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{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6100 }
Medical Text: Admission Date: [**2105-3-3**] Discharge Date: [**2105-3-6**] Date of Birth: [**2105-3-3**] Sex: M Service: NB HISTORY OF PRESENT ILLNESS: Baby [**Name (NI) **] [**Known lastname **] is a term male infant who was the 3,125 gram product of a 29-year-old G2, P1, now 2, mother. Prenatal screens included blood type B positive, antibody negative, hepatitis B surface antigen negative, RPR nonreactive, rubella immune, and GBS negative. The pregnancy was reportedly uncomplicated. Delivery was a normal spontaneous vaginal one, after two hours ruptured membranes, and without maternal fever. Delivery was noted to be rapid. At three hours of life, Baby [**Name (NI) **] [**Known lastname **] was noted to have tachypnea in the Newborn Nursery with respiratory rate increasing to 80-110. He also seemed dusky, but did not have any episodes of apnea. He was transferred to the Neonatal Intensive Care Unit for further care. ADMISSION PHYSICAL EXAM: Birthweight was 3,125 grams. In general, Baby [**Name (NI) **] [**Known lastname **] was an alert and active term male with mild to moderate respiratory distress. HEENT exam revealed an anterior fontanel that was soft and flat, red reflexes present bilaterally, intact palate, and normal facies. Chest exam revealed mild retractions both subcostally and sternally, with coarse, equal bilateral breath sounds. Heart was noted to be regular rate and rhythm, with a II-III/VI harsh, low-pitched systolic murmur heard loudest at the left sternal border. Pulses were palpable in his upper and lower extremities, though more easily palpable in his upper extremities. Perfusion was noted to be good. Four-extremity blood pressures revealed right arm 70/47 with a mean of 64, right leg 60/40 with a mean of 44, left arm 80/40 with a mean of 58, left leg 61/49 with a mean of 49. Abdomen was soft without distention and with no hepatosplenomegaly. GU exam revealed normal male external genitalia with testes descended bilaterally. Neurologic exam revealed normal, symmetric tone throughout. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: 1. RESPIRATORY: On admission, Baby [**Name (NI) **] [**Known lastname **] was noted to be in mild to moderate respiratory distress with tachypnea in the 80s. He was requiring blow-by oxygen supplementation. Chest x-ray revealed normal lung volumes, a slightly increased cardiothoracic silhouette, and hazy lung fields bilaterally. He was placed in nasal cannula oxygen, and a cardiac evaluation was undertaken. The cardiac evaluation, as detailed below, yielded normal results, and his respiratory distress gradually improved. A follow-up chest x-ray 24 hours after admission revealed decreased haziness of the lung fields, and a normal heart size. Baby [**Name (NI) **] [**Known lastname **] was able to wean from nasal cannula oxygen by 48 hours of life, and at the time of discharge has had a regular respiratory rate in the 50s in room air for greater than 24 hours. He has had no episodes of desaturation or apnea during this admission. 2. CARDIOVASCULAR: Baby [**Name (NI) **] [**Known lastname **] was noted to have a murmur on admission to the Neonatal Intensive Care Unit. Evaluation of this murmur included four-extremity blood pressures, as detailed in the physical exam section. It also included a hyperoxia test with a left radial ABG, but had a pH of 7.29, PCO2 51, PO2 168, in 100 percent oxygen. Echocardiogram revealed a small PDA and trivial tricuspid regurgitation at 12 hours of life. EKG was unremarkable. His murmur had resolved by 24 hours of life and has not since been appreciated. He has remained hemodynamically stable with good perfusion and blood pressures during the remainder of his hospital stay. 3. FLUID, ELECTROLYTES AND NUTRITION: Baby [**Name (NI) **] [**Known lastname **] was initially held NPO on D10W IV fluid at 60 cc/kg/D. Once his respiratory distress had resolved, feedings were initiated of breast milk and Similac 20. He has been taking ad lib feeds well of 30-50 cc q 3-4 h with a total fluid intake of 92 cc/kg/D over the 24 hours preceding discharge. He has been voiding and stooling appropriately. Electrolytes at 24 hours of life were normal. 4. HEMATOLOGY: Baby [**Name (NI) **] [**Known lastname 58731**] initial hematocrit was 55.1 percent. A bilirubin at 24 hours of life was 7.2 with a direct component of 0.3. 5. INFECTIOUS DISEASE: In light of his respiratory distress and concern for pneumonia, Baby [**Name (NI) **] [**Known lastname **] underwent a sepsis evaluation and was treated with ampicillin and gentamicin. His CBC was reassuring with a white count of 17.9 with 64 percent polys and 1 percent bands. Platelets were 295,000. As repeat chest x-ray at 24 hours of life did not reveal any evidence of pneumonia, the haziness seen on the first day was felt to be more consistent with TTN than with pneumonia. Antibiotics were stopped when blood cultures were negative at 48 hours. 6. SENSORY: Hearing screening was performed with automated auditory brain stem responses, and he passed. 7. GI: Bilirubin drawn [**2105-3-6**] was 11.1. No photo therapy was initiated. CONDITION AT DISCHARGE: Good. DISCHARGE DISPOSITION: To home with parents in car seat. PRIMARY PEDIATRICIAN: [**Hospital3 **]. CARE/RECOMMENDATIONS: 1. Feedings at discharge are Similac 20 or breast milk po ad lib. 2. Baby [**Name (NI) **] [**Known lastname **] is on no medications. 3. State newborn screen has been sent. 4. Hepatitis B vaccination was given on [**2105-3-5**]. 5. Influenza immunization is recommended annually in the fall for all infants once they reach 6 months of age. Before this age (and for the first 24 months of the child's life), immunization against influenza is recommended for household contacts and out-of-home caregivers. FOLLOW-UP APPOINTMENTS: An appointment should be scheduled with [**Hospital3 **] Pediatrics for [**Last Name (LF) 766**], [**2105-3-9**]. DISCHARGE DIAGNOSES: Respiratory distress/transient tachypnea of the newborn--resolved. Heart murmur--resolved. Rule out sepsis--resolved. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 48738**], MD [**MD Number(2) 55708**] Dictated By:[**Name8 (MD) 58732**] MEDQUIST36 D: [**2105-3-6**] 10:43:31 T: [**2105-3-6**] 11:34:23 Job#: [**Job Number 58733**] ICD9 Codes: V290, V053
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6101 }
Medical Text: Admission Date: [**2112-12-5**] Discharge Date: [**2112-12-12**] Date of Birth: [**2060-11-12**] Sex: F Service: MEDICINE Allergies: Bactrim Attending:[**First Name3 (LF) 4028**] Chief Complaint: Upper GI Bleed Major Surgical or Invasive Procedure: Endoscopy with cauterization Intubation/Extubation Central line placement History of Present Illness: Ms. [**Known lastname 4427**] is a 52 year old F with HIV (CD4 488 and VL <48 [**7-8**]) who presented with 2days of hematemesis and melena. Pt called Dr. [**First Name (STitle) 1075**] of ID with report of feeling dizzy with black stool, and was referred to the ED. In the ED she initially vomited dark material but this progressed to bright red emesis. In the ED, vital signs were 98.4 125 111/51 22 100%. She was subsequently intubated in the ED for airway protection (not respiratory distress.) EKG had shown sinus tachycardia. She was given 2 PIVs, 1upRBCs, 3L IVF, and Protonix 40 IV x 1, then transferred to the MICU. Pt has a history of viral illness and tylenol/ibuprofen use of unknown amount. She has a history of prior EGD [**4-7**] that showed esophagitis. . Allergies: Bactrim (rash) Past Medical History: HIV: >10 yrs. Contracted via heterosexual activity. CD4 488, VL >48 as of [**7-8**]. h/o esophagitis s/p EGD [**4-7**] hiatal hernia HTN Asthma anemia carpal tunnel Obesity HSV I/II Crack cocaine abuse Social History: lives with daughter and [**Name2 (NI) 12496**]. no smoking or drinking, has worked as school bus monitor ([**4-7**] OMR) Family History: noncontributory Physical Exam: ON ADMISSION TO MICU Vitals T 97.9 P 87 Bp 117/68 RR 16 O2 100% on AC 500x14 0.4 General Obese woman intubated and sedated HEENT Sclera pale, conjunctiva anicteric Neck Larger neck, can't assess JVP Pulm Lungs clear bilaterally CV Regular S1 S2 no m/r/g Abd Soft obese +bowel sounds nontender Extrem Feet cool with palpable pulses Neuro Opens eyes to voice, shakes head when asked about pain with sedation lightened ON ADMISSION TO THE FLOOR VS: 97.1 114/84 90 22 95% RA Gen: awake, sleepy, NAD HEENT: oropharynx clear, no LAD, PERRL, EOMI grossly; [**Month/Year (2) **] in place, no erythema CV: RRR, no m/r/g, S1 S2 LUNGS: CTAB anteriorly ABD: obese, soft, NTND, bs+ EXT: no c/c/e, wwp, pneumoboots on Pertinent Results: ***LABS ON ADMISSION*** [**2112-12-5**] 08:15PM HCT-31.8* [**2112-12-5**] 06:10PM TYPE-ART PO2-188* PCO2-46* PH-7.34* TOTAL CO2-26 BASE XS--1 [**2112-12-5**] 05:56PM GLUCOSE-114* UREA N-33* CREAT-0.5 SODIUM-143 POTASSIUM-4.2 CHLORIDE-113* TOTAL CO2-26 ANION GAP-8 [**2112-12-5**] 05:56PM estGFR-Using this [**2112-12-5**] 05:56PM ALT(SGPT)-11 AST(SGOT)-15 LD(LDH)-123 ALK PHOS-39 TOT BILI-0.3 [**2112-12-5**] 05:56PM ALBUMIN-3.2* CALCIUM-7.8* PHOSPHATE-3.8 MAGNESIUM-2.0 [**2112-12-5**] 05:56PM WBC-6.5 RBC-3.49* HGB-11.1* HCT-31.6* MCV-91 MCH-31.8 MCHC-35.1* RDW-13.9 [**2112-12-5**] 05:56PM PLT COUNT-205 [**2112-12-5**] 05:56PM PT-13.5* PTT-22.5 INR(PT)-1.2* [**2112-12-5**] 01:29PM TYPE-ART PO2-514* PCO2-41 PH-7.38 TOTAL CO2-25 BASE XS-0 [**2112-12-5**] 01:29PM GLUCOSE-159* K+-3.7 [**2112-12-5**] 01:29PM HGB-10.4* calcHCT-31 [**2112-12-5**] 12:20PM WBC-8.3# RBC-3.64* HGB-11.2* HCT-33.4* MCV-92 MCH-30.7 MCHC-33.4 RDW-13.6 [**2112-12-5**] 12:20PM NEUTS-70.0 LYMPHS-26.8 MONOS-2.2 EOS-0.5 BASOS-0.6 [**2112-12-5**] 12:20PM PLT COUNT-258 ***LABS DURING HOSPITAL STAY*** [**2112-12-9**] 08:12PM BLOOD Hct-25.2* [**2112-12-9**] 03:56AM BLOOD Plt Ct-208 [**2112-12-9**] 03:56AM BLOOD Glucose-110* UreaN-13 Creat-0.5 Na-140 K-3.2* Cl-107 HCO3-29 AnGap-7* [**2112-12-9**] 03:56AM BLOOD Calcium-8.4 Phos-4.1 Mg-1.8 Urine culture- negative MRSA Screen- negative H.Pylori- pending **IMAGING** EKG [**2112-12-7**] Sinus tachycardia. Low limb lead voltage. Since the previous tracing of [**2102-9-26**] limb lead voltage is lower. Intervals Axes Rate PR QRS QT/QTc P QRS T 106 138 82 330/410 68 49 63 CXR [**2112-12-5**] FINDINGS: Portable upright AP chest radiograph is obtained. Right CP angle is excluded thus limiting evaluation. Evaluation is also limited by underpenetrated technique. The lungs appear clear bilaterally. Cardiomediastinal silhouette is stable. Osseous structures appear intact. Left AC joint hypertrophic changes are noted. IMPRESSION: Limited study without evidence of acute process. Right CP angle exclusion limits evaluation. CXR [**2112-12-8**] There are relatively low inspiratory volumes on this examination. Right-sided IJ central venous catheter remains present, with the tip difficult to visualize but probably at the cavoatrial junction. The cardiac and mediastinal silhouettes remain unchanged. Allowing for low inspiratory volume, no gross pulmonary consolidation is seen. No evidence of pneumothorax. Osseous structures remain unchanged and grossly unremarkable aside from mild degenerative changes at the right acromioclavicular joint. IMPRESSION: Low inspiratory volumes; no appreciable interval change or evidence of acute cardiopulmonary disease. Brief Hospital Course: #. GIB: Hematemesis has been consistent with an upper GI source. Patient was transferred to the ICU from ED intubated for airway protection and underwent emergent EGD, with clot in fundus that was not unroofed, but no other sources of bleeding. Patient then underwent placement of a Right Internal Jugular central line and received a total of 3 units of blood for a hematocrit which nadered at 26. She was initially started on a protonix drip which was changed to [**Hospital1 **] dosing of 40 mg after her HCT was stable. She was extubated on ICU day 2 and remained somewhat confused and disoriented. This was thought to be related to the Benzodiazepines administered for sedation. She underwent a second EGD by GI, which found flat lesions and an ulcer in the cardia treated with epinepherine and gold probe. She also had some evidence of esophagitis. On the third ICU day, patient remained somewhat confused, but was otherwise hemodynamically stable and was transferred to the floor. On the floor, crit continued to remain stable, ranging between 25-27.3. Pt received one additional unit pRBC on the floor. Pt continued to remain hemodynamically stable, and was resumed on her home HCTZ. Pt did not have any additional episodes of melena or hemetemesis. Mental status and lethargy cleared up and patient as alert and oriented on day of discharge. She was continued on a high dose PPI (40mg PO bid), and will be following up as outpt with her PCP. [**Name10 (NameIs) **] was removed prior to discharge (had been maintained on the floor as pt had poor peripheral access.) PT was consulted, and initially felt that pt would benefit from continued PT, but upon re-eval, pt was doing much better and will be able to go home without PT. H.pylori is pending and will need to be followed up as outpatient. . # HIV: Pt is on anti-retroviral therapy. Her last CD4 count was 488 and VL <48 as of [**7-8**]. She was continued on her HAART during her stay (Lamivudine, Abacavir, Tenofovir, Ritonovir, Fosamprenivir.) CD4/VL was re-checked per pt request and results are pending, so will need to be followed up as outpt. Pt will need to follow-up for further HIV management with her PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11528**] (appt scheduled.) . # HTN: Pt is on HCTZ at home. This was held on admission given bleed. This was resumed at discharge as pt was hemodynamically stable (systolic BPs stable in 100-130s)with no further obvious signs of bleed on day of discharge. . # FEN: regular heart healthy diet. Pt was cleared by speech and swallow evaluation for advancing as tolerated s/p extubation, and pt was tolerating regular solids on day of discharge. . # PPX: Pneumoboots, PO PPI [**Hospital1 **] . # ACCESS: no PIVs (poor access), [**Hospital1 **] (pulled before discharge) . # Communication: patient . # Code: presumed full . # Dispo: discharge to home with PCP [**Last Name (NamePattern4) 702**]. Medications on Admission: Epzicom Tenofovir Fosamprenavir, ritonavir Albuterol HCTZ omeprazole Oxybutynin Tylenol Sarna Ferrous sulfate Simethicone Discharge Medications: 1. Fosamprenavir 700 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). 2. Ritonavir 100 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 3. Tenofovir Disoproxil Fumarate 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Epzicom 600-300 mg Tablet Sig: One (1) Tablet PO once a day. 5. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: 1-2 Puffs Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. 6. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 7. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 8. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO three times a day. 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 10. Iron 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 11. Sarna Anti-Itch 0.5-0.5 % Lotion Sig: One (1) application Topical twice a day as needed for itching. 12. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO bid or tid as needed for urinary frequency. 13. Tylenol Extra Strength 500 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for pain: Please do not take more than 4000mg per day. 14. Simethicone 60 mg Tablet Sig: One (1) Tablet PO once a day as needed for bloating. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Upper GI bleed; ulcer HIV Anemia from acute blood loss Discharge Condition: hemodynamically stable, anemia stable, afebrile, tolerating PO solids Discharge Instructions: You were admitted for uppger GI bleeding from a stomach ulcer. You were in the ICU, and required blood transfusions. There was also concern of your airway from all of the bleeding, therefore you were intubated in the ICU as well. You were extubated and did well. You had an ENDOSCOPY (camera in your throat) that saw an ulcer, which was cauterized (medication to stop the bleeding). Your blood counts remained stable. You were started on OMEPRAZOLE 40 mg TWICE DAILY to help with the bleeding ulcer. Please take all remaining medications as prescribed. Please AVOID NSAIDS for pain relief (e.g. Advil, Aleve, Ibuprofen), given your recent ulcer. Please keep all scheduled appointments. If you develop any of the following concerning symptoms, please call your PCP or go to the ED: chest pains, shortness of breath, fevers, chills, lightheadedness, dizziness, or blood from your stools. Followup Instructions: Appt with Dr. [**Last Name (STitle) 8499**]: [**2111-12-15**] 10:15 AM. Please have him follow up on your h.pylori antibody test and CD4/Viral load test results. Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] BLOOD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2113-1-4**] 11:00 Completed by:[**2112-12-12**] ICD9 Codes: 2851, 4589
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6102 }
Medical Text: Admission Date: [**2162-12-19**] Discharge Date: [**2162-12-21**] Date of Birth: [**2162-12-15**] Sex: M Service: NBB HISTORY OF PRESENT ILLNESS: Baby [**Name (NI) **] [**Name2 (NI) 58777**] [**Known lastname 58778**] delivered at 37 5/7 weeks gestation weighing 3890 grams and was readmitted from home to [**Hospital1 69**] Newborn Intensive Care Unit on day of life four for management of hyperbilirubinemia. The mother is a 30 year old gravida IV, para II, now III woman with estimated date of delivery [**2162-12-29**]. Her prenatal screens included: blood type A positive, antibody screen negative, RPR nonreactive, Rubella immune, hepatitis B surface antigen negative, and group B strep positive. The pregnancy was complicated by elevated blood pressure treated with Aldomet. Labor was induced due to elevated blood pressure. Artificial rupture of membranes around five hours prior to delivery for clear fluid. No maternal fever. She received intrapartum penicillin for GBS colonization around 12 hours prior to delivery. The infant was vigorous at delivery, Apgars were 9 at one minute and 9 at five minutes. The infant did well in the Newborn Nursery and was discharged home on day of life two. His bilirubin at 36 hours of life was 12. Physical examination was notable for a left flank mass. An abdominal ultrasound was done at [**Hospital3 18242**] following discharge which showed the following findings: Examination of the abdomen demonstrated a normal liver, pancreas, gallbladder, and spleen. The kidneys have a mildly echogenic cortex and markedly echogenic regions at the inferiormost portion of the medullary pyramid. This finding is consistent with TAMM Horsfall protein, which can be seen in the newborn and resolves over the first two days to weeks of life. The kidneys are generous in size, the right kidney measuring approximately 5.5 cm and the left kidney measuring approximately 5.3 cm. There is no evidence of hydronephrosis or renal masses. There was no free fluid in the abdomen or pelvis. The bladder was normal. No follow-up was recommended. A bilirubin was done as an outpatient on [**2162-12-18**] and was 16. A follow up bilirubin done the following day on [**2162-12-19**] was 20.4 prompting an admission to the Newborn Intensive Care Nursery. PHYSICAL EXAMINATION ON ADMISSION: Weight 3880 grams. Anterior fontanelle open, flat. Alert and active. Diffuse jaundice. Clear breath sounds with good aeration. Regular rate and rhythm without murmur. Abdomen soft, nondistended, no masses, no hepatosplenomegaly. Normal male genitalia, circumcised, patent anus. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: RESPIRATORY: There have been no issues. He is comfortable on room air. The respiratory rate has been in the 30s to 50s. CARDIOVASCULAR: He has been hemodynamically stable during hospitalization. Heart rate ranges in the 1-teens to the 140s. Recent blood pressure 87/55 with a mean of 67. No heart murmur. FLUIDS, ELECTROLYTES AND NUTRITION: On admission was placed on intravenous fluid of D10W at 80 ml per kilo per day which ran for about 24 hours. He also had been ad lib feeding breast or bottle feeding since admission, voiding and stooling appropriately. Discharge weight 3990 grams. GASTROINTESTINAL: The mother's blood type is A positive, antibody negative. The infant's blood type is O positive, Coombs negative. He was placed on triple phototherapy on admission for a bilirubin of 20. A bilirubin about four hours later on triple phototherapy remained at 20.5. Another phototherapy with light was added to give him four phototherapy lights and a follow up bilirubin was 18.5. Twenty four hours after admission under phototherapy the bilirubin dropped down to 13 and the phototherapy was decreased to 2 lights. On [**2162-12-21**] the bilirubin total was 12.3 with a direct of .4. The phototherapy was discontinued. Rebound bilirubin about six hours later was 11.6. There has been no evidence of hemolysis. The final diagnosis is exaggerated physiologic jaundice. HEMATOLOGY: Hematocrit on admission was 54 percent, reticulocyte count was 3.1 percent. Did not receive any blood products during this admission. INFECTIOUS DISEASE: A CBC and blood culture was drawn on admission. The CBC was benign. The blood culture was negative. He did not receive any antibiotics. NEUROLOGY: His examination has been age appropriate. SENSORY: A hearing screening was performed with automated auditory brain stem responses. He passed both ears. CONDITION ON DISCHARGE: A six day old term infant, feeding well with resolving hyperbilirubinemia. DISCHARGE DISPOSITION: Discharged home with parents. NAME OF PRIMARY PEDIATRICIAN: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, [**Hospital 58779**] [**Hospital 40483**] Pediatrics, telephone number [**Telephone/Fax (1) 58780**]. Fax [**Telephone/Fax (1) 58781**]. CARE AND RECOMMENDATIONS: 1. Feeds: Ad lib breast or bottle feeding. Mother had a lactation consult on [**12-22**] and has been given phone numbers to set up further support services. She also plans on renting a breastpump. 2. Medications: None. 3. State Newborn Screen was drawn after birth in the Newborn Nursery and is pending. 4. Immunizations: He received his hepatitis B immunization on [**2162-12-17**]. 5. Follow up appointments: Has a follow up appointment with Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] [**Hospital 40483**] Pediatrics in [**Location (un) 38**] on [**2162-12-23**] at 11:45AM. [**First Name (Titles) 407**] [**Last Name (Titles) 28085**] has been made to [**Hospital3 **] [**Hospital6 407**]. DISCHARGE DIAGNOSES: 1. Term appropriate gestational age male. 2. Exaggerated physiologic jaundice. 3. Sepsis ruled out. Addednum - FU bilirubin done at the [**Hospital1 **] on [**2162-12-22**] was 14.0/13.6 - follow up bili is recommended tomorrow [**2162-12-23**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 55750**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2162-12-21**] 17:19:02 T: [**2162-12-21**] 18:28:36 Job#: [**Job Number 58782**] ICD9 Codes: V290
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6103 }
