,"prawn",true],[911,921,".",false],[1016,1021,"Mm-hmm.",false],[1072,1077,"Mm-hmm. 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Oh.",false],[4409,4409,"all",false],[4435,4446,"Ohh I feel a little dizzy",true],[4471,4471,"ohh. Are you .",false],[4487,4498,"dizzy. OK",true],[4623,4635,"uh all right",false],[4968,4973,"mum's. Um",false],[4995,4998,"mum",false],[5035,5040,"OK all",false],[5144,5144,"Ohh no",false],[5171,5172,"I'll",false],[5241,5241,". Hey ohh",false],[5302,5325,"any more. Thank. All right OK",false],[5457,5457,"worried",false],[5634,5642,"uh Mum Mum",false],[5692,5710,"K.",false],[5742,5745,"mum",false],[5755,5758,"Mum",false],[5780,5781,"uh",false],[5899,5903,"OK. Ohh yeah yeah we do .",false],[5938,5938,"All right",false],[5997,6017,"all right. OK OK.",false],[6028,6028,". And after you",false],[6170,6174,"will",false],[6190,6199,". All . OK",false],[6237,6237,"thank",false],[6253,6260,"bye bye.",true]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Exposure recorded as prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'approximately 30 minutes post-ingestion'."],["The note captures: Upper lip swelling is progressively worsening.","yes","Swelling 'progressing to upper lip' and 'increasing during consultation'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Dyspnoea present' and 'Possible chest tightness, though patient uncertain'."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not recorded (only 'increasingly distressed')."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'Similar episode approximately one year ago... late-night Chinese meal... lip swelling and breathing difficulty'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'History of asthma, managed with salbutamol inhaler'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'Known peanut allergy with anaphylactic reaction requiring hospitalisation at age 6'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylaxis' with emergency ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Emergency ambulance called for immediate transfer'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and call recorded but number given as 000 not 999, and staying with patient omitted."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised immediate administration of antihistamine (sourced by mother)'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'Adrenaline auto-injector to be arranged following hospital discharge'."]],"claims":[["Mother to call 000","The clinician said to call 'nine nine nine'; 000 is a different emergency number never stated."],["27-year-old female","DOB 1 October 1999 and session date 22/09/2026 make her 26; the stated age is wrong."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 4:18 pm\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn soup (laksa) consumption at approximately 7:00 pm today\n\nSwelling began in left corner of mouth approximately 30 minutes post-ingestion, progressing to upper lip\n\nReports sensation of swelling increasing during consultation\n\nDyspnoea present - reports difficulty breathing\n\nPossible chest tightness, though patient uncertain\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese meal (curry), with lip swelling and breathing difficulty\n\nKnown peanut allergy with anaphylactic reaction requiring hospitalisation at age 6\n\nHistory of asthma, managed with salbutamol inhaler\n\nUses antihistamines for peanut allergy (specific type unknown)\n\nNo antihistamines available at home at time of consultation\n\nMother arrived during consultation and confirmed antihistamines available in home\n\n\n\n\nObjective:\n\nProgressive lip swelling observed during consultation\n\nPatient became increasingly distressed during consultation\n\nMother present by end of consultation\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown food allergies (peanuts)\n\nAsthma\n\n\n\n\nPlan:\n\nEmergency ambulance called for immediate transfer to emergency department\n\nAdvised immediate administration of antihistamine (sourced by mother)\n\nMother instructed to call 000 for emergency services with notification of suspected anaphylactic reaction\n\nPatient to be assessed in emergency department\n\nAdrenaline auto-injector to be arranged following hospital discharge\n\nFollow-up appointment with practice required after hospital review\n\nPatient advised to contact practice after emergency department assessment\n\n\n\n\nTreating Clinician","review":129.28947368421052,"saved":150.21052631578948,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis (possible haemodynamic compromise) not recorded."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency number recorded as 000 instead of 999; staying with patient omitted."]],"mb":17.406785,"latency":21.894,"signable":151.18347368421053},{"label":"Run 4","wer":15.170770452740271,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I didn't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think oh, sorry. The swelling is getting oh, my god. Oh, yeah. I think when I was right. Are you okay now? You're busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. It, I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are work\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[[19,26,"I'm Maria.",true],[99,107,"all right",false],[202,209,"all right",false],[273,290,"Trabalotsa. OK",false],[348,357,"ninety-nine. OK",false],[404,409,"Traba",false],[590,594,"",false],[830,838,"prawn",true],[911,921,".",false],[1016,1021,"Mm-hmm.",false],[1072,1077,"Mm-hmm. Um",false],[1130,1139,"it",false],[1152,1156,"laksa",false],[1206,1210,"Yeah.",false],[1234,1242,"feel",false],[1256,1261,"started",false],[1338,1343,"Mm-hmm.",false],[1621,1621,"Yeah. Right. All",false],[1971,1984,"you developed",false],[2064,2074,"it it",false],[2519,2524,"the chest",false],[2656,2659,"",false],[2812,2812,"Mm-hmm.",false],[2855,2862,"kinda",false],[2930,2930,"Sure OK.",false],[2987,2988,"I've",false],[3116,3122,"don't",false],[3170,3181,"something I think. OK. Right. OK. Uh",false],[3335,3339,"took",false],[3348,3348,"ohh",false],[3569,3569,"Ohh I",false],[3672,3679,"Piriton",true],[3714,3722,"",false],[3726,3731,"I got no I do",false],[3820,3824,"",false],[3864,3877,"antihistamines",true],[3963,3970,"any time",false],[3975,3978,"have",false],[4103,4110,"'cause",false],[4128,4129,"I've",false],[4169,4172,"mum",false],[4320,4322,"Ohh",false],[4355,4357,"ohh",false],[4367,4369,"ohh",false],[4395,4395,"six. Oh. You all",false],[4421,4432,"Ohh I feel a little dizzy",true],[4457,4457,"ohh. Are",false],[4462,4478,". You're feeling dizzy. OK",true],[4596,4608,"uh all right",false],[4945,4950,"mum's. Um",false],[4972,4975,"mum",false],[5011,5011,"OK all",false],[5115,5115,"Ohh no",false],[5142,5143,"I'll",false],[5212,5212,". Hey ohh",false],[5273,5296,"any more. Thank. All right OK",false],[5429,5433,"worried",false],[5610,5618,"uh Mum Mum",false],[5668,5686,"K.",false],[5718,5721,"mum",false],[5731,5734,"Mum",false],[5756,5757,"uh",false],[5875,5879,"OK. Ohh yeah yeah we do .",false],[5914,5914,"All right",false],[5973,5993,"all right. OK OK.",false],[6004,6004,". And after you",false],[6146,6150,"will",false],[6166,6175,". All . OK",false],[6213,6213,"thank",false],[6229,6236,"bye bye.",true]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Prawn-based soup identified as the exposure."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling commenced approximately 30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Left corner progressing to upper lip, worsening during consultation."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea present, possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not documented; note says only \"feeling unwell and anxious\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Episode ~1 year ago after Chinese curry with lip swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Background of asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with reaction requiring hospitalisation at age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis secondary to prawn ingestion\" with emergency transfer."],["The note captures: Urgent ambulance/999 call is advised or arranged.","partial","Ambulance call captured but recorded as \"via 000\"; the clinician specified 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival captured, but not that she was asked to stay with the patient and call emergency services."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Immediate administration of antihistamine (provided by mother)\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Post-discharge follow-up to arrange adrenaline auto-injector."]],"claims":[["27-year-old female","Patient gave DOB 1 October 1999; on the 22/09/2026 session date she is 26, so the age is wrong."],["Emergency ambulance called via 000","Clinician explicitly said to call \"nine nine nine\"; 000 is never mentioned."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 5:56 pm\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn laksa consumption at approximately 7:00 pm today\n\nSwelling commenced approximately 30 minutes post-ingestion, initially left corner of mouth, progressing to upper lip\n\nReports progressive worsening of swelling during consultation\n\nDyspnoea present, possible chest tightness\n\nSimilar episode approximately one year ago (September 2025) following Chinese curry consumption, with lip swelling and breathing difficulty\n\nKnown peanut allergy since childhood with anaphylaxis requiring hospitalisation at age 6\n\nBackground of asthma, managed with salbutamol inhaler\n\nTakes antihistamines for peanut allergy (specific type unknown)\n\nNo antihistamines available at home at time of consultation\n\nMother arrived during consultation and confirmed antihistamines available\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive lip swelling observed during consultation\n\nPatient reported feeling unwell and anxious\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nLikely shellfish/prawn allergy\n\nKnown peanut allergy with previous anaphylaxis\n\nAsthma\n\n\n\n\nPlan:\n\nEmergency ambulance called via 000\n\nImmediate administration of antihistamine (provided by mother)\n\nTransfer to hospital for adrenaline injection and emergency management\n\nFollow-up post-discharge required to arrange adrenaline auto-injector prescription and allergy action plan\n\nPatient advised to contact practice after hospital discharge\n\n\n\n\nTreating Clinician","review":132.71052631578948,"saved":146.78947368421052,"clean":false,"effort":34.61538461538461,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness is recorded only as 'unwell and anxious', which loses a sign of cardiovascular compromise."]],"mb":17.55461,"latency":23.15,"signable":155.86052631578949},{"label":"Run 5","wer":15.250198570293886,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think oh, sorry. The swelling is getting oh, my god. Oh, yeah. I think when I was right. Are you okay now? You're busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[[19,26,"I'm Maria.",true],[99,107,"all right",false],[202,209,"all right",false],[273,290,"Trabalotsa. OK",false],[348,357,"ninety-nine. OK",false],[404,409,"Traba",false],[590,594,"",false],[830,838,"prawn",true],[911,921,".",false],[1016,1021,"Mm-hmm.",false],[1072,1077,"Mm-hmm. 