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Discharge summary
report
Admission Date: [**2173-7-13**] Discharge Date: [**2173-7-17**] Date of Birth: [**2127-8-16**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 668**] Chief Complaint: end stage renal disease Major Surgical or Invasive Procedure: [**2173-7-13**] Living unrelated kidney transplant History of Present Illness: 45-year-old gentleman with end-stage renal disease secondary to multiple etiologies. He underwent nephrectomy at age 15 for recurrent infections and underwent a renal biopsy of his remaining kidney, which demonstrated a secondary FSGS. He has over the last several years progressed to end-stage renal disease and presented on [**2173-7-13**] for living unrelated kidney transplant from his fiancee. Past Medical History: PMH: HTN, diabetes (formerly treated with insulin, currently on oral agents) PSH: left nephrectomy in [**2142**] and an AV fistula constructed in [**2171**] Social History: ETOH is one to two times per week. No smoking, no IV drug use or marijuana use. Family History: His mother died at age 54. His father is currently alive with heart disease. He has three siblings, two of the three with diabetes and two children that are aged 12 and 15 are currently healthy. Physical Exam: Day of discharge: AVSS Gen NAD CV RRR Chest CTAB Abd soft, nontender, nondistended; incision clean/dry/intact; JP drain site with suture in place Ext no edema; WWP Pertinent Results: [**2173-7-17**] 04:35AM BLOOD WBC-2.8* RBC-2.94* Hgb-8.4* Hct-26.4* MCV-90 MCH-28.7 MCHC-31.9 RDW-17.9* Plt Ct-114* [**2173-7-17**] 04:35AM BLOOD Glucose-202* UreaN-58* Creat-2.8* Na-139 K-4.8 Cl-108 HCO3-21* AnGap-15 [**2173-7-17**] 04:35AM BLOOD Calcium-8.5 Phos-2.8 Mg-2.0 [**2173-7-17**] 04:35AM BLOOD tacroFK-4.9* [**2173-7-16**] 05:10AM BLOOD tacroFK-4.0* [**2173-7-15**] 05:30AM BLOOD tacroFK-2.1* [**2173-7-14**] 05:00AM BLOOD tacroFK-4.4* [**2173-7-13**] Renal transplant ultrasound: 1. Patent renal transplant vasculature with appropriate waveforms. 2. No hydronephrosis. Brief Hospital Course: The patient presented for a living unrelated kidney trasnplant on [**2173-7-13**]. In the perioperative period he was kept intubated due to moderate intraoperative hypotension requiring pressors. He was noted to have a metabolic acidosis at the time of surgery and started on a bicarbonate drip and sent to the SICU, intubated. Overnight his acidosis improved and his blood pressure stabilized off pressors. Urine output was 300-500mL/hr in the first 24 hours postop. He was extubated in the morning of postop day #1 and transferred to the floor later that day. On the floor his diet was advanced from clear liquids to regular diet. His pain was well controlled with oral pain medications. He was initialy given cc per cc repletion of his urine output with IVF, then transitioned to 1/2 cc per cc repletion. The repletion was then discontinued and his urine output remained appropriate. He ambulated and moved his bowels without difficulty. The foley catheter was removed. His creatinine decreased from >10 preop to 2.8 on the day of discharge. He tolerated his immunosuppresion regimen and antibiotic prophylaxis. His blood sugars were elevated to the 200-400s initially and he was treated with first an insulin drip, then transitioned to SC insulin lantus and sliding scale. He received med teaching and demonstrated understanding of his home meds and self care. His JP drain output decreased and the JP drain was removed on the day of discharge. At the time of discharge he was ambulating, voiding and eating without difficulty. He is discharged to home on [**2173-7-17**] in good condition. Medications on Admission: AMLODIPINE - 5 mg Tablet - 1 Tablet(s) by mouth once a day EPOETIN ALFA [PROCRIT] 20,000 unit/mL Solution - 40,000 units every 2 weeks SIMVASTATIN 20 mg Tablet - 1 Tablet(s) by mouth once a day SITAGLIPTIN [JANUVIA] 25 mg Tablet - 1 Tablet(s) by mouth once [**Last Name (un) 5490**] VALSARTAN-HYDROCHLOROTHIAZIDE [DIOVAN HCT] - (Prescribed by Other Provider) - 320 mg-12.5 mg Tablet - 1 Tablet(s) by mouth once a day CALCIUM CITRATE-VITAMIN D3 [CALCIUM CITRATE + D] 315 mg-200 unit Tablet - 1 Tablet(s) by mouth once a day OMEGA 3-VITAMIN E-FISH OIL - 1,100 mg-700 mg-15 unit Capsule - 2 Capsule(s) by mouth once a day Discharge Medications: 1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 2. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 3. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 7. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours) as needed for pain. 10. tacrolimus 1 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours) for 2 doses: DOSE AS DIRECTED BY TRANSPLANT CENTER; YOU WILL BE CONTACT[**Name (NI) **] BY PHONE WITH YOUR DOSE STARTING TONIGHT [**2173-7-17**]. 11. hydralazine 10 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). Disp:*120 Tablet(s)* Refills:*2* 12. insulin glargine 100 unit/mL Solution Sig: Ten (10) units Subcutaneous at bedtime. Disp:*qS 30 days* Refills:*2* 13. Humulin N 100 unit/mL Suspension Sig: One (1) Unit Subcutaneous with meals and at bedtime: Per insulin sliding scale. Disp:*qS 30 days* Refills:*2* 14. prednisone 10 mg Tablet Sig: 2.5 Tablets PO once for 1 days: Take ONCE on [**Last Name (LF) 1017**], [**2173-7-18**] for your last dose of prednisone. 15. test strips Sig: One (1) strip every four (4) hours: For use with glucometer. Disp:*qS 30 days* Refills:*2* 16. Alcohol Wipes Pads, Medicated Sig: One (1) wipe Topical every four (4) hours. Disp:*qS 30 days* Refills:*2* 17. syringe (disposable) Syringe Sig: One (1) syringe Miscellaneous every four (4) hours: Insulin syringe and needle. Disp:*qS 30 days* Refills:*2* 18. Pepcid (pt taking own home dexlansoprazole in lieu of this medication) Discharge Disposition: Home Discharge Diagnosis: End stage renal disease Living unrelated renal transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Please call the Transplant Office [**Telephone/Fax (1) 673**] if you have any of the following: fever (101 or greater), chills, nausea, vomiting, increased abdominal pain or distension, constipation, pain/burning/urgency with urination or incision redness/bleeding/drainage You may shower; Do not apply powder/lotion/ointment to incisions No driving while taking pain medication No heavy lifting (nothing heavier than 10 pounds) or straining You need to have your blood drawn on [**Last Name (LF) 766**], [**7-19**] for the following: Chemistry, liver function tests, and tacrolimus level. The blood should be drawn JUST BEFORE your morning dose of tacrolimus is due. If you have this done at an outside hospital, please ensure that the results are called or faxed to Dr.[**Name (NI) 670**] office ASAP. You will need to take insulin at home. Please call Dr.[**Name (NI) 670**] office if you have any questions about your insulin dose. When your are finished with the prednisone, your blood sugars are expected to decrease and you may need less insulin. Followup Instructions: Department: TRANSPLANT CENTER When: THURSDAY [**2173-7-22**] at 1:10 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD [**Telephone/Fax (1) 673**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: TRANSPLANT CENTER When: THURSDAY [**2173-7-29**] at 8:20 AM With: [**Name6 (MD) 2105**] [**Name8 (MD) 2106**], MD [**Telephone/Fax (1) 673**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: TRANSPLANT CENTER When: [**Hospital Ward Name **] [**2173-8-2**] at 10:10 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD [**Telephone/Fax (1) 673**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage
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Discharge summary