Medical Text: Admission Date: [**2190-2-8**] Discharge Date: [**2190-2-15**] Date of Birth: [**2144-2-23**] Sex: M Service: ENT SURGERY CHIEF COMPLAINT: Chronic aspiration. HISTORY OF THE PRESENT ILLNESS: This is a 45-year-old male with Down's syndrome with frequent aspirations resulting in several episodes of aspiration pneumonia. The patient has had a gastric feeding tube since [**2182-1-3**]. A swallowing video fluoroscopy in [**2180**] revealed moderate to severe oropharyngeal swallowing disturbance with aspiration after the swallow and poor laryngeal sensitivity noted by absent cough following the aspiration. PAST MEDICAL HISTORY: 1. Down's syndrome with profound mental retardation. 2. Hepatitis B carrier. 3. Osteoporosis. 4. Hiatal hernia. 5. Allergic rhinitis. 6. Constipation. 7. Left retractile testis. 8. Right hip subluxation. 9. Atopic dermatitis. PAST SURGICAL HISTORY: 1. Right total hip replacement in [**2188-6-2**]. 2. G tube placement in [**2182-1-3**]. 3. Excision of thigh lipoma in [**2182-5-4**]. 4. Left cataract extraction with lens implant. ALLERGIES: Keflex which causes a rash, Reglan which causes dystonia, and acetazolamide. ADMISSION MEDICATIONS: 1. Protonix 40 b.i.d. 2. Theophylline 200 q.p.m. 3. Multivitamin. 4. Milk of magnesia. 5. Loratadine 10 mg every evening. 6. Lactobacillus 40 b.i.d. SOCIAL HISTORY: The patient is a resident of [**Location 6151**] Developmental Center. PHYSICAL EXAMINATION ON ADMISSION: Cardiac: Regular rate and rhythm. Lungs: Clear to auscultation bilaterally. Abdomen: Soft, nondistended, nontender with a G tube in place. Extremities: Severe muscular atrophy, no edema, clubbing, or cyanosis. HOSPITAL COURSE: The patient was admitted to preop and holding where he underwent narrow-field laryngectomy. The patient tolerated this procedure well. Please see the operative note for details. Chest x-ray postoperatively revealed a tracheostomy tube in good position with no pneumothorax. The patient was transferred to the Surgical Intensive Care Unit on the ventilator. He was placed on IV Clindamycin and IV Flagyl. On postoperative day number one, it was attempted to wean the patient off the ventilator. The patient was weaned to CPAP; however, he was placed back on the ventilator due to desaturations. Pink frothy sputum was noted at the site of the tracheostomy. Chest x-ray showed a small amount of CHF; however, the patient's lungs were clear to auscultation and it was again attempted to wean the ventilator. Tube feeds were also started on postoperative day number two at 10 cc per hour and tube feeds were advanced conservatively to a goal of 50 cc per hour. The patient was weaned from the ventilator on postoperative day number three successfully. The patient was transferred from the ICU to a floor bed on postoperative day number five. His tracheostomy tube was removed and [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-Singer tracheostomy tube was put in its place to support the stoma until it had matured. Duoderm was placed in the parastomal area to protect skin from breakdown. The patient was placed in a continuous 02 sat monitor setting. He was kept n.p.o. and tube feeds were advanced to goal. On postoperative day number seven, it was attempted to obtain a Barium swallow study to test for any esophageal leak; however, per the Radiology staff, the patient was unable to cooperate with the Barium swallow in that he was unable to maintain proper positioning during the study and was unable to follow commands as to when to swallow the barium contrast. However, the patient was felt to be stable and was discharged on postoperative day number seven. Throughout his hospital stay, his electrolytes were monitored and repleted as needed. Nutrition was consulted for advice regarding the patient's tube feeds and he remained stable throughout his hospital stay. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: To an extended care facility. DISCHARGE DIAGNOSIS: 1. Chronic aspiration. 2. Status post narrow-field laryngectomy. DISCHARGE INSTRUCTIONS: The patient should follow-up with Dr. [**Last Name (STitle) 1837**] in one week. The office should be contact[**Name (NI) **] for an appointment. DISCHARGE INSTRUCTIONS FOR THE TRANSFER FACILITY: 1. Remove and clean the [**Last Name (un) **]-Singer tracheostomy device with warm water twice a day. 2. Clean the crust from his stoma using moist Q-Tips twice a day. 3. Keep Duoderm on the parastomal areas. 4. Continue humidified air to his stoma. DIET: The patient should follow a clear liquid diet. He should receive Probalance full-strength tube feeds at 50 cc per hour and residuals should be checked every four hours and tube feedings should be held for residuals greater than or equal to 150 milliliters. His tube should be flushed with 30 milliliters of water q. four hours and as needed. DISCHARGE MEDICATIONS: 1. Theophylline 200 mg per the G tube once a day. 2. [**Doctor First Name **] 60 mg twice a day per G tube. 3. Calcium carbonate 12.5 milliliters once a day per the G tube. 4. Flovent inhaler two puffs twice a day. 5. Colace 100 mg twice a day per the G tube. 6. Percocet [**4-12**] milliliters every four to six hours as needed for pain. 7. Benadryl 25 mg one capsule every six hours as needed for itching per the G tube. 8. Albuterol inhaler, one nebulizer treatment every six hours as needed for shortness of breath or wheezing. 9. Protonix 40 mg once a day per the G tube. 10. Lopressor 37.5 mg three times a day per the G tube. 11. Lasix 20 mg one tablet twice a day per the G tube. [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 6152**], M.D. [**MD Number(1) 6153**] Dictated By:[**Last Name (NamePattern1) 6154**] MEDQUIST36 D: [**2190-2-15**] 12:22 T: [**2190-2-15**] 12:35 JOB#: [**Job Number 6155**] cc:[**Numeric Identifier 6156**] ICD9 Codes: 5070
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Medical Text: Admission Date: [**2200-1-19**] Discharge Date: [**2200-1-27**] Date of Birth: [**2147-7-2**] Sex: F Service: CHIEF COMPLAINT: 1. Seizure. HISTORY OF PRESENT ILLNESS: The patient is a 52 year-old female with a history of hydrocephalus status post right posterior occipital shunt placement in a prior seizure disorder who presented to an outside hospital for seizures. According to her prior records the patient had the onset of a focal seizure possibly involving the right arm for which she presented to an outside hospital. She was treated with up to 20 milligrams of prn Ativan as well as additional doses of her prior anti-epileptic drugs without improvement. She was subsequently intubated and started on an Ativan drip and was transferred to the [**Hospital1 69**] for further management. At the outside hospital her particular treatment had including Fentanyl 50 micrograms, Ativan 4 milligrams, Phenobarbitol 300 milligrams bolus, ativan drip, Valium 5 milligrams, Ativan 2 to 4 milligrams up to eight doses, Neurontin 400 milligrams, Trileptal 300 milligrams. The patient had also been given Versed prior to her transfer. REVIEW OF SYSTEMS: Unable to assess. PAST MEDICAL HISTORY: 1. Seizure disorder described previously as a focal seizure with occasional generalization. 2. Hypercholesterolemia. 3. Normal pressure hydrocephalus. 4. SIADH. 5. Hypertension. ALLERGIES: Include 1. Penicillin. 2. Codeine. 3. Aspirin. 4. Dilantin. MEDICATIONS ON ADMISSION: 1. The patient had recently been started on Trileptal. 2. Neurontin. SOCIAL HISTORY: The patient is college educated. She has occasional alcohol use, no tobacco use. PHYSICAL EXAMINATION: On initial physical exam her heart rate was 100, blood pressure 139/87, respiratory rate 15, FIO2 60, assist control at 12 and tidal volume of 600. In general the patient appeared older than her stated age and was lying in bed intubated with minimal spontaneous movement. HEENT was normocephalic, atraumatic with white sclerae. Her neck was supple without JVD or bruits. Her lungs were clear to auscultation with vented breath sounds bilaterally. Cardiovascular exam revealed a regular rate and rhythm with normal S1, S2 and no murmurs, rubs, or gallops. Her abdomen had normal bowel sounds. It was soft, nontender, nondistended. Extremities were warm without cyanosis, clubbing or edema. NEUROLOGIC EXAMINATION: The patient was not responsive to voice and had no spontaneous ability to open her eyes. Cranial nerves - her face appeared symmetric and her eyes were conjugate with forward gaze. Pupils were fixed at 1 mm and nonreactive to light. OCR was not present and corneal reflexes as well as blinking to threat were also absent. Gag reflex was present. Funduscopic demonstrated small ectatic retinal vasculature but sharp disc borders bilaterally. On motor and sensory exam the patient withdrew from painful stimuli in the upper extremity with triple flexion response in the lower extremities. She grimaced to pain in all extremities. Reflexes were equal and symmetric bilaterally with upgoing plantar responses. There was no ankle clonus. LABORATORY DATA: Initial labs demonstrated a head CT scan obtained at the outside hospital that showed bilateral hydrocephalus with the presence of a right posterior occipital shunt. Brain MRI obtained in [**2199-6-16**] had a previous [**Location (un) 1131**] of a right frontal craniotomy, bilateral craniotomies. There was right frontal encephalomalacia. Initial EKG showed sinus tachycardia with a normal axis, a Q wave in the inferior leads and early R wave progression. Her initial labs of note include a WBC 15.5, with 87% neutrophils, and a hematocrit of 36.6 and a normal MCV. Her urine tox screen was negative. Her coags as well as her LFTs were normal. Her initial sodium was slightly decreased at 134 and her chloride was slightly elevated at 134. Her bicarb was decreased at 19. The patient was admitted to the Neuro ICU and continued initially on the Ativan drip while she was loaded with Depakote. SUMMARY OF HOSPITAL COURSE: A Neurosurgery consult was obtained to assess the possibility of a shunt malfunction. On review of her prior images it was felt that there was no significant change in the size of her hydrocephalus according to the Neurosurgical consult. It was subsequently determined that Dr. [**Last Name (STitle) **] in the Department of Neurosurgery had been her surgeon in the past and the consult was deferred to Dr. [**Last Name (STitle) **] who saw the patient later in her hospital course and also felt that it was unlikely that her subsequent ataxia was related to shunt malfunction. In the Intensive Care Unit the patient continued to have decreased mental status presumably from ativan and postictal stated that required continued intubation until approximately [**2200-1-21**]. The patient was then transferred to the General Neuro Medical Service. During her ICU stay she had an EEG that demonstrated occasional left temporal and generalized burst of beta slowing. She also had a wide spread faster beta rhythm background particularly in the frontal regions. This is felt to be most likely a medication affect probably due to her Ativan. No clear epileptiform features were documented. On transfer to the General Neurology Service the patient was noted to be quite ataxic both trunkly and in her extremities. The etiology of this was unclear but the patient reported that she had prior episodes of gait instability related to Neurontin which she was being continued on. It was decided to taper her Neurontin and continue Depakote for the time being. After discussing her anti-epileptic regimen with her outside neurologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 40860**], at [**Telephone/Fax (1) 103122**] the decision was made to start the patient on Trileptal and maintain her on Depakote until her Trileptal had reached a therapeutic range. Otherwise the patient has continued to do well. DISCHARGE DIAGNOSIS: 1. Focal status epilepticus. 2. Gait ataxia of unclear etiology possibly from medication affect. 3. History of hydrocephalus status post shunt placement. DISCHARGE DIET: Low sodium diet, low cholesterol diet. DISCHARGE ACTIVITIES: As defined by Physical Therapy. DISPOSITION: The patient is to be discharged to a rehabilitation facility. DISCHARGE MEDICATIONS: 1. Neurontin 100 milligrams po tid. This could be tapered to [**Hospital1 **] one day after transfer and then q day and then off. 2. Trileptal 300 milligrams po bid which should be increased after seven days of treatment by 600 milligrams to Trileptal 600 milligrams po bid. Trileptal was started on [**2200-1-26**]. While the patient is on Trileptal her sodium levels need to be followed closely given her history of SIADH. She has a prior adverse affect from Tegretol which has included hyponatremia. 3. Robitussin DM 30 cc po q six hours prn. 4. Depakote 250 milligrams po q A.M., 250 milligrams po q noon, 500 milligrams po q P.M. The patient's Depakote level should be followed as well as her CBC and LFTs. 5. Heparin 5000 units subcutaneous [**Hospital1 **]. FOLLOW UP INSTRUCTIONS: On arrival to the rehab facility the patient's neurologist described above should be contact[**Name (NI) **] to inform him of her status. The patient should follow up with her neurologist on an outpatient basis. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1941**], M.D. [**MD Number(1) 37533**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2200-1-27**] 14:10 T: [**2200-1-27**] 14:16 JOB#: [**Job Number 44176**] ICD9 Codes: 2761, 4019
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Medical Text: Admission Date: [**2123-1-8**] Discharge Date: [**2123-1-21**] Date of Birth: [**2058-3-31**] Sex: F Service: CARDIOTHORACIC Allergies: Lisinopril Attending:[**First Name3 (LF) 922**] Chief Complaint: Abdominal pain Major Surgical or Invasive Procedure: [**2123-1-10**] ERCP [**2123-1-11**] Transjugular Liver Biopsy [**2122-1-30**] Cardioversion History of Present Illness: Mrs. [**Known lastname 6692**] is a 64 year old female who recently underwent a bioprosthetic mitral valve replacement and Maze procedure on [**2122-12-31**]. Her hospital course was rather uneventful and she was discharged on postoperative day seven. She re-presented with multiple vague complaints including RUQ abdominal pain and right flank pain. The pain was described as dull and was rated a [**6-29**]. Patient also admitted to some nausea and vomiting which was associated with some fevers, and chills. She denied rigors, weight loss/gain, bleeding and change in bowel habits. She did describe her urine as a dark, amber color. Initial evaluation was notable for elevated LFT's, elevated BNP, elevated white count, supratherapeutic INR along with a slight increase in creatinine. She was therefore admitted for further evaluation and treatment. Past Medical History: History of Mitral Regurgitation/Stenosis and Atrial Fibrillation s/p Mitral Valve Replacement(Bioprosthesis) and Full Left Sided Maze Procedure on [**2122-12-31**], Diastolic Congestive Heart Failure, Systemic Lupus Erythematosus with History of Lupus Anticoagulant and Hypercoagulable state, Anti-cardiolopin Antibody, History of Stroke [**2106**], History of Coronary Artery Disease - s/p RCA stent in [**2121-1-19**], Dyslipidemia, Asbestos exposure with pleural plaque, s/p Vein ligation and stripping Social History: Married, lives with husband. [**Name (NI) 1403**] as a registered nurse [**First Name (Titles) **] [**Last Name (Titles) **] [**Location (un) 620**]. Smoked 1 [**1-20**] ppd x 30 years, quit 16 years ago. 1 glass red wine/day Family History: There is no family history of premature coronary artery disease or sudden death. Mother - deceased age 76 DM, CAD. Father - deceased age 84, CAD. Two brothers s/p CABG. Daughter - deceased age 36, leukemia. Physical Exam: Vitals: Afebrile, BP 150/70, HR 70, RR 14, SAT 100% RA General: WDWN female in no acute distress HEENT: Oropharynx benign, EOMI, sclera anicteric Neck: Supple, no JVD Lungs: soft bibasilar rales, otherwise CTA bilaterally Heart: Regular rate and rhythm, normal s1s2 Abdomen: Soft, slightly tender to deep palpation in RUQ. normoactive bowel sounds, no ascites, negative [**Doctor Last Name **] sign Ext: Warm, no edema Pulses: 1+ distally Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal deficits noted Pertinent Results: [**2123-1-7**] 06:35AM BLOOD WBC-7.5 RBC-2.95* Hgb-9.1* Hct-26.1* MCV-89 MCH-30.7 MCHC-34.7 RDW-15.0 Plt Ct-120* [**2123-1-8**] 05:20AM BLOOD Neuts-84.9* Bands-0 Lymphs-9.5* Monos-3.8 Eos-1.5 Baso-0.3 [**2123-1-7**] 06:35AM BLOOD PT-42.7* PTT-52.8* INR(PT)-4.7* [**2123-1-7**] 06:35AM BLOOD Glucose-115* UreaN-15 Creat-1.3* Na-135 K-4.0 Cl-101 HCO3-26 AnGap-12 [**2123-1-8**] 05:20PM BLOOD ALT-300* AST-321* AlkPhos-441* Amylase-71 TotBili-1.5 [**2123-1-8**] 05:20AM BLOOD proBNP-7858* [**2123-1-8**] RUQ Ultrasound: 1. Normal gallbladder and liver, with no evidence of cholecystitis or gallstones. 2. Right-sided pleural effusion. [**2123-1-9**] HIDA Scan: Images show prompt uptake of tracer into the hepatic parenchyma. No tracer activity is seen during this time within the gallbladder, biliary tree, or GI tract. The above findings are consistent with cholestasis. [**2123-1-9**] Abdominal MR: 1. Limited study secondary to motion artifact from patient's breathing throughout the examination. 2. Cholangitis involving the left lobe of the liver, better visualized on recent CT. No focal fluid collections identified within the liver. 3. Dilated side branch within the tail of the pancreas likely representing side branch IPMT. [**2123-1-9**] Abdominal CT Scan: 1. Multiple enhancing tubular and rounded hypodensities within the left hepatic lobe, likely representing microabscesses with reactive cholangitis. [**2123-1-9**] Transthoracic ECHO: The left atrium is mildly dilated. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. A bioprosthetic mitral valve prosthesis is present. The mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. Trivial mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is a small pericardial effusion which is most prominent posterior to the atria. [**2123-1-11**] RUQ Ultrasound: There is no biliary dilatation identified, but there is pneumobilia seen throughout the liver. The portal vein is patent with hepatopetal flow. Flow is identified in the right hepatic vein, middle hepatic vein and the left hepatic vein. There is no ascites identified. There is a right pleural effusion seen. [**2123-1-14**] Renal Ultrasound: The right kidney measures 12.1 cm, and demonstrates diffusely increased echogenicity. A tiny subcentimeter cyst is identified in the interpolar region. There is no evidence of stone, mass or hydronephrosis. The left kidney measures 13.2 cm. There is no evidence of stone, mass, or hydronephrosis. [**2123-1-21**] 05:42AM BLOOD WBC-8.0 RBC-2.73* Hgb-8.0* Hct-24.1* MCV-88 MCH-29.4 MCHC-33.3 RDW-17.5* Plt Ct-259 [**2123-1-20**] 08:39AM BLOOD WBC-11.4* RBC-3.00* Hgb-8.9* Hct-25.9* MCV-86 MCH-29.5 MCHC-34.1 RDW-16.2* Plt Ct-212 [**2123-1-21**] 05:42AM BLOOD PT-32.1* PTT-47.1* INR(PT)-3.3* [**2123-1-20**] 08:39AM BLOOD PT-26.1* PTT-43.0* INR(PT)-2.6* [**2123-1-19**] 06:00AM BLOOD PT-23.6* INR(PT)-2.3* [**2123-1-21**] 05:42AM BLOOD Glucose-109* UreaN-22* Creat-1.7* Na-136 K-3.6 Cl-97 HCO3-28 AnGap-15 ABDOMEN U.S. (COMPLETE STUDY) [**2123-1-18**] 8:23 AM ABDOMEN U.S. (COMPLETE STUDY) Reason: evaluate for ascites [**Hospital 93**] MEDICAL CONDITION: 64 year old woman with elevated LFTs s/p MVR and MAZE REASON FOR THIS EXAMINATION: evaluate for ascites STUDY: Abdominal ultrasound. INDICATION: 64-year-old female presenting with elevated LFTs. Status post MVR and MAZE procedure. COMPARISONS: MRCP dated [**2123-1-9**] and CT dated [**2123-1-9**]. FINDINGS: Multiple hypoechoic foci present within the left lobe of the liver are consistent in appearance with small abscesses and appear unchanged compared to the recent CT and MR evaluations. These hypoechoic foci appear solid. The right lobe of the liver appears normal in echotexture. There is prominent pneumobilia which is new compared to the previous examinations and consistent with the recent history of ERCP and common bile duct stent placement. A stent is visualized within the common bile duct which measures approximately 6 mm in diameter. There is no intra- or extra-hepatic biliary dilatation. The gallbladder wall appears mildly thickened. There is no pericholecystic fluid or wall edema and overall the gallbladder is not distended. Note is made of prominent sludge within the gallbladder. A small amount of perihepatic free fluid is noted. There are bilateral small pleural effusions. The spleen is prominent in size measuring 12.5 cm in length. Images of the head and body of the pancreas are unremarkable. The pancreatic duct is not distended. The main portal vein is patent with appropriate direction of flow. IMPRESSION: 1. Multiple hypoechoic foci within the left lobe of the liver consistent in appearance with small abscesses. All foci appear solid and non-drainable. 2. Pneumobilia and common bile duct stent placement are new compared to CT and MRI of [**2123-1-9**]. 3. Tiny amount of abdominal ascites. 4. Bilateral small pleural effusions. 5. Gallbladder sludge. Brief Hospital Course: Mrs. [**Known lastname 6692**] was admitted and underwent extensive evaluation. An echocardiogram was unremarkable while the abdominal CT scan was notable for multiple enhancing tubular and rounded hypodensities within the left hepatic lobe, likely representing microabscesses with reactive cholangitis. She was made NPO and pan-cultures were obtained. The ID and hepatology services were consulted along with general surgery. They all agreed with broad spectrum antibiotic therapy. Given her supratherapeutic INR, Warfarin was held and several units of fresh frozen plasma were given. ERCP with stenting was performed on [**1-11**] without complication. The renal service was also consulted as she continued to experience further decline in renal function. Her creatinine peaked to 2.4 on [**1-12**]. Her acute renal failure was attributed to acute tubular necrosis from intravenous contrast. Renal ultrasound was obtained and was unremarkable. Liver biopsy on [**1-12**] revealed no necrosis, changes consistent with cholangitis vs biliary obstruction. Despite antibiotics, she continued to experience intermittent fevers. She remained on broad spectrum antibiotics for ? bartonella and was followed very closely by the ID service. Serial abdominal exams were performed while liver function tests were monitored daily. Antibiotics were titrated accordingly. She was transferred to the floor on [**1-14**]. Her abdominal pain improved as did her liver and renal function. She continued to be diuresed. She awaited return of her creatinine to baseline prior to repeat CT scan. She was seen by EP, Flecainide was dc'd and restarted and cardioversion was successfully performed. She was ready for discharge to rehab on hospital day 14. Medications on Admission: Aspirin 81 qd, Zetia 10 qd, Crestor 20 qd, Flecanide 150 [**Hospital1 **], Lopressor 150 [**Hospital1 **], Warfarin, Vicodin prn Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*0* 2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 6. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0* 7. Flecainide 50 mg Tablet Sig: Two (2) Tablet PO Q12H (every 12 hours). Disp:*120 Tablet(s)* Refills:*0* 8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 9. Ursodiol 300 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day). Disp:*120 Capsule(s)* Refills:*0* 10. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1) gm Intravenous once a day: until [**2123-2-5**]. Disp:*16 gm* Refills:*0* 11. Ertapenem 1 gram Recon Soln Sig: One (1) gm Intravenous once a day: until [**2123-2-5**]. Disp:*16 * Refills:*0* 12. Outpatient Lab Work Please check a weekly CBC/diff, chem 7, LFTs, and Vanco trough and fax results to [**Hospital **] clinic nurse ([**Telephone/Fax (1) 16411**] 13. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1) ML Intravenous once a day as needed. Disp:*16 ML(s)* Refills:*0* 14. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 15. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Location (un) 582**] Of [**Location (un) 620**] Discharge Diagnosis: Cholestasis with Hepatic Microabscesses, Acute Renal Failure, History of Mitral Regurgitation/Stenosis and Atrial Fibrillation s/p Mitral Valve Replacement and Maze Procedure on [**2122-12-31**], Systemic Lupus Erythematosus with History of Lupus Anticoagulant and Hypercoagulable state, History of stroke, History of Coronary Artery Disease - s/p RCA stent in [**2121-1-19**], Dyslipidemia 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. Followup Instructions: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], M.D. Phone:[**Telephone/Fax (1) 2934**] Date/Time:[**2123-1-27**] 2:40 [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2123-1-28**] 11:00 [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2123-2-3**] 2:00 [**Hospital **] clinic [**2123-2-4**] at 1:30 PM LMOB Basement [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 6732**] Weekly CBC, LFT, Chem 7, and Vancomycin trough should be taken and sent to ([**Telephone/Fax (1) 16411**] ([**Hospital **] clinic) Abdominal ultrasound Wednesday [**2123-2-3**] 9 AM [**Location (un) **] [**Hospital Ward Name **] 5B, please do not eat or drink anything after midnight the night before the ultrasound Completed by:[**2123-1-21**] ICD9 Codes: 5849, 2761, 2724, 4280