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You all",false],[4421,4432,"Ohh I feel a little dizzy",true],[4457,4457,"ohh. Are",false],[4462,4478,". You're feeling dizzy. OK",true],[4596,4608,"uh all right",false],[4941,4946,"mum's. Um",false],[4968,4971,"mum",false],[5008,5013,"OK all",false],[5117,5117,"Ohh no",false],[5144,5145,"I'll",false],[5214,5214,". Hey ohh",false],[5275,5298,"any more. Thank. All right OK",false],[5430,5430,"worried",false],[5607,5615,"uh Mum Mum",false],[5665,5683,"K.",false],[5715,5718,"mum",false],[5728,5731,"Mum",false],[5753,5754,"uh",false],[5872,5876,"OK. Ohh yeah yeah we do .",false],[5911,5911,"All right",false],[5970,5990,"all right. OK OK.",false],[6001,6001,". And after you",false],[6143,6147,"will",false],[6163,6172,". All . OK",false],[6210,6210,"thank",false],[6226,6233,"bye bye.",true]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","partial","Prawn soup exposure captured, but it is named \"prawn laksa\", a dish name never spoken in the transcript."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling commenced approximately 30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Swelling progressing to upper lip with progressive worsening."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea present, possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented; only \"feeling unwell and anxious\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode ~1 year ago after late-night Chinese meal with lip swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Background of asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Known peanut allergy with reaction at age 6 requiring injection and hospitalisation."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis\"; emergency ambulance called."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance called\"; mother to call 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother arrived; instructed to call 999; patient to remain with mother."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","partial","Antihistamine captured but stated as \"administered\" rather than advised to take immediately while awaiting ambulance."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up post-discharge to arrange adrenaline auto-injector."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 6:38 pm\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn laksa consumption at approximately 7:00 pm today\n\nSwelling commenced approximately 30 minutes post-ingestion, initially left corner of mouth, progressing to upper lip\n\nReports progressive worsening of swelling during consultation\n\nDyspnoea present, possible chest tightness\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese meal, with lip swelling and breathing difficulty\n\nKnown peanut allergy with history of anaphylaxis at age 6 requiring injection and hospitalisation\n\nBackground of asthma, managed with salbutamol inhaler\n\nTakes antihistamine for peanut allergy (specific type unknown)\n\nNo antihistamines available at home initially\n\nMother arrived during consultation with antihistamines\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive lip swelling observed during consultation\n\nPatient reported feeling unwell and anxious\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown peanut allergy with previous anaphylaxis\n\nAsthma\n\n\n\n\nPlan:\n\nEmergency ambulance called for suspected anaphylactic reaction\n\nAntihistamine administered immediately upon availability\n\nMother instructed to call 999 for emergency services\n\nPatient advised to remain with mother until ambulance arrival\n\nFollow-up appointment required post-hospital discharge to arrange adrenaline auto-injector prescription\n\nPatient instructed to contact practice after hospital review\n\n\n\n\nTreating Clinician","review":110.21052631578948,"saved":169.28947368421052,"clean":false,"effort":15.384615384615385,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during an evolving anaphylaxis (possible haemodynamic compromise) is omitted."],["partial","Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","Antihistamine recorded as administered when it was only advised; hospital could misjudge dosing already given."]],"mb":17.504782,"latency":22.002,"signable":132.2125263157895}],"preve":[{"label":"Run 1","wer":16.838760921366163,"text":"Hi.\n\nHello? Hi. Hi, I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing?\n\nI'm\n\nalright.\n\nThank you. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could\n\nyour full name for me, please?\n\nYes.\n\nMaria Trabowatza.\n\nOkay. Day... And your date of birth?\n\nThat is the 10/01/1999.\n\nOkay. And your email address for me, please?\n\nYes. Mtrava@gmail.com.\n\nOkay.\n\nAnd just to confirm that you're in a secure location, and we can have a confidential\n\nYes. I think I am. Yeah. Good.\n\nRight. You've mentioned in your... In in your patient notes that you're having some...\n\nOf lip swelling and you... After you had a sandwich?\n\nIs that correct?\n\nYeah. That is\n\nwell, I don't think I don't think it was... It it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends\n\nto to this place called\n\nAnd we we regularly have... Like, usually, I have\n\nlike, a normal vegetarian soup or something. Mhmm. And... Yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\na soup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my... It feels like... Like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe... That there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was... That must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan... Half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's... Can\n\nyou still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd just a few. Have you ever had these\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I'm not sure what it was I had. It was like a\n\ncurry or something, I think.\n\nAnd what did\n\nyou take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell... I I take... Oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight.\n\nAnd so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah.\n\nLike,\n\nalways had it. Yeah.\n\nI think\n\nI did get antihistamines for that.\n\nBut I'm not sure which ones.\n\nAnd any\n\npoint... Because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that... Well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh, you\n\nI think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've\n\nbeen busy?\n\nOkay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo.\n\nRight. Okay. So\n\nright. Oh, alright. I... I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say an\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any... Anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at\n\nthe moment. Yeah. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to\n\nyou.\n\nOkay?\n\nAnd...\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nOh, okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements\n\naround? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away, and\n\nAnd if mom can call... Mom, if you can call the 99999, yeah, and say that your... There is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay.\n\nYes.\n\nThank\n\nyou. Out\n\nfrom\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay? Yes.\n\nYes. I'll do. Yes.\n\nThank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. Bye.","marks":[[82,87,"",false],[114,122,"all right",false],[219,226,"all right",false],[239,239,"confirm",false],[285,303,"Trabalotsa. OK",false],[348,366,"first of October ninety-nine. OK",false],[412,436,"M Traba at Gmail dot com. OK",false],[522,522,"conversation",false],[583,590,"",false],[642,642,"sort",false],[834,841,"prawn",true],[1013,1018,"Mm-hmm.",false],[1073,1078,"Mm-hmm. Um",false],[1133,1142,"it",false],[1155,1163,"laksa",false],[1248,1264,"feel",false],[1280,1285,"started",false],[1362,1367,"Mm-hmm.",false],[1538,1542,"",false],[1651,1651,"Yeah. Right. All",false],[1804,1810,"seven o'clock",false],[1954,1959,"I don't know",false],[2004,2017,"you developed",false],[2094,2115,"it it",false],[2717,2720,"",false],[2767,2770,"After",true],[2880,2885,"Mm-hmm.",false],[3070,3071,"I've",false],[3199,3211,"I don't know",false],[3435,3442,"took",false],[3455,3457,"ohh",false],[3557,3561,"taken",false],[3682,3682,"Ohh I",false],[3789,3798,"Piriton",true],[3831,3840,"Hmm",false],[3848,3853,"I got no I do",false],[3979,3982,"do",false],[4077,4096,"peanut allergy any time",true],[4232,4239,"'cause",false],[4257,4258,"I've",false],[4300,4303,"mum",false],[4356,4356,"had an",false],[4452,4454,"Ohh",false],[4483,4502,"ohh my god ohh yeah",false],[4522,4522,"six. Oh. You all",false],[4550,4561,"Ohh I feel a little dizzy",true],[4588,4613,"ohh. Are you . You're feeling dizzy. OK",true],[4743,4755,"uh all right",false],[5094,5099,"mum's. Um",false],[5121,5124,"mum",false],[5162,5167,"OK all",false],[5276,5276,"Ohh no",false],[5384,5384,". Hey ohh",false],[5446,5465,"any more. Thank. All right OK",false],[5788,5795,"uh Mum Mum",false],[5812,5825,"antihistamines",true],[5846,5865,"K.",false],[5903,5906,"mum",false],[5919,5922,"Mum",false],[5944,5949,"uh nine nine nine nine nine",false],[6061,6065,"OK. Ohh yeah yeah we do .",false],[6096,6096,"yes. All right",false],[6156,6177,"all right. OK OK.",false],[6190,6190,". And after",false],[6196,6196,"come",false],[6342,6346,"will",false],[6363,6373,". All . OK",false],[6412,6412,"thank",false],[6433,6433,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Onset after prawn soup around 19:00\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"lip swelling began ~30 min later\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Upper lip swelling starting left corner, now enlarging\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Breathing feels difficult; unsure about chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Prior similar episode ~1 year ago after late-night Chinese meal with next-day swelling and difficult breathing\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma listed with a salbutamol inhaler."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"severe allergic reaction in childhood requiring hospital care (injection administered)\" plus peanut allergy."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis; risk of airway compromise\"; needs an ambulance straight away."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Instructed to call 999 for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother arriving and staying is captured, but the note does not say the mother was asked to make the call."