report
Admission Date: [**2157-4-18**] Discharge Date: [**2157-4-22**] Date of Birth: [**2100-12-21**] Sex: F Service: NEUROLOGY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 618**] Chief Complaint: left hemiparesis s/p tPA at OSH; called as Code Stroke Major Surgical or Invasive Procedure: Intravenous tPA at outside hospital History of Present Illness: Patient is Spanish speaking and during emergent situation, history obtained from her husband, who speaks English and from review of transfer records. Ms. [**Known lastname 1005**] is a 56 year old Spanish speaking woman with a PMH significant for HTN, HLD and DMII who was found down at home at 2:30 AM. She was last seen normal at 2:00 AM, when she was reported to be washing dishes by her husband. At 2:30 AM, the family heard a thud and found her on the ground with slurred speech and inability to move her left side. She was brought to OSH, where she had a CT head that was negative for hemorrhage and then she received IV tPA at 4:05 AM. Also, her FS was 509 at OSH, so she received 10 units Insulin with resulting FS in the 320s She was then transferred to [**Hospital1 18**] for further management. ROS: Positive for the slurred speech and left sided weakness as per HPI. According to her husband, she was more lethargic than usual over the past few days, with increased sleepiness. No recent illnesses. Past Medical History: -HTN -HLD -DM II Social History: She lives with her husband and children. She works in a daycare center. No smoking, drinking or illicit drug use. Family History: HTN and DMII in her family. Her husband believes her mother and brother may have had strokes, though he is not positive. Physical Exam: Vitals: T: 97.7 P: 88 R: 18 BP: 214/101 SaO2: 100% 4L NC General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple Pulmonary: lcta b/l Cardiac: RRR, S1S2, no murmurs appreciated Abdomen: soft, NT/ND, +BS Extremities: warm, well perfused Neurologic: NIH Stroke Scale score was: 11 1a. Level of Consciousness: 0 1b. LOC Question: 0 1c. LOC Commands: 0 2. Best gaze: 0 3. Visual fields: 0 4. Facial palsy: 1 5a. Motor arm, left: 4 5b. Motor arm, right: 0 6a. Motor leg, left: 4 6b. Motor leg, right: 0 7. Limb Ataxia: 0 8. Sensory: 1 9. Language: 0 10. Dysarthria: 1 11. Extinction and Neglect: 0 Mental Status: Awake, alert, oriented to person, place and date. Spanish speaking but able to answer yes/no appropriately to questions. Speech dysarthric (sounds slurred according to husband). Able to name objects in Spanish. Cranial Nerves: Pupils 3mm b/l and sluggishly reactive to light. VFF to confrontation. EOMI without nystagmus. L lower facial droop. Palate elevates symmetrically. Tongue protrudes in midline. Motor: Left hemiplegia. Flaccid left upper and lower extremities. Normal tone and full strength on right. Sensory: diminished pinprick on left compared to right. No extinction to DSS. DTRs: [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach L 1 0 1 0 0 R 2 0 2 1 0 Plantar response was flexor on the right and extensor on the left. Coordination: No intention tremor or dysmetria on finger-nose on right. Unable to assess on left due to weakness. Gait: deferred given left hemiplegia Pertinent Results: Labs on admission: [**2157-4-18**] 05:45AM BLOOD WBC-8.2 RBC-4.20 Hgb-12.0 Hct-35.2* MCV-84 MCH-28.5 MCHC-33.9 RDW-13.3 Plt Ct-226 [**2157-4-18**] 05:45AM BLOOD Neuts-73.9* Lymphs-21.3 Monos-3.9 Eos-0.5 Baso-0.4 [**2157-4-18**] 05:45AM BLOOD PT-11.3 PTT-18.1* INR(PT)-0.9 [**2157-4-18**] 05:45AM BLOOD Glucose-260* UreaN-12 Creat-0.6 Na-140 K-4.2 Cl-103 HCO3-27 AnGap-14 [**2157-4-19**] 02:32AM BLOOD ALT-15 AST-15 AlkPhos-74 TotBili-0.7 [**2157-4-19**] 02:32AM BLOOD Calcium-9.0 Phos-3.5 Mg-2.0 Cholest-325* [**2157-4-19**] 02:32AM BLOOD %HbA1c-13.4* eAG-338* [**2157-4-19**] 02:32AM BLOOD Triglyc-167* HDL-56 CHOL/HD-5.8 LDLcalc-236* . Urine/Micro: [**2157-4-18**] 03:44PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020 [**2157-4-18**] 03:44PM URINE Blood-TR Nitrite-NEG Protein-300 Glucose-70 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-TR [**2157-4-18**] 03:44PM URINE RBC-3* WBC-10* Bacteri-NONE Yeast-NONE Epi-0 [**2157-4-18**] 03:44PM URINE CastHy-1* [**2157-4-18**] 03:44PM URINE Mucous-RARE [**2157-4-20**] 02:15PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.007 [**2157-4-20**] 02:15PM URINE Blood-NEG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG [**2157-4-20**] 02:15PM URINE RBC-2 WBC-<1 Bacteri-NONE Yeast-NONE Epi-0 [**2157-4-20**] 02:15PM URINE Mucous-RARE [**2157-4-20**] URINE CULTURE-PENDING [**2157-4-18**] URINE CULTURE-NEG [**2157-4-18**] MRSA SCREEN-NEG . Imaging: [**2157-4-19**] CT HEAD W/O CONTRAST: Stable extent of acute infarcts as described above with no evidence of hemorrhagic conversion. [**2157-4-18**] MR HEAD W/O CONTRAST: 1. Acute infarcts in the right putamen, posterior limb of the right internal capsule, right corona radiata, and left cerebral peduncle in the mid brain. No evidence of hemorrhagic conversion. 2. Chronic small vessel ischemic disease as well as a lacune in the left corona radiata. [**2157-4-18**] CTA HEAD&NECK W&W/O C & RECON: 1. Hypodensity within the right frontal corona radiata, right putamen, left head of caudate, left lateral thalamus and left medial temporal lobe concerning for infarct, age-indeterminate on CT. If clinically warranted, MRI could be obtained to age these abnormalities. 2. While there is no large-vessel occlusion within the head, there is slight paucity of distal M3 branches on the right compared to the left, particularly on the inferior division. 3. Crescentic filling defect of the distal left common carotid artery which may be secondary to focal atherosclerosis or a focal dissection, though the latter is less likely as the location is not typical. 4. Marked irregularity of the right vertebral artery which is diffusely small in caliber and focal high-grade narrowing of the left vertebral artery V4 segment intracranially. These likely reflect a combination of hypoplastic vessels with underlying atherosclerosis or dissection. [**2157-4-18**] ECHO: The left atrium is elongated. No thrombus/mass is seen in the body of the left atrium. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. No masses or vegetations are seen on the aortic valve. The mitral valve appears structurally normal with trivial mitral regurgitation. No mass or vegetation is seen on the mitral valve. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. Brief Hospital Course: Ms. [**Known lastname 1005**] is a 56 year old Spanish speaking woman with a PMH significant for HTN, HLD and DMII who was found down at home with slurred speech and left hemiparesis. She was within window for tPA upon arriving to OSH, so she received the tPA at 4:05 AM and was sent to [**Hospital1 18**] for further management. Upon arrival to [**Hospital1 18**], about 15 minutes after IV tPA completed, her NIHSS was 11, for left hemiplegia, left facial droop, dysarthria and sensory loss on the left. She underwent CTA, which did not show any major artery flow limiting stenosis or thrombosis. She therefore was not sent for interventional angio. Based on the CT scan, it appears she may have a stroke in the posterior limb of the internal capsule on the right. She does have numerous vascular risk factors, including poorly controlled HTN, DMII, and HLD. She was initially admitted to the neuro ICU in light of receiving intravenous tPA at OSH. . Neurologic: As noted above [**4-18**] CTA revealed patent vasculature. [**4-18**] MRI head showed acute infarcts in the right putamen, posterior limb of the right internal capsule, right corona radiata, and left cerebral peduncle in the mid brain. No evidence of hemorrhagic conversion. Chronic small vessel ischemic disease as well as a lacune in the left corona radiata. CT head 24H s/p tPA showed stable extent of acute infarcts as described above with no evidence of hemorrhagic conversion. Stroke Risk Factors were checked: LDL was 236 and we increased home simvastatin to 80mg daily. HgbA1c 13.4; pt was started back on home antiglycemics as it appeared pt was not taking medications regularly. She was also placed on a insulin sliding scale. . Cardiovascular: We allowed for autoregulation of blood pressure initially to maintain SBP < 180. Home amlodipine 5mg daily to restarted on [**Last Name (LF) 766**], [**4-25**], with holding parameters of SBP < 100. TTE showd no thrombus/mass is seen in the body of the left atrium. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. . Pulmonary: No acute issues during admission. . Gastrointestinal / Abdomen: Pt tolerated PO diet as described below. GI prophylaxis with famotidine during admission. . Nutrition: Evaluated by speech and swallow, cleared for regular Cardiac/Heart healthy, Diabetic/Consistent Carbohydrate Consistency: Soft (dysphagia); Thin liquids; medications with thin liquids. . Renal: No acute issues; urine cultures negative x 2. . Hematology: Hct remained stable s/p tPA. . Endocrine: Pt was restarted on home PO regimen of glyburide and metformin; insulin sliding scale was administered for goal FSBG < 150. . Infectious disease: No active issues during admission. . Patient is discharged acute rehab and will be following up with Dr. [**First Name (STitle) **] [**Name (STitle) **] as outpatient on [**2157-6-14**]. If patient is still at the acute rehab facility at this point, please call [**Telephone/Fax (1) 1694**] to reschedule. Patient is encouraged to follow-up with neurology/Dr. [**Last Name (STitle) **] after being discharged out of acute rehab. Medications on Admission: -Glyburide/Metformin 2.5/500 2 tabs [**Hospital1 **] -Amlodipine 5 mg daily -Simvastatin 20 mg daily Discharge Medications: 1. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day as needed for stroke secondary prophylaxis; LDL 236. 2. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for stroke secondary prevention. 3. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day): [**Month (only) 116**] discontinue once patient has increased mobility/activity. 4. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 5. glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 7. amlodipine 5 mg Tablet Sig: One (1) Tablet PO once a day: Please start on [**Last Name (LF) 766**], [**4-25**]. Do not administer if systolic BP less than 100. 8. insulin lispro 100 unit/mL Insulin Pen Sig: Two (2) unit Subcutaneous three times a day: insulin dose depedent on finger stick glucose after each meals - please see attached sliding scale . Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: R anterior choroidal artery stroke and small L cerebral peduncle stroke. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Ms. [**Known lastname 1005**], You were admitted due to a stroke. This was thought to be due to your high blood pressure. You were started on aspirin for stroke protection. Your stroke risk factors were checked. Your cholesterol LDL was 236. Your home simvastatin was increased to 80mg daily as your LDL cholesterol is too high (goal less than 70). You were checked for blood glucose control with a HgB A1c. The level was 13.4 (goal less than 7.0). Please be sure to take your diabetes medications as prescribed. You had a cardiac echocardiogram which demonstrated no cardioembolic source. You need to continue your blood pressure control. You should not smoke. You should continue to eat a low fat healthy diet and follow up with your primary care physician and stroke Neurology as noted below. It was a pleasure taking care of you. Followup Instructions: Please be sure to call your primary care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 6382**] [**Last Name (NamePattern1) 29065**], at [**Telephone/Fax (1) 29068**] to schedule an appointment within [**6-5**] days of leaving your rehabiliation center. You are scheduled to follow-up with Dr. [**First Name (STitle) **] [**Name (STitle) **], who oversaw your care during this admission: Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 2574**] Date/Time:[**2157-6-14**] 2:00 [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**] Completed by:[**2157-4-22**]
[ "342.90", "781.94", "787.21", "272.4", "V45.88", "434.91", "250.00", "401.9" ]
icd9cm
[ [ [] ] ]
[]
icd9pcs
[ [ [] ] ]
11544, 11591
7215, 10373
360, 397
11707, 11707
3388, 3393
12759, 13452
1629, 1752
10524, 11521
11612, 11686
10399, 10501
11882, 12736
1767, 2431
266, 322
425, 1441
2675, 3369
3407, 7192
11722, 11858
1463, 1481
1497, 1613
10,748
109,320
9768
Discharge summary
report
Admission Date: [**2170-10-16**] Discharge Date: [**2170-10-22**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 11495**] Chief Complaint: abdominal pain, shortness of breath Major Surgical or Invasive Procedure: cardiac catheterization History of Present Illness: 84 year old male with type 2 DM, hyperlipidemia, HTN, and anemia presents abdominal pain and "feeling lousy" since the night prior to admission. The patient reports that the pain began yesterday before he went to bed, persisted and worsened until early this am when he decided to go to the ED. He also reports some mild SOB. Brought to [**Hospital1 18**] by EMS. . In ED, SBPs 100s, satting 96% on NRB. CXR showed pulmonary edema, bilateral effusions. He was given IV lasix with some improvement in oxygenation followed by an additional IV lasix, ntg gtt, heparin gtt and plavix 300mg. Abdominal pain, shortness of breath resolved and on admission to CCU pt reported that he felt better than he had in a long time. . No prior cardiac history. Past Medical History: DM, type 2, diagnosed 40 years ago Hyperlipidemia Hypertension Anemia PVD, claudication CRI (baseline 1.8) b/l carotid bruits (right approx 70% peak 323/52, left 60-69% peak 172) Prostate CA Bladder CA s/p appendectomy s/p hernia repair Social History: Retired truckdriver. Lives with his girlfriend who helps to take care of him. Ex-smoker (quit 40 years ago), denies alcohol use. Family History: Non-contributory Physical Exam: VS T 99.2, HR 65, BP 161/54, RR 29, O2sat 93% on 4L Gen: Well appearing male in NAD, alert, awake HEENT: MMM, EOMI Neck: +JVD (JVP 14), carotid bruit b/l, L>R CV: normal s1s2, no m/r/g Resp: crackles bilaterally midway up lung field. Abd: obese, soft, NT, ND, +BS Ext: trace pulses b/l, no edema noted Pertinent Results: EKG: NSR, nl axis, 1-2 mm STD V4-V6, STE aVR . Cardiac cath: LCMA: diffuse disease and heavily calcified, 60-70% distally LAD: hazy ostial lesion with non-laminar flow, likely 60-70% stenosed. Heavily calcified vessel with prox 40%, mid 40-50%, supplies single diag. LCx: mid AV groove 40%, branching OM3/LPL with 50% stenosis prior to bifurcation, small caliber distal AV groove. RCA: heavily calcified vessel with dense aortic calcium at its origin; ostial 80% stenosis with mild pressure dampening; proximal-mid 50%, mid-distal 70%, distal AV groove 50% Hemodynamics: CO 6.34, CI 3.47 . Chest CT: IMPRESSION: 1. Limited evaluation of the pulmonary arteries and aorta without IV contrast. 2. Pulmonary edema and bilateral pleural effusions. 3. Cholelithiasis. 