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Medical Text: Admission Date: [**2139-7-31**] Discharge Date: [**2139-8-3**] Service: CCU HISTORY OF PRESENT ILLNESS: This is an 81-year-old female with hypertension, hypercholesterolemia, CVA, who experienced severe chest pain at 14:30 on the day of admission. The patient had chest pain previously with associated shortness of breath and diaphoresis, and recently had a positive stress test and was recommended for cardiac catheterization. She refused catheterization, went home with instructions for bed rest. On the day of admission, she experienced [**11-20**] chest pressure which decreased to [**5-21**] with three sublingual nitroglycerin. The pain was substernal associated with shortness of breath and diaphoresis. She called 911 and was taken to an outside hospital, where she was noted to have [**Street Address(2) 1766**] elevations in leads V2 through V4. She received aspirin and Heparin drip, Lopressor, and Integrilin with resolution of her chest pain, but had persistent electrocardiogram changes. She was transferred to the [**Hospital1 69**] for catheterization, but refused. PHYSICAL EXAM ON ADMISSION: Temperature 98.5, heart rate 60, blood pressure 90/50, respiratory rate 18, oxygenating 96% on 2 liters nasal cannula at 57 kg. General: Elderly female in no apparent distress. HEENT: Pupils are equal, round, and reactive to light. Clear oropharynx. Neck is supple, normal jugular venous distention. Pulmonary: Clear to auscultation bilaterally. Cardiovascular: Regular, rate, and rhythm, 2/6 systolic murmur. Abdomen: Positive bowel sounds, soft, nontender, nondistended. Extremities: Trace edema, 2+ dorsalis pedis. Neurologic: Cranial nerves II through XII are grossly intact, alert and oriented times three. LABORATORIES ON ADMISSION: White count 5.8, hematocrit 35.2, platelets 236. Sodium 145, potassium 3.8, chloride 110, bicarb 24, BUN 21, creatinine 0.9, glucose 107. CK 140, MB 20. Electrocardiogram at the outside hospital showed normal sinus rhythm at 80 with left axis deviation, Q's in leads V1 and V2, [**Street Address(2) 1766**] elevations in leads V2 through V4. Electrocardiogram at [**Hospital3 **]: Normal sinus rhythm at 60 beats per minute, left axis deviation, Q's in leads V1 through V3, [**Street Address(2) 4793**] elevations in V3 through V4. HOSPITAL COURSE: Once in the catheterization laboratory after the patient refused the catheterization, she was started on a Heparin drip and sent to the CCU for medical management. Once in the CCU, the patient was asymptomatic and was hemodynamically stable. In the CCU, she was placed on aspirin, Heparin drip, Integrilin, Lopressor 12.5, captopril 6.25, Lipitor 10, and Zantac. She showed no arrhythmias on Telemetry. On day two of her hospitalization, her CKs dropped from 140 to 128. MB dropped from 20 to 15, and the patient remained asymptomatic. Based on the low CK MB with downward trend, it was thought that the myocardial infarction was a nonacute event, and that she probably had a prior myocardial infarction or possible two in the past weeks. Patient was continued to be monitored and her CKs were observed. However, she was transferred to the floor on [**2139-8-1**]. On [**8-2**], on the floor, a Physical Therapy consult was obtained which recommended that the patient was safe to go home with normal activity. On the evening of [**8-2**], the patient's blood pressure was minimally hypotensive to 90/50 and her blood pressure medications (beta blocker and ACE inhibitor) were held. It was decided that her ACE inhibitor should be discontinued, but her beta blocker would be re-administered at the next scheduled dose. On [**8-3**], the patient was observed to have some swelling and erythema at the peripheral IV site, felt to be consistent with cellulitis, and the patient was placed on Keflex for seven days. The patient remained hemodynamically stable at the time of discharge. CONDITION ON DISCHARGE: Stable/satisfactory condition with home health services (Physical Therapy and teaching regarding medications) and home health services of VNA for medical teaching. DISCHARGE MEDICATIONS: 1. Aspirin 325 mg tablet take one oral q day. 2. Atorvastatin. 3. Calcium 10 mg tablet one tablet oral q day. 4. Ranitidine HCL 1 mg tablet one tablet oral [**Hospital1 **]. 5. Warfarin sodium 5 mg tablet take 1 mg oral q hs. 6. Clopidigrel bisulfate 75 mg tablet one tablet oral q day, dispensed 30 tablets, refills three. 7. Isosorbide mononitrate 60 mg tablets one tablet oral q day. 8. Metoprolol succinate 50 mg tablet one q hs. 9. Cephalexin monohydrate 250 mg capsule, take one capsule oral q8h for seven days. DISCHARGE DIAGNOSES: 1. Acute ST segment elevation myocardial infarction 2. Hypotension 3. Cellulitis 4. Coronary artery disease 5. Chest pain FOLLOW-UP INSTRUCTIONS: The patient was advised to followup with her primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **], [**0-0-**]. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 5214**] Dictated By:[**Female First Name (un) 48072**] MEDQUIST36 D: [**2139-8-7**] 17:17 T: [**2139-8-14**] 08:48 JOB#: [**Job Number 48073**] ICD9 Codes: 4019, 2720
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Medical Text: Admission Date: [**2127-11-3**] Discharge Date: [**2127-11-3**] Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 99**] Chief Complaint: Fever, cough Major Surgical or Invasive Procedure: None History of Present Illness: [**Age over 90 **]F with h/o MGUS, CHF [**2-12**] severe MR/TR (EF >55%), afib not on coumadin, presents with fever and cough. Patient is currently not conversant, therefore details of HPI are obtained from family. Per her family, pt was in her USOH until a fall 4 days ago. Fall was witnessed, no head trauma or LOC. She appeared to be back at her baseline until the following morning when she developed fevers at home to 101.3 and cough x 2 days. She did not seek medical attention because she has preferred not to see a doctor for the past 2 years. Family notes that she was generally at her baseline (AAOx3, playing cards), but was intermittently "out of it" for the past 2 days. This AM she was more lethargic, and they persuaded her to go to the ED for evaluation. . In the ED, initial vitals were T 100.0, HR 101, BP 104/58, RR 16, O2 sat 94% 2L. BP gradually decreased to 80s/50s and she became increasingly tachypneic, switched to NRB. Received 1.5L NS in boluses, SBP increased to 90s. CXR showed e/o LLL pna. She was given 2g IV cefepime and 500mg IV levofloxacin. She was transferred to MICU for further management. . On arrival to MICU vitals were T 102.6, HR 93, BP 73/35, RR 26, O2 sat 100% on NRB. Currently she appears awake but is not conversant. Family states that she was always very clear about her decision to be DNR/DNI and would not want aggressive interventions, including central lines or pressors. . ROS: Unable to obtain. To family's knowledge, only notable as described in HPI. Past Medical History: - Chronic pancytopenia seconary to suspected underlying myelodysplastic syndrome, followed by Heme/Onc until [**2125**] (pt elected not to continue f/u) - IgM kappa monoclonal gammopathy of unknown significance - Atrial fibrillation, not on coumadin [**2-12**] thrombocytopenia - H/o CHF [**2-12**] severe MR/TR (last EF in [**2125**] >55%) - Hypertension - Hyperlipidemia Social History: Lives with daughter and son-in-law in [**Name (NI) 2312**]. Per family, independent in ADLs at baseline. Non-smoker. Family History: NC Physical Exam: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact Pertinent Results: CBC: [**2127-11-3**] 10:35AM WBC-13.9*# RBC-3.43* HGB-9.5* HCT-28.3* MCV-83 MCH-27.6 MCHC-33.4 RDW-17.0* [**2127-11-3**] 10:35AM NEUTS-80* BANDS-3 LYMPHS-6* MONOS-8 EOS-0 BASOS-0 ATYPS-1* METAS-1* MYELOS-1* [**2127-11-3**] 10:35AM PLT SMR-VERY LOW PLT COUNT-61* [**2127-11-3**] 10:35AM HYPOCHROM-NORMAL ANISOCYT-2+ POIKILOCY-2+ MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-OCCASIONAL SCHISTOCY-1+ Chem-7: [**2127-11-3**] 10:35AM GLUCOSE-158* UREA N-52* CREAT-1.4* SODIUM-129* POTASSIUM-3.1* CHLORIDE-91* TOTAL CO2-25 ANION GAP-16 UA: [**2127-11-3**] 10:50AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-5.0 LEUK-NEG [**2127-11-3**] 10:50AM URINE RBC-<1 WBC-<1 BACTERIA-NONE YEAST-NONE EPI-0 [**2127-11-3**] 10:50AM URINE COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.013 CXR [**2127-11-3**]: FINDINGS: Portable AP radiograph of the chest was obtained. Low lung volumes. There is airspaze opacity seen over the left mid lung most likely representing a pneumonia. There is stable cardiomegaly. The aorta is tortuous with calcifications seen in the aortic knob. There are no pleural effusions or pneumothorax. Bony structures are unremarkable. IMPRESSION: Left mid lung consolidation consistent with pneumonia. Recommend followup to resolution. Brief Hospital Course: Primary Reason for MICU Admission: Hypotension, hypoxia Brief Hospital Course: On arrival to MICU vitals were T 102.6, HR 93, BP 73/35, RR 26, O2 sat 100% on NRB. Currently she appears awake but is not conversant. Family states that she was always very clear about her decision to be DNR/DNI and would not want aggressive interventions, including central lines or pressors. She continued to receive IV NS, however her blood pressure continued to decline to 50s-60s/30s. At 6:38PM, Ms. [**Known lastname 11949**] passed away with daughter and son-in-law at bedside. Family declined autopsy. Medications on Admission: -Furosemide 40mg qAM, 20mg qPM -Metoprolol tartrate 25mg PO BID -Timolol maleate -Valsartan 160mg PO daily -Acetaminophen 500mg PO BID prn hip pain -Docusate 100mg [**Hospital1 **] Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: Sepsis Community-acquired pneumonia (organism unknown) Discharge Condition: Deceased Discharge Instructions: N/A Followup Instructions: N/A ICD9 Codes: 0389, 486, 4240, 4280, 4019, 2724
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Medical Text: Admission Date: [**2163-1-30**] Discharge Date: [**2163-2-5**] Date of Birth: [**2146-12-9**] Sex: M Service: Trauma. HISTORY OF PRESENT ILLNESS: This is a 16 year old male, rear seat passenger, of an auto into a tree accident at high speed. Extensive damage to vehicle with 30 minute extraction time and two fatalities on scene. PAST MEDICAL HISTORY: None. PAST SURGICAL HISTORY: None. ALLERGIES: Penicillin, unknown reaction. PHYSICAL EXAMINATION: The patient was transferred from an outside hospital with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma scale of 15. He was intubated at the outside hospital for pain control. Cervical spine was in a collar. Pupils were equal, round and reactive to light. The pupil was 3 to 2 mm. The left was 3 to 2 mm. Blood was coming from the nares. Heart had regular rate and rhythm. Lungs were clear to auscultation bilaterally. There were no deformities or tenderness to the chest. Abdomen was nondistended. Pelvis was stable. There were no deformities at either flank with no CVA tenderness. No deformities of the back. No deformities or step-off of tenderness to the cervical spine. TLS: No deformities, step-off or tenderness. The patient had good rectal tone with a negative guaiac. There were no deformities of the upper extremities. The right lower extremity had an open femur fracture; left lower extremity had a closed femur fracture. Dorsalis pedis pulses were 2+/4 bilaterally. LABORATORY DATA: CT of the head was negative. CT of the cervical spine negative. CT of the chest: Questionable bilateral pulmonary contusion. CT of the abdomen with periportal fluid, no duodenal leak with p.o. contrast. TLS negative. Bilateral femur fracture. Hematocrit was 36.2; hemoglobin of 12.5; white blood cell count of 24.5. Platelet count 246. PT 18.6; PTT 30.0; INR of 2.3. Fibrinogen 83. Glucose 126. BUN 8; creatinine 0.6. Sodium of 141; potassium of 3.6; chloride 113; bicarbonate 22; anion gap of 10. ALT 193; AST 231; alkaline phosphatase 144; amylase 78; total bilirubin of 0.4. Lipase 38. Calcium 7.6; phosphorus of 3.5; magnesium of 1.4. Toxicology screen, including alcohol, was negative. Arterial blood gas: P02 of 569; PC02 of 33; pH of 7.36; calculated bicarbonate 19; excess base -5. The patient was intubated. Lactate 1.0. incomplete report -- cut off! [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. [**MD Number(1) 521**] Dictated By:[**Last Name (NamePattern1) 52643**] MEDQUIST36 D: [**2163-2-4**] 08:42 T: [**2163-2-4**] 08:54 JOB#: [**Job Number 53246**] ICD9 Codes: 2859
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Medical Text: Admission Date: [**2103-9-15**] Discharge Date: Service: HISTORY OF PRESENT ILLNESS: This is an 81-year-old woman with a past medical history of dermatomyositis on chronic steroids, and hypertension, who was transferred from [**Hospital6 3622**] on [**2103-9-15**], after presenting with chest pain radiating to the left arm, shortness of breath, diaphoresis, and malaise. She then demonstrated a non-Q wave myocardial infarction with CPK greater than 1100, and troponin-T of .82. She underwent echocardiogram and catheterization, which showed three vessel disease with 50 to 80% stenosis in the left anterior descending, and 95% stenosis in the D1, 50% stenosis of the circ, 80% stenosis of the obtuse marginal I, 90% stenosis of the obtuse marginal II, an ejection fraction of 65%, and 4+ mitral regurgitation. She additionally had been found to be in atrial flutter at the outside hospital, and was started on a Diltiazem drip as well as heparin. On [**9-15**], she was transferred to [**Hospital1 190**] for further management, and was admitted to Cardiothoracic Surgery service. PAST MEDICAL HISTORY: Significant for dermatomyositis, on chronic prednisone, hypertension, gastroesophageal reflux disease, macular degeneration, status post colectomy, status post cholecystectomy, status post right total hip replacement, and depression. MEDICATIONS: Medications on transfer included Diltiazem drip, heparin drip, Digoxin .25 once daily, aspirin 325 once daily, Losartan 25 once daily, atenolol 25 twice a day, and prednisone 5 mg once daily. ALLERGIES: She was admitted with no known drug allergies, but subsequently developed a poor tolerance for morphine, which caused confusion and hallucinations. PHYSICAL EXAMINATION: On admission, blood pressure was 145/65, heart rate 145, respiratory rate 20, oxygen saturation 99%, temperature 97.7, weight 59.4 kg. Her lungs had minimal crackles bilaterally. The heart was tachycardic and regular. The abdomen was soft, nontender, nondistended. The extremities had minimal edema. LABORATORY DATA: On admission, white count 9.8, hematocrit 37.0, platelets 242. PT 13.3, PTT 93. Sodium 138, potassium 4.0, chloride 96, bicarbonate 27, BUN 15, creatinine 0.4, glucose 120. Calcium 1.05, magnesium 1.9. HOSPITAL COURSE: The patient underwent a three vessel coronary artery bypass graft on [**9-17**], including a left internal mammary artery to the left anterior descending, saphenous vein graft to the obtuse marginal, and saphenous vein graft to the D1. Additionally, she continued to have atrial flutter, for which she was started on Lopressor and amiodarone, and her heparin drip was continued. A TSH was checked and was within normal limits. She additionally had a urinary tract infection, for which she was treated with Cipro for three days. Postoperatively, she was extubated on [**9-18**], however, she required reintubation on [**9-20**] secondary to pulmonary secretions and respiratory distress. She was started on levofloxacin and Flagyl for presumed aspiration. On [**9-21**], she underwent a repeat catheterization, which showed her grafts to be patent, her mitral regurgitation to be decreased to 1 to 2+, and an ejection fraction of 50%. She was again extubated on [**9-22**], and underwent a swallowing study on [**9-25**], which was positive for aspiration. Subsequently the patient was started on tube feeds. The patient was noted to have bloody stools on [**9-26**], and her heparin was discontinued. On [**9-28**], she again required reintubation for respiratory failure, and she underwent a bronchoscopy which showed aspirated barium from her swallowing study in her right bronchial system. Additionally, Infectious Disease consultation was requested, and the patient was changed from levofloxacin to Zosyn 4.5 mg every eight hours in addition to Flagyl, for worsening pneumonia. On [**9-29**], she continued to have bloody bowel movements, and she was lavaged, which was clear. She was transfused packed cells, and a Gastroenterology consultation was requested. The patient subsequently had an esophagogastroduodenoscopy and percutaneous endoscopic gastrostomy tube placement on the 11th. Esophagogastroduodenoscopy revealed gastritis. On [**9-29**] as well, the patient had a blood culture return positive for coag negative staph. Vancomycin had been added to the patient's regimen of Zosyn and Flagyl starting on [**9-29**], and was continued for a ten day total. On [**9-30**], a Rheumatology consultation was obtained, which concluded that the patient was not having a flare of her dermatomyositis, and she was switched to Solu-Medrol 8 mg intravenously twice a day. On [**10-1**], the patient had a tracheostomy performed, and a repeat bronchoscopy to check tracheostomy placement and suction secretions. On [**10-1**], the patient's Flagyl was discontinued, given low suspicion for anaerobic infection. On [**10-3**], the patient had had recurrent atrial flutter, and she underwent DC cardioversion, which was successful. She was continued on her Lopressor and amiodarone. After receiving approximately two weeks of 400 mg by mouth twice a day, the patient was decreased to 400 mg by mouth once daily, which was ultimately reduced to 200 mg once daily after approximately ten days due to bradycardia. On [**10-5**], the patient was noted to have again a rising white blood cell count. Chest CT and thoracentesis were recommended. Her anticoagulation was held prior to this procedure. She underwent a thoracentesis on the 16th, where 300 cc of serous fluid was removed. Prior to the thoracentesis, she had a chest CT which showed multilobar pneumonia, large effusions, consolidation in multiple lobes, bilateral lower lobe collapse. A CT had been performed prior to her thoracentesis. On [**10-8**], the patient underwent a repeat bronchoscopy, where a small amount of barium was noted to be present. Additionally, the patient was noted to have vesicles throughout the right main stem bronchus area, which was felt to be possibly a chemical irritation vs. possible infectious etiology. Specimens were sent to the Laboratory, which showed cultures all negative at the time of this dictation, and pathology of the biopsy taken during the bronchoscopy showed squamous metaplasia and acute inflammation. The patient was continued on her Zosyn. On [**10-9**], the patient's vancomycin was discontinued after a ten day course. Additionally, she was noted to have bloody pulmonary secretions. Because of this and her recent history of gastritis with bloody stools, and the fact that she was now in normal sinus rhythm, the patient's anticoagulation was held. On [**10-9**], the patient was transferred from the general floor back to the Intensive Care Unit, as her pulmonary secretions required more frequent suctioning. In the Intensive Care Unit, she received aggressive pulmonary toilet. Cultures were followed, which were all negative at the time of this dictation. The patient's white count was decreasing, and she remained afebrile. A chest x-ray on [**10-11**] raised a question of a possible area of aerated lung vs. cavity, and the patient underwent repeat CT scan on [**10-12**], which revealed no abscess, but pockets of aerated lung. The patient's pulmonary secretions decreased considerably over the next several days, and rehabilitation planning was arranged. The patient remained in normal sinus rhythm and, as noted above, her amiodarone was decreased to 200 mg by mouth once daily secondary to bradycardia. She was continued on her lasix and afterload reducing agents as well as the rest of her antihypertensive medications. She was continued on Zosyn for her pneumonia, with the last day, per Infectious Disease consult service, to be [**10-13**]. Additionally, her Solu-Medrol was continued for her dermatomyositis. During her time in the Intensive Care Unit, the patient also requested that her code status be changed to Do Not Resuscitate/Do Not Intubate. This was discussed with both the patient and her daughter, and they both agree. Currently rehabilitation screening is taking place. The patient has been maintained on trach mask and FIO2 of 0.4, with very acceptable saturations, and significant improvement in her pulmonary secretions. She will need follow up after discharge with her primary care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], here in [**Location (un) 86**], as well as with Dr. [**Last Name (STitle) **], her cardiothoracic surgeon. DISCHARGE MEDICATIONS: Prozac 10 mg once daily, Ambien 10 mg daily at bedtime, Solu-Medrol 8 mg intravenously every 12 hours, Norvasc 5 mg once daily, Zosyn 4.5 grams intravenously every eight hours through [**2103-10-13**], ProMod with fiber tube feeds, Lopressor 25 mg twice a day, Colace 100 mg twice a day, Hydralazine 5 mg four times a day, Lisinopril 80 mg once daily, Prevacid 30 mg once daily, amiodarone 200 mg once daily, lasix 20 mg once daily. [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3113**] Dictated By:[**Name8 (MD) 29900**] MEDQUIST36 D: [**2103-10-12**] 20:35 T: [**2103-10-13**] 00:45 JOB#: [**Job Number 6368**] ICD9 Codes: 4280, 4240, 5070, 9971
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Medical Text: Service: Date: [**2161-7-2**] Date of Birth: [**2089-2-6**] Sex: F Surgeon: [**Last Name (LF) 3662**], [**First Name3 (LF) 3661**] 12-269 CHIEF COMPLAINT: Headache, nausea, vomiting, chest pain HISTORY OF PRESENT ILLNESS: Patient is a 72-year-old female with a history of atrial fibrillation, bradycardia, resulting in syncope, status post pacemaker placement on [**6-15**], who complains of headache, nausea, vomiting, and jaw and chest pain. Patient stated that these symptoms came on over the course of a one-hour period. She laid down and was unable to get out of bed secondary to weakness. Patient then went to [**Hospital1 43954**], where her blood pressure was found to be 60/palp. Echocardiogram there was consistent with an effusion. She was given 2 liters of normal saline and started on dopamine and transferred to [**Hospital1 36918**] Emergency Room, where a repeat echocardiogram showed a moderate-size effusion, but no evidence of tamponade. Patient was given 6 more liters of IV fluid of normal saline and dopamine was continued at 10 mcg per hour. In the Emergency Department, patient had an episode of nausea and vomiting, denied fever, abdominal pain, dysuria, neck stiffness, chest pain at the time of admission, or cough and was transferred to the medical Intensive Care Unit for further management. PAST MEDICAL HISTORY: Significant for atrial fibrillation, recent pacemaker placement in [**Hospital6 1129**] on [**6-15**], gastroesophageal reflux disease, hypercholesterolemia. ALLERGIES: No known drug allergies. MEDICATIONS: Sotalol 160 mg p.o. b.i.d., Toprol, Coumadin 5 mg p.o. q.d., Nexium one tab p.o. q.d. FAMILY HISTORY: Significant for her father with coronary artery disease, sister and brother with history of unspecified thyroid disorder. SOCIAL HISTORY: No tobacco or alcohol use, lives alone at home, has no children PHYSICAL EXAMINATION: Vital signs: Afebrile, blood pressure 124/55 on dopamine, pulse 68, respirations 20, O2 saturation 96% on 4 liters. In general, an elderly female, lethargic but arousable. HEENT exam: Pupils equal, round and reactive to light and accommodation. Mucous membranes dry. Neck was supple, no evidence of jugular venous distention. Heart: Normal S1, S2, no murmurs, rubs or gallops. Lungs clear to auscultation bilaterally. Abdomen soft, nontender, nondistended, normal active bowel sounds. Extremities: Trace 1+ edema. Extremities cool LABORATORY DATA ON ADMISSION: White blood count 19.3, hematocrit 34.7, platelet count 353,000. Neutrophils 89, bands 2, sodium 141, potassium 4.2, chloride 111, bicarb 14, BUN 13, creatinine 0.7, glucose 162, calcium 7.3, magnesium 1.8, phosphorus 2.8. INR 2.0, PTT 31.2, ALT 73, AST 64, alkaline phosphatase 80, lipase 33, amylase 24, total bilirubin 0.7. Urinalysis significant for 6 to 10 white blood cells, small leukocyte esterase. BK (no. 1) was 69, BK (no. 2) 63, troponin less than 0.3 times two. Arterial blood gas: pH 7.38, CO2 29, O2 74, lactate 2.0. Electrocardiogram: Atrial fibrillation with a rate of 109, normal axis, Q wave in lead 3, no acute ST or T wave changes. Head CT scan: No mass, no shift or bleed. Chest x-ray: Cardiomegaly, right internal jugular line in place, increased cephalization, peribronchial cuffing. IMPRESSION: Patient is a 72-year-old female with persistent hypertension admitted with evidence of a pericardial effusion, possibly secondary to pacer placement. HOSPITAL COURSE: 1) Cardiovascular: Patient was volume resuscitated over the course of two days with 8 liters of IV fluids and was also on a dopamine drip, which was gradually weaned over the course of three days. By [**6-28**], her dopamine drip had been stopped. No IV fluids were needed and her pressures were now in the systolic blood pressure range of the 130s. Repeat echocardiogram showed no change in the size of her pericardial effusion with no evidence of tamponade. However, there was a note made that there was perforation of the right ventricular free wall with the pacer wire on repeat echocardiogram on [**6-29**]. The pericardial effusion was also noted to be significantly smaller in size on that date. Patient also had note of increased pulmonary edema and O2 requirements secondary to significant volume resuscitation, was able to diurese on her own with improvement of her hypoxia as well as her lung exam. On [**6-30**], [**2160**], her pacer leads were repositioned within the right ventricle. There was no evidence of tamponade or increasing pericardial effusion after the procedure was done. The following day, patient had a repeat echocardiogram, which confirmed these findings. At the time of discharge, patient's pressure was normotensive and her O2 saturation was 94 to 95% on room air, including on ambulation. Patient will be sent home on sotalol 160 mg b.i.d., is still in atrial fibrillation; however, will likely need to be switched from sotalol to a different medication such as amiodarone in the near future, potentially after her LFTs have normalized after the hepatic congestion has cleared. Will also start Lopressor for rate control and anticoagulation with Lovenox and Coumadin. 2) Infectious Diseases: Patient was noted to have a urinary tract infection, was treated with Levofloxacin for a seven-day course, was also given Vancomycin peri-procedure for repositioning of her leads and was sent home on Keflex. DISCHARGE DIAGNOSIS: 1) Hemopericardium secondary to pacer lead perforation through right ventricle 2) Atrial fibrillation DISCHARGE CONDITION: Good. Patient was once again normotensive and will follow up with Dr. [**First Name (STitle) 437**] in about one month and with the Electrophysiology service at [**Hospital3 **] in about one week and will follow up with the [**Hospital 197**] clinic in three days for adjustment of her Coumadin dosing. DISCHARGE MEDICATIONS: Sotalol 160 mg p.o. b.i.d., Lopressor 25 mg p.o. b.i.d., Coumadin 5 mg p.o. q.d., Enoxaparin 80 mg subcutaneously b.i.d., Levofloxacin 500 mg p.o. q.d. times two days, Keflex 500 mg p.o. t.i.d. times two days, Zantac 150 mg p.o. b.i.d. [**Last Name (LF) 3662**], [**First Name3 (LF) 3661**] 12-269 Dictated By:[**First Name3 (LF) 11194**] MEDQUIST36 D: [**2161-7-2**] 10:59 T: [**2161-7-5**] 17:20 JOB#: [**Job Number 43955**] ICD9 Codes: 4019