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact clinic to arrange adrenaline auto-injector prescription\"."]],"claims":[["Salbutamol inhaler as needed","Patient said \"I do take that regularly\"; 'as needed' contradicts the stated frequency."]],"note":"Presenting Condition\n\nOnset after prawn soup around 19:00; lip swelling began ~30 min later\n\nUpper lip swelling starting left corner, now enlarging; pulsatile sensation\n\nBreathing feels difficult; unsure about chest tightness\n\nPrior similar episode ~1 year ago after late-night Chinese meal with next‑day swelling and difficult breathing\n\nPeanut allergy since childhood\n\nReason for visit: acute swelling after suspected food trigger, concern about worsening symptoms\n\n\n\n\nRadiology\n\n- \n\n\n\n\nPrevious MSK injuries\n\n- \n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy since childhood\n\nHistory of severe allergic reaction in childhood requiring hospital care (injection administered)\n\n\n\n\nMedications\n\nSalbutamol inhaler as needed\n\nNo regular preventer inhaler reported\n\nNo current antihistamines on hand prior to call\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: reports difficulty breathing\n\nChest tightness: unsure\n\nPrevious lip swelling episodes: yes, ~1 year ago after meal\n\nUse of antihistamines previously: uncertain\n\nUse of adrenaline injection in past: possibly in childhood\n\nCurrent safety: initially alone, later mother present\n\n\n\n\nSocial History\n\nEats out with friends; mother available at home\n\n\n\n\nGoals\n\nAdvised to call back post-hospital for injection prescription planning\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: visible/progressive upper lip swelling reported by patient\n\nFunctional tests: breathing subjectively difficult\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction to seafood (prawn) given rapid onset swelling and breathing difficulty\n\nPrognosis: requires urgent emergency management\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nSuspected anaphylaxis; risk of airway compromise\n\nNeed immediate ambulance attendance\n\nActions:\n\nInstructed to call 999 for suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nEnsure accompaniment by mother until ambulance arrives\n\n// Patient reported mother present; antihistamine available and to be taken; ambulance to be called urgently\n\n\n\n\nPlan\n\nImmediate ED assessment and treatment\n\nPost‑hospital: contact clinic to arrange adrenaline auto‑injector prescription and allergy management plan\n","review":130.23684210526315,"saved":149.26315789473685,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call is not documented."],["fabrication","Salbutamol inhaler as needed","Salbutamol frequency changed from regular to as-needed, misrepresenting asthma control relevant to anaphylaxis risk."]],"mb":14.086936,"signable":153.81084210526316},{"label":"Run 2","wer":16.838760921366163,"text":"Hi. Hello?\n\nHi. Hi. I'm Maria. Hello. I'm doctor Jake and welcome to Babylon. Mhmm. How are you doing?\n\nI'm alright. Thank you. I feel a little weird.\n\nToday, to be honest. Yeah. So just before we we start, is it alright if you could\n\nyour full name for me, please? Yes.\n\nMaria Trabalotza. Okay. Day and your date of birth?\n\nThat is the 10/01/1999. Okay. And your email address for me, please?\n\nYes. Mtrava@gmail.com. Okay.\n\nAnd just to confirm that you're in a secure location and we have a confidential\n\nconversation. Yes. I think I am. Yeah. Good.\n\nRight. You've mentioned in your in in your patient notes that you're having some, let's\n\nsort of lip swelling and you after you had a sandwich?\n\nIs that correct? Yeah. That is\n\nwell, I don't think I don't think it was it it wasn't a farm rich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends\n\nto to this place called\n\nAnd we we regularly have, like, usually, a half\n\nlike, a normal vegetarian soup or something. Mhmm. And, yeah, and\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\nsoup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my it feels like my lips start\n\nfeeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat of banter. It wasn't really\n\npaying attention. Now I feel\n\nthat that there is a swelling. Yep. There is, like, a\n\nswelling on my on my upper lip, and it's kind of getting bigger.\n\nI don't know what to do. Right.\n\nSo when did you have\n\nthe prawn soup? What time?\n\nThat was that must have been just\n\nto work, so maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention, so\n\nit must have been, like, must have been, like,\n\nI don't know, half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah. Okay.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's can you still feel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay.\n\nSo just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I I feel like I can't breathe that\n\nwell right now.\n\nOkay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if it's the chest. It just generally feels a little\n\ndifficult. Okay. But, yeah, it might be. I'm not\n\nsure.\n\nOkay. Right.\n\nAnd just a few. Have you ever had\n\nthese\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends. Mhmm.\n\nAnd I think we went, like,\n\nto late night kinda Chinese place, and I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad. And\n\nquite difficult breathing. Right. But I didn't know what it was I had\n\nwas like a curry or something, I think. Okay.\n\nAnd what did you take\n\nat\n\nthat\n\ntime? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell I I take oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have\n\nasthma. And any other inhalers? Is\n\njust the salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No.\n\nRight.\n\nAnd so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those?\n\nKind of things?\n\nAbout no. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah.\n\nI always had it.\n\nYeah. I think I do get antihistamines for that, but I'm not\n\nsure which ones.\n\nAnd any point because you've had penitillas,\n\nany time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom\n\ntold me about it, but I don't know what it was because I was small. And I changed doctors since.\n\nRight. Has your mom ever said that you had to go to\n\nbecause you had an severe allergic reaction?\n\nYeah. Is that well, I was, like, six or something. I\n\nI I think, oh, sorry. The swelling is getting\n\nOkay. Like that. Ugh. Yeah. I think when I was run.\n\nAre you okay\n\nnow?\n\nYou're busy right now.\n\nBe honest.\n\nYou're\n\nbeing\n\nbusy? Okay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo.\n\nRight. Okay. So\n\nRight. Alright. I I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because from what\n\nhistory you've been telling me, it sounds like you\n\ncould be going into what we say an anaphylactic reaction.\n\nThat's when your throat and your chest, you know, closes in.\n\nAnd you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any anyone with you at the moment, or\n\nare you alone?\n\nI'm alone at the moment. Oh, no.\n\nSo\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to you. Okay?\n\nAnd Somebody just\n\ncame. Somebody just came. Yeah. I'm not alone anymore.\n\nOkay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah?\n\nAnd because we are worried about an anaphylactic reaction\n\nso you need to go straight away. Could you ask the\n\nperson whether they have any antihistamines around in the interim?\n\nWhile we're waiting. Yes.\n\nMom, mom, do we have any announcements around? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away. And if mom can call mom, if you can\n\ncall the, 99999. Yeah?\n\nAnd say that your there is a suspected anaphylactic reaction\n\nand they need to come straight away. Okay?\n\nYes. She said she will. Yes. Yes. So\n\nstraight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay. Yes. Thank you. Come out from\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out.\n\nWith your injections and things like that. Okay?\n\nYeah.\n\nYes. I'll do. Yes. Thank\n\nyou. Okay then. Take\n\ncare.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[[49,53,"Jacob",false],[78,83,"",false],[108,116,"all right",false],[213,220,"all right",false],[233,233,"confirm",false],[278,295,"Trabalotsa. OK",false],[337,354,"first of October ninety-nine. OK",false],[400,423,"M Traba at Gmail dot com. OK",false],[484,484,"can",false],[579,583,"",false],[634,639,"",false],[785,794,"sandwich",false],[830,837,"prawn",true],[954,960,"I have",false],[1007,1012,"Mm-hmm.",false],[1065,1070,"Mm-hmm. Um",false],[1125,1134,"it",false],[1147,1155,"laksa",false],[1235,1243,"feel",false],[1257,1262,"started",false],[1340,1345,"Mm-hmm.",false],[1514,1518,"",false],[1628,1628,"Yeah. Right. 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Ohh",false],[5336,5336,". Hey ohh",false],[5398,5413,"any more. Thank. All right OK",false],[5735,5743,"uh Mum Mum",false],[5760,5773,"antihistamines",true],[5793,5812,"K.",false],[5845,5848,"mum",false],[5858,5861,"Mum",false],[5885,5891,"uh nine nine nine nine nine",false],[5998,6002,"OK. Ohh yeah yeah we do .",false],[6038,6038,"All right",false],[6098,6119,"all right. OK OK.",false],[6130,6130,". And after",false],[6288,6292,"yes will",false],[6309,6318,". All . OK",false],[6358,6358,"thank",false],[6377,6377,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after prawn laksa soup\" identifies prawn soup exposure."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Onset ~30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Progression: increasing swelling; pulsatile sensation; worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"breathing difficulty; possible chest tightness\"; throat closing sensation present."