4. Focal dilatation of the distal right ureter could represent reflux. . [**2170-10-16**] 03:11PM GLUCOSE-185* UREA N-44* CREAT-1.7* SODIUM-138 POTASSIUM-3.4 CHLORIDE-108 TOTAL CO2-20* ANION GAP-13 [**2170-10-16**] 03:11PM ALT(SGPT)-53* AST(SGOT)-23 CK(CPK)-126 ALK PHOS-107 AMYLASE-63 TOT BILI-0.5 [**2170-10-16**] 03:11PM CK-MB-7 cTropnT-0.58* [**2170-10-16**] 03:11PM ALBUMIN-2.7* [**2170-10-16**] 03:11PM %HbA1c-7.1* [Hgb]-DONE [A1c]-DONE [**2170-10-16**] 03:11PM WBC-9.9 RBC-2.75* HGB-8.8* HCT-25.2* MCV-92 MCH-32.2* MCHC-35.0 RDW-17.4* [**2170-10-16**] 03:11PM PLT COUNT-239 [**2170-10-16**] 03:11PM PT-13.0 PTT-30.6 INR(PT)-1.1 [**2170-10-16**] 02:40PM TYPE-ART PO2-68* PCO2-34* PH-7.42 TOTAL CO2-23 BASE XS--1 INTUBATED-NOT INTUBA [**2170-10-16**] 02:40PM HGB-10.0* calcHCT-30 O2 SAT-92 [**2170-10-16**] 08:00AM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.014 [**2170-10-16**] 08:00AM URINE BLOOD-SM NITRITE-NEG PROTEIN-500 GLUCOSE-250 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2170-10-16**] 08:00AM URINE RBC-0 WBC-0-2 BACTERIA-MOD YEAST-NONE EPI-0-2 [**2170-10-16**] 07:54AM LACTATE-1.2 [**2170-10-16**] 07:50AM GLUCOSE-362* UREA N-43* CREAT-1.8* SODIUM-136 POTASSIUM-4.1 CHLORIDE-106 TOTAL CO2-20* ANION GAP-14 [**2170-10-16**] 07:50AM CK(CPK)-78 [**2170-10-16**] 07:50AM CK-MB-NotDone cTropnT-0.13* [**2170-10-16**] 06:45AM cTropnT-0.15* [**2170-10-16**] 06:45AM CK-MB-NotDone . Brief Hospital Course: Mr. [**Known lastname 32923**] is a 84 year old male with DM2 who presented with shortness of breath and abdominal pain, found to be consistent with heart failure exacerbation resulting in demand ischemia vs. UA/NSTEMI, found to have 3VD on cath. . Cardiac 1)Ischemia: Mr. [**Known lastname 32923**] presented with heart failure and ST elevation of aVR. As his ECG was concerning for severe disease, he was taken to the cath lab for possible evaluation. He was found to have 3VD and he was evaluated by CV surgery for possible CABG. He was taken off of Plavix for possible surgery. They requested an echocardiogram and carotid ultrasound. He was found to have right ICA 70-79% stenosis, left ICA 60-69% stenosis. It was also noted that the patient had aortic calcifications on CT scan. The above risk factors in addition to his renal disease and advanced age pushed the decision towards medical management. Plavix and aspirin were restarted. . 2) LV function: The patient had a echo done on [**10-17**] which showed an EF>60%. However, it was felt that the patient's shortness of breath was likely secondary to pulmonary edema as he had a PCWP >18. He was diuresed during this admission (78kg->73kg) and electrolytes were followed. Diuresis resulted in improved oxygen saturation and he was weaned from 4L NC to 2L NC. Given appearance on CXR, there was some concern he may have underlying lung disease. Would consider outpatient PFTs and chest CT for further evaluation. He was discharged to home with home O2 and PCP f/u. . 3) Hypertension: Mr. [**Known lastname 32923**] had persistently high blood pressures on hospital day [**2-2**]. He was placed on a nitro drip, started on metoprolol. He was switched back to his outpatient regimen of labetolol 900mg [**Hospital1 **], valsartan 160mg [**Hospital1 **], and norvasc 10mg QD. The nitro drip was weaned off on HD4 and imdur was started in its place. Off of the nitro drip his SBPs have been in the 150-160s which is probably appropriate for him given his heart disease. . 4) Renal: The patient's baseline creatinine is 1.8. He was given a dye load during catheterization and therefore his creatinine was carefully monitored. He has a slight increase in creatinine which was felt to be due to diuresis. At discharge, the patient's creatinine was at baseline. . 5) Neuro: Mr. [**Known lastname 32923**] was disoriented during the admission, occassionally unable to name the hospital and the date, likely due to acute delerium on baseline dementia. His mental status appeared to improve throughout the day. His delirium was likely due to the hospitalization. He was closely monitored for signs of infection and his CXR was clear of infiltrate and UA was negative. . 6) Anemia: The patient reports a history of anemia for which he receives procrit every 3 weeks. He received 2U on this admission with a less than expected bump in hematocrit. He was guaiac negative and following hematocrits increased appropriately. 7) Endocrine: Mr. [**Known lastname 32923**] has type 2 DM, with a HgbA1c of 7.1%. He was placed on a regular insulin sliding scale, with QACHS finger sticks, but given his daily requirements was also placed on fixed dose glargine. He was discharge on home insulin and was instructed to measure fingersticks [**Hospital1 **] prior to his PCP f/u appointment so that his insulin regimen can be appropriately adjusted. 8) FEN: The patient was diuresed and therefore electrolytes were checked frequently. He was repleted as necessary. He was taking good PO. His B12 level was checked as he was on supplementation as an outpatient and was found to be within normal limits. He was continued on supplemental B12 while an inpatient. 9) PPx: He was given pneumoboots while he was unable to ambulate. Medications on Admission: Avandia 8mg daily Insulin 2U qam (plus novolog) Procrit (every 3 weeks) Cilostazol 100mg [**Hospital1 **] Lipitor 80mg daily Diovan 320 daily Glyburide 15.0 qam Labetolol 600mg [**Hospital1 **] Furosemide 40mg daily ASA 81mg daily Norvasc 10mg daily Vitamin B12 Discharge Medications: 1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Cyanocobalamin 100 mcg Tablet Sig: 0.25 Tablet PO DAILY (Daily). 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Furosemide 40 mg Tablet Sig: 1.5 Tablets PO once a day. 7. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 8. insulin insulin sliding scale per attached scale. 9. Insulin Glargine 100 unit/mL Solution Sig: Twelve (12) units Subcutaneous once a day. Disp:*1 1* Refills:*2* 10. syringe 0.5 cc insulin syringe with 25 guage needle dispense 100 refill 2 11. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO BID (2 times a day). Disp:*60 Tablet Sustained Release 24HR(s)* Refills:*2* 12. Labetalol 200 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*2* 13. oxygen 3.5L O2/min continuous for portability pulse dose system. 14. Insulin Lispro (Human) 100 unit/mL Solution Sig: per sliding scale units Subcutaneous prn, per attached sliding scale. Disp:*1 1* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary: Congestive heart failure Coronary artery disease Secondary: Diabetes mellitus, type 2 Anemia Renal insufficiency Discharge Condition: Stable. The patient is chest pain free, denies shortness of breath and is ambulating on his own. Discharge Instructions: You were admitted for a small heart attack. You underwent cardiac catheterization and were found to have multivessel coronary artery disease. After evaluation by the surgeons, it was decided that medical management of your heart disease would be the best treatment for you. It is therefore important that you take all of your medications as prescribed. You are taking some new medications including a medication called plavix. Additionally, you are taking a medication called Imdur which is used to treat high blood pressure and the dose of your labetolol has been increased to 900mg twice daily, from 600mg twice daily. The other medications remain the same. Please keep all outpatient appointments. If you begin to experience any shortness of breath, chest pain, lightheadedness or dizziness please call 911 or your physician [**Name Initial (PRE) 2227**]. . Please discuss with your PCP about getting pulmonary function tests as an outpatient. Followup Instructions: You need to follow up with your PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5292**] on Thursday [**10-25**] at 10 am. [**Telephone/Fax (1) 5294**]. . Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 8937**] in cardiology on [**10-30**] at 1:00pm.