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Medical Text: Admission Date: [**2138-12-2**] Discharge Date: [**2138-12-12**] Date of Birth: [**2071-12-12**] Sex: M Service: CARDIOTHORACIC SURGERY HISTORY OF THE PRESENT ILLNESS: This is a 66-year-old man with a past medical history significant for coronary artery disease, status post coronary artery bypass grafting in [**2128-10-21**], at which time they performed a left internal mammary artery to the left anterior descending, saphenous vein graft to the OM-I and OM-II sequential and saphenous vein graft to the PDA. He is also status post stenting of his saphenous vein graft to the OM-I, OM-II territory in [**2135-3-21**], and PTCA and brachytherapy to the saphenous vein graft to the OM-I, OM-II in [**2137-12-21**]. The patient also has a past medical history significant for insulin-dependent diabetes mellitus, hypertension, hypercholesterolemia, depression, mild dementia, history of TIA, status post bilateral carotid endarterectomies in [**2134**]. The patient is a 66-year-old male with a long-standing history of coronary artery disease, who was admitted [**2138-12-2**] due to unstable angina with a troponin level ranging between 4.5 and 5.9. Cardiac catheterization was performed on [**2138-12-2**] which revealed a patent left internal mammary artery graft, occluded OM-1 and OM-2 graft, and a 90% occlusion in the in-stented segment of the PDA. The last echocardiogram was performed in [**2137-5-21**] which revealed a left ventricular ejection fraction of 40%. ADMISSION MEDICATIONS: 1. Atenolol 50 mg p.o. q.d. 2. Lipitor 40 mg p.o. q.d. 3. Aspirin 325 mg p.o. q.d. 4. Aricept 5 mg p.o. q.d. 5. Zestril 20 mg p.o. q.d. 6. Metformin 850 mg b.i.d. 7. Terazosin 5 mg q.h.s. 8. Paxil 5 mg p.o. q.d. 9. Buspar 15 mg t.i.d. 10. Depakote 750 mg b.i.d. 11. Vitamin E. 12. Nitroglycerin patch. 13. Plavix which is being held. 14. NPH insulin 12 units q.a.m., 8 units q.p.m., regular insulin 4 units q.a.m. HOSPITAL COURSE: An off-pump redo coronary artery bypass grafting was performed on [**2138-12-8**]. It was a coronary artery bypass grafting times one with the saphenous vein graft to the obtuse marginal via left thoracotomy incision. The patient was transferred to the Cardiac Surgery Recovery Unit in stable condition on Neo-Synephrine at 0.6 micrograms per kilogram per minute and propofol in normal sinus rhythm at 57 beats per minute. He was extubated the same day of surgery without any incidents around 6:00 p.m. On postoperative day number one, the patient had a low-grade temperature at 100.3 in sinus rhythm at 88. The vital signs were stable. The white count was 9.1, hematocrit 31.3, platelet count 147,000 with an unremarkable physical examination. The plan was to continue to keep his blood pressure down on Nipride and to start the patient on his p.o. medications as well as his p.o. diet. If able to wean off the Nipride, the plan was to transfer the patient to the floor. On postoperative day number two, the patient was mildly disoriented, however, calm without complaints with his pain well controlled. He was still with a low-grade temperature of 100.1 in sinus rhythm at 88, mildly hypertensive at 170/88. On physical examination, he had mild crackles bilaterally, otherwise his examination was benign. The plan was just to continue monitor his mental status and pain control. On postoperative day number three, the patient was still without complaints, however, still requiring a sitter for his disorientation. Currently, afebrile. The vital signs were stable, saturating at 94% on room air. The physical examination was benign. The plan was to go for a cardiac catheterization this morning with a possible PTCA with plus or minus stenting of the stenotic area. He did undergo cardiac catheterization on [**2138-12-11**] which now revealed a saphenous vein graft to the obtuse marginal patent and a saphenous vein graft to the posterior descending artery with a 90% distal stenosis with a 3 by 13 mm stent with distal protection and 0% residual with normal flow. The plan was to continue the patient on aspirin and Plavix 75 mg p.o. daily for 30 days and to administer Integrelin overnight. The anticipated date of discharge is [**2138-12-12**]. The patient is to be discharged home on the following medications. DISCHARGE MEDICATIONS: 1. Metformin 850 mg p.o. b.i.d. 2. Lisinopril 2.5 mg p.o. q.d. 3. Sliding scale of insulin. 4. Metoprolol 50 mg p.o. b.i.d. 5. Divalproex 500 mg p.o. b.i.d. 6. Buspar 15 mg p.o. t.i.d. 7. Paxil 5 mg p.o. q.d. 8. Atrovastatin 40 mg p.o. q.d. 9. Plavix 75 mg p.o. q.d. for three months. 10. Donepezil 5 mg p.o. q.h.s. 11. Dulcolax, milk of magnesia, p.r.n. 12. Percocet 5 one to two tablets p.o. q. 4-6 hours p.r.n. pain. 13. NPH 3 units at breakfast, 4 units at bedtime. 14. Ibuprofen 400 mg q.i.d. 15. Acetaminophen 650 mg q. four hours p.r.n. 16. Aspirin 325 mg p.o. q.d. 17. Colace 100 mg p.o. b.i.d. 18. Lasix 20 mg p.o. b.i.d. 19. Potassium chloride 20 mEq p.o. q.d. PLAN: The plan is for the patient to arrange a follow-up visit with Dr. [**Last Name (STitle) 1537**] in one month, Dr. [**Last Name (STitle) 120**] in one month, and his primary care physician in two to four weeks. CONDITION AT DISCHARGE: Good. DISCHARGE DIAGNOSIS: Coronary artery disease, status post re-do off-pump coronary artery bypass grafting times one. [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D. [**MD Number(1) 1540**] Dictated By:[**Doctor Last Name 2011**] MEDQUIST36 D: [**2138-12-12**] 13:20 T: [**2138-12-14**] 15:05 JOB#: [**Job Number 2012**] ICD9 Codes: 4019, 2720
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Medical Text: Admission Date: [**2144-1-12**] Discharge Date: [**2144-1-23**] Date of Birth: [**2096-8-12**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 783**] Chief Complaint: hyperglycemia Major Surgical or Invasive Procedure: SVC central line placement and removal. PICC placement and removal. History of Present Illness: 47yo F with history of DM, HTN and CRI presents with weakness and dehydration. He was recently discharged on [**2143-12-30**] for DKA. Patient signed out AMA when glucose better controlled. He was again admitted on [**2144-1-7**] for DKA at [**Hospital1 2177**]. . In ED, his VS were T96.7 P103 BP184/64 R24 100% on RA. His BP went up to as high as 221/88 and he was given Sl nitro. His glucose was found to be in 800s, insulin gtt started and he received 2L fluid. He has old STE in V2-V4 and new TWI in V5-6. He was given aspirin. . On ROS, he complains of polyuria and polydipsia today. Patient claims to be compliant with insulin. The last time he checked his FS was this AM and it was 140s. He denies chest pain, shortness of breath, cough, recent URI, abdominal pain, nausea, diarrhea, urinary complaints, headahce, dizziness, fever, chills, recent sick contact or recent travel. He claims that he had been abstinent from alcohol for more than a month and has not used any drugs recently. Past Medical History: # HTN # Insulin dependent DM - has had multiple admissions for DKA in setting EtOH use - last HgbA1C 7.6 ([**2143-10-31**]) - has peripheral neuropathy, retinopathy # CRI - thought to be due to diabetic and hypertensive nephropathy # Sarcoid - CT [**6-/2129**] = hilar/subcarinal [**Doctor First Name **], nodules in parenchyma - [**1-/2134**] = L eye proptosis -> CT showed L maxillary mass -> bx showed non caseating granulomas c/w sarcoid - decision was made not to begin systemic tx since pt asx # H/o Chronic RUQ pain - Present for over 13 yrs (by [**Hospital1 18**] records), evaluated with at least 12 abdominal/RUQ ultrasounds and multiple abdominal CT's without evidence of suspicious pathology # Polysubstance abuse - Pt drinks regularly 2-3drinks daily; occasionally uses cocaine (last use many weeks ago) Social History: Lives w/ a friend, no children. Works part time as a tire-changer. Denies tobacco use. Denies recent EtOH or cocaine use (per report daily EtOH use in past). Family History: Mother had diabetes, niece has diabetes. Denies FH of coronary artery disease, hypertension, cancer, liver disease, or renal disease. Physical Exam: T98.1 P96 BP 169/73 R23 98% on RA Gen- sleepy but easily arousable HEENT- left eye injected, right pupil reactive to light, no sinus tenderness, dry mucus membrane, neck supple, no JVD CV- regular, no r/m/g RESP- clear bilaterally, no distress, no accessroy muscle use ABDOMEN- soft, nontender, nondistended, no hepatosplenomeglay, normal bowel sounds EXT- no edema, no lacerations, DP 2+ bilaterally NEURO- A+O x3, CNII-XII intact, muscle strengh [**6-14**] bilateral upper and lower extremity, sensation grossly intact Pertinent Results: [**2144-1-12**] 09:30PM TYPE-ART PO2-102 PCO2-29* PH-7.25* TOTAL CO2-13* BASE XS--12 [**2144-1-12**] 09:30PM LACTATE-1.7 [**2144-1-12**] 09:18PM GLUCOSE-515* UREA N-46* CREAT-3.3* SODIUM-136 POTASSIUM-4.3 CHLORIDE-107 TOTAL CO2-11* ANION GAP-22* [**2144-1-12**] 09:18PM CALCIUM-7.8* PHOSPHATE-3.1# MAGNESIUM-2.2 [**2144-1-12**] 09:18PM OSMOLAL-331* [**2144-1-12**] 09:18PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG . CXR: [**1-12**] - Satisfactory positioning of this central venous catheter. Brief Hospital Course: AP: 47yo HTN, CRI, sarcoidosis, & poorly controlled DM w/ mult admissions for DKA who p/w DKA, then hospital course complicated by fevers thought to be secondary to pneumonia. . . # DKA: In the MICU, he initially had: AG 29, CXR clear, no intraabdominal complains, afebrile w/ no leukocytosis, EKG show TWI and troponin of 0.36, but in [**2143-11-28**] clean cath, CK remained flat and troponin stable. Underlying cause of DKA thought to be medication non-compliance. No obvious other cause of DKA--pt does not appear to be infected, no clear ischemic event (trop elevation [**3-14**] leak in setting of CRI). Patient was given aggressive hydration and started on insulin gtt in the ICU. electrolytes checked q2hours initially. His anion gap closed and he was able to be transitioned to SC insulin. [**Last Name (un) **] was consulted and assisted in control of sugars during hospitalization. He was discharged on a simple and effective regimen of 30U of 75/25 [**Hospital1 **]. He has outpatient follow up with [**Last Name (un) **]. . # Trop elevation: Likely leak in setting of CRI. EKG unchange (non-specific TWI in inferior & lateral precordial leads). Pt had clean cath [**2143-11-25**]. Trop trending down. Continued on aspirin, lipitor, Beta-blocker. . # HTN: He was continued on all of his home medications (nifedipine, furosemide, and labetalol) with an increase in dosage of his labetolol from 400mg TID to 600mg TID. . # ARF on CKD: Admission Cr of 3.5, with baseline of [**4-12**].2, was likely pre-renal in setting of DKA and improved w/ hydration. CKD is thought to be due to HTN & diabetic nephropathy. Protein to Cr ratio of 6.0. Improved to 2.8-3.1 during hospitalization. . # Anemia: Baseline hct 27-29, during his hospitalization he was between 24-27. No obvious sources of bleeding. Likely [**3-14**] renal insufficiency. We continued epogen. Iron studies from [**Month (only) **] [**2143**] show a mix of iron deficiency anemia (low fe, low fe/tibc ratio)and anemia of chronic disease (ferritin > 100). Could consider outpatient iron supplementation to help with epogen. . # Cardiomyopathy: EF 40-45%, likely related to hypertension/alcohol. No active issues during hospitalization. . # acute angle glaucoma: Patient was seen by opthamology. We continued all eyedrops per their recommendations. He will need outpatient follow up. . # Barrett's esophagus: We continued his protonix. . # RUE swelling: RUE slightly swollen and uncomfortable at sight of Right SVC line. Ultrasound was negative for clot. See below. . # Pneumonia: Patient had fevers and leukocytosis with right lower lobe opacity on chest x-ray, oxygen sats around 95% and right flank pain. The fever and leukocytosis was initially attributed to ?line infection while central line was in (red tender at site) and treated temporarily with vancomycin, but the blood cultures were all negative. He had negative lenis. He also had a negative RUQ ultrasound. He was discharged on a 7 day course of levofloxacin. . # code- full Medications on Admission: Aspirin 325 mg DAILY Atorvastatin 80 mg DAILY Nifedipine 90 mg DAILY Labetalol 400 mg PO TID Albuterol prn Tobramycin-Dexamethasone 0.3-0.1 % Drops QID Latanoprost 0.005 % Drops HS Epoetin Alfa 3,000 Units QMOWEFR Pantoprazole 40 mg Q12H Scopolamine HBr 0.25 % Drops [**Hospital1 **] Dorzolamide-Timolol 2-0.5 % Drops [**Hospital1 **] Apraclonidine 0.5 % Drops [**Hospital1 **] Furosemide 40 mg PO DAILY Insulin Lisp & Lisp Prot (75-25) 25 units QAM and 25 units QPM Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 5. Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO DAILY (Daily). 6. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day): OS. 7. Tobramycin-Dexamethasone 0.3-0.1 % Ointment Sig: One (1) Appl Ophthalmic QID (4 times a day): OS. 8. Labetalol 200 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*2* 9. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 7 doses: Please take for 7 days. Last day will be [**2144-1-28**]. Disp:*7 Tablet(s)* Refills:*0* 10. Apraclonidine 0.5 % Drops Sig: One (1) Drop Ophthalmic TID (3 times a day): OS. 11. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime): OU . 12. Scopolamine HBr 0.25 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day): OS. 13. Insulin Lisp & Lisp Prot (Hum) 100 unit/mL (75-25) Insulin Pen Sig: Thirty (30) Units Subcutaneous QAM. 14. Insulin Lisp & Lisp Prot (Hum) 100 unit/mL (75-25) Insulin Pen Sig: Thirty (30) Units Subcutaneous 30 minutes after dinner. 15. Insulin Lispro (Human) 100 unit/mL Solution Sig: Sliding Scale Subcutaneous QACHS: Per sliding scale attached. Discharge Disposition: Home Discharge Diagnosis: Primary: Diabetic ketoacidosis Type I diabetes mellitus Community acquired Pneumonia Secondary Hypertension Glaucoma Discharge Condition: Stable. Discharge Instructions: Please take all medications as prescribed. In particular please take your insulin as prescribed, 30U twice a day. This will help reduce need to be admitted to the hospital and help with your vision. Please also take the right amount of your blood pressure medicine labetalol. We increased your dose from 400mg to 600mg three times daily. Followup Instructions: Please follow up in [**Company 191**] with Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2144-1-29**] 2:00. . Please follow up with your PCP [**Name Initial (PRE) 2169**]: [**First Name11 (Name Pattern1) 198**] [**Last Name (NamePattern4) 199**], M.D. Date/Time:[**2144-2-26**] 9:00. . Please follow up with [**Last Name (un) **] ([**Telephone/Fax (1) 2378**]). You have an appoinment [**2144-1-28**] at 10:10am for vision and another at 11am with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3640**]. . Please follow up with opthamology [**2144-1-22**] at 3:45pm in [**Hospital Ward Name 23**] [**Location (un) 442**]. [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**] ICD9 Codes: 5849, 486
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Medical Text: Admission Date: [**2131-5-8**] Discharge Date: [**2131-5-10**] Date of Birth: [**2057-6-22**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2777**] Chief Complaint: thoracic aortic aneurysm Major Surgical or Invasive Procedure: [**2131-5-8**]: Endovascular Thoracic Aortic Aneurysm Repair with stent graft History of Present Illness: The patient is a 73-year-old gentleman with an increasing in size descending thoracic aortic aneurysm measuring 7 cm who presents for thoracic endograft repair. Past Medical History: Past Medical History: -COPD -? Atrial fibrillation vs atrial tachycardiac -CHF with diastolic dysfunction -Severe aortic stenosis -Psoriasis -Renal cancer s/p ablation -known ventral hernia, followed by Dr [**Last Name (STitle) **] - thoracic aortic aneurysm Past Surgical History: -Appendectomy -Ventral herniorrhaphy -Exlap/LOA/hernia repair ([**Doctor Last Name **] [**2128**]) -cardiac cath Social History: H/O Smoked 2-3 packs daily, ceased tobacco use 3 years ago Family History: non-contributory Physical Exam: BP114/65 HR 100 RR 20 Card:S1S2, 2/6 systolic murmur Lungs:Scattered wheezes throughout Abd:Soft, non tender Extremities: warm, well perfused, pulses palpable throughtout Groin puncture site dry, no drainage. Pertinent Results: [**2131-5-10**] 05:50AM BLOOD WBC-11.0 RBC-4.58* Hgb-13.1* Hct-41.0 MCV-90 MCH-28.7 MCHC-32.0 RDW-13.5 Plt Ct-142* [**2131-5-10**] 05:50AM BLOOD Glucose-92 UreaN-17 Creat-1.0 Na-138 K-4.0 Cl-102 HCO3-26 AnGap-14 [**2131-5-10**] 05:50AM BLOOD Calcium-8.4 Phos-2.4* Mg-2.0 Brief Hospital Course: Mr. [**Known lastname 87780**] was admitted on [**5-8**] after undergoing endovascular repair of thoracic aortic aneurysm with thoracic stent graft. He tolerated the procedure well,and was transfered to the CVICU post operatively. He remained neurovascularly intact with good blood pressure control. On POD 1 he tolerated a regular diet, was de-lined and transfered to the vascular floor. He remained in sinus rhythm with brief episodes of tachycardia to the 160s treated with lopressor IV with good response. Cardiology was consulted and felt this represented atrial tachycardia and not atrial fibrillation. We increased his metoprolol to 50 mg [**Hospital1 **] from 25mg [**Hospital1 **]. He will follow up with his cardiologist within 2 weeks and Dr. [**Last Name (STitle) **] in 1 month with CTA. Medications on Admission: ProAir 180"", Spiriva 18', Symbicort 160/4.5", ASA 81', furosemide 20', metoprolol 25", O2 2L nc prn Discharge Medications: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Symbicort 160-4.5 mcg/actuation HFA Aerosol Inhaler Sig: Two (2) Inhalation twice a day. 3. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 5. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device Sig: One (1) Inhalation once a day. 6. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q8H PRN () as needed for wheeze. 7. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: thoracic aortic aneurysm Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to the hospital after a repair of a thoracic aneurysm. During the hospitalization, your heart rate was elevated. We consulted with cardiology service and made the following changes to your medications: *Please increase your metoprolol to 50mg twice daily. Division of Vascular and Endovascular Surgery Endovascular Aortic Aneurysm Repair Discharge Instructions Medications: ?????? Take Aspirin 81mg (enteric coated) once daily ?????? Do not stop Aspirin unless your Vascular Surgeon instructs you to do so. ?????? Continue all other medications you were taking before surgery. ?????? You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort What to expect when you go home: It is normal to have slight swelling of the legs: ?????? Elevate your leg above the level of your heart (use [**1-26**] pillows or a recliner) every 2-3 hours throughout the day and at night ?????? Avoid prolonged periods of standing or sitting without your legs elevated It is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? Drink plenty of fluids and eat small frequent meals ?????? It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication What activities you can and cannot do: ?????? When you go home, you may walk and go up and down stairs ?????? You may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? After 1 week, gradually increase your activities and distance walked as you can tolerate ?????? No driving until you are no longer taking pain medications Followup Instructions: Dr.[**Name (NI) 14643**] office will call you to arrange an appointment within the next 1-2 weeks. Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 590**] Date/Time:[**2131-6-13**] 1:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 2625**] Date/Time:[**2131-6-13**] 3:00 Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2131-8-16**] 11:00 Completed by:[**2131-5-10**] ICD9 Codes: 496, 4280, 4241