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"~1 year ago after late-night Chinese/curry; woke with swelling and breathing difficulty\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with \"Salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Peanut allergy since childhood\" with \"Possible prior anaphylaxis in childhood requiring injection\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction ... urgent medical treatment required\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call emergency services immediately for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother present and patient to remain with another person, but mother arriving and being asked to call emergency services is not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Post-hospital follow-up for adrenaline autoinjector provision\"."]],"claims":[["asthma review (consider preventer)","No asthma review or preventer inhaler was proposed; the clinician only asked whether she used other inhalers."]],"note":"Presenting Condition\n\nSudden upper lip swelling after prawn laksa soup around 19:00\n\nOnset ~30 minutes post-ingestion\n\nProgression: increasing swelling; pulsatile sensation; worsening\n\nLocation: upper lip, started at left corner\n\nAssociated symptoms: breathing difficulty; possible chest tightness\n\nPrevious episode: ~1 year ago after late-night Chinese/curry; woke with swelling and breathing difficulty\n\nReasons for visit: acute lip swelling and breathing difficulty after meal\n\n\n\n\nRadiology\n\n- \n\n\n\n\nPrevious MSK injuries\n\n- \n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy since childhood\n\nPossible prior anaphylaxis in childhood requiring injection (per mother’s report)\n\n\n\n\nMedications\n\nSalbutamol inhaler PRN\n\nIntermittent antihistamines for peanut allergy (unsure type)\n\nNo preventer (“brown”) inhaler\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present\n\nBreathing difficulty: present\n\nChest tightness: uncertain\n\nPast similar reactions: present (approx 1 year ago; childhood severe reaction)\n\nCurrent access to antihistamines: initially none on person; mother has antihistamines at home\n\n\n\n\nSocial History\n\nLives with mother (present during call)\n\n\n\n\nGoals\n\nImmediate relief of swelling and breathing difficulty\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: progressive upper lip swelling reported; dyspnoea reported during call\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction following shellfish (prawn) exposure; differential includes isolated angioedema, but respiratory symptoms concerning for anaphylaxis\n\nPrognosis: urgent medical treatment required; risk of rapid deterioration\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nCall emergency services immediately for suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nRemain with another person until help arrives\n\nPost-hospital follow-up for adrenaline autoinjector provision and allergy management\n\n// Patient’s mother present; antihistamine available; ambulance to be called; symptoms worsening during call\n\n\n\n\nPlan\n\nImmediate transfer to emergency via ambulance\n\nAfter discharge: contact clinic to arrange prescription/training for adrenaline autoinjector and allergy referral (shellfish/peanut), asthma review (consider preventer)\n","review":128.0263157894737,"saved":151.4736842105263,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during suspected anaphylaxis signals possible circulatory compromise and is absent."],["fabrication","asthma review (consider preventer)","Invents an asthma review and preventer consideration as a follow-up plan item."]],"mb":13.809089,"signable":161.8943157894737},{"label":"Run 3","wer":16.918189038919778,"text":"Hi.\n\nHello? Hi. Hi, I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing?\n\nI'm\n\nalright.\n\nThank you. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could\n\nyour full name for me, please?\n\nYes.\n\nMaria Trabowatza.\n\nOkay. Day... And your date of birth?\n\nThat is the 10/01/1999.\n\nOkay. And your email address for me, please?\n\nYes. Mtrava@gmail.com.\n\nOkay.\n\nAnd just to confirm that you're in a secure location, and we can have a confidential\n\nYes. I think I am. Yeah. Good.\n\nRight. You've mentioned in your... In in your patient notes that you're having some...\n\nOf lip swelling and you... After you had a sandwich?\n\nIs that correct?\n\nYeah. That is\n\nwell, I don't think I don't think it was... It it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends\n\nto to this place called\n\nAnd we we regularly have... Like, usually, I have\n\nlike, a normal vegetarian soup or something. Mhmm. And... Yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\nsoup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my... It feels like... Like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe... That there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was... That must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan... Half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's... Can\n\nyou still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd\n\njust\n\na few. Have you ever had\n\nthese\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I'm not sure what it was I had. It was like a\n\ncurry or something, I think.\n\nAnd what did\n\nyou take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell... I I take... Oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight.\n\nAnd so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah.\n\nLike,\n\nalways had it. Yeah.\n\nI think\n\nI did get antihistamines for that.\n\nBut I'm not sure which ones.\n\nAnd any\n\npoint... Because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that... Well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh, you\n\nI think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've\n\nbeen busy?\n\nOkay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo.\n\nRight. Okay. So\n\nright. Oh, alright. I... I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say an\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any... Anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at\n\nthe moment. Yeah. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to\n\nyou.\n\nOkay?\n\nAnd...\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nOh, okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements\n\naround? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away, and\n\nAnd if mom can call... Mom, if you can call the 99999, yeah, and say that your... There is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay.\n\nYes.\n\nThank\n\nyou. Out\n\nfrom\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay?\n\nYes.\n\nYes.\n\nI'll\n\ndo. Yes.\n\nThank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. Bye.","marks":[[82,87,"",false],[114,122,"all right",false],[219,226,"all right",false],[239,239,"confirm",false],[285,303,"Trabalotsa. OK",false],[348,366,"first of October ninety-nine. OK",false],[412,436,"M Traba at Gmail dot com. OK",false],[522,522,"conversation",false],[583,590,"",false],[642,642,"sort",false],[834,841,"prawn",true],[1013,1018,"Mm-hmm.",false],[1073,1078,"Mm-hmm. Um",false],[1133,1142,"it",false],[1155,1163,"laksa",false],[1246,1262,"feel",false],[1278,1283,"started",false],[1360,1365,"Mm-hmm.",false],[1536,1540,"",false],[1649,1649,"Yeah. Right. All",false],[1802,1808,"seven o'clock",false],[1952,1957,"I don't know",false],[2002,2015,"you developed",false],[2092,2113,"it it",false],[2717,2720,"",false],[2768,2771,"After",true],[2881,2886,"Mm-hmm.",false],[3071,3072,"I've",false],[3200,3212,"I don't know",false],[3436,3443,"took",false],[3456,3458,"ohh",false],[3558,3562,"taken",false],[3683,3683,"Ohh I",false],[3790,3799,"Piriton",true],[3832,3841,"Hmm",false],[3849,3854,"I got no I do",false],[3980,3983,"do",false],[4078,4097,"peanut allergy any time",true],[4233,4240,"'cause",false],[4258,4259,"I've",false],[4301,4304,"mum",false],[4357,4357,"had an",false],[4453,4455,"Ohh",false],[4484,4503,"ohh my god ohh yeah",false],[4523,4523,"six. Oh. You all",false],[4551,4562,"Ohh I feel a little dizzy",true],[4589,4614,"ohh. Are you . You're feeling dizzy. OK",true],[4744,4756,"uh all right",false],[5095,5100,"mum's. Um",false],[5122,5125,"mum",false],[5163,5168,"OK all",false],[5277,5277,"Ohh no",false],[5385,5385,". Hey ohh",false],[5447,5466,"any more. Thank. All right OK",false],[5789,5796,"uh Mum Mum",false],[5813,5826,"antihistamines",true],[5847,5866,"K.",false],[5904,5907,"mum",false],[5920,5923,"Mum",false],[5945,5950,"uh nine nine nine nine nine",false],[6062,6066,"OK. Ohh yeah yeah we do .",false],[6097,6097,"yes. All right",false],[6157,6178,"all right. OK OK.",false],[6191,6191,". And after",false],[6197,6197,"come",false],[6345,6349,"will",false],[6367,6377,". All . OK",false],[6416,6416,"thank",false],[6437,6437,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after eating prawn laksa'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'started ~30 min after eating'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'now enlarging and throbbing'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Throat narrowing sensation, difficulty breathing, chest tightness uncertain."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'Previous similar episode ~1 year ago after late-night Chinese curry... swelling and difficult breathing'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'Asthma' and 'Salbutamol inhaler used regularly'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'Peanut allergy' and 'prior severe allergic reaction in childhood requiring injection and hospital visit'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction... Urgent condition requiring ambulance transfer'."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Immediate ambulance transfer to hospital'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother present and 'Keep companion present' recorded, but mother being asked to call emergency services is not explicit."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Take available antihistamine while awaiting ambulance'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'contact clinic to arrange autoinjector'."]],"claims":[["Post-hospital follow-up to include 'allergy action plan, and review asthma control'","The clinician only said to ring back to 'sort you out with your injections'; neither an action plan nor asthma review was stated."]],"note":"Presenting Condition\n\nAcute upper lip swelling started ~30 min after eating prawn laksa around 19:00\n\nSensation of throatal narrowing and difficulty breathing; feels chest may be tight\n\nSwelling started left corner of upper lip, now enlarging and throbbing\n\nPrevious similar episode ~1 year ago after late-night Chinese curry with next-morning swelling and difficult breathing\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nNo musculoskeletal injuries mentioned\n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy since childhood\n\nHistory suggestive of prior severe allergic reaction in childhood requiring injection and hospital visit\n\nAllergies:\n\nPeanut\n\n\n\n\nMedications\n\nSalbutamol inhaler used regularly\n\nNo preventer (“brown”) inhaler\n\nIntermittent antihistamine use in past (unsure which)\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present\n\nBreathing difficulty: present\n\nChest tightness: uncertain\n\nPrior lip swelling episodes: present (~1 year ago)\n\nCurrent access to antihistamines: initially none; mother located some during call\n\n\n\n\nSocial History\n\nLives with/has access to mother at time of call\n\n\n\n\nGoals\n\nSeek emergency care for current reaction\n\nPost-hospital: arrange prescriptions for injections (e.g., autoinjector) per doctor advice\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Patient reports progressive upper lip swelling; subjective dyspnoea\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction after shellfish (prawn) exposure; differential includes acute allergic angioedema\n\nUrgent condition requiring ambulance transfer\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nCall emergency services immediately for suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nKeep companion present until ambulance arrives\n\nAfter hospital discharge, contact clinic to arrange autoinjector and management plan\n\n// Ambulance to be called; mother present and locating antihistamines; patient to take antihistamine immediately\n\n\n\n\nPlan\n\nImmediate ambulance transfer to hospital\n\nPost-hospital: follow-up to organise epinephrine autoinjector, allergy action plan, and review asthma control\n\nPatient to ring clinic after discharge to arrange further management\n","review":130.55263157894737,"saved":148.94736842105263,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis not recorded."],["fabrication","Post-hospital follow-up to include 'allergy action plan, and review asthma control'","Invented follow-up plan items (allergy action plan, asthma review)."]],"mb":14.370863,"signable":156.25263157894736},{"label":"Run 4","wer":16.997617156473392,"text":"Hi.