[ "285.9", "585.9", "V10.46", "272.4", "433.30", "401.9", "410.71", "428.0", "293.0", "250.00", "414.01", "V10.51" ]
icd9cm
[ [ [] ] ]
[ "88.56", "88.53", "37.23" ]
icd9pcs
[ [ [] ] ]
9535, 9593
4134, 7924
301, 326
9760, 9860
1884, 4111
10865, 11235
1529, 1547
8236, 9512
9614, 9739
7950, 8213
9884, 10842
1562, 1865
226, 263
354, 1105
1127, 1365
1381, 1513
23,473
159,740
250
Discharge summary
report
Admission Date: [**2151-2-21**] Discharge Date: [**2151-3-19**] Date of Birth: [**2084-2-28**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1283**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: [**2-23**] Redo sternotomy, CABG x 2, MVRepair (#26 annuloplasty band) History of Present Illness: 66 yo M admitted preoperatively. Past Medical History: CAD s/p CABGx2 [**2124**], PPM, multiple PCI, NIDDM, GERD s/p dilation of esophageal stricture, proxysmal A.fib, HTN Social History: retired communications technician Physical Exam: NAD Admission exam unremarkable Brief Hospital Course: Mr. [**Known lastname 2487**] was admitted on [**2151-2-21**]. He remained on heparin and nitroglycerin until he was taken to the operating room on [**2151-2-23**] where he underwent a redo sternotomy, CABG x 2, and MV repair. He was transferred to the SICU in critical but stable condition on propofol, insulin, epinephrine, levophed, milrinone, vasopressin. He was seen by electrophysiology for his permenant pacer as well as for atrial fibrillation with pressor dependency. He was started on amiodarone. His IABP was removed on POD #2. He was started on heparin for a fib. He was started on tube feeds. He was seen by heart failure who recommended TEE/cardioversion, and he was cardioverted successfully, but he reverted to a fib. He remained in the ICU, on inotropes and pressors for many days. They were slowly weaned off with stable hemodynamics. Bilateral chest tubes were placed for large effusions. On [**3-6**] he was extubated. His milrinone was weaned to off. On [**3-11**] he was seen by vascular surgery for R flank and RLQ pain with a hematacrit and BP drop, retroperitoneal bleed was found on CT scan, his heparin was stopped and he was transfused. His creatinine rose to 3.0 after the bleed and stabilized at 1.6. Anticoagulation was stopped, and his hematocrit stabilized without further intervention. He was transferred to the floor on POD #20. His creatinine rose to 1.6, but has remained there. His Lasix was decreased due to his creatinine. He'd had a persistent, small, right apical pneumothorax which was unchanged with his pleural chest tube on suction, water seal, or clamped. It was therefore removed, and his post-removal chest x-ray showed no change. His hemodynamics, and respiratory status have remained stable, his oxygen saturation on room air is 94-95%, and he is ready to be discharged home today. Medications on Admission: lisinopril, asa, zocor, reglan, protonix, toprol, actos, glucotrol, plavix Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Carvedilol 3.125 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 6 days: then 200 mg daily until discontinued by Dr. [**Last Name (STitle) 1295**]. Disp:*40 Tablet(s)* Refills:*0* 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 8. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 10. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 11. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 12. Insulin Glargine 100 unit/mL Solution Sig: Fifteen (15) Units Subcutaneous at bedtime. Disp:*1 vial* Refills:*2* 13. Insulin Lispro (Human) 100 unit/mL Solution Sig: as directed Units Subcutaneous once a day. Disp:*1 vial* Refills:*2* 14. Insulin syringes 1/2 cc syringes Dispense # 100 with 2 refills prn Discharge Disposition: Home With Service Facility: VNA of [**Hospital1 **] Discharge Diagnosis: CAD MI [**2124**] CABG x 2 [**2124**] A fib HTN NIDDM GERD Esophageal dilation Mult PCI Discharge Condition: Good. Discharge Instructions: Call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. Shower, no baths, no lotions, creams or powders to incisions. No lifting more than 10 pounds or driving until follow up with surgeon. [**Last Name (NamePattern4) 2138**]p Instructions: Dr. [**Last Name (STitle) 1295**] next week Dr. [**Last Name (Prefixes) **] 2 weeks Dr. [**Last Name (STitle) 931**] 2 weeks Completed by:[**2151-3-19**]
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icd9cm
[ [ [] ] ]
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icd9pcs
[ [ [] ] ]
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Discharge summary
report
Admission Date: [**2121-3-27**] Discharge Date: [**2121-4-2**] Date of Birth: [**2042-6-30**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2186**] Chief Complaint: Hematocrit drop, presumed GIB Major Surgical or Invasive Procedure: EGD Colonoscopy 2 units of packed red blood cells History of Present Illness: 78 yo M w/ prior MWT, PVD (s/p SFA stending on [**2-16**] admission started on [**Month/Year (2) 4532**]), DM, HTN, HCV/EtOH abuse, urinary retention who presents to the ED from PCP's office in setting of confusion, weakness and hypotension. . Of note, the patient had partial amputation of his right great toe, caused by vasulopathy. The patient was recently admitted to [**Hospital1 18**] for right SFA and popliteal stenting at which time he was started on [**Hospital1 **] and pletal. In addition, course was complicated by UTI (Klebsiella) and monitored for EtOH withdrawal. The patient has been at [**Hospital3 **] until this Monday when he returned home. He is unsure of his current medications. He denies any drinking since before [**3-3**] when he was initially hospitalized. The patient thinks he may have had some dark stools earlier in the week. The patient further mentions taking two Aleve per night for back pain. Mr. [**Known lastname 23050**] has an abrasion on his upper lip but cannot remember any trauma. He denies any recent incidents of nausea, vomiting. He denies pain, chest pain, dyspnea, hematemesis of known history of liver disease, but states that he has been drinking since he was 16 years old. He does not remember his earlier endoscopy or any diagnosis of [**Doctor First Name **]-[**Doctor Last Name **] tears. In the ED, initial VS were 98.3F 94 81/44 100% on unknown amount of O2. He received 1.2L of NS, with SBPs to low 100s. Labs revealed an HCT of 21 (baseline 30), thrombocytosis, BUN/Cr 18/1.1, Lactate of 2.4 and normal coags. WBC was wnl. Given these findings, was started on PPI gtt and admitted for further evaluation to MICU. CXR was negative for acute process and CT head revealed no . . On arrival to the MICU, the patient was resting comfortably and had no complaints. He was being prepared for endscopy Past Medical History: -Peripheral arterial disease -Diabetes -Hypertension -Hep C -Urinary retention requiring