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Medical Text: Admission Date: [**2180-5-9**] Discharge Date: [**2180-5-20**] Service: HISTORY OF PRESENT ILLNESS: This is a [**Age over 90 **] year old female who has a history of hypertension, congestive heart failure, and aortic stenosis. She was admitted in [**2179-4-2**], to [**First Name8 (NamePattern2) **] [**Location (un) 620**] with congestive heart failure and was readmitted with left lower lobe pneumonia and congestive heart failure from [**2180-5-4**], to [**2180-5-8**]. She was transferred to [**Hospital1 69**] for cardiac catheterization and underwent catheterization on [**2180-5-9**], which revealed left ventricular ejection fraction of 60%, ascending aorta 0.47 centimeters squared, coronaries without disease. Echocardiogram at the outside hospital revealed affect gradient of 62 mmHg and an ejection fraction of 25%. She was also noted to have moderate mitral regurgitation and mild tricuspid regurgitation She is now being evaluated for aortic valve repair. PAST MEDICAL HISTORY: 1. Hypertension. 2. Coronary artery disease. 3. Congestive heart failure. 4. Colon cancer. 5. Aortic stenosis. 6. Bundle branch block. 7. Gastrointestinal bleed in [**2179**]. 8. Diverticulosis. 9. Hemorrhoids. 10. Cholecystectomy. 11. Interstitial obstructive pneumonia. 12. Chronic urinary tract infections. 13. Pyelonephritis. 14. Uremia. 15. Uterine cancer. MEDICATIONS ON ADMISSION: 1. Aspirin 325 mg p.o. once daily. 2. Cholestyramine one package three times a day. 3. Macrobid 100 mg p.o. twice a day times three days. 4. Heparin intravenous per protocol. 5. Combivent p.r.n. 6. Metoprolol 25 mg p.o. twice a day. 7. Pepcid 20 mg p.o. twice a day. 8. Lisinopril 40 mg p.o. once daily. 9. Lipitor 10 mg p.o. once daily. ALLERGIES: Sulfonamides. ALLERGIES: The patient lives in an [**Hospital3 **] facility in [**Location (un) 620**]. She is a nonsmoker and does not drink alcohol. PHYSICAL EXAMINATION: Temperature is 98.6, heart rate 110, blood pressure 122/68, oxygen saturation 96% on two liters. In general, the patient is a pleasant, thin, elderly woman in no acute distress. Head, eyes, ears, nose and throat - Conjunctiva erythematous. The pupils are 2.0 millimeters. Neck - delayed upstroke, carotids bilaterally. The heart is regular rate and rhythm, III/VI soft systolic ejection murmur. The abdomen is soft, nontender, nondistended. Extremities - 1+ bilaterally pitting edema. Symmetrical 2+ dorsalis pedis pulses. HOSPITAL COURSE: The patient was initially admitted on [**2180-5-9**], and treated by the medicine team and also seen by cardiology who recommended cardiothoracic surgery consultation. Cardiothoracic surgery saw the patient on [**2180-5-10**], and also recommended an aortic valve replacement. The patient was taken to the operating room on [**2180-5-11**], and underwent aortic valve replacement with a 21 millimeter C/A pericardial valve by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**]. The operation was complicated by a partial aortic dissection which was repaired. Postoperatively, the patient required a Dobutamine and Propofol drip. Also, postoperatively, the patient was started on Neo-Synephrine drip and Dobutamine drip. The patient was sent to the operating room with mediastinal chest tubes and pacing wires. She also received perioperative antibiotic. Postoperatively, the patient had an episode of arrhythmia requiring an Amiodarone drip. The patient at appropriate times had her chest tubes and pacing wires removed. Her Vancomycin perioperatively and antimicrobial prophylaxis was stopped after four doses. The patient was started on beta blocker and Lasix. When the patient was stable, the patient was transferred to the regular cardiothoracic floor. Her pacing wires were discontinued. The atrial wires required cutting because they were tied into the atrial muscle. The ventricular wires were removed. On postoperative day six, the patient had an episode in which her white blood cell count increased to 20.5. House officer was called to the scene while the patient had decreased oxygen saturation, labile blood pressure and excessive low pelvic pain. The Foley catheter was manipulated and immediately 350cc of urine flowed. The patient's pain quickly improved although after some time the pelvic pain returned and the patient continued to have fluctuating blood pressure and she was sent back to the Intensive Care Unit where her condition spontaneously improved as her urine output was maintained with a patent Foley catheter. The patient was therefore seen by urology who indicated they would like to follow-up on the patient's condition although not in the acute setting. They requested that the Foley catheter be left until the patient was able to use the rest room on her own and the patient be started on empiric Levofloxacin therapy. This was done, however, the Foley catheter was removed and she will be electively straight catheterized because there is a great concern of seating her aortic valve due to urinary tract infection. The patient when straight catheterized was noted to have a quite prominent yeast infection and the patient was given Miconazole cream, Miconazole suppositories and one dose of Diflucan 150 mg. The patient did well with the straight catheterization and has been free of any cardiac episodes or respiratory episodes. It is now [**2180-5-20**], and the patient is being discharged to rehabilitation center. She is to avoid strenuous activity. She is to avoid baths but may shower. She may not drive while on pain medication. She should be straight catheterized every six hours and p.r.n. FOLLOW-UP: She is to follow-up with Dr. [**Last Name (STitle) 261**] of the urology department in approximately two weeks. She is to follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] in four weeks. She is to follow-up with her primary care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5293**], in one to two weeks. MEDICATIONS ON DISCHARGE: 1. Miconazole vaginal suppositories, one application vaginally for seven days. 2. Lasix 20 mg p.o. twice a day for seven days and need for Lasix to be reassessed. 3. Nystatin Ointment topically applied four times a day p.r.n. 4. Levofloxacin 250 mg p.o. once daily until her urological issue is sorted out. 5. Lopressor 25 mg p.o. twice a day. 6. Colace 100 mg p.o. twice a day. 7. Atorvastatin 10 mg p.o. once daily. 8. Cholestyramine 4 grams p.o. three times a day. 9. Albuterol Ipratropium two puffs inhaled q6hours. 10. Pantoprazole 40 mg p.o. once daily. 11. Percocet one tablet p.o. q6hours p.r.n. pain. 12. Enteric Coated Aspirin 325 mg p.o. once daily. 13. Potassium Chloride 20 meq p.o. q12hours for seven days to have need reassessed thereafter. [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D. [**MD Number(1) 1540**] Dictated By:[**Last Name (NamePattern4) 12487**] MEDQUIST36 D: [**2180-5-20**] 11:34 T: [**2180-5-20**] 12:01 JOB#: [**Job Number 49822**] ICD9 Codes: 4241, 4280, 5990, 4019
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Medical Text: Admission Date: [**2189-6-23**] Discharge Date: [**2189-6-30**] Date of Birth: Sex: F Service: DIAGNOSIS: Spontaneous left renal hemorrhage. DISCHARGE DIAGNOSIS: Same. HISTORY: Mrs. [**Known lastname **] is a 62-year-old female who was admitted to the urology service with acute onset of left flank pain. Radiologic studies which included CT scan of the abdomen and pelvis and CT angiography demonstrated a spontaneous renal hemorrhage in the left kidney and perinephric hematoma. During this hospitalization she underwent a CT guided coiling of the renal artery and her condition stabilized. Her course was stable throughout her hospitalization and she was discharged on [**2189-6-30**]. [**Name6 (MD) **] [**Last Name (NamePattern4) 8918**], MD Dictated By:[**Last Name (NamePattern4) 19074**] MEDQUIST36 D: [**2190-6-9**] 18:34:58 T: [**2190-6-9**] 22:30:29 Job#: [**Job Number 97800**] ICD9 Codes: 7907, 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6116 }
Medical Text: Admission Date: [**2158-6-22**] Discharge Date: [**2158-9-16**] Date of Birth: [**2103-6-1**] Sex: F Service: MEDICINE Allergies: Dilaudid / Codeine / Ativan Attending:[**First Name3 (LF) 5301**] Chief Complaint: dyspnea Major Surgical or Invasive Procedure: None History of Present Illness: 55 F with complicated medical history who has been transferred from Rehab/[**Hospital3 417**] for dyspnea, acute on chronic renal failure, volume overload, and fungemia. In [**Month (only) 116**] of this year, presented to [**Hospital1 18**] ED with abdominal pain. Has significant PMHx for T1DM, HTN, PVD and was found in the ED to have extensive calcification of her mesenteric arteries. She was taken to the OR and found to have infarction of her colon with intact small bowel. She under went a colectomy with iliostomy at that time. Post op had respiratory failure requiring prolonged intubation and eventual tracheostomy. The etiology of her respiratory failure was unclear at her discharge. She was discharged to [**Location (un) 4368**] [**Hospital 21079**] rehab on [**2158-6-1**] after ~30 day hospitalization on TPN via CVL with tube feeds started. The plan was to advance tube feeds and wean TPN. On [**2158-6-17**], she was still on TPN at rehab and spiked a temperature up to 103 and blood cultures were positive for yeast ([**Female First Name (un) **] albicans by telephone report but not documented in transfer records). She was transferred to [**Hospital3 417**] in [**Hospital1 1474**] for further management. There she was initially given voriconazole and her central line replaced. Culture from the line again reportedly grew [**Female First Name (un) **]. She was then switched to fluconazole and finally to caspofungin today. She was also treated with ticarcillin/clavulanate for unclear reasons. During her hospitalization, she also had a "troponin leak" without EKG changes thought to be demand ischemia by their cardiology consultants. An echo done on [**2158-6-18**] showed global hypokinesis with EF 25-30%, dilated LA, LVH, moderated MR, moderate TR, although image quality was poor. Her hospitalization was also complicated by hyponatremia of unclear [**Name2 (NI) 10810**]. Her hospitalization was also complicated by acute on chronic renal failure (s/p transplant in [**2143**]). She did have episode of ATN in setting of her mesenteric ischemia with peak Cr of 4.3 with return to her baseline of 1.4-1.8 at time of discharge. Upon admission to [**Hospital3 417**] her Cr was 3.7 and remained elevated. It is unclear what work up was done for this. On the day of admission, she also developed respiratory distress with increasing volume retention. Attempts at diuresis with Lasix 400 mg IV were unsuccesful. She was transferred to [**Hospital1 18**] for management of her fungemia, renal failure and repiratory distress. Immediately prior to discharge or in the ambulance she was started on a nitro dip for again unclear reasons. Past Medical History: PMH: -Mesenteric ischmia requiring coloectomy [**2158-4-24**] -Respiratory failure requiring trach [**4-/2158**] -CRI s/p transplant in [**2143**] (followed by Dr[**Doctor Last Name **] at [**Last Name (un) **], transplant followed by Dr. [**Last Name (STitle) 15473**] -b/l Breast Cancer s/p lumpectomy/XRT and Chemo 199 (followed by Dr. [**Last Name (STitle) 3274**] -PVD s/p L BKA (followed by Dr.[**Last Name (STitle) 21080**]) - [**6-/2147**], fem-[**Doctor Last Name **] '[**48**] with [**Doctor Last Name **]-DP bypass, -MI X2 s/p CABG times 2 -hypercholesterolemia -DM1 with retinopathy/neuropathy/nephropathy -left eye prosthesis -bilateral breast cancer -chronic anemia -gout Social History: lives with husband (a math professor [**First Name (Titles) **] [**Last Name (Titles) **]). Family History: NC Physical Exam: Vitals: T:96.0 P:98-107 R:22-24 BP:163-176/76-95 SaO2:98% on 4L CVP 21 General: Awake, alert, . HEENT: NC/AT, Pupil reactive on right, EOMI without nystagmus, no scleral icterus noted, MMM, no lesions noted in OP Neck: supple, no carotid bruits appreciated. unable to assess JVP Pulmonary: crackles bilaterally Cardiac: distant RRR, nl. S1S2, no M/R/G noted Abdomen: soft, obese, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: 2+ edema in upper and lower ext, 2+ radial, DP and PT pulses on right. Skin: diffuse brusing on abdomen. No other rash noted. Neurologic: -mental status: Alert, oriented x 3. -cranial nerves: II-XII Pertinent Results: POTASSIUM-3.9 CHLORIDE-90* TOTAL CO2-16* ANION GAP-23* [**2158-6-22**] 08:23PM WBC-18.9*# RBC-3.13* HGB-9.9* HCT-29.5* MCV-94 MCH-31.7 MCHC-33.6 RDW-18.9* NEUTS-95* BANDS-1 LYMPHS-1* MONOS-2 EOS-0 BASOS-0 ATYPS-0 METAS-1* MYELOS-0 [**2158-6-22**] 08:53PM PT-12.8 PTT-25.9 INR(PT)-1.1 [**2158-6-22**] 08:51PM TYPE-ART TEMP-36.7 O2 FLOW-3 PO2-40* PCO2-29* PH-7.36 TOTAL CO2-17* BASE XS--7 INTUBATED-NOT INTUBA COMMENTS-NASAL [**Last Name (un) 154**] [**2158-6-22**] 08:51PM LACTATE-2.4* [**2158-6-22**] 08:23PM GLUCOSE-293* UREA N-131* CREAT-3.1*# SODIUM-125* [**2158-6-22**] 08:23PM CK(CPK)-17* [**2158-6-22**] 08:23PM CK-MB-4 cTropnT-0.26* [**2158-6-22**] 08:23PM CALCIUM-8.3* PHOSPHATE-4.7*# MAGNESIUM-2.5 Brief Hospital Course: 55 YOF with volume overload, dyspnea, renal failure, elevated WBC, fungemia, chest pain, and hyponatremia; details below. . ## Fungemia: Patient was diagnosed with fungemia by blood culture at [**Hospital1 **] and [**Hospital3 417**], likely due to TPN. Other sources include possible seeding of chronic thrombus in UE. TTE on [**2158-6-23**] demonstrated no evidence of vegetations. Ophthalmology eval demonstrated no opthalmic candidemia. Patient was initially started on PO fluconazole from 6.30.06-7.13.06. Patient did however continue to spike fevers while on antibiotic therapy, concerning for a new or resistant infection in the context of patient's immunosuppresion. Another possible source was pulmonary since patient's CT chest from [**2158-7-6**] demonstrated interval development of bilateral pulmonary nodules. Unclear etiology for bilateral pulmonary nodules. Nodules may have represented septic emboli from endocarditis, although no vegetations were demonstrated by echo on [**2158-6-23**] or [**2158-7-11**]. Patient was converted to IV caspofungin on [**2158-7-6**] until [**2158-7-12**]. During this time, patient remained afebrile and was converted back to PO fluconazole prior to discharge. Blood cultures from [**7-23**] had come back positive for yeast and per ID was switched to caspofungin. The evening before transfer to the floor, the patient's HD cath was removed as a possible site for infection. She was given a loading dose of 70mg IV and then given a daily dose of 50mg IV. She remained afebrile. Further workup was done to search for the source of the fungemia. A renal ultrasound was done which was normal. Ophthalmology was consulted to evaluate eye grounds and they did not feel the eye was a source of infection. A TTE was done which showed a small (0.7 x0.7 cm) mass attached to the highly calcified mitral annulus which may be a vegetation or a mobile piece of calcification coming off the larger mitral annular calcification. A follow up TEE was recommended, however the patient began to have increased emesis and it was unable to be performed. ID further recommended the PICC line to be replaced which was to be done with HD catheter placement. Cultures from [**Date range (1) 21081**] remained negative and a urine culture from this time was negative as well. . ## Klebsiella PNA: retrocardiac, pt received 10d of cefepime. course completed. . ## Renal Failure: Patient was admitted to MICU initally and received hemodialysis which greatly improved mental status. Renal u/s [**2158-6-23**] showed stable borderline hydronephrosis in the transplant kidney with elevated resistive indices and CT ab/pelvis [**2158-6-23**] showed air within the transplant kidney collecting systems, new from comparison, likely iatrogenic from foley placement. Then upon admission to the floor, patient had intractable fluid overload with associated edema and shortness of breath. Patient underwent hemodialysis three times which greatly improved fluid overload and shortness of breath. The patient's creatinine fell to a low of 1.9 while on the floor. However, the creatinine soon began to rise again to a high of 3.3 on the floor. The patient's acute on chronic renal failure was believed to be ATN vs. prerenal. The renal service was closely following the patient and recommended placement of an HD catheter in preparation for hemodialysis based on her worsening renal function and fluid status. She was given boluses and started on NS at 50cc/hr per renal. She was started on Bicitra 30 mL TID for acidosis. Allopurinol was decreased to q48h from q24 based on the renal function. The tacrolimus dose was halved and then held. . ## s/p renal transplant: Pt is normally on prednisone, tacrolimus, and azathioprine for immunosuppression. Patient was continued on steroids but tacrolimus and azathioprine were temporarily discontinued during this admission secondary to fungemia. Patient was eventually restarted on tacrolimus once she demonstrated improved control of her infection. Tacrolimus and prednisone was continued while the patient was on the floor. The FK506 was elevated and the tacrolimus dose was halved. When the level did not decrease, tacrolimus was held. Tacrolimus levels were followed with a goal trough [**2-26**]. Azathioprine was held. . ## Respiratory failure and shortness of breath: Patient initially had respiratory failure in the MICU, likely secondary to a combination of acid-base abnormalities, stiffness from fluid overload, and infectious process. Patient was started on cefepime and vancomycin initially for concern of gram negatives and MRSA, which was noted on OSH blood culture. Cefepime was discontinued since there was no obvious target and vancomycin was maintained for MRSA. Vancomycin was then discontinued given negative blood cultures and concern for vancomycin-induced thrombocytopenia. After transfer from the MICU, patient developed increasing shortness of breath with concern for fluid overload and infectious process. Patient's shortness of breath improved significantly with three rounds of hemodialysis. However, a CT scan of chest demonstrated interval development of pleural effusions and bilateral pulmonary nodules, concerning for an infectious process. Thoracentesis demonstrated a transudate effusion. Patient received antibiotic treatment with PO fluconazole and IV caspofungin. The patient was transferred on a trach collar, 40%, satting 100%, with upper airway secretions. She was suctioned frequently and O2 sats remained within normal limits. She was given nebulizers as indicated. Her fluid status was closely monitored as she was getting an increasing fluid load for hypercalcemia treatment. The patient was triggered on 8/? for altered mental status and question of respiratory distress. A CXR was done which showed worsening pulmonary edema however the patient had good oxygen saturation The patient's mental status did not impro . ## Hypercalcemia: Ms. [**Known lastname **] had a persistently elevated Ca with unknown cause. A bone scan was negative for metastatic osseous disease. TSH and PTH were within normal limits. She was treated with calcitonin and pamidronate, given lasix and fluids with some response. Per renal, further calcitonin was held as the patient did not respond adequately to it and they did not recommend pamidronate as it can contribute to renal failure. PTHrp was sent and was normal. Hypercalcemia thought to be secondary to imobilization. . ## Hyponatremia: Pt was initially hyponatremic to 125 on admission, likely in setting of volume overload from CHF/renal failure. Patient's sodium resolved with hemodialysis and was stable during admission. The patient's sodium remained stable while on the floor. . ## Type 1 Diabetes melitus: Patient has type 1 diabetes with major complications as listed above. She initially was started on an insulin drip and her insulin regimen was adjusted with help from [**Last Name (un) **]. . ## Anemia: Patient had anemia of chronic disease, most likely secondary to chronic renal insufficiency. HCT was trending down and guiac was positive, and patient received 1unit pRBC. She was stable post transfusion on [**6-26**]. No other transfusions were given, and th pt may require outpt colonoscopy. .. ## Thrombocytopenia: Patient developed thrombocytopenia during admission. Thrombocytopenia was thought to have developed secondary to vancomycin and platelets increased after discontinuing vancomycin. . ## UTI: During admission, patient's urine culture began growing vancomycin-resistant enterococcus. Patient was treated with linezolid. She again grew out many bacteria on a urine culture and was treated with ciprofloxacin and fluconazole (last day of cipro [**2158-9-23**], last day of fluconazole [**2158-9-18**]) . ## CAD: Patient is s/p MI x 2. Patient had no symptoms during admission. Patient was maintained on home meds of ASA, BB, and isosorbide dinitrate. . ## HTN: Patient's blood pressures have been occasionally elevated and hydralazine was increased to 15mg PO qid to assess for improved BP control. Patient was otherwise maintained on home doses of Clonidine, Metoprolol, and Isosorbide without other problems. . ## Depression/anxiety Patient was maintained on paxil. Ativan and ambien were discontinued secondary to increased somnolence with these meds. . . . MICU Transfer [**2158-8-21**] - [**2158-9-3**] Pt was admitted for hypotension. There was no clear source, with possiblities being septic (LLL opacity and 4+ MRSA in sputum, though no fever or WBC), adrenal insufficiency (started empirically on stress dose steroids), or cardiogenic. As she was not felt to clearly be septic and didn't seem to briskly respond to stress dose steroids, she had an echo performed, showing an EF of 25%, down from an echo one month prior showing 35-45%. Cardiology was consulted who felt that this was not acute ischemia, and that the decrement in function was likely overstated; it was felt that her prior study had been of sub-optimal quality and that probably had not been a significant interval change in LV-EF, and that this low EF was probably a mix of a baseline ischemic cardiomyopathy with a superimposed toxic/infectious cardiomyopathy. There was also concern, despite the physiologic controversy of this theory, that she was grossly volume overloaded and thus had tipped over to the disadvantageous arm of Starling's curve. In the setting of this gross volume overload with associated large bilateral pleural effusions (that had been tapped one month prior and found to be transudative, thought to be due to heart failure), she developed worsening respiratory distress and was placed back on the ventilator on minimal settings (p/s [**9-28**], fio2 40%) with immediate relief of her dyspnea. Over the next few days, she continued with treatment of her VAP and was diuresed during CVVH. She tolerated this well and was able to be weaned off pressure support and onto a trach mask without difficulty. By the time she was called out of the unit she had been tolerating trach collar alone for several days. . She was treated for ten days with vancomycin and ceftazidime for a hospital acquired pneumonia. Her stress dose steroids were tapered after three days of full dose, over the course of the following week. She was started on CVVHD to relieve her gross volume overload. With the combined effect of these interventions, her bp slowly climbed over the week, and she eventually became hypertensive with bp's in the 140-160's. She was then switched from CVVHD back to intermitten HD. . During the course, she had one episode of afib with RVR. At the time, her hr was in the 140's to 160's and a bp was not able to be obtained, though she did not lose conciousness. She was bolused 500cc of NS and a phenylephrine drip was started. She received 20mg of diltiazem IV with heart rate decreasing to the 90's to low 100's and bp up to the 120's. She receieved a 24` IV amiodarone load with reversion to sinus rhythm and was then switched over to oral amiodarone. . FLOOR COURSE: . ## Hallucinations/delusions: Pt having active hallucinations. Being treated for urine bacterial and fungal infections. No other abnormalities other than encephalopthy per EEG to explain new hallucinations. Unlikely to be from new-onset psyichiatric disease. MRI was unrevealing, Ca under control, head CT negative x2. Continue ciprofloxacin until [**9-23**]. Continue fluconazole until [**9-18**]. . ## Atrial fibrillation: Pt went into atrial fibrillation in the unit. Now in sinus rhythm after being treated with amiodarone. Rate-controlled. INR goal is 2.0-3.0. Pt's warfarin dosing has not been finalized, so should be adjusted daily. She was continued on metoprolol 50 [**Hospital1 **] for rate control and amiodarone 200 for rhythm control. . ## Coronary artery disease: No evidence of active ischemia. Continued metoprolol 50 PO bid, aspirin 81 PO qd . ## HTN: Pt is relatively normotensive. Continued metoprolol, hydralazine, isosorbide. . ## Ischemic cardiomyopathy: Total body volume overloaded given sacral edema and bilateral pleural effusions. Not symptomatic. . ## End stage renal disease s/p transplant: Needed HD and CVVH in unit. Now being evaluated daily for HD requirement. . ## Diabetes mellitus, Type 1: Mildly hyperglycemic throughout the day. Followed by [**Last Name (un) **] service to adjust insulin daily. . ## Respiratory failure: Pt c/o mild shortness of breath, but ascribes this to the valve on the trach collar. Has required intermittent nebs for wheeziness. . ## Hypercalcemia: Unlikely to be related to breast cancer as she has had a negative bone scan during this hospitalization. [**Month (only) 116**] be hypercalcemia from immobility. Received pamidronate 30 mg IV x2 with some normalization of calcium. . ## Breast cancer: Pt was started back on letrozole, but then discontinued again when she started having hallucinations. Medications on Admission: -hydrocortisone 100 mg iv q8h -SSI -azathioprine 50 mg qd -tylenol prn -allopurinol 100mg qd -clopidogrel 75 mg qd -metoclopramide 20 mg qid -nystatin swish and spit qid -epo 10K qwk -Femara 2.5 mg qd -tacrolimus 1mg [**Hospital1 **] -clonidine 0.2 mg tid -Colshicine 0.6 mg qd -colace -emeprazole 40 qd -Caspofungin 70 mg iv times 1 given [**6-22**] -lasix 40 mg iv bid -ASA 81 mg qd -paroxetine 20mg qd -metoprolol 50 mg tid -lorazepam 0.5 prn -Calcium [**Last Name (un) **] 500 mg tid -calcium acetate 667 tid -isosorbide dinitrate 50mg tid -albuterol prn -ipratropium prn -Ticarcillin/clavulanate 3.1g q8h -Nitro drip Discharge Disposition: Extended Care Facility: [**Hospital3 105**] Northeast - [**Location (un) 38**] Discharge Diagnosis: PRIMARY - s/p renal transplant in [**2143**] - Candidemia - Urinary tract infection - Fluid Overload - Acute on Chronic Renal Failure - Thrombocytopenia - Anemia - Type 1 Diabetes Mellitus - Hypertension SECONDARY - Depression Discharge Condition: Fair - Patient is taking oral intake and breathing well on room air. Patient still requires PT to help her mobilize. Discharge Instructions: Please take all medications as prescribed. If you have symptoms of fevers, chills, night sweats, chest pain, worsening shortness of breath, or worsening swelling in lower extremities, please seek immediate medical attention. Followup Instructions: -- Please see your kidney transplant [**Last Name (LF) 5059**], [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15475**], MD on Date/Time:[**2158-7-25**] 10:45. His phone number is [**Telephone/Fax (1) 673**]. -- Please see your infectious disease physician, [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6400**], MD on Date/Time:[**2158-8-17**] 11:00. Her phone number is [**Telephone/Fax (1) 457**]. -- Please see your cardiologist, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. at Date/Time:[**2158-8-29**] 11:20. His phone number is [**Telephone/Fax (1) 5003**] ICD9 Codes: 5845, 5990, 5856, 4280