\n\nHello? Hi. Hi. I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing? I'm alright.\n\nThank\n\nyou. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could confirm your full name for me, please?\n\nYes.\n\nMaria Trabalotza.\n\nOkay. Date and your date of birth? That is the 10/01/1999. Okay.\n\nAnd your email address for me, please? Yes.\n\nMtraba@gmail.com.\n\nOkay. And just to confirm that you're in a secure location, and we can have a\n\nYes. I think\n\nI am. Yeah.\n\nGood. Right. You've mentioned in your in in your patient notes\n\nthat you're having some sort of lip swelling and you after you had a sandwich,\n\nIs that correct? Yeah. That is\n\nwell, I don't think I don't think it was it it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends to to the\n\nplace called, and we\n\nwe regularly have, like usually, I have, like,\n\na normal\n\nvegetarian soup or something. Mhmm. And yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\na soup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my it feels like like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe that there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was that must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah.\n\nIt's it's it's can you still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd just a few. Have you ever had these\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto a late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I didn't know what it was I had. It was like\n\ncurry or something, I think.\n\nAnd what did you take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell I I take oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight. And so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah. Like,\n\nalways had it.\n\nYeah.\n\nI think I did get into his\n\nhistamines for that, but I'm not sure which ones.\n\nAnd any\n\npoint because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh,\n\nYeah. I think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've\n\nbeen\n\nbusy? Okay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo? Right. Okay. So\n\nright. Oh, alright. I I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say and\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at the\n\nmoment. Oh, no. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to you. Okay?\n\nAnd\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nAlright. Okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements around? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away, and\n\nAnd if mom can call mom, if you can call the 99999, yeah, and say that your there is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay. Yes. Thank\n\nyou. Out from the\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay? Yes.\n\nYes. I'll do. Yes. Thank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. Bye.","marks":[[82,87,"",false],[112,120,"all right",false],[218,225,"all right",false],[291,314,"Trabalotsa. OK day",false],[351,368,"first of October ninety-nine. OK",false],[415,439,"M Traba at Gmail dot com. OK",false],[511,511,"confidential conversation",false],[573,577,"",false],[816,823,"prawn",true],[994,999,"Mm-hmm.",false],[1051,1056,"Mm-hmm. Um",false],[1111,1120,"it",false],[1133,1141,"laksa",false],[1223,1236,"feel",false],[1252,1257,"started",false],[1334,1339,"Mm-hmm.",false],[1507,1511,"",false],[1620,1620,"Yeah. Right. 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Ohh",false],[5328,5328,". Hey ohh",false],[5390,5414,"any more. Thank. All right OK",false],[5737,5744,"uh Mum Mum",false],[5761,5774,"antihistamines",true],[5794,5813,"K.",false],[5851,5854,"mum",false],[5864,5867,"Mum",false],[5889,5894,"uh nine nine nine nine nine",false],[6003,6007,"OK. Ohh yeah yeah we do .",false],[6038,6038,"yes. All right",false],[6098,6119,"all right. OK OK.",false],[6130,6130,". And after",false],[6136,6136,"come",false],[6280,6284,"will",false],[6300,6310,". All . OK",false],[6349,6349,"thank",false],[6370,6370,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after eating prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Onset ~30 mins post-meal\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Acute upper lip swelling ... progressive increase in swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports breathing difficulty and possible throat involvement\"; chest tightness unsure."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Previous similar episode after late-night Chinese food about a year ago with swelling and breathing difficulty\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma and \"Salbutamol inhaler used regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Peanut allergy; childhood episode required hospital treatment and injection\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Immediate emergency response required due to suspected anaphylaxis\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Urgent ambulance transfer to hospital now\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Initially alone, mother later present; accompanying person to call emergency services and remain present."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Post-discharge contact for \"prescription of emergency injection device\"."]],"claims":[["antihistamine ... later confirmed available and taken as advised / antihistamine taken","Transcript only shows antihistamines confirmed available and patient told to take them; taking them is never reported."]],"note":"Presenting Condition\n\nAcute upper lip swelling after eating prawn soup around 19:00\n\nOnset ~30 mins post‑meal; progressive increase in swelling\n\nReports breathing difficulty and possible throat involvement\n\nPrevious similar episode after late-night Chinese food about a year ago with swelling and breathing difficulty\n\nReasons for visit: concern about worsening lip swelling and breathing difficulty\n\n\n\n\nRadiology\n\n\n\n\nPrevious MSK injuries\n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy; childhood episode required hospital treatment and injection reported by mother\n\n\n\n\nMedications\n\nSalbutamol inhaler used regularly\n\nAntihistamines used previously for peanut allergy; specific agent unknown\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present\n\nBreathing difficulty: present\n\nChest tightness: unsure\n\nPrior lip swelling with foods: present\n\nAccess to antihistamines now: initially no, later confirmed available and taken as advised\n\n\n\n\nSocial History\n\nWas alone initially; mother later present to assist and call ambulance\n\n\n\n\nGoals\n\nSeeks urgent relief of swelling and breathing difficulty\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Patient reports rapidly increasing upper lip swelling; dyspnoea subjectively worsening during call\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction following seafood ingestion\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nImmediate emergency response required due to suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nHave accompanying person call emergency services and remain present\n\nReferrals/communications:\n\nAdvised calling emergency services for urgent assessment and possible injection (e.g., adrenaline) and hospital care\n\n// Patient’s mother present; antihistamine taken; ambulance call initiated\n\n\n\n\nPlan\n\nUrgent ambulance transfer to hospital now\n\nPost-discharge: contact clinic for allergy management plan and prescription of emergency injection device (per discussion)\n","review":104.0,"saved":175.5,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis signals possible circulatory involvement; omitting it understates severity."],["fabrication","antihistamine ... later confirmed available and taken as advised / antihistamine taken","Records antihistamine as taken when only its availability and advice to take it were stated; misstates treatment given before ED."]],"mb":13.933604,"signable":128.472},{"label":"Run 5","wer":16.997617156473392,"text":"Hi.\n\nHello? Hi. Hi. I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing? I'm alright.\n\nThank\n\nyou. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could confirm your full name for me, please?\n\nYes.\n\nMaria Trabalotza.\n\nOkay. Date... And your date of birth? That\n\nis\n\nthe 10/01/1999. Okay.\n\nAnd your email address for me, please? Yes.\n\nMtraba@gmail.com.\n\nOkay. And just to confirm that you're in a secure location, and we can have a\n\nYes. I think I am. Yeah.\n\nGood. Right. You've mentioned in your in in your patient notes\n\nthat you're having some sort of lip swelling and you... After you had a sandwich,\n\nIs that correct? Yeah. That is\n\nwell, I don't think I don't think it was... It it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends to to the\n\nplace called, and we\n\nwe regularly have, like... Usually, I have,\n\nlike, a normal\n\nvegetarian soup or something. Mhmm. And... Yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\na soup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my... It feels like... Like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe... That there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was... That must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan... Half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's... Can\n\nyou still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd just a few. Have you ever had these\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto a late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I didn't know what it was I had. It was like\n\ncurry or something, I think.\n\nAnd what did you take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell... I I take... Oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight. And so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well. Yeah. Like,\n\nalways had it.\n\nYeah.\n\nI think I did get into his\n\nhistamines for that, but I'm not sure which ones.\n\nAnd any\n\npoint... Because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that... Well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh,\n\nYeah. I think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've been busy?\n\nOkay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo? Right. Okay. So\n\nright. Oh, alright. I... I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say and\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any... Anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at the\n\nmoment. Oh, no. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to you. Okay?