straight cath at home{has refused TURP} -hx of GI bleed with resolving [**Doctor First Name 329**] [**Doctor Last Name **] tear -ETOH abuse(active) -Dyslipidemia -Right superficial femoral artery and tibioperoneal trunk stenting for nonhealing hallux ulcer. sp right partial hallux amputation [**2120**] Social History: SUBSTANCE ABUSE HISTORY (INCLUDE HISTORY OF D.T.'S, WITHDRAWAL SEIZURES, BLACKOUTS, DETOX TREATMENT, I.V. USAGE): alcohol:hx of drinking regularly since he was 16 and has desribed himself as a recovering alcoholic for the last 20 yrs and attends AA but does have relapses and last night he said that he drank a [**1-6**] pt of whiskey and a beer, denies w/d sz of blackouts drugs: denies tob:smoked 4ppd until 15 yrs ago caffeine: [**2-7**] cups of coffee a day Grew up in the [**Location (un) 86**] area. Entered National Guard in [**2055**] and ultimately sent to [**Country 2784**]. Returned in the early 50s and started working as a court officer. He was married once. He and his ex-wife divorced about 25 years ago but still are in close contact. She is remarried. He has a son who owns a local paper company who recently got married. Currently lives alone in a senior living facility in JamaicaPlain but was recently discharged from [**Hospital 100**] Rehab following vascular surgery. Family History: Noncontributory Physical Exam: Admission Exam: SBP 80s --> 110s, HR high 90s General: Alert, oriented x 3, no acute distress, can state the days of the week forward and backward HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: Supple, no LAD CV: Heart sounds quiet, but S1, S2 no murmurs auscultated Lungs: Clear to auscultation bilaterally Abdomen: Soft, non-tender, non-distended, midline scar, bowel sounds present GU: No foley Ext: Warm and without edema, patient has had amputation of right great toe Skin: Hyperkeratosis and sloughing of dead skin on feet Neuro: CNIII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation guiac + w dark stool Discharge Exam: VS: 97.5 110/60 65 18 100%RA General: Alert, A&Ox3, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: Supple, no LAD, No JVD CV: Heart sounds quiet, reg rate and rhythm, nl S1/S2, no murmurs auscultated Lungs: Clear to auscultation bilaterally Abdomen: Soft, non-tender, non-distended, midline scar, bowel sounds present GU: No foley Ext: Warm extremities bilaterally, no edema, patient has had amputation of right great toe, 1+ DP b/l Skin: Hyperkeratosis and sloughing of dead skin on feet, melanotic lesion and dual colored dark lesion with irregular borders in midline of back. superficial abrasion over right knee. Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, normal sensation of feet bilaterally Pertinent Results: Admission Labs: [**2121-3-27**] 01:00PM BLOOD WBC-7.6 RBC-2.60*# Hgb-6.2*# Hct-21.6*# MCV-83 MCH-23.9* MCHC-28.7*# RDW-16.4* Plt Ct-603*# [**2121-3-27**] 01:00PM BLOOD Neuts-84.5* Lymphs-12.2* Monos-2.8 Eos-0.1 Baso-0.3 [**2121-3-27**] 01:00PM BLOOD PT-11.0 PTT-24.8* INR(PT)-1.0 [**2121-3-27**] 01:00PM BLOOD Glucose-183* UreaN-18 Creat-1.1 Na-135 K-4.5 Cl-103 HCO3-22 AnGap-15 [**2121-3-27**] 01:00PM BLOOD ALT-35 AST-48* LD(LDH)-200 AlkPhos-41 TotBili-0.3 [**2121-3-27**] 01:00PM BLOOD Lipase-60 [**2121-3-27**] 01:00PM BLOOD Calcium-9.4 Phos-3.9 Mg-2.1 [**2121-3-27**] 01:00PM BLOOD Hapto-60 [**2121-3-27**] 01:00PM BLOOD TSH-2.1 [**2121-3-27**] 01:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2121-3-27**] 01:34PM BLOOD Lactate-2.4* [**2121-3-27**] 08:57PM BLOOD Lactate-1.1 [**2121-3-27**] 08:47PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.016 [**2121-3-27**] 08:47PM URINE Blood-NEG Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG [**2121-3-27**] 08:47PM URINE RBC-3* WBC->182* Bacteri-FEW Yeast-NONE Epi-1 [**2121-3-27**] 08:47PM URINE CastHy-4* Hct trend (received 2 units PRBCs on [**3-28**] in AM): [**2121-3-27**] 01:00PM BLOOD WBC-7.6 RBC-2.60*# Hgb-6.2*# Hct-21.6*# MCV-83 MCH-23.9* MCHC-28.7*# RDW-16.4* Plt Ct-603*# [**2121-3-27**] 06:36PM BLOOD Hct-18.5* [**2121-3-28**] 01:02AM BLOOD Hct-23.2*# [**2121-3-28**] 05:16AM BLOOD WBC-7.2 RBC-3.02* Hgb-7.4* Hct-23.9* MCV-79* MCH-24.4* MCHC-30.8* RDW-17.0* Plt Ct-479* [**2121-3-28**] 03:13PM BLOOD Hct-25.7* [**2121-3-28**] 11:38PM BLOOD WBC-9.1 RBC-3.44* Hgb-8.2* Hct-27.9* MCV-81* MCH-23.9* MCHC-29.5* RDW-17.1* Plt Ct-577* [**2121-3-29**] 08:34AM BLOOD WBC-8.4 RBC-3.57* Hgb-8.6* Hct-28.7* MCV-81* MCH-24.1* MCHC-30.0* RDW-17.4* Plt Ct-523* Micro: [**3-27**] Blood culture [**3-27**] MRSA screen [**3-27**] Urine Culture negative [**3-27**] HELICOBACTER PYLORI ANTIBODY TEST positive Imaging: CXR [**2121-3-27**]: 1. No evidence of acute disease. 2. Newly apparent nodular focus projecting along the right lower lung, probably a nipple shadow, although a pulmonary nodule should be considered. When clinically appropriate, repeat PA view with nipple markers is recommended. . CT head w/o contrast [**2121-3-27**]: 1. No evidence of acute intracranial process. 2. Age-related atrophy. 3. Chronic small vessel ischemic disease. . CT abdomen/pelvis w/o contrast [**2121-3-27**]: IMPRESSION: 1. No evidence of retroperitoneal or intramuscular hematoma. 2. Left adrenal hypoattenuating mass is likely an adenoma. 3. Multiple bladder diverticula. 4. Extensive atherosclerotic disease and coronary artery disease. 5. Old right posterior rib fractures and anterior wedge compression of L2 and multilevel lumbar degenerative disease. 6. Multiple tiny renal cysts, too small to characterize but without concerning features. 7. Right femoral stent is noted, patency cannot be assessed. . EGD [**2121-3-27**]: Impression: Small hiatal hernia Mild erythema and friability in the antrum compatible with mild gastritis Normal mucosa in the duodenum Otherwise normal EGD to second part of the duodenum Recommendations: The findings do not account for the symptoms Serial hcts, monitor stool output; consider extraluminal blood losses given recent femoral puncture. Would consider non-urgent colonoscopy prior to d/c if within patient wishes and no extraluminal bleeding site localized. Would discuss [**Month/Day/Year 4532**]/aspirin with vascular surgery. Given overall well appearance of the patient, would seem in favor of continuing if stent high risk for occlusion. . [**2121-3-29**] CXR: PA and lateral upright chest radiographs were reviewed in comparison to [**2121-3-27**]. Heart size and mediastinum are unremarkable. Lungs are essentially clear. No pleural effusion or pneumothorax is demonstrated. Hyperinflation of the upper lungs most likely reflects emphysema. No nodular opacity along the right lower lung is currently demonstrated, most likely reflecting nipple shadow on the prior examination. . Colonoscopy [**2121-3-31**]: Polyp in the proximal ascending colon (polypectomy) Polyp in the distal ascending colon (polypectomy) Polyp in the hepatic flexure (polypectomy, endoclip) Otherwise normal colonoscopy to terminal ileum Brief Hospital Course: The patient is a 78-year-old man with a history of alcohol abuse, Mallroy [**Doctor Last Name **] tear, peripheral vascular disease, and diabetes who presents with confusion, weakness and hypotension, susequently found to a large hematocrit drop. . # Anemia, probable GI bleed: The patient has a history of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear and gastritis. His anemia and episode of hypotension was thought to be secondary to hypovolemia from a GI bleed. The patient received a bolus of normal saline and two units of packed red blood cells. His hematocrit responded by improving from 18 to 23. GI performed an endoscopy which showed gastric erythema and friability, but no obvious source of GI bleed. Because he had recently undergone stenting of peripheral artery, a retroperitoneal bleed remained on the differential. CT of abdomen and pelvis showed no evidence of RP bleed. His hematocrit remained stable and steadily increasing, so he was transferred to the Medicine service with plans to perform colonoscopy after appropriate preparation. His aspirin and [**Last Name (NamePattern1) **] were held. After contacting his vascular surgeon, his [**Name (NI) **] continued to be held in the setting of a likely lower GI bleed. ASA was restarted. Colonoscopy showed 3 polyps but no active bleeding. The polyps were biopsied. The patient's hematocrit remained stable and he had no more bloody stools. Discharged with plans for close outpatient follow-up and repeat hematocrit on [**2121-4-3**]. Crit on discharge was 30.2. . # Presumed urinary tract infection: The patient has a history of urinary retention requiring straight catheterization. His urinalysis in the ICU was suggestive of infection so he was started on ceftriaxone therapy. Urine culture showed mixed bacteria growth, without evidence of UTI. Ceftriaxone was stopped and a repeat Ucx was unremarkable. Antibiotics not restated. . # Alcohol abuse: Patient has history of alcohol abuse, according to old records. It appears he has been at home the last few days, which means he may have started drinking again, though the patient denies it. He was placed on CIWA, though he never triggered and did not require benzodiazepines. He was provided thiamine and folate. Social work was consulted. The patient was discharged on thiamine and folate. . # Diabetes: Provided insulin sliding scale while in hospital. . # Urinary retention: Continued home tamsulosin. . # Incidentalomas: Left adrenal adenoma. Multiple bladder diverticula Old right posterior rib fxs. Anterior wedge compression of L2 . Transitional Issues: - Repeat hematocrit on [**4-3**]. Hematocrit on dischare was 30.2. If drifting downwards, GI would recommend capsule study. - Patient should have dermatology follow up for two skin lesions noted on his upper back - F/u GI biopsies. Patient is concerned about these and would like to be contact[**Name (NI) **] about results - F/u H. Pylori stool antigen Medications on Admission: -cilostazol 100 mg Tablet 1 Tablet(s) by mouth twice a day -clopidogrel [[**Name (NI) **]] 75 mg Tablet 1 Tablet(s) by mouth once a day -metformin 500 mg Tablet 1 Tablet(s) by mouth twice a day -pantoprazole 40 mg Tablet, Delayed Release (E.C.) 1 Tablet Qday -tamsulosin 0.4 mg Capsule, Ext Release 24 hr 1 Capsule Qhs -aspirin 81 mg Tablet, Delayed Release (E.C.) daily Discharge Disposition: Home With Service Facility: [**Hospital1 100**] Senior Life for Home Care Discharge Diagnosis: Primary Diagnosis: Gastrointestinal bleed Secondary Diagnosis: Peripheral Vascular Disease s/p stent placement Alcohol Abuse Diabetes Skin lesions Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname 23050**], It was a pleasure taking care of you at [**Hospital1 827**]. You were admitted because you were feeling weak and were found to have very low blood levels. It was presumed that you were bleeding from your intestines. You had a scope of your upper and and lower intestinal tract which showed polyps but no active bleeding. You did not have any further episodes of bleeding and your blood counts improved during your time in the hospital. You are safe for discharge home. Your primary care doctor should follow up on the results of the biopsies of the polyps. You should have your blood counts rechecked on Friday [**2121-4-4**] and the results faxed to your primary doctor. Please also discuss with your primary care doctor getting a referral to dermatology to look at the skin lesions on your back. Please continue all your home medications with the exception of the following, which have been changed: 1) Please START Thiamine 100mg daily 2) Please Start Folic acid 1mg daily 3) Please START Simethicone 40mg four times daily as needed for gas 4) START mupirocin cream; apply this on the rash under your nose twice a day Followup Instructions: Department: BIDHC [**Location (un) **] With: [**First Name11 (Name Pattern1) 3295**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3296**] [**Last Name (NamePattern1) 3297**], MD Phone # [**Telephone/Fax (1) 608**] Specialty: Primary Care When: TUESDAY [**2121-4-8**] at 1 PM Building: 545A Centre St. ([**Location (un) 538**], MA) None Campus: OFF CAMPUS Department: VASCULAR SURGERY When: THURSDAY [**2121-5-15**] at 1:30 PM With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 1490**], MD [**Telephone/Fax (1) 1237**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Completed by:[**2121-4-2**]
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icd9cm
[ [ [] ] ]
[ "45.13", "45.42" ]
icd9pcs
[ [ [] ] ]
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Discharge summary
report
Admission Date: [**2120-4-25**] Discharge Date: [**2120-5-1**] Date of Birth: [**2064-3-25**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 6075**] Chief Complaint: left sided weakness Major Surgical or Invasive Procedure: IV TPA History of Present Illness: 56 yo man with hx angioplasty in [**2116**] for cad, hx afib prior to that (none documented since, on no anticoag), p/w fall to L at work and sudden onset L sided weakness (face, arm and leg) at 4:30PM; CODE STROKE activated. Pt had been in USOH prior to event, and fall was witnessed by colleagues - pt collapsed to L against a filing cabinet, noted by colleagues to be weak on the L with facial droop on L as well. EMS got call at 5PM and pt arrived in ER at 5:30PM. VS in field included BG 91, BP 116/68, HR 60. Neurology at bedside upon pt arrival. NIHSS score 6 for facial droop (2), motor/arm (1), mild dysarthria (1), and extinction to DSS (2). Pt himself initially denied L sided weakness and denied that anything was wrong either with strength of limbs or with speech. He had been noted by EMS to at times be