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Medical Text: Admission Date: [**2189-10-16**] Discharge Date: [**2189-10-26**] Date of Birth: [**2115-9-22**] Sex: M Service: MEDICINE Allergies: Lactose Attending:[**Doctor First Name 3290**] Chief Complaint: Low back pain, shortness of breath Major Surgical or Invasive Procedure: Thoracentesis Pigtail pleural catheter placement History of Present Illness: The patient is a 74M who presented to the ED with back pain. He has had three mechanical falls in the past two weeks. He has had difficulty ambulating secondary to pain. He denied fevers, chills, chest pain, cough or cold symptoms, nausea, vomiting, abdominal pain, and dysuria though does endorse worsened dyspnea. On arrival to the ED, he triggered for hypoxia to 88% which improved with supplemental oxygen. A head CT was negative, CXR showed PNA in RLL and CT torso showed a loculated effusion and compression fractures. He was started on vanc and zosyn and 1L NS. He was also given morpinge 4mg IV and percocet. Spine was consulted for the compression fractures and recommended a TLSO brace and an MRI on a non-urgent basis. Past Medical History: BPH Anemia Dyspepsia Weight Loss Atrial flutter diagnosed in [**2187**], s/p ablation in [**2188-4-26**] Vitamin D Deficiency DMII MDS Colonic adenomas h/o Sigmoid diverticulitis. h/o Basal cell carcinoma. h/o Left hip fracture, status post ORIF in [**2183**]. Social History: Retired, lives with wife. [**Name (NI) **] denies any alcohol. Is currently smoking tobacco pipes, 50y history. Denies any other illicit drug use. Family History: Maternal aunt with diabetes. There is no family history of premature coronary artery disease, arrhythmias, or sudden death. Physical Exam: Physical Exam on admission: GENERAL - cachectic male appearing older than stated age HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, dry mucous membranes with poor dentition NECK - supple, no thyromegaly, no JVD, no lymphadenopathy LUNGS - bronchial on right HEART - PMI non-displaced, RRR, no MRG, nl S1-S2 ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) SKIN - no rashes or lesions LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact Physical Exam on discharge - Unchanged from above except for: HEENT - moist MM LUNGS - Mild crackles and bronchial breath sounds in the right lung base. Pertinent Results: Labs on admission: [**2189-10-15**] 08:21PM BLOOD WBC-27.6*# RBC-3.48* Hgb-9.2* Hct-30.7* MCV-88 MCH-26.3* MCHC-29.8* RDW-17.3* Plt Ct-179 [**2189-10-15**] 08:21PM BLOOD Neuts-85* Bands-1 Lymphs-3* Monos-6 Eos-0 Baso-0 Atyps-0 Metas-2* Myelos-2* NRBC-1* Other-1* [**2189-10-15**] 08:21PM BLOOD PT-13.3 PTT-27.4 INR(PT)-1.1 [**2189-10-15**] 08:21PM BLOOD Glucose-140* UreaN-36* Creat-1.1 Na-139 K-4.2 Cl-101 HCO3-29 AnGap-13 [**2189-10-15**] 08:21PM BLOOD ALT-35 AST-71* AlkPhos-373* Amylase-51 TotBili-0.3 [**2189-10-16**] 03:43AM BLOOD TotProt-6.1* Albumin-2.3* Globuln-3.8 Calcium-10.6* Phos-3.7 Mg-2.0 [**2189-10-16**] 03:43AM BLOOD PTH-6* [**2189-10-15**] 08:26PM BLOOD Lactate-3.8* K-4.4 [**2189-10-16**] 02:53AM BLOOD Lactate-2.3* [**2189-10-16**] 04:42AM PLEURAL WBC-[**Numeric Identifier 38617**]* RBC-1625* Polys-97* Lymphs-3* Monos-0 [**2189-10-16**] 04:42AM PLEURAL TotProt-4.2 Glucose-15 LD(LDH)-2507 [**2189-10-17**] 05:44PM PLEURAL WBC-[**Numeric Identifier 43204**]* RBC-2500* Polys-94* Lymphs-2* Monos-4* [**2189-10-17**] 05:44PM PLEURAL TotProt-3.1 Glucose-2 LD(LDH)-2393 Cholest-44 Blood culture [**10-15**] and [**10-16**]: Pending [**2189-10-16**] 2:40 am SPUTUM Source: Expectorated. **FINAL REPORT [**2189-10-18**]** GRAM STAIN (Final [**2189-10-16**]): >25 PMNs and <10 epithelial cells/100X field. NO MICROORGANISMS SEEN. RESPIRATORY CULTURE (Final [**2189-10-18**]): SPARSE GROWTH Commensal Respiratory Flora. [**2189-10-16**] 4:42 am PLEURAL FLUID GRAM STAIN (Final [**2189-10-16**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Preliminary): NO GROWTH. ANAEROBIC CULTURE (Preliminary): NO GROWTH. Legionella antigen: negative [**2189-10-17**] 5:44 pm PLEURAL FLUID PLEURAL FLUID. GRAM STAIN (Final [**2189-10-17**]): 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Preliminary): NO GROWTH. ANAEROBIC CULTURE (Preliminary): Images: -CXR [**2189-10-18**]: Small residual of right pleural effusion has remained stable since insertion of the pigtail pleural drain at the base of the lung. Consolidation primarily in the right lower lobe, to a lesser degree anterior segment of the right upper and middle lobes is improving. Infrahilar atelectasis in the left lower lobe, however, is worsening. Heart size normal. Normal pulmonary vasculature. No edema. No pneumothorax. -CT head [**2189-10-15**]: no acute intracranial process -CXR ([**2189-10-23**]): 1. No evidence of pneumothorax following right pigtail pleural catheter removal. 2. Improving mass-like consolidation in right lower lobe consistent with pneumonia. 3. Small pleural effusions, right greater than left. -Abd US ([**2189-10-23**]): No evidence of gallstones or biliary dilatation. Splenomegaly. Ascites. EKG at admission: sinus tachy, LAD, q waves v1-2 Discharge labs: [**2189-10-16**] 03:07PM BLOOD PTH-7* [**2189-10-20**] 04:55AM BLOOD VITAMIN D [**1-20**] DIHYDROXY-24 (nl) [**2189-10-17**] 06:56AM BLOOD PARATHYROID HORMONE RELATED PROTEIN-negative [**2189-10-16**] 03:43AM BLOOD VITAMIN D 25 HYDROXY- 27 [**2189-10-26**] 06:25AM BLOOD WBC-5.6 RBC-3.04* Hgb-7.8* Hct-26.1* MCV-86 MCH-25.8* MCHC-30.0* RDW-18.1* Plt Ct-221 [**2189-10-26**] 06:25AM BLOOD Glucose-76 UreaN-16 Creat-1.0 Na-140 K-3.8 Cl-103 HCO3-32 AnGap-9 [**2189-10-26**] 06:25AM BLOOD Calcium-8.7 Phos-2.7 Mg-2.4 Brief Hospital Course: 74 year old male with history of MDS, weight loss of 70-80 pounds, multiple falls, diabetes mellitus, who presented for low back pain, found to have multifocal pneumonia and complicated parapneumonic effusion. #) Pneumonia with complicated parapneumonic effusion/loculation: On admission to the MICU he had a thoracentesis and 1L of cloudy non-purulent fluid was drained. He was initially covered broadly with Vanc/Zosyn/Levofloxacin. On [**10-17**], he had an additional throacentesis with chest tube placement by IP. There was concern for aspiration versus community acquired PNA. Once legionella antigen was negative levofloxacin was discontinued. Early in the hospitalization, he had occasional desaturations overnight which required oxygen via facemask. This was not occurring for the 5-6 days prior to discharge. At time of discharge, he had completed a 9 day course of antibiotics and will not need further antibiotics. Clinically, his breathing was improved at discharge, he was maintaining good oxygen saturation on room air and there was no reaccumulation of the pleural effuion on repeat CXR. #) Leukocytosis: Persistent in the in the high 20's on admission, but decreased to normal range at the time of discharge. Increased WBC likely secondary to his pneumonia. C. diff was negative x3. #) Hypercalcemia: Given unintentional weight loss of 70-80 lbs and smoking history, there is concern for malignancy. PTH was appropriately low at 7. 1,25-OH-VitD was normal and PTHrP was also negative. Skeletal survey did not show evidence of lytic lesions, only suggestive of osteoporotic changes. He was given a dose of pamidronate 60mg on [**2189-10-20**] and his calcium level decreased to the normal range. A urine N-telopeptide was sent and was elevated, suggesting some process leading to increased bone turnover. Paget's is another possible explaiantion given elevated alk phos and calcium, no evidence of Paget's on skeletal survery per radiology. Had a bone scan in [**2-/2188**] which also did not show evidence of Paget's. #) Weight loss: PSA was 0.5 in [**2188**]. Per pt he had a normal colonoscopy last year. As mentioned above, no obvious cause despite negative PET/CT as well as negative bone marrow biopsy prior to admission. Has follow-up with hematology/oncology arranged. #) Pain control: He was treated with acetaminophen 1g q8h, toradol 15 mg IV q8h for three days, lidocaine patch, morphine sulphate prn, oxycodone prn. A TLSO brace was placed. MRI showed compression fracture in L1 and L2, recommended follow-up in 4 weeks. At discharge, pain well controlled only on PRN tylenol and lidocaine patch, not requiring narcotics. #) DM: Metformin was held and he was covered with insulin sliding scale. Blood sugars remained well controlled during admission and he will be restarted on metformin at discharge. #) Diarrhea: Had diarrhea during this admission with 4-5 BMs per day. C. diff was negative x3. It is thought that he had antibiotic-associated diarrhea which should improve at discharge now that he is off antibiotics. Also encouraged yogurt to improve the diarrhea. #) Code status during this admission: FULL CODE Trnasitional Issues: -Follow-up MRI in 4 weeks from [**2189-10-18**] to follow-up on lumbar compression fractures -Ongoing work-up for weight loss and hypercalcemia, as described above -Emailed pt's Hemotologist who is aware of weight loss and has talked with PCP regarding concern for malignancy -Received Pamidronate 60mg IV on [**2189-10-20**], would be due for this every month if ongoing therapy with bisphosphonates is desired Medications on Admission: LISINOPRIL - (Prescribed by Other Provider) - 5 mg Tablet - one Tablet(s) by mouth daily METFORMIN - (Prescribed by Other Provider) - 500 mg Tablet - one Tablet(s) by mouth twice a day PRAVASTATIN - (Prescribed by Other Provider) - 20 mg Tablet - one Tablet(s) by mouth daily Medications - OTC ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day CALCIUM CARBONATE [TUMS] - (Prescribed by Other Provider) - Dosage uncertain CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] - (Prescribed by Other Provider) - 1,000 unit Tablet, Chewable - one Tablet(s) by mouth daily Discharge Medications: 1. miconazole nitrate 2 % Powder Sig: One (1) application Topical three times a day: Apply to buttocks. 2. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. 3. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day. 4. pravastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. 6. cholecalciferol (vitamin D3) 1,000 unit Capsule Sig: One (1) Capsule PO once a day. 7. dextromethorphan-guaifenesin 10-100 mg/5 mL Syrup Sig: Five (5) ml PO every six (6) hours as needed for cough or chest congestion. 8. Fleet Enema 19-7 gram/118 mL Enema Sig: One (1) enema Rectal once a day as needed for constipation. 9. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection three times a day. 10. DuoNeb 0.5 mg-3 mg(2.5 mg base)/3 mL Solution for Nebulization Sig: One (1) neb Inhalation every four (4) hours as needed for shortness of breath or wheezing. 11. Lidoderm 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) patch Topical once a day: Apply to L1-L2 area. 12 hours on, 12 hours off. 12. pamidronate 60 mg/10 mL (6 mg/mL) Solution Sig: Sixty (60) mg Intravenous once a month: Last given [**2189-10-20**]. 13. aluminum-magnesium hydroxide 200-200 mg/5 mL Suspension Sig: Five (5) mL PO four times a day as needed for indigestion. 14. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital 4316**] Rehabilitation & [**Hospital **] Care Center - [**Location (un) **] Discharge Diagnosis: Primary: Aspiration pneumonia Lumbar Compression fracture Rib fractures Hypercalcemia Secondary: Diabetes Mellitus Myelodysplastic Syndrome 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 Mr. [**Known lastname 5749**], It was a pleasure taking care of you during your hospitalization at [**Hospital1 69**]. You were admitted with low back pain, for which we found that you had a new compression fracture. Orthapedics did not recommend surgery and instead placed you in a special type of brace. You also presented with shortness of breath and oxygen saturation. We discovered that you had a pneumonia, for which we treated you with two different intravenous antibiotics. We also placed a tube to drain some of the fluid that had accumalated in the pneumonia. At discharge, you were breathing more comfortably and do not need any more antibiotics after discharge. Your calcium level was found to be elevated. We did not find a cause for this, although you have had an extensive work-up priot to this admission which also did not find a cause. You were given Pamidronate and your calcium level improved, this medication should be given every month. You also had significant diarrhea, which was negative for the infection C. diff 3 times. It is likely related to the antibiotics, which we have stopped now. Eating foods like yogurt can help improve your symptoms, and you should feel better now that the antibiotics are stopped. MEDICATION CHANGES: START guaifenesin-dextromethorphan 5mL by mouth as needed for cough START Pamidronate 60mg IV every month (last given [**2189-10-20**]) START lidoderm patch 1 patch apply to L1-L2 area, on for 12 hours and off for 12 hours. START Duonebs 1 nebulizer every 4 hours as needed for shortness of breath of chest tightness START miconazole powder 1 application to buttocks and groin three times daily Followup Instructions: PCP appointment to be arranged by rehab Department: HEMATOLOGY/ONCOLOGY When: FRIDAY [**2189-11-6**] at 11:00 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9052**], MD [**Telephone/Fax (1) 22**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage ICD9 Codes: 5070, 2875, 5119, 2724, 3051
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Medical Text: Admission Date: [**2199-12-4**] Discharge Date: [**2199-12-13**] Date of Birth: [**2133-9-12**] Sex: M Service: NEUROSURGERY Allergies: Benadryl / Phenytoin Attending:[**First Name3 (LF) 78**] Chief Complaint: HEADACHE Major Surgical or Invasive Procedure: Angiogram [**2199-12-5**] Angiogram [**2199-12-12**] History of Present Illness: 66 y/o male with history of headache since Friday presents to [**Hospital1 18**] from OSH. Patient states that while watching TV on Friday night felt a "splitting" headache, [**11-19**] with nausea. He states that the headache was present throughout the weekend, but was not as severe as on Friday. On Sunday, he reports that he also began to experience neck pain with the headache. On Tuesday, headache became worse and patient was unable to go to work. His wife noticed that the patient was more weak and encouraged the patient to come to [**Hospital3 **] ED. At the OSH, a head CT was done which showed a basilar aneurysm with trace SAH. Patient was then transferred to [**Hospital1 18**] for further neurosurgical workup. Patient states that he has a headache that is [**2200-3-17**], dizziness upon standing with increase in headache, nausea. He denies any nuchal rigidity, blurred vision, or vomiting. Past Medical History: appendectomy, tonsillectomy, hypercholesteremia, costochondritis, LBP Social History: Denies any tobacco, 6 pack of beer/year Family History: NC Physical Exam: T:99.5 BP:177/94 HR: 88 R:21 O2Sats: 91% RA Gen: WD/WN, comfortable, NAD. HEENT: atraumatic, normocephalic Pupils:3-2mm bilaterally EOMs: intact Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**3-12**] objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, 3 to 2 mm bilaterally. Visual fields are full to confrontation. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**5-14**] throughout. No pronator drift Sensation: Intact to light touch Toes downgoing bilaterally Coordination: normal on finger-nose-finger, rapid alternating movements, heel to shin ON DISCHARGE Pertinent Results: [**Known lastname **],[**Known firstname **] [**Medical Record Number 83988**] M 66 [**2133-9-12**] Radiology Report CHEST (PORTABLE AP) Study Date of [**2199-12-4**] 10:34 PM [**Last Name (LF) **],[**First Name3 (LF) **] J. NSURG SICU-A [**2199-12-4**] 10:34 PM CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 83989**] Reason: SUBARACHNOID HEMORRHAGE [**Hospital 93**] MEDICAL CONDITION: 66 year old man with SAH, evaluate for infectious process REASON FOR THIS EXAMINATION: 66 year old man with SAH, evaluate for infectious process Final Report REASON FOR EXAMINATION: Fever in a patient with subarachnoid hemorrhage. Portable AP chest radiograph was reviewed with no prior studies available for comparison. Heart size is top normal. Mediastinal position, contour and width are unremarkable. Lungs are essentially clear except for bibasal atelectasis and questionable right suprahilar opacity that also might represent asymmetric calcification within the first right rib cartilage. No evidence of infection is present on the current study. Further evaluation with PA and lateral view whenever possible is recommended for clarification of the suprahilar abnormality on the right. [**Known lastname **],[**Known firstname **] [**Medical Record Number 83988**] M 66 [**2133-9-12**] Radiology Report CTA HEAD W&W/O C & RECONS Study Date of [**2199-12-4**] 10:51 PM [**Last Name (LF) **],[**First Name3 (LF) **] J. NSURG SICU-A [**2199-12-4**] 10:51 PM CTA HEAD W&W/O C & RECONS Clip # [**Clip Number (Radiology) 83990**] Reason: 66 year old man with SAH, evaluate for aneurysm or AVM Contrast: OPTIRAY Amt: 70 [**Hospital 93**] MEDICAL CONDITION: 66 year old man with SAH, evaluate for aneurysm or AVM REASON FOR THIS EXAMINATION: 66 year old man with SAH, evaluate for aneurysm or AVM CONTRAINDICATIONS FOR IV CONTRAST: None. Wet Read: [**First Name9 (NamePattern2) 42546**] [**Doctor First Name **] [**2199-12-5**] 12:48 AM No aneurysm or malformation noted. Hyperdense material in prepontine cistern, could be blood, or less likely mass. Final Report EXAM: CT angiography of the head. CLINICAL INFORMATION: Patient with subarachnoid hemorrhage. TECHNIQUE: Axial images of the head were obtained without contrast. Following this, using departmental protocol, CT angiography of the head was acquired. FINDINGS HEAD CT: There is subarachnoid hemorrhage seen in the perimesencephalic region. There is no midline shift or hydrocephalus. CT ANGIOGRAPHY HEAD: CT angiography of the head demonstrates no evidence of vascular occlusion, stenosis or an aneurysm greater than 3 mm in size. IMPRESSION: Head CT shows subarachnoid hemorrhage. CT angiography of the head demonstrates no obvious abnormalities including no obvious aneurysms. Correlation with scheduled cerebral angiography is recommended. COMMENT: This report is provided without the availability of 3D reformatted images. When these images are available, an addendum will be given if additional information is obtained. Brief Hospital Course: Patient presented to OSH s/p "splitting" headache on Friday night. He stated that his headache was persistent throughout the weekend and he developed a stiff neck as well as weakness. His wife urged him to go to the [**Name (NI) **] where a head CT was performed. Result showed a basilar tip aneurysm that measure 1.2cm with trace SAH. He was transferred to [**Hospital1 18**] for further neurosurgical workup. Upon arrival to [**Hospital1 18**] patient was nonfocal, a&ox3 with full strength. A CTA was ordered and he was admitted to the ICU for Q1H neuro checks. On [**12-5**], patient was taken to angiogram, where no aneurysm was seen, but a subarachnoid blood was observed. Post angio, patient remained non-focal in ICU. On [**12-6**], the patient was to be transferred to step down but he was slightly lethargic in the evening. The femoral incison remain intact. This lethargy improved and he was transfered to the SDU on [**2199-12-7**]. He had a mild temp on [**2199-12-9**] for which a UA was sent and dopplers performed and were both negative. An MRI of the brain and C-spine to r/o underlying mass and AV-fistula were performed and negative. His angiogram on [**2199-12-12**] was negative for aneurysm and patient remains non focal on post angiogram check. Femoral incision was clean, dry, and intact with no hematoma or bleeding. Patient is stable for discharge home. Medications on Admission: prilosec, statin, ibuprofen Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*1* 2. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**1-11**] Tablets PO Q4H (every 4 hours) as needed for PAIN. Disp:*60 Tablet(s)* Refills:*0* 4. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for Headache. Disp:*40 Tablet(s)* Refills:*0* 5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 6. Levetiracetam 500 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). Disp:*90 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: SAH Discharge Condition: Neurologically Stable Discharge Instructions: Angiogram with Embolization and/or Stent placement Medications: ?????? Continue all other medications you were taking before surgery, unless otherwise directed ?????? You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort. What activities you can and cannot do: ?????? When you go home, you may walk and go up and down stairs. ?????? You may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal). ?????? After 1 week, you may resume sexual activity. ?????? After 1 week, gradually increase your activities and distance walked as you can tolerate. ?????? No driving until you are no longer taking pain medications What to report to office: ?????? Changes in vision (loss of vision, blurring, double vision, half vision) ?????? Slurring of speech or difficulty finding correct words to use ?????? Severe headache or worsening headache not controlled by pain medication ?????? A sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg ?????? Trouble swallowing, breathing, or talking ?????? Numbness, coldness or pain in lower extremities ?????? Temperature greater than 101.5F for 24 hours ?????? New or increased drainage from incision or white, yellow or green drainage from incisions ?????? Bleeding from groin puncture site *SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call our office. If bleeding does not stop, call 911 for transfer to closest Emergency Ro Followup Instructions: Follow-Up Appointment Instructions ??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**First Name (STitle) **], to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. Completed by:[**2200-1-24**] ICD9 Codes: 2720