\n\nAnd...\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nAlright. Okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements around? Yes.\n\nYes. Oh,\n\nyeah. Yeah. We do. That straight\n\naway, and\n\nAnd if mom can call... Mom, if you can call the 99999, yeah, and say that your... There is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay. Yes. Thank you. Out from\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay? Yes.\n\nYes. I'll do. Yes. Thank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. Bye.","marks":[[82,87,"",false],[112,120,"all right",false],[218,225,"all right",false],[291,317,"Trabalotsa. OK day",false],[356,373,"first of October ninety-nine. OK",false],[420,444,"M Traba at Gmail dot com. OK",false],[516,516,"confidential conversation",false],[577,581,"",false],[826,833,"prawn",true],[1007,1012,"Mm-hmm.",false],[1067,1072,"Mm-hmm. Um",false],[1127,1136,"it",false],[1149,1157,"laksa",false],[1242,1258,"feel",false],[1274,1279,"started",false],[1356,1361,"Mm-hmm.",false],[1532,1536,"",false],[1645,1645,"Yeah. Right. 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Ohh",false],[5381,5381,". Hey ohh",false],[5443,5467,"any more. Thank. All right OK",false],[5790,5797,"uh Mum Mum",false],[5814,5827,"antihistamines",true],[5847,5866,"K.",false],[5904,5907,"mum",false],[5920,5923,"Mum",false],[5945,5950,"uh nine nine nine nine nine",false],[6062,6066,"OK. Ohh yeah yeah we do .",false],[6097,6097,"yes. All right",false],[6157,6178,"all right. OK OK.",false],[6189,6189,". And after",false],[6194,6194,"come",false],[6339,6343,"will",false],[6359,6369,". All . OK",false],[6408,6408,"thank",false],[6429,6429,"bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"after eating prawn soup around 19:00\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Lip swelling began ~30 min after eating\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Progressed to larger upper lip swelling; feels it is worsening."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing and possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior swelling episode about a year ago after late-night food with difficult breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma; salbutamol inhaler used regularly."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Peanut allergy with severe reaction in childhood requiring hospital care\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"; \"Requires urgent emergency management\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Instructed to call emergency services (999) with suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother present; ensure someone stays with patient; ambulance to be called."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised taking available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Post-discharge: call clinic to arrange adrenaline auto-injector prescription\"."]],"claims":[["Avoid suspected triggers (prawn/shellfish) until specialist assessment","No avoidance advice or specialist assessment was given; the plan was ambulance, antihistamine and a call back after hospital."]],"note":"Presenting Condition\n\nLip swelling began ~30 min after eating prawn soup around 19:00\n\nSwelling started at left upper lip corner, progressed to larger upper lip swelling\n\nReports difficulty breathing and possible chest tightness\n\nFeels swelling is worsening\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nNo musculoskeletal injuries discussed\n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy with severe reaction in childhood requiring hospital care (per mother’s report)\n\n\n\n\nMedications\n\nSalbutamol inhaler used regularly\n\nHas taken antihistamines previously for peanut allergy, unsure which\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present (reports difficulty breathing)\n\nChest tightness: uncertain, possibly present\n\nPrior similar swelling episodes: yes, after late-night food about a year ago with difficult breathing\n\nCurrent access to antihistamines: initially no, then found at home and advised to take\n\n\n\n\nSocial History\n\nEats out with friends; tried new prawn soup dish prior to reaction\n\n\n\n\nGoals\n\nAccess emergency care for suspected anaphylaxis\n\nArrange follow-up for allergy management and emergency injection provision\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Progressive upper lip swelling reported; breathing difficulty reported during call\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction following shellfish (prawn) exposure\n\nPrognosis: Requires urgent emergency management\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nExplained concern for anaphylaxis and need for immediate emergency care\n\nAdvised taking available antihistamine while awaiting ambulance\n\nActions:\n\nInstructed to call emergency services (999) with suspected anaphylaxis\n\nEnsure someone stays with patient until ambulance arrives\n\n// Patient’s mother present; antihistamine available and to be taken; ambulance to be called immediately\n\n\n\n\nPlan\n\nImmediate transfer to ED via ambulance\n\nPost-discharge: call clinic to arrange adrenaline auto-injector prescription and allergy management review\n\nAvoid suspected triggers (prawn/shellfish) until specialist assessment\n","review":110.94736842105263,"saved":168.55263157894737,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."]],"mb":14.153843,"signable":136.64536842105264}],"patientnotes":[{"label":"Run 1","wer":18.268467037331217,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, m.trab@gmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pak, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called Luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my Feel like my lips start feeling a little weird. Just in the corner, sort of on the left first, and then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I\nwasn't really paying attention, so\nit\nmust\nhave been like. Must have been, like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nStill feel it\nlike.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest, it just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember, like, a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like always had it? Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors Distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Right. Are you okay now? I feel busy right\nnow,\nto be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. So hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, we'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[88,95,"all right",false],[188,195,"all right",false],[259,276,"Trabalotsa. OK day",false],[313,316,"first",false],[329,338,"ninety-nine. OK",false],[383,405,"M Traba at Gmail dot com. OK",false],[793,800,"prawn",false],[875,882,".",false],[973,973,"Mm-hmm.",false],[1024,1024,"Mm-hmm. Um",false],[1069,1069,"it it's it",false],[1082,1087,"laksa",false],[1186,1191,"started",false],[1261,1261,"Mm-hmm.",false],[1448,1448,"on my",false],[1523,1523,"Yeah. Right. 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OK",false],[5899,5899,"thank",false],[5914,5914,"bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Records the exposure as \"prawn soup\"; the corrected food is captured."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Approximately 30 minutes later she noticed swelling\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling \"has progressively increased in size\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"reports feeling unable to breathe well\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","no","The prior episode after a Chinese meal a year earlier is omitted."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"uses a Salbutamol inhaler regularly for asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy noted, but the severe childhood reaction needing hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"possible anaphylactic reaction\" with advice to call an ambulance immediately."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"advised to call an ambulance immediately\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Says \"have someone stay with them\" but never mentions the mother arriving or being asked to call emergency services."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"instructed to take any available antihistamine while awaiting the ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact the clinic after hospital discharge ... including possible allergy injections\"."]],"claims":[["She also reports ... a sensation of chest tightness.","Patient explicitly unsure: \"I don't know if it's the chest ... I'm not sure\"; stated as definite."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports swelling of the upper lip that started shortly after eating prawn soup, accompanied by difficulty breathing.\n\nHistory of Presenting Complaint::\n\nThe patient ate a prawn soup at approximately 7 pm. Approximately 30 minutes later she noticed swelling of the left corner of her upper lip, which has progressively increased in size. She also reports feeling unable to breathe well and a sensation of chest tightness. No specific relieving factors were identified.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: possible anaphylactic reaction.\n\nPlan\n\nMedications::\n\nPatient uses a Salbutamol inhaler regularly for asthma.\n\nPatient has a peanut allergy and sometimes uses antihistamines such as cetirizine or loratadine, though the specific agent was not confirmed.\n\nNo other inhalers were reported.\n\nPatient was advised to call an ambulance immediately and have someone stay with them until emergency services arrive.\n\nPatient was instructed to take any available antihistamine while awaiting the ambulance.\n\nPatient was told to contact the clinic after hospital discharge for further management, including possible allergy injections.","review":139.36842105263156,"saved":140.13157894736844,"clean":false,"effort":34.61538461538461,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call signals systemic involvement in suspected anaphylaxis and is absent."],["missing","A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","Prior similar reaction with breathing difficulty a year ago is key allergy history and is omitted."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Severe childhood reaction needing hospital/injection bears on adrenaline auto-injector planning and is omitted."]],"mb":24.211212,"latency":28.112,"signable":167.48042105263156},{"label":"Run 2","wer":19.53931691818904,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabaloza. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, mtrabagmail.com. okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your patient notes that.\nYou're having some sort of lip swelling after you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to this place called Fat Puff, and we. We regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called laks. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my feel stuff. Like, my lips started feeling a little weird just in the corner, sort of on the left first, and then. I don't know. And then.\nWe went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is like a swelling on my upper lip and it's kind of getting bigger. I don't know what to do.\nRight. So when did you have the prawn soup? What time? That must have been just after work. So. So maybe like around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like. Must have been like, I don't know, half an hour maybe. Okay, in half an hour you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nYou still feel it, like really pumping blood and it's kind of getting bigger. It feels like.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like your chest is tight? I don't know if it's the chest. Just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, mainly I remember like a year ago, a year ago I was out with my friends, and I think.\nI think we went like to a late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nIt. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell. I take.\nWhat's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers.\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, Periton, any of those kind of things?\nSometimes I don't know which ones. So I have a peanut allergy as well. Yeah. Like always had it? Yeah. Think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you hadn't severe allergic reaction? Yeah, when I was like 6 or something. I think.\nOh, sorry. The swelling is getting. Yeah, I think when I was. Are you okay now? I feel busy right now, to be honest. You feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. You know what your mom told you as you were a young child. Right. So is there anyone with you at the moment, or are you all.\nI'm alone at the moment, so hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we are waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom. If you can call the 999. Yeah. And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes,\nSo straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yeah. Yes, I'll do. Yes. Okay, then. Take care. Thank you very much.","marks":[[18,18,"I'm Maria.",false],[88,95,"all right",false],[188,195,"all right",false],[259,275,"Trabalotsa. OK day",false],[312,315,"first",false],[328,337,"ninety-nine. OK",false],[382,404,"M Traba at Gmail dot com. OK",false],[783,790,"prawn",false],[861,869,".",false],[964,964,"Mm-hmm.",false],[1015,1015,"Mm-hmm. Um",false],[1060,1060,"it it's it",false],[1073,1078,"laksa",false],[1164,1170,"",false],[1261,1261,"Mm-hmm.",false],[1447,1447,"on my",false],[1521,1521,"Yeah. Right. All",false],[1665,1675,"o'clock",false],[1874,1881,"developed",false],[1956,1959,"it's it it",false],[2010,2017,"kinda",false],[2049,2054,"it's getting worse. 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Bye bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Swelling of upper lip after prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"progressing to swelling within ~30 min\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Swelling enlarging\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"feeling unable to breathe well and vague chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","no","The prior episode after a Chinese meal a year earlier is not documented."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Salbutamol inhaler used regularly for asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy mentioned only in relation to antihistamines; severe childhood hospital/injection reaction omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Possible anaphylactic reaction\" with immediate ambulance call."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call ambulance immediately for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","no","Only \"patient alone initially\"; mother's arrival and her instructions are not documented."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take any available antihistamine while awaiting emergency services\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"consider epinephrine autoinjector\" at follow-up after hospital assessment."]],"claims":[["Follow up for allergy testing; arrange future review of asthma and allergy management","Clinician only said they might need to sort out her injections after hospital; allergy testing and asthma review were never mentioned."]],"note":"Subjective\n\nChief Complaint::\n\nSwelling of upper lip after prawn soup with difficulty breathing.\n\nHistory of Presenting Complaint::\n\nOnset ~7 pm after prawn soup; tingling in left upper lip progressing to swelling within ~30 min.\n\nSwelling enlarging, associated with feeling unable to breathe well and vague chest tightness.\n\nNo known relieving measures; patient alone initially.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible anaphylactic reaction.\n\nPlan\n\nMedications::\n\nSalbutamol inhaler used regularly for asthma.\n\nOccasional antihistamines for peanut allergy (specific agent not identified).\n\nNo other inhalers reported.\n\nCall ambulance immediately for suspected anaphylaxis.\n\nTake any available antihistamine while awaiting emergency services.\n\nFollow up with primary care after hospital assessment for allergy testing and consider epinephrine autoinjector.\n\nArrange future review of asthma and allergy management.","review":134.71052631578948,"saved":144.78947368421052,"clean":false,"effort":38.46153846153847,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during suspected anaphylaxis signals possible circulatory compromise and is absent."],["missing","A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","Prior similar reaction with breathing difficulty a year ago is omitted, key for allergy risk."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Severe childhood reaction needing hospital/injection is omitted, key for adrenaline auto-injector decision."],["fabrication","Follow up for allergy testing; arrange future review of asthma and allergy management","Invents allergy testing and asthma review as follow-up plan items."]],"mb":23.199592,"latency":25.236,"signable":159.94652631578947},{"label":"Run 3","wer":18.34789515488483,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, m.trabagmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pak, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called Luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my Feel like my lips start feeling a little weird. Just in the corner, sort of on the left first, and then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I\nwasn't really paying attention, so\nit\nmust\nhave been like. Must have been, like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nStill feel it\nlike.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest, it just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember, like, a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like always had it? Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors Distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Right. Are you okay now? I feel busy right\nnow,\nto be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. So hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, we'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[88,95,"all right",false],[188,195,"all right",false],[259,276,"Trabalotsa. OK day",false],[313,316,"first",false],[329,338,"ninety-nine. OK",false],[383,405,"M Traba at Gmail dot com. OK",false],[793,800,"prawn",false],[875,882,".",false],[973,973,"Mm-hmm.",false],[1024,1024,"Mm-hmm. Um",false],[1069,1069,"it it's it",false],[1082,1087,"laksa",false],[1186,1191,"started",false],[1261,1261,"Mm-hmm.",false],[1448,1448,"on my",false],[1523,1523,"Yeah. Right. 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OK",false],[5899,5899,"thank",false],[5914,5914,"bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after prawn soup ingestion'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'Onset 30 min post prawn soup (7 pm)'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'progressive enlargement'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports difficulty breathing'."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","no","Previous episode after a Chinese meal a year earlier is not recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'Uses salbutamol inhaler for asthma'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy recorded; childhood severe reaction needing hospital/injection omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction to prawns' with immediate ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Call 999; ambulance dispatched immediately'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","'Have companion stay until ambulance arrives' but mother's arrival and her calling 999 not specified."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'take any available antihistamine'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'Follow-up with GP post-hospital... consider epinephrine auto-injector'."]],"claims":[["Chest tightness reported as present","Patient said 'I don't know if it's the chest... it might be, I'm not sure'; tightness was not confirmed."],["Follow-up 'for allergy testing'","The clinician only mentioned sorting out injections after hospital; allergy testing was never stated."]],"note":"Subjective\n\nChief Complaint::\n\nAcute lip swelling with dyspnea after prawn soup ingestion.\n\nHistory of Presenting Complaint::\n\nOnset 30 min post prawn soup (7 pm).\n\nSwelling started at left upper lip corner, progressive enlargement.\n\nReports difficulty breathing and chest tightness.\n\nNo known relieving measures during call.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nSuspected anaphylactic reaction to prawns.\n\nPlan\n\nMedications::\n\nUses salbutamol inhaler for asthma.\n\nHas peanut allergy; occasional antihistamines (cetirizine/loratadine) not specified.\n\nCall 999; ambulance dispatched immediately for suspected anaphylaxis.\n\nHave companion stay until ambulance arrives; take any available antihistamine.\n\nFollow‑up with GP post‑hospital for allergy testing and consider epinephrine auto‑injector.","review":130.8421052631579,"saved":148.6578947368421,"clean":false,"effort":46.15384615384615,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis not recorded."],["missing","A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","Previous similar reaction a year earlier omitted; key allergy history."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Severe childhood reaction requiring hospital/injection omitted."],["fabrication","Follow-up 'for allergy testing'","Invented investigation (allergy testing) in follow-up plan."]],"mb":23.949133,"latency":26.153,"signable":156.99510526315788},{"label":"Run 4","wer":18.268467037331217,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, m.trab@gmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pak, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called Luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my Feel like my lips start feeling a little weird. Just in the corner, sort of on the left first, and then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I\nwasn't really paying attention, so\nit\nmust\nhave been like. Must have been like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nStill feel it\nlike.