unable to move his L arm, and at other times able to touch his nose with L hand. C/o no other sx except mild L temple headache. No visual or hearing changes, problems swallowing, hearing problems, or other sx except as above. Stat head CT showed hyperdense L MCA, and CTA showed clot at M1. TPA given at 6:30PM (bolus) and infusion to be run for 1hr after. Past Medical History: PMH: CAD s/p angio in [**2116**] Hx afib prior to angio/stent placement, not documented since Hx L diaphragm paralysis after neck surgery No hx htn, high chol, dm to pt's knowledge (though on lipitor) Social History: Social History: Lives with wife, has kids; no tob, few drinks etoh/nt, no drugs; works in office Family History: Family History: No strokes or heart attacks in family. Father with DM. Physical Exam: Admission Examination: afebrile 116/68 HR 56 99%RA 16 wt 200 lbs General appearance: white male, NAD HEENT: moist mucus membranes, clear oropharynx Neck: supple, no bruits Heart: regular rate and rhythm, no murmurs Lungs: clear to auscultation bilaterally Abdomen: soft, nontender +bs Extremities: warm, well-perfused Skull & Spine: Neck movements are full and not painful to palpation in the paraspinal soft tissues Rectal: nl, guaiac neg stool Mental Status: The patient is alert and attentive, could provide accurate history. Language is intact with no errors, normal [**Location (un) 1131**] and comprehension, repetition, naming. There is however anosagnosia, with pt repeatedly saying L side working fine; no hand agnosia. Cranial Nerves: The visual fields are full to confrontation, but there is extinction to DSS on L, and he has a R gaze preference, though no gaze palsy. The optic discs are normal in appearance. Eye movements are normal, with no nystagmus. Pupils react equally to light 3.5->2 bilat, both directly and consensually. Sensation on the face is intact to light touch, pin prick per pt, with no ext to DSS. Facial movements are notable for L droop. Hearing is intact to finger rub. The palate elevates in the midline. The tongue protrudes in the midline and is of normal appearance. Mild dysarthria for labial sounds. Motor System: There is 5-/5 strength at the left deltoid and tricep, 4+/5 at finger extensors on L, 5-/5 L hamstring, elsewhere mms are full stength. There is no tremor, or abnormal movements. There is L drift and vacillation. Reflexes: The tendon reflexes are mildly depressed on L [**Hospital1 **]/[**Last Name (un) **] compared to R. Knees and ankles equal. The L toe is up, R is down. Sensory: Sensation is intact to LT, position, but he has intermittent extinction to DSS on the left to tactile and visual stim, neglects L side. Coordination: L F->N Ataxia is not out of proportion to weakness or neglect, improves with looking at hand on L; no ataxia elsewhere. The R finger/nose test normal. Gait: deferred for now Pertinent Results: CT head [**2120-4-25**]: IMPRESSION: Relatively "hyperdense" proximal right MCA, raising the possibility of acute embolic or thrombotic occulsion of this vessel, with no definite evidence of acute major vascular territorial infarct on this non- contrast head CT. Please refer to concurrent CTA, including post-processed CT perfusion study for more complete assessment of this finding.2. No acute hemorrhage. CTA head and neck [**2120-4-25**]: IMPRESSION: Findings consistent ischemia within the right middle cerebral artery territory, due to embolic occlusive fragment seen near the origin of the right middle cerebral artery on CT angiography. CT head [**2120-4-26**]: New hypodense region within the right basal ganglia with associated slight edema and mass effect on the ventricular system suggests acute stroke; however, no complication including no intracranial hemorrhage is detected CTA chest [**2120-4-30**]: IMPRESSION: 1. No evidence of pulmonary embolism. 2. Multifocal, patchy air space disease. Findings nonspecific but differential diagnosis includes infectious or inflammatory process, including cryptogenic organizing pneumonia. While this is an atypical distribution for aspiration, given the patient's clinical history, this would also be a consideration. TEE [**2120-5-1**]: No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are structurally normal. Mild to moderate ([**12-26**]+) mitral regurgitation is seen. There is no pericardial effusion. No aortic atheroma. IMPRESSION: No cardiac source of embolism seen. Brief Hospital Course: Patient presented to ED with exam of NIHSS of 6 as per above. He has a hyperdense right MCA sign confirmed by cut off on CTA and decreased CBF on perfusion. Mechanism of stroke is likely cardioembolic from atrial fibrillation. Patient received IV tPA after risk of 6.4% risk of ICH discussed with family and patient . No complications after bolus and infusion and patient monitored in ICU 24 hours with no complications. He was transferred to Neurology floor where he was noted to have a normal neurological exam with only some very mild left pronator drift. The patient was on telemetry and no arrhythmias noted. He had an echocardiogram which was poor quality so had a transesophageal echocardiogram which showed no cardiac embolic source for stroke. Patinet complained of shortness of breath during his hospital stay that persisted for two days. He had nml cardiac enzymes, nml EKG and chest ct-with perfusion which showed some lung space disease and small pleural effusions. His shortness of breath improved with ambulation and incentive spirometry. Patient worked with Pt/OT who felt he did not need any inpatient or home PT/OT service. Medications on Admission: Meds: Digoxin 250mcg ASA 81 mg Nadolol unknown dose Lipitor 10 mg Discharge Medications: 1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 2. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*120 Tablet(s)* Refills:*2* 3. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 3 days. 4. Coumadin 3 mg Tablet Sig: One (1) Tablet PO once a day: please do NOT take medication till your PCP checks INR blood level and tells you to continue the medication. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: stroke Discharge Condition: stable Discharge Instructions: Take medications as instructed Followup Instructions: DRS. [**Name5 (PTitle) **] & [**Doctor Last Name **] Neurology [**Hospital 4038**] Clinic Phone:[**Telephone/Fax (1) 44**] [**2120-5-29**] 4:30 pm [**Hospital 18**] [**Hospital 878**] Clinic [**Hospital Ward Name 23**] bldng [**Location (un) **]. YOU MUST CALL TO CONFIRM THIS APPOINTMENT
[ "434.91", "V45.82", "412", "414.01", "342.80", "427.31", "518.0" ]
icd9cm
[ [ [] ] ]
[ "99.10", "88.72" ]
icd9pcs
[ [ [] ] ]
7959, 7965
6190, 7335
335, 343
8016, 8025
4107, 6167
8105, 8398
1930, 1988
7452, 7936
7986, 7995
7361, 7429
8049, 8081
2003, 2455
276, 297
371, 1558
2756, 4088
2470, 2740
1580, 1783
1815, 1898