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Medical Text: Admission Date: [**2168-2-11**] Discharge Date: [**2168-3-5**] Date of Birth: [**2106-1-30**] Sex: F Service: MEDICINE Allergies: Zestril / Coumadin Attending:[**First Name3 (LF) 2145**] Chief Complaint: Dyspnea on exertion and lower extremity edema Major Surgical or Invasive Procedure: medical intensive care unit (MICU) monitoring History of Present Illness: This is a 62 year old female with history of pulmonary embolus in [**2160**] treated with heparin/coumadin complicated by large retroperitoneal bleed from a supratherapeutic INR, diastolic congestive heart failure, diabetes [**Year (4 digits) **], obstructive sleep apnea on Bipap who presents with increased dyspnea on exertion. One day prior to admission, she had increase in weight of 2 lbs and increasing lower extremity edema to mid leg bilaterally. On day of admission she had a 10 lb increase in weight and today her dypsnea on exertion became severe, her balance was off, she felt lightheaded/dizzy with standing. Patient denies chest pain or fever. She admits to a chronic cough with increased sputum production and phlegm over the past several weeks. She also notes right scapula pain with inspiration over the past several weeks. She sleeps with bed elevated and has cpap machine at home. She has urinary incontinence and thinks she has had worsened symptoms recently. Past Medical History: 1. Pulmonary emboli ([**2160**]) status post IVC filter secondary to retroperitoneal bleed on coumadin; Sadddle embolus ([**2168**]) 2. Thoracic osteomyelitis status post 6 week treatment with vancomycin. Also concern for underlying tumor that is being worked up. 3. Insulin dependent diabtes complicated by neuropathy and retinopathy. 4. Congestive heart failure recently diagnosed per patient. Echocardiagram during this admission does not demonstrate any heart failure. 5. Chronic lower extremity edema 6. Obesity 7. Right foot ulcers 8. Fibromyalgia 9. Osteoarthritis, left knee status post "injection" and prior knee surgery [**72**]. multiple surgeries: appendectomy, cholecystectomy (ex lap), partial hysterectomy 11. Obstructive sleep apnea on BIPAP at night 13. L4-5 herniated disc, status post steroid injections Social History: She quit smoking 23 years ago - she started at age 13 with 1 pack per day and then increased to 2-3 packs per day until she quit. She denies alcohol. She lives at home with a [**Doctor Last Name **] child who is 20 years old. She has cleaning lady. She walks independantly. Family History: Her brother had a stroke at age 65. There is a family history of diabetes, hypertension, and Multiple sclerosis. Physical Exam: Vitals: Temperature:98.9 Pulse:79 Blood pressure:107/53 Respiratory rate:18 Oxygen Saturation:95% on room air. GENERAL: pleasant morbidly obese female in no acute distress, breathing comfortably HEENT: Extraoccular movements intact, pupils equal and reactive, moist mucous membranes. NECK: unable to appreciate JVP given body habitus, no bruits. CARDIAC: distant heart sounds, regular rate and rhythm, no appreciable murmurs, rubs, or gallops. PULMONARY: Clear to ausculatation bilaterally, no respiratory distress, no accessory muscle use. BACK: midline lower surgical scar appreciated ABDOMEN: obese, soft, normoactive bowel sounds, nontender, nondistended surgical scar transverse from left lower costal edge towards right hepatic area, right lower quadrant surgical scar at McBurney's point. EXTREMITIES: Edema, trace-1+ pitting to knee bilaterally, Dorsalis pedis 1+ bilaterally, ulcer on dorsal surface of right first digit NEURO: alert and oriented times 3. Gait not observed. Cranial nerves II-XII grossly intact. Pertinent Results: Hematology: WBC-9.3 HGB-13.6 HCT-39.9 PLT COUNT-193 NEUTS-69.2 BANDS-0 LYMPHS-22.0 MONOS-3.8 EOS-3.5 BASOS-1.5 . Chemistries: SODIUM-143 POTASSIUM-4.8 CHLORIDE-105 TOTAL CO2-29 UREA N-36 CREAT-1.0 GLUCOSE-163 CALCIUM-9.2 PHOSPHATE-2.3 MAGNESIUM-2.2 . Cardiac: CK(CPK)-42 CK-MB-NotDone cTropnT-0.06 proBNP-50 . Coagulation: PT-11.5 PTT-18.5 INR(PT)-0.9 D-DIMER-4006 . Urinalysis: negative. . EKG: sinus tachycardia, normal intervals, no ST changes. . Imaging: 1. Chest x-ray: No radiographic evidence of failure. 2. Chest CTA: Large saddle embolus involving the right and left main pulmonary arteries extending to the middle and lower lobes bilaterally. The CT obstruction index is about 50%. Stable appearance of right upper lobe lung nodule. Brief Hospital Course: This is a 62 year-old female who presented with dyspnea on exertion and lower extremity edema who was found to have saddle pulmonary emboli. . 1. Pulmonary emboli: Her CTA was notable for a saddle embolus involving the right and left main pulmonary arteries extending to the middle and lower lobes bilaterally with an obstruction index of about 50%. She was started on heparin as a bridge to Coumadin. Her Coumadin dose was increased until a therapeutic level was achieved. This is her second pulmonary emboli and therefore she will likely need anticoagulation for life. She will need a hypercoagulable work-up as an outpatient. She was discharged on 7.5 mg daily of Coumadin. . 2. Hematomas: While on anticoagulation, she developed 2 hematomas in her left flank and left groin. She had no evidence of compartment syndrome. Her pain was controlled with Tylenol and oxycodone. She did require red cell transfusions for blood loss anemia. . 3. Hypotension: Early on during this admission, she developed hypotension to 85/41. Her blood pressure responded to a fluid challenge. An EKG had no signs of ischemia and a echocardiogram had no sign of right ventricular dysfunction. Her hematocrit at that time was stable and there was no sign of acute bleed. She appeared intravascularly dry with an low Fe Urea. Therefore, her hypotension was attributed to overdiuresis. Her blood pressure improved with hydration. . 4. Lower extremity edema: On admission, she had increased lower extremity edema above her baseline. There was no evidence of heart failure on echocardiogram. She was initially overdiuresed resulting in hypotension, as above. Once her blood pressure had stabilized, she was restarted on her outpatient Lasix dose with decrease in lower extremity edema. She appeared to be overdiuresed on her previous outpatient dose of Lasix; therefore, she was discharged on a lower dose (20 mg daily). . 5. Urinary tract infection: She was noted to have cloudy urine and a urine culture was positive for klebsiella. She was treated with a 7-day course of ceftriaxone. . 6. Diabetes: She had been on 36 units of Lantus as an outpatient. Her sugars were under poor control (A1c = 9.3), so her Lantus was increased to 42 units. This regimen yielded good glucose control. . 7. Obstructive sleep apnea: She was maintained on CPAP at night. . 8. Right toe ulcer: She had been seen by [**Doctor Last Name **] for debridement of her ulcer. She was maintained on wet-to-dry saline dressing changes daily. . 9. Back pain: She was maintained on her outpatient gabapentin and baclofen. . 10. FEN: Low sodium cardiac diabetic diet. She had hyperkalemia on admission that was treated. She had no further episodes of hyperkalemia. . 11. Prophylaxis: Anticoagulation with heparin/Coumadin, Colace/senna, PPI, ambulation. . 12. Access: Peripheral IV . 13. FULL CODE . 14. DISPO: She was discharged to home once she was therapeutic on Coumadin for 48 hours. She will follow-up in clinic 4 days post-discharge for an INR and hematocrit check. Medications on Admission: 1. spectravite 2. gabapentin 800mg qid 3. baclofen 10mg ([**2082-11-1**]) 4. spironolactone 25mg' 5. diovan 40mg' 6. lasix 80mg' 7. protonix 40mg' 8. mirapex 0.5mg' 9. ranitidine 300mg' 10. aspirin 81mg' 11. lipitor 10mg' 12. citalopram 40mg' 13. bethenachol 25mg qid 14. tramadol 100mg qid Discharge Medications: 1. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 3. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO QID (4 times a day). 4. Baclofen 10 mg Tablet Sig: ASDIR Tablet PO TID (3 times a day): Take 10 mg (1 tablet) in the morning, 10 mg in the afternoon, and 20 mg (2 tablets) at bedtime. 5. Pramipexole 0.25 mg Tablet Sig: Two (2) Tablet PO QD (). 6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 7. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 9. Tramadol 50 mg Tablet Sig: Two (2) Tablet PO QID (4 times a day). 10. Bethanechol Chloride 25 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): Take while still taking oxycodone. Disp:*60 Capsule(s)* Refills:*2* 12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation: Continue while taking oxycodone. Disp:*30 Tablet(s)* Refills:*0* 13. Warfarin 5 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 14. Oxycodone 5 mg Tablet Sig: 1-3 Tablets PO Q3-4H (Every 3 to 4 Hours) as needed: Take until leg pain resolves. Disp:*45 Tablet(s)* Refills:*0* 15. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 16. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours): until left leg pain resolves. Disp:*100 Tablet(s)* Refills:*2* 17. Insulin Glargine 100 unit/mL Solution Sig: Forty Two (42) units Subcutaneous at bedtime. 18. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital1 3894**] Health VNA Discharge Diagnosis: saddle pulmonary embolism Discharge Condition: Stable. She has large left medial thigh hematoma that is stable in size. Her left leg pain is stable if not slightly improved. her respiratory status is stable. Discharge Instructions: Please take all medications as prescribed and keep all follow-up appointments. . Call your doctor or go to emergency room if you develop sudden worsening shortness of breath, fever/chills, lightheadedness, chest pain, palpitations, bleeding that doesn't stop or anything else that you find worrisome. Followup Instructions: You have the following appointment to have your INR checked: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2967**], [**Name12 (NameIs) 280**] Phone:[**Telephone/Fax (1) 5808**] Date/Time:[**2168-3-9**] 1:40 . You also have the following appointments: Provider: [**Name10 (NameIs) 706**] MRI Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2168-4-4**] 10:00 Provider: [**Name10 (NameIs) 5005**] [**Last Name (NamePattern4) 5342**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2168-4-4**] 11:00 [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**] Completed by:[**2168-3-7**] ICD9 Codes: 2851, 5990, 2875, 2767, 3572
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Medical Text: Admission Date: [**2110-10-25**] Discharge Date: [**2110-10-27**] Date of Birth: [**2060-5-13**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2485**] Chief Complaint: Shortness of breath, Weakness Major Surgical or Invasive Procedure: None History of Present Illness: 50 y/o F with metastatic adenoid cystic carcinoma, GERD, PE, recent esophageal stent placement presents with increasing cough. She presented intially to her PCP 2 days back with cough and was given levoflox. However continued to have worsening cough with phlegm and difficulty swallowing. Of note, she had esophageal stents placed twice in the last month. . ED: Initial vitals were 99.3, 156, 122/81, 18, 100%/2L. Imaging showed aspiration PNA and did not show any PE or significant pericardial effusion. Started on Ceftriaxone, Zithro, Flagyl. She remained tachycardiac to 120s non-responsive to fluids. She was admitted to the ICU given her low pulm reserve and likely semi-urgent esophageal stent placement. Past Medical History: 1. Adenoid cystic carcinoma, diagnosed [**3-/2103**], details below 2. Left vocal cord paralysis 3. GERD 4. History of PE, [**2099**], [**2107**] 5. Cerebral vein thrombosis 6. Depression? (found in ED note) 7. CVA? (found in ED note) 8. Esophogeal stent [**2110-9-30**] . Onc Hx: [**2102**]: diag after work-up 8 months of cough, L pneumonectomy and carinal resection and postop radiation. [**2105**]: Recurrent dz in pleural space. [**2106**]: palliative radiation with concurrent low-dose Taxotere. [**2107**]: Hepatic involvement --> 4 cycles of cisplatin and Adriamycin. [**2107**]: CT showed progression in lungs/liver. 2 cycles of carboplatin and Taxol given, still with pulm progression. Tx complicated by thrombocytopenia and PE on CT, started on Lovenox. [**2108**]: Brachial plexus MRI showed tumor L paraspinal region from T2-T5 [**2108**]: 4 cycles of dose-reduced cisplatin, Navelbine [**2108**]: CT showed renal hepatic progression. [**2108**]: started on gemcitabine, held sev times for myelosuppression. [**2108**]: MRI showed leptomeningeal enhancement L frontal lobe. [**2109**]: seizure, vein of Trolard thrombosis. [**2109**]: weekly epirubicin, received 3 cycles, but multiple doses were held because of poor performance status. [**2109**]: onc team and pt decided upon symptom managment as CT scan showed progression, she received single [**Doctor Last Name 360**] cisplatin. Social History: She does not smoke cigarettes or drink alcohol. She moved from [**Country 3594**] to [**State 350**] in [**2091**]. She has a daughter who lives in [**Location 17065**]. She also has a brother and sister who live in the Greater [**Name (NI) 86**] area. She denies tobacco or alcohol use and is currently not working. In the past, she has worked in a bakery. Family History: Her mother is alive and healthy. Her father died at age 80 from a stroke and heart attack. She has 5 sisters and 2 brothers, and some of them have hypertension, hypercholesterolemia, and diabetes. She has 6 daughters and a son; they are all healthy. Physical Exam: PE: T 99, BP 105/80, HR 130, RR 18, 100% 2L Gen: cachectic, chronically ill-appearing F in moderate discomfort [**12-27**] neck pain; mostly Spanish speaking. HEENT: EOMI. dry mucous membranes, clear oropharynx without thrush. Neck: flat JVP, tenderness diffusely along right paracervical muscles without associated LAD, erythema or discrete mass palpated. full ROM on neck. mild distension of neck veins on right. Lungs: good air movement R, decreased left, w/o focal ronchi,rales, or wheeze Cardiac: tachycardic, RRR, S1, S2, no murmurs Abd: SNTND, +bs Extr: thin, warm, well perfused. no clubbing/cyanosis/edema. Skin: no rashes or other lesions. port on right chest c/d/i, no erythema, tenderness to palpation. Neuro: A&O, CNs grossly intact, no focal deficits Affect: appropriate Pertinent Results: Labs on Admission: [**2110-10-25**] WBC-11.8* RBC-3.43* Hgb-9.7* Hct-29.1* MCV-85 MCH-28.3 MCHC-33.3 RDW-15.2 Plt Ct-398 Neuts-92.2* Bands-0 Lymphs-4.2* Monos-3.4 Eos-0.1 Baso-0.1 Hypochr-2+ Anisocy-NORMAL Poiklo-1+ Macrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL Ovalocy-1+ Target-1+ Plt Smr-NORMAL Plt Ct-398 [**2110-10-26**] PT-17.3* PTT-60.6* INR(PT)-1.6* [**2110-10-25**] Glucose-95 UreaN-5* Creat-0.4 Na-139 K-3.5 Cl-98 HCO3-31 AnGap-14 Calcium-7.9* Phos-3.4 Mg-1.0* [**2110-10-26**] 12:20AM BLOOD Type-ART pO2-84* pCO2-55* pH-7.32* calTCO2-30 Base XS-0 Intubat-NOT INTUBA [**2110-10-26**] Lactate-2.2* Imaging: [**2110-10-25**] CXR FINDINGS: Single bedside AP examination labeled "erect, 16:45 hours" is compared with the recent study dated [**10-23**], as well as previous study, dated [**2110-10-9**]. There has been progressive opacification of the right hemithorax over the series of studies, which may represent confluent aspiration pneumonitis. The patient is s/p left pneumonectomy and tubular- appearing, presumably pleural, calcifications in the medial left hemithorax are unchanged. Again demonstrated are esophageal stent in situ, with slight narrowing at its mid-portion, as before, as well as right subclavian venous access device with tip likely at the cavo-atrial junction or high right atrium. [**2110-10-25**] CTA IMPRESSION: 1. No PE and no significant pericardial effusion. 2. Patchy airspace disease in the right lower lobe consistent with aspiration pneumonitis. 3. Study is otherwise overall unchanged since the recent study dated [**2110-9-25**]. Brief Hospital Course: 50 y/o F w/ h/o adenoid cystic carcinoma, GERD, PE, presented with aspiration pneumonitis in the setting of likely obstructed esophageal stent. # Aspiration PNA: Aspiration from obstructed esophageal stent in the setting of widely metastatic adenoid cystic carcinoma. Patient was maintained NPO and started on Ceftriaxone, Azithromycin, Flagyl for aspiration pneumonia. Given end-stage carcinoma and high likelihood of repeated aspiration events in the setting of esophageal obstruction and stent failure, goals of care were changed to comfort measures only after discussion with family on day 2 of admission. Patient received morphine for respiratory distress. # adenoid cystic carcinoma: Patient with known widely metastatic disease on admission; was home hospice but family reversed it 2 days prior to admission as the service was not helping the patient to be comfortable. Extensively discussed with patient and family about goals of care: they would like comfort care and minimal intervention to help make her comfortable. Patient was given morphine for pain and comfort. . # Code: DNR/DNI on admission, made comfort measures only on day 2 of admission. The patient died the following day from respiratory failure. . # FEN: The patient was maintained NPO during this hospital admission. . # Dispo: The patient died one day after decision to continue comfort measure care. Medications on Admission: Levoquin Codeine,couh suppresant Neurontin Fentanyl patch Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Aspiration Pneumonitis Esophageal Stent Occlusion Adenoid cystic carcinoma, metastatic Respiratory Failure Discharge Condition: Deceased Discharge Instructions: None Followup Instructions: None ICD9 Codes: 5070
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Medical Text: Admission Date: [**2178-12-9**] Discharge Date: [**2178-12-15**] Date of Birth: [**2105-4-19**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 425**] Chief Complaint: Ventricular tachycardia Major Surgical or Invasive Procedure: VT-ablation Arterial line placement and removal History of Present Illness: 73 yo M with nonischemic cardiomyopathy, ventricular tachycardia s/p VT ablation and AICD, who was admitted to [**Hospital 794**] Hospital for multiple AICD shocks on [**2178-12-6**], now transferred for repeat VT-ablation. . At [**Hospital 794**] Hospital, he was started on amiodarone and lidocaine drip, which decreased his heart rate. He then underwent a right-sided catheterization, which showed muliple vessel disease and had PCI to the LAD/LCx. The procedure was uncomplicated. This morning, patient again went into sustained monomorphic ventricular tachycardia. He was thus transferred to [**Hospital1 18**] for repeat VT-ablation. . Patient reports that when he has VT, he experiences palpitations, diaphoresis, and weakness. Recently, he had these symptoms at the end of [**Month (only) **] and was hospitalized at [**Hospital **] Hospital from [**10-19**] - 11/31, when he was treated with potassium and plan was to consider upgrading his ICD to biventricular pacing. He was discharged home and then had repeated symptoms on [**10-6**]. . Of note, patient had his ICD placed approximately 8 years ago, but had recurrent VTs. He underwent VT ablation by Dr. [**Last Name (STitle) **] in [**2172**] but continued to have VTs. He was then succesfully medically managed with amiodarone for 3 years, but had to stop due to hepatic toxicity. Since then, he has been shocked "more than 50 times", including one episode where he had an induced ICD firing, presumably for slow VT. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, or syncope. Past Medical History: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension 2. CARDIAC HISTORY: - CABG: none - PERCUTANEOUS CORONARY INTERVENTIONS: [**2179-10-7**] with 3 stents placed to LAD and LCx. - PACING/ICD: VT storm s/p AICD and ablation [**2179**] in [**Location (un) 86**] - Cardiomyopathy, EF 20% - Myocardial infarction in [**2154**] 3. OTHER PAST MEDICAL HISTORY: - COPD - Hypothyroidism - Abdominal aortic aneurysm repair with stent - Eczema - Multiple hemorrhoidectomies Social History: Patient lives alone. He is independent for all ADLs, continues to drive. - Tobacco history: ~75 pack year history, quit 7 years ago - ETOH: Occasional beer but used to drink heavily. - Illicit drugs: None Family History: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - Extensive history of cancers. Physical Exam: Physical exam on discharge: VS: <<<<<<<<<< >>>>>>>>> GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 6 cm CARDIAC: PMI located in 5th intercostal space, midclavicular line. Soft heart sounds, RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. ICD in left chest. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. No femoral bruits. Right post-cath side no hematoma, no bruits. SKIN: eczematous changes in finger nails and elbows PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Pertinent Results: 1. Labs on admission: [**2178-12-9**] 01:13AM BLOOD WBC-8.6 RBC-4.06* Hgb-12.3* Hct-35.5* MCV-88 MCH-30.2 MCHC-34.6 RDW-13.5 Plt Ct-262 [**2178-12-9**] 01:13AM BLOOD PT-12.6 PTT-26.3 INR(PT)-1.1 [**2178-12-9**] 01:13AM BLOOD Glucose-104* UreaN-23* Creat-0.9 Na-135 K-4.2 Cl-101 HCO3-23 AnGap-15 [**2178-12-9**] 01:13AM BLOOD ALT-12 AST-22 LD(LDH)-224 AlkPhos-98 TotBili-0.5 [**2178-12-9**] 01:13AM BLOOD Albumin-3.9 Calcium-9.2 Phos-3.3 Mg-2.1 [**2178-12-9**] 01:13AM BLOOD TSH-0.11* [**2178-12-9**] 01:13AM BLOOD Free T4-1.4 . 2. Labs on discharge: <<<<<<<<<<<< >>>>>>>>>> . 3. Imaging/diagnostics: - Echocardiogram ([**2178-12-9**]): The left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. There is moderate to severe regional left ventricular systolic dysfunction with near-akinesis of the distal [**11-23**] of the left ventricle and global hypokinesis in the remaining segments. A left ventricular mass/thrombus cannot be excluded. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Dilated left ventricular cardiomyopathy with near-akinesis of the distal [**11-23**] of the left ventricle and global hypokinesis in the remaining segments. Mild mitral regurgitation. . - CXR ([**2178-12-9**]): Heart is moderately enlarged, but there is no pulmonary edema or even vascular congestion and the hila are normal size. No pleural effusion or evidence of central adenopathy. Lungs clear. Transvenous right atrial pacer lead follows the expected course. A transvenous right ventricular pacer defibrillator lead ends closer to the midline than we generally see but cannot be more carefully localized without a lateral view. . - CXR ([**2178-12-10**]): ICD leads remain in standard position. Cardiomediastinal contours are unchanged. Lungs and pleural surfaces are clear. . Brief Hospital Course: 73 yo M with recurrent ventricular tachycardia despite ablation and AICD, cardiomyopathy, CAD s/p PCI, COPD, hypothyroidism, treated with dofetilide and repeat VT-ablation. . # Ventricular tachycardia: Pt admitted for initiation of dofetilide ggt which was maintained for 3 days eventually being decreased to 250mcg q12h. However, on HOD 2 he developed VT into the 140s, with sBP in the 110s-120s. Received lidocaine bolus, placed on gtt, and ativan. Broke after 5 minutes and did not require firing of ICD. He subsequently went for ventricular substrate ablation the following day (see report). After the procedure his antiarrhythmic therapy was changed to mexilitine 150mg q8h and quinidine was started at 324mg TID. Dofetalide was d/c'd. Of note When arterial sheath was being pulled, he became transiently hypotensive to 60s, got 1 amp of atropine and recovered. He remained hemodynamically stable for the remainder of admission, but was noted to have occasional runs of 20-40 beats of vtach during which he remained asymptomatic. He was discharged on mexilitine 150 TID and quinidine 324mg TID. . # Fever: Febrile to 102 on admission. Influenza swabs sent, came back positive. Patient remianed on droplet precautions. He remained afebrile throughout admission. . # Cardiomyopathy: Repeat echocardiogram here confirmed EF of 25-30%, with severe regional left ventricular systolic dysfunction, near-akinesis of distal [**11-23**] of the LV and global hypokinesis. He diuresed well and remained euvolemic on home dose 20 mg PO Lasix. . # CAD s/p stent: History of MI in [**2154**] with anteriolateral distribution on EKG, consistent with catheterization finding of LAD, LCX stenosis. Patient has been asymptomatic and cardiac enzymes at OSH were not elevated. Underwent uncomplicated catheterization with three stents placed in the LAD and LCX. Discharged on aspirin and plavix. . # Hypothyroid: TSH low at 0.11 (0.14 at OSH) and T4 appropriate at 1.4. Just started on new lower dose of levothyroxine 50 mcg three days ago so do not expect TSH to change dramatically. Kept on same dose. . # HTN: Currently normotensive on Carvedilol and Losartan. Increased carvedilol to 6.25 [**Hospital1 **]. . # HLD: Lipid panel at OSH showed good control on home medication of Cholestipol. Held during admission as was non-formulary. To be continued at discharge. Medications on Admission: -Synthroid 88mcg qd -Carvedilol 3.125 mg [**Hospital1 **] -Aspirin 325 mg qd -Losartan 25 mg qd -MAgnesium oxide 400mg [**Hospital1 **] -Klonopin 1.0 mg qd -Colestipol 1 mg [**Hospital1 **] -Lasix 20 mg po daily -Vitamin D Discharge Medications: 1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Tablet(s) 2. magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. clonazepam 1 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 5. carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO once a day. 8. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 9. mexiletine 150 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours). Disp:*90 Capsule(s)* Refills:*2* 10. quinidine gluconate 324 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q8H (every 8 hours). Disp:*90 Tablet Sustained Release(s)* Refills:*2* 11. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. cholestipol Sig: One (1) tab once a day. 13. Outpatient Lab Work Check Chem-10 for [**2178-12-22**]. Please fax results to: Dr. [**First Name (STitle) **] [**First Name (STitle) 49514**]: [**Telephone/Fax (1) 89952**] Discharge Disposition: Home Discharge Diagnosis: Primary: Ventricular Arrythmia Coronary Artery Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were seen in the hospital because of a persistent fast rhythm called ventricular tachycardia and because your ICD went off multiple times. You had a procedure called an ablation and the settings on your ICD/pacemaker were adjusted. You also had new stents placed in the arteries supplying blood to your heart. Because of this, YOU NEED TO TAKE PLAVIX EVERY DAY. DO NOT STOP PLAVIX FOR ANY REASON UNTIL YOU SPEAK WITH YOUR CARDIOLOGIST FIRST. . We made the following changes to your medications: STARTED Plavix 75 mg once a day STARTED Quinidine 324 mg 3 times a day STARTED Mexiletine 150 mg three times a day INCREASED Carvedilol to 6.25 mg [**Hospital1 **] Please note your follow up appointments below with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 49514**]. We have also include a prescription for bloodwork to be done [**2178-12-22**] with the results to be faxed to Dr. [**Last Name (STitle) 49514**]. It was a pleasure taking care you during your hospital stay. Followup Instructions: Please make an appointment to see your PCP in the next [**11-22**] weeks. Cardiology appointment with Dr. [**First Name (STitle) **] [**First Name (STitle) 49514**] [**2178-12-31**] at 2:15 PM [**Street Address(2) 85853**], [**Location (un) 796**], RI ([**Telephone/Fax (1) 85855**] Department: CARDIAC SERVICES When: FRIDAY [**2179-1-1**] at 1 PM With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], M.D. [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage ICD9 Codes: 4271, 4254, 2724, 4019, 412, 2449, 2859