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest, it just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember, like, a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like always had it? Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors Distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Right. Are you okay now? I feel busy right\nnow,\nto be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. So hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, we'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[88,95,"all right",false],[188,195,"all right",false],[259,276,"Trabalotsa. OK day",false],[313,316,"first",false],[329,338,"ninety-nine. OK",false],[383,405,"M Traba at Gmail dot com. OK",false],[793,800,"prawn",false],[875,882,".",false],[973,973,"Mm-hmm.",false],[1024,1024,"Mm-hmm. Um",false],[1069,1069,"it it's it",false],[1082,1087,"laksa",false],[1186,1191,"started",false],[1261,1261,"Mm-hmm.",false],[1448,1448,"on my",false],[1523,1523,"Yeah. Right. 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OK",true],[4343,4352,"moment No",true],[4375,4375,"no. OK",false],[4421,4421,"a bit",false],[4666,4666,"you know",false],[4726,4732,"mum's. Um you know",false],[4745,4753,"mum",false],[4790,4795,"OK all",false],[4814,4814,"any",false],[4888,4888,"yeah. Ohh no",false],[4915,4916,"I'll",false],[4976,4981,"OK and . Hey ohh",false],[5001,5001,"somebody just came yes",false],[5016,5024,"any more. Thank.",false],[5353,5357,"uh Mum Mum",false],[5404,5404,"K. Do that",false],[5428,5431,"mum",false],[5442,5445,"Mum",false],[5467,5471,"uh nine nine nine nine nine",false],[5490,5490,"your",false],[5572,5577,"OK. Ohh yeah yeah we do .",false],[5606,5606,"yes. All right",false],[5656,5665,"meantime",true],[5677,5688,"OK OK. Yes thank . And after you",false],[5694,5696,"out",false],[5829,5834,"will",false],[5850,5859,". All . OK",false],[5898,5898,"thank",false],[5913,5913,"bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"after eating prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"lip swelling began ~30 min later\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"left upper lip, progressive\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"difficulty breathing and vague chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Past episode ~1 yr ago after curry with alcohol, swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"History of asthma, uses salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy captured but the severe childhood reaction requiring hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction secondary to prawn exposure\" with 999 call."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call 999 ambulance\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","no","Mother's arrival and her role staying with patient and calling 999 are not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Administer any available antihistamine while awaiting EMS\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow up post-discharge for allergy work-up and possible epinephrine autoinjector\"."]],"claims":[["Review asthma control and inhaler technique","No asthma control or inhaler-technique review was planned; the only follow-up discussed was for injections after hospital."],["no clear relieving factors","Relieving factors were never asked about or discussed in the transcript; this is an invented negative."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with acute lip swelling and difficulty breathing after eating prawn soup.\n\nHistory of Presenting Complaint::\n\nPatient ate prawn soup ~19:00, lip swelling began ~30 min later, left upper lip, progressive\n\nReports difficulty breathing and vague chest tightness, no clear relieving factors\n\nPast similar episode ~1 yr ago after curry with alcohol, associated swelling and breathing difficulty\n\nHistory of asthma, uses salbutamol inhaler regularly\n\nKnown peanut allergy, occasional antihistamine use (unspecified)\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nSuspected anaphylactic reaction secondary to prawn exposure\n\nPlan\n\nMedications::\n\nSalbutamol inhaler (asthma)\n\nAntihistamines (cetirizine/loratadine) used for peanut allergy (unspecified)\n\nCall 999 ambulance; patient transported to ED\n\nAdminister any available antihistamine while awaiting EMS\n\nFollow up post‑discharge for allergy work‑up and possible epinephrine autoinjector\n\nReview asthma control and inhaler technique","review":120.3157894736842,"saved":159.18421052631578,"clean":false,"effort":42.30769230769231,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","A prior severe reaction that needed hospital care and an injection is key to anaphylaxis risk and auto-injector planning."]],"mb":24.550485,"latency":25.139,"signable":145.4547894736842},{"label":"Run 5","wer":19.142176330420966,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, mtraba@gmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pap, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called a luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my feel like my lips start feeling a little weird just in the corner, sort of on the left first. And then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like. Must have been, like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest. Just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember like a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like I always had it. Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Are you okay now? You're a little busy right now, to be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there any. Anyone with you at the moment, or are you alone? I'm alone at the Memantine. So hang on the line while I call the ambulance, okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we are waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, I'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[[18,18,"I'm Maria.",false],[88,95,"all right",false],[188,195,"all right",false],[259,276,"Trabalotsa. OK day",false],[313,316,"first",false],[329,338,"ninety-nine. OK",false],[383,405,"M Traba at Gmail dot com. OK",false],[793,800,"prawn",false],[875,882,".",false],[973,973,"Mm-hmm.",false],[1024,1024,"Mm-hmm. Um",false],[1069,1069,"it it's it",false],[1082,1089,"laksa",false],[1188,1193,"started",false],[1263,1263,"Mm-hmm.",false],[1449,1449,"on my",false],[1524,1524,"Yeah. Right. All",false],[1674,1684,"o'clock",false],[1885,1892,"developed",false],[1966,1966,"it's it it still feel it like really",false],[1981,1994,"and it's kinda",false],[2369,2373,"if it's",false],[2508,2511,"",false],[2662,2662,"Mm-hmm.",false],[2703,2710,"kinda",false],[2778,2778,"Sure OK.",false],[2835,2836,"I've",false],[3017,3022,"I think. OK. Right. OK. Uh",false],[3176,3181,"took I",false],[3189,3189,"ohh",false],[3314,3320,"asthma.",true],[3409,3409,"Ohh I",false],[3432,3432,"no. OK",false],[3502,3512,"Piriton",true],[3549,3554,"I got no I do",false],[3774,3781,"any time",false],[3786,3789,"have",false],[3912,3919,"'cause",false],[3936,3937,"I've",false],[3954,3963,"since.",false],[3980,3983,"mum",false],[4075,4079,"is that well",false],[4119,4121,"Ohh",false],[4150,4150,"ohh my god ohh",false],[4176,4176,"six. Oh. You all right",false],[4195,4201,"Ohh I feel",false],[4211,4215,"dizzy",true],[4240,4240,"ohh. Are",false],[4245,4261,". You're feeling dizzy. OK",true],[4324,4333,"moment No",true],[4356,4356,"no. OK",false],[4402,4402,"a bit",false],[4647,4647,"you know",false],[4707,4713,"mum's. Um you know",false],[4726,4734,"mum",false],[4771,4776,"OK all",false],[4867,4877,"moment yeah. Ohh no",true],[4904,4905,"I'll",false],[4965,4970,"OK and . Hey ohh",false],[4990,4990,"somebody just came yes",false],[5005,5013,"any more. Thank.",false],[5322,5328,"we're",false],[5343,5347,"uh Mum Mum",false],[5394,5394,"K. Do that",false],[5418,5421,"mum",false],[5432,5435,"Mum",false],[5457,5461,"uh nine nine nine nine nine",false],[5480,5480,"your",false],[5562,5567,"OK. Ohh yeah yeah we do .",false],[5596,5596,"yes. All right",false],[5646,5655,"meantime",true],[5667,5678,"OK OK. Yes thank . And after you",false],[5684,5686,"out",false],[5819,5823,"will",false],[5839,5848,". All . OK",false],[5887,5887,"thank",false],[5902,5902,"bye bye.",false]],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Acute lip swelling with dyspnea after prawn soup ingestion\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Onset ~30 min post-prandial\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"left upper lip first, now larger\" - progression captured."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Associated difficulty breathing, possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Past episode ~1 yr ago after curry with alcohol, with swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Salbutamol inhaler used regularly for asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy mentioned only via antihistamine use; the severe childhood reaction needing hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction to prawns\" with immediate 999 call."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call 999 ambulance immediately\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","no","Mother's arrival and her being asked to stay and call emergency services are not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take any available antihistamine while awaiting EMS\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up after discharge for allergy work-up and possible injectable therapy\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nAcute lip swelling with dyspnea after prawn soup ingestion.\n\nHistory of Presenting Complaint::\n\nOnset ~30 min post‑prandial at ~7 pm; swelling progressed, left upper lip first, now larger.\n\nAssociated difficulty breathing, possible chest tightness.\n\nPast similar episode ~1 yr ago after curry with alcohol, with swelling and breathing difficulty.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nSuspected anaphylactic reaction to prawns.\n\nPlan\n\nMedications::\n\nSalbutamol inhaler used regularly for asthma.\n\nOccasional antihistamines (cetirizine/loratadine) for peanut allergy, specific agent not confirmed.\n\nCall 999 ambulance immediately; go to ED for suspected anaphylaxis.\n\nTake any available antihistamine while awaiting EMS.\n\nFollow‑up after discharge for allergy work‑up and possible injectable therapy.","review":89.36842105263158,"saved":190.13157894736844,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","A prior severe reaction that needed hospital care and an injection is key to anaphylaxis risk and auto-injector planning."]],"mb":23.754246,"latency":35.13,"signable":124.49842105263158}]}}