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Medical Text: Admission Date: [**2193-10-18**] Discharge Date: [**2193-10-22**] Date of Birth: [**2112-3-5**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1481**] Chief Complaint: Hypoxia, nausea, vomiting, increased abdominal distention Major Surgical or Invasive Procedure: [**10-18**] Endotracheal intubation History of Present Illness: Mr. [**Known lastname 97639**] is a 81 year old male transferred to [**Hospital1 18**]-ED on [**10-18**] from his residence of [**Hospital3 2558**] via ambulance. While eating breakfast that morning he aspirated, desaturated to the 80's, and he was noted to have increased abdominal distention. Upon arrival to the ED he was intubated, sedated, a nasogasatric tube was placed with gastric contents which were dark red, guaiac positive. He has a past medical history of seizures, dementia, and depression. He was transferred to the intensive care unit and admitted to the surgical service for further management. Past Medical History: Past Medical History: Dementia Seizure disorder Depression Osteoarthritis IBS Vitamin B12 deficiency Past Surgical History: [**1-27**] ORIF Social History: Full time residence at Cooledge house facility; [**Location (un) 86**], MA Family History: Non-contributory Physical Exam: Upon admission: 100.6 109 144/55 30 91% on NRB Gen: Elderly male, tachypneic Eyes: Anicteric Neck: Supple Chest: Diffuse crackles and rhonchi CV: S1 S2, tachycardic Abd: Obsese, distended Rectal: Brown stool, guaiac positive MSK: No clubbing, cyanosis, or edema Skin: Warm, dry Neuro: Alert Pertinent Results: Admission: [**2193-10-18**] 10:50AM BLOOD WBC-24.7*# RBC-4.65 Hgb-15.6 Hct-47.4 MCV-102* MCH-33.5* MCHC-32.9 RDW-13.6 Plt Ct-306# [**2193-10-18**] 10:50AM BLOOD Neuts-70 Bands-19* Lymphs-8* Monos-3 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2193-10-18**] 10:50AM BLOOD Plt Ct-306# [**2193-10-18**] 12:33PM BLOOD PT-14.0* PTT-23.7 INR(PT)-1.2* [**2193-10-18**] 10:50AM BLOOD Glucose-269* UreaN-38* Creat-1.6* Na-144 K-4.9 Cl-101 HCO3-16* AnGap-32* [**2193-10-18**] 10:50AM BLOOD ALT-24 AST-31 CK(CPK)-47 AlkPhos-137* Amylase-103* TotBili-0.2 [**2193-10-18**] 10:50AM BLOOD Lipase-22 [**2193-10-18**] 10:50AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2193-10-18**] 10:50AM BLOOD Albumin-4.1 Calcium-9.0 Phos-4.8* Mg-2.2 [**2193-10-18**] 03:46PM BLOOD Phenoba-18.9 [**2193-10-18**] 01:13PM BLOOD Type-ART pO2-275* pCO2-47* pH-7.23* calTCO2-21 Base XS--7 Intubat-INTUBATED Vent-CONTROLLED [**2193-10-18**] 03:55PM BLOOD freeCa-1.06* Discharge: [**2193-10-22**] 07:05AM BLOOD WBC-12.0* RBC-3.30* Hgb-10.4* Hct-32.2* MCV-98 MCH-31.6 MCHC-32.4 RDW-13.4 Plt Ct-154 [**2193-10-22**] 07:05AM BLOOD Plt Ct-154 [**2193-10-22**] 07:05AM BLOOD Glucose-121* UreaN-10 Creat-1.2 Na-143 K-3.3 Cl-105 HCO3-25 AnGap-16 [**2193-10-22**] 07:05AM BLOOD Calcium-7.5* Phos-3.9 Mg-1.9 [**2193-10-20**] 03:22PM BLOOD Phenoba-18.7 [**2193-10-19**] 11:55AM BLOOD freeCa-1.14 RADIOLOGY Final Report CHEST PORT. LINE PLACEMENT [**2193-10-18**] 8:13 PM CHEST PORT. LINE PLACEMENT Reason: line placemnt [**Hospital 93**] MEDICAL CONDITION: 81 year old man with resp distress REASON FOR THIS EXAMINATION: line placemnt HISTORY: Line placement. One portable view at 20:55. Comparison with the previous study done earlier the same day. There is slight interval worsening of interstitial edema. The heart and mediastinal structures are unchanged. An endotracheal tube and nasogastric tube remain in place. A right subclavian catheter has been inserted and terminates at the level of the junction of the superior vena cava and right atrium. There is no other significant change. IMPRESSION: Interval worsening of interstitial edema. Right subclavian line placement as described. DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4392**] Approved: SUN [**2193-10-20**] 2:19 PM RADIOLOGY Final Report CT PELVIS W/O CONTRAST [**2193-10-18**] 12:05 PM CT ABDOMEN W/O CONTRAST; CT PELVIS W/O CONTRAST Reason: DARK BROWN MATERIAL FROM OGT, ASPIRATED, PROB UGIB, EVAL FOR MESENTERIC ISCHEMIA [**Hospital 93**] MEDICAL CONDITION: 81 year old man with dark brown material from OGT, aspirated, prob UGIB, ? mesenteic ischemia w/ lactate 9.6. REASON FOR THIS EXAMINATION: eval for mesenteric ischemia CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: 81-year-old male with dark brown material from OGT, aspiration. Question mesenteric ischemia. TECHNIQUE: Contiguous axial CT images of the abdomen and the pelvis were obtained without the administration of intravenous or oral contrast. COMPARISON: Abdominal radiograph taken approximately one hour earlier on the same day. FINDINGS: The evaluation of abdominal organs and major vessels are extremely limited due to lack of intravenous contrast [**Doctor Last Name 360**]. There is no evidence of free air or free fluid. Note is made of mildly dilated small bowel in the midabdomen with air-fluid level, measuring up to 3.1 cm. Transverse colon is somewhat prominent, measuring up to 7 cm, however, gas is seen down to the rectum. The limited evaluation of the abdominal organs demonstrates no focal liver lesion. The patient is status post cholecystectomy. Spleen, pancreas, and left adrenal gland are within normal limits. There is right adrenal mass with 6HU, representing adenoma. Kidneys are somewhat atrophic with large left renal cyst. There is no significant lymphadenopathy. PELVIS: There is no evidence of ascites. No free fluid or free air. In the visualized portion of the lung bases, note is made of bibasilar consolidations with small amount of effusion. There is no suspicious lytic or blastic lesion in skeletal structures. SI joints are fused due to degeneration. Multiplanar reformation images confirmed the above finding. IMPRESSION: 1. CT study for the evaluation of mesenteric vessels and abdominal organs for mesenteric ischemia without intravenous contrast. 2. Mildly dilated small bowel in the midabdomen measuring up to 3.5 cm with air-fluid level. 3. Bilateral renal cysts. Some of the small low density lesions on the right kidney are too small to characterize. 4. Right aderenal adenoma. 5. Bibasilar consolidations with small effusion. The wet read was provided to ED dashboard, and discussed with Dr. [**Last Name (STitle) **] in person immediately after the completion of the study. RADIOLOGY Final Report PORTABLE ABDOMEN [**2193-10-18**] 11:01 AM PORTABLE ABDOMEN Reason: evalf or acute process [**Hospital 93**] MEDICAL CONDITION: 81 year old man with resp distress REASON FOR THIS EXAMINATION: evalf or acute process INDICATION: 81-year-old man with respiratory distress. Evaluate for acute process. COMPARISON: None. FINDINGS: Single portable supine plain radiograph of the abdomen and pelvis was obtained. Air-filled dilated small and large bowel is identified. The small bowel measures up to approximately 3.9 cm in diameter. The large bowel measures approximately 8.4 cm in diameter. Air is seen to the mid descending colon. However, air is not definitively identified within the rectum. There is no evidence of free intraperitoneal air; however, the diaphragms are not visualized on this radiograph. An orthopedic screw is identified in the right femur. IMPRESSION: Moderately dilated air-filled small and large bowel without air definitively seen in the rectum. This may represent an ileus versus a low obstruction. Recommend CT for further evaluation. These findings were related to the ED via the wet read-board at approximately 12:20 p.m. on [**2193-10-18**]. RADIOLOGY Final Report CHEST (PORTABLE AP) [**2193-10-19**] 6:15 AM CHEST (PORTABLE AP) Reason: interval change [**Hospital 93**] MEDICAL CONDITION: 81 year old man with resp distress REASON FOR THIS EXAMINATION: interval change PORTABLE CHEST. History of respiratory distress. There are persistent bilateral pulmonary infiltrates, which most likely represent edema. The heart and mediastinal structures are unchanged. An endotracheal tube, nasogastric tube, and right subclavian catheter remain in place. Compared with the previous study, there is slight interval worsening at the bases. IMPRESSION: Bilateral pulmonary infiltrates consistent with edema. Slight interval worsening. DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4392**] Approved: SAT [**2193-10-19**] 2:42 PM [**2193-10-18**] 6:19 pm MRSA SCREEN Site: RECTAL Source: Rectal swab. **FINAL REPORT [**2193-10-20**]** MRSA SCREEN (Final [**2193-10-20**]): NO STAPHYLOCOCCUS AUREUS ISOLATED. [**2193-10-18**] 11:30 am SPUTUM Site: ENDOTRACHEAL **FINAL REPORT [**2193-10-20**]** GRAM STAIN (Final [**2193-10-18**]): THIS IS A CORRECTED REPORT [**2193-10-19**]. >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND CLUSTERS. 1+ (<1 per 1000X FIELD): YEAST(S). PREVIOUSLY REPORTED AS [**2193-10-18**]. >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM POSITIVE ROD(S). 2+ (1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S). 2+ (1-5 per 1000X FIELD): MULTIPLE ORGANISMS CONSISTENT WITH OROPHARYNGEAL FLORA. RESPIRATORY CULTURE (Final [**2193-10-20**]): MODERATE GROWTH OROPHARYNGEAL FLORA. [**2193-10-18**] 10:45 am BLOOD CULTURE AEROBIC BOTTLE (Pending): ANAEROBIC BOTTLE (Pending): [**2193-10-18**] 10:50 am BLOOD CULTURE AEROBIC BOTTLE (Pending): ANAEROBIC BOTTLE (Pending): [**2193-10-18**] 11:25 am URINE Site: CATHETER **FINAL REPORT [**2193-10-19**]** URINE CULTURE (Final [**2193-10-19**]): NO GROWTH. [**2193-10-18**] 6:20 pm MRSA SCREEN Site: NARIS (NARE) Source: Nasal swab. **FINAL REPORT [**2193-10-21**]** MRSA SCREEN (Final [**2193-10-21**]): No MRSA isolated. STAPH AUREUS COAG +. SPARSE GROWTH. Oxacillin sensitivity performed by agar screen. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | OXACILLIN------------- S Brief Hospital Course: Upon admission to the intensive care unit he was intubated, sedated, received intravenous hydration and bolussing for hypotension, intravenous proton pump inhibitor was started; nasogastric tube and foley catheter were placed. A central venous catheter was placed for optimal intravenous access. A CT scan demonstrated mildly dilated small bowel with air-fluid level, no free air, and bibasilar consolidations with small effusion. His white blood cell count was elevated to 24.7k, he was treated with broad spectrum antibiotics. He has a history of seizures and is stable on Phenobarbital, his level was therapeutic and his current dose was continued intravenously. His hematocrit on admission was 47.4, serial hematocrits were initiated with a downward trend, the lowest was his 26.9; his stools were guaiac positive, however he remained hemodynamically stable and did not require transfusions. On HD 2 his white blood cell count had decreased to 12.2k, he was successfully extubated, and he was without abdominal pain. On HD 3 he was oxygenating well on nasal cannula and remained afebrile. On HD 4 he was transferred to an in-patient nursing unit, his nasogastric tube was removed, and his diet was advanced. His antibiotics were discontinued secondary to his cultures being mixed oropharyngeal flora; blood cultures were pending at the time of discharge. He received a dose of Lasix after a chest x-ray demonstrated pulmonary congestion; his mental status was back to baseline being oriented to person and time. On HD 5 he remained afebrile, his white blood cell count was stable at 12.2k, his hematocrit was also stable at 32.2, he was tolerating a regular diet, and had regular bowel movements with flatus. On HD 5 he received another dose of Lasix and Potassium replacement; he was started back on his home medications with Potassium daily. His foley catheter remained in secondary to diuresis with Lasix. He still had bilateral lower extremitiy edema with improvement. He was requiring 2 liters nasal cannula to maintain his saturations above 94% with no respiratory distress. He was transferred back to his place of residence at the Cooledge house in good condition. He will continue on the proton pump inhibitor and will be followed by his PCP. Medications on Admission: Phenobarbitol Vitamin B12 Celexa MVI Imodium Bisocodyl Zyprexa Mirtazapine Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Syringe Sig: One (1) Injection twice a day: Until patient ambulating and/or mobile. 2. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Phenobarbital 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Olanzapine 7.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Multivitamins Tablet, Chewable Sig: One (1) Cap PO DAILY (Daily). 8. Mirtazapine 30 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 9. Loperamide 2 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for diarrhea. 10. Potassium Chloride 20 mEq Packet Sig: One (1) PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: Aspiration Discharge Condition: Good Discharge Instructions: Notify MD/NP/PA/RN at rehabilitation facility patient experience's: *Increased or persistent pain *Fever > 101.5 or chills *Nausea, vomiting, diarrhea, or increased abdominal distention *Inability to pass gas, stool, or urine *Change in mental status *Bright red blood from rectum *Shortness of breath or labored breathing *Any other symptoms concerning to you Followup Instructions: Follow-up with PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1007**] within 1-2 weeks of discharge from hospital, call [**Telephone/Fax (1) 10492**] for an appointment Completed by:[**2193-10-22**] ICD9 Codes: 5070, 5789, 311
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Medical Text: Admission Date: [**2139-12-19**] Discharge Date: [**2140-1-19**] Date of Birth: [**2139-12-19**] Sex: M Service: Neonatology HISTORY OF PRESENT ILLNESS: This is a 32 and [**2-14**] week gestation twin I admitted for prematurity. Maternal history was significant for being a 36-year-old gravida 1, para 0, woman with insulin-dependent diabetes mellitus for 12 years (currently on an insulin pump). Hemoglobin A1c during pregnancy was 5.8%. Mother also has [**Name (NI) 25670**] disease. Prenatal screens were O positive, antibody negative, hepatitis negative, Rubella immune, rapid plasma reagin was nonreactive, and group B strep status unknown. PREGNANCY HISTORY: In [**Last Name (un) 5153**] fertilization pregnancy with estimated date of delivery of [**2140-2-11**] for an estimated gestational age of 32 and 2/7 weeks. Dichorionic-diamniotic twin gestation with concordant growth and normal fetal surveys. The pregnancy was complicated by preterm contractions since [**64**] weeks, not requiring therapy or bed rest. Today, rupture of membranes 21 hours prior to delivery. Question of meconium stained amniotic fluid in twin I. Started on antibiotics for prophylactic antibiotic therapy. Betamethasone complete. Proceeded to cesarean section for decelerations in twin I. PRENATAL COURSE: Infant vigorous at delivery. Orally and nasally bulb suctioned and free-flow oxygen provided. Subsequently pink with mild retractions with free-flow oxygen. Apgar scores were 8 at one minute of age and 8 at five minutes of age. Transferred to the Neonatal Intensive Care Unit uneventfully. PHYSICAL EXAMINATION ON PRESENTATION: This was a well-appearing infant in no respiratory distress. Heart rate was 150, respiratory rate was 46, temperature was 98.1, oxygen saturation was 97% on room air. Blood pressure was 58/30, with a mean of 43. Birth weight was 1795 grams (50th percentile). Head circumference was 29 cm (25th percentile. Length was 45.5 cm (75th percentile). Head, eyes, ears, nose, and throat examination was normal with AFSF, nondysmorphic, palate was intact, neck and mouth were normal. No nasal flaring. Chest with mild retractions currently. Good bilateral breath sounds. No crackles. Cardiovascular was well perfused. A regular rate and rhythm. Femoral pulses were normal. Normal first heart sounds and second heart sounds. No murmurs. Abdominal examination revealed the abdomen was soft and nontender. No organomegaly. No masses. Bowel sounds were active. The anus was patent. Genitourinary revealed normal preterm male genitalia. Testes undescended bilaterally. Active, alert, and responsive to stimulation, tone normal. Moved all extremities symmetrically. Musculoskeletal examination revealed normal spine, limbs, hips, and clavicle. Dipstick was 48. IMPRESSION: This was a 32 and [**2-14**] week gestational twin I baby boy with sepsis risk factors based on preterm labor, prolonged rupture of membranes, unknown maternal group B strep status colonization status that was partially attenuated with intrapartum antibiotic therapy 20 hours prior to delivery, risk for hypoglycemia based on maternal insulin-dependent diabetes mellitus. The parent was followed in the maturity of respiratory drive, maintained vigilance for patent ductus arteriosus, followed dipsticks, and sepsis workup. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: 1. RESPIRATORY ISSUES: From a respiratory standpoint, the baby remained stable without any need for intubation or mechanical ventilation. On [**12-21**], however, there was noted some significant spells overnight, and caffeine was started to stabilize the respiratory drive. The baby remained on room air without any further significant spells. The caffeine was discontinued on [**1-1**], following which there was no significant apneic episodes. 2. CARDIOVASCULAR ISSUES: The patient's cardiovascular course was stable with no evidence of a murmur early in his Neonatal Intensive Care Unit course. There was no evidence of a hemodynamically significant patent ductus arteriosus in his early Neonatal Intensive Care Unit course. He continued to do well with good blood pressures and equal pulses throughout. 3. GASTROINTESTINAL ISSUES: The baby was started on initial total fluids of 80 cc/kg per day. Feedings were begun on day of life two with PE-20 and breast milk by PG. Feedings were advanced, and the infant was on full volume feeds within one week. The maximum calories on the feedings were up to 26 calories per ounce. This was weaned down to 24 calories per ounce. This was weaned to breast milk 24 calories per ounce as the baby continued to gain good weight and tolerate his oral intake. By the time of discharge, the infant had tolerated all his feeds by mouth for approximately 48 hours to 72 hours. 4. INFECTIOUS DISEASE ISSUES: An initial sepsis workup was unremarkable. Ampicillin and gentamicin were started and continued for 48 hours. The infant was started on a phototherapy for a brief period of hyperbilirubinemia. 5. DISCHARGE PLANNING ISSUES: (a) Hearing screens passed and car seat test passed. (b) Immunizations: Hepatitis given on [**1-2**]. 6. SOCIAL ISSUES: The parents demonstrated an excellent understanding of the baby's care and were ready to receive the baby at home on the day of discharge. 7. PRIMARY PEDIATRICIAN: Name of primary pediatrician is Dr. [**Last Name (STitle) 53119**] (telephone number [**Telephone/Fax (1) 43573**]). DISCHARGE DIAGNOSES: 1. Prematurity. 2. Mild respiratory distress. 3. Ruled out sepsis. Reviewed By: [**Doctor Last Name **] [**Last Name (NamePattern5) 36094**], M.D. [**MD Number(1) 36250**] Dictated By:[**Name8 (MD) 47147**] MEDQUIST36 D: [**2140-1-19**] 07:28 T: [**2140-1-19**] 07:39 JOB#: [**Job Number 53120**] ICD9 Codes: 7742, V290, V053
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Medical Text: Admission Date: [**2165-8-26**] Discharge Date: [**2165-9-3**] Date of Birth: [**2085-11-14**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Chest Pain, abnormal Stress Major Surgical or Invasive Procedure: [**2165-8-28**] Cardiac Cath [**2165-8-29**] Intra-aortic balloon pump insertion [**2165-8-29**] Coronary bypass grafting x 3 on intra-aortic balloon pump, urgent, with left internal mammary artery left anterior descending coronary; reverse saphenous vein single graft from aorta to first diagonal coronary artery; reverse saphenous vein single graft from aorta to posterior descending coronary artery History of Present Illness: 79 year old male with history of Hypertension, Diabetes (on insulin), Hyperlipidemia, reports acute Shortness of breath on exertion while down on [**Hospital3 **]. He woke up the next morning with tightness across the middle of his chest, without radiation, that lasted minutes and then resolved. He denies a history of angina or SOB but has noticed an increase in fatigue and lower extremity edema. Mr.[**Known lastname **] went to his PCP, [**Name10 (NameIs) 1023**] did an EKG and found normal sinus rhythm at 60 beats per minute, prolonged PR interval of 248 consistent with first-degree AV block, a right bundle-branch block and T-wave inversions primarily in leads III, T-wave flattening in aVF, T-wave inversions in V1 through V3 (not markedly changed from his prior EKG in [**2164-2-7**]). He was referred to the ED. In the ED he had 3 negative sets of CE, and was ordered for stress test given his ECG. MIBI grossly abnormal= 4 [**Last Name (LF) 1364**], [**First Name3 (LF) **] depressions, 1mm ST elevation, also had nuclear-- moderate reversible inferolateral wall with an inappropriate BP drop. Patient was sent to cath lab which revealed mutivessel coronary artery disease with significant Left Main stenosis. Dr.[**Last Name (STitle) 914**] was consulted for coronary revascularization. Past Medical History: Hypertension Type 2 diabetes mellitus Prostate cancer Spinal stenosis for which he received steroid injections Gout Past Surgical History: s/p Left Knee Social History: -Tobacco history: Denies any tobacco use -ETOH: Denies alcohol -Illicit drugs: None Family History: Father who passed away from MI at 60, otherwise noncontributory. Physical Exam: Pulse:SB-53 Resp: 16 O2 sat: 94% R/A B/P Right:147/61 Left: Height: Weight: General:A&Ox3 Skin: Dry [x] intact [] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM x[] Chest: Lungs clear bilaterally [CTA] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema Varicosities: None [x] Neuro: Grossly intact Pulses: Femoral Right: Left: DP Right:2+ Left:2+ PT [**Name (NI) 167**]: Left: Radial Right: Left: Carotid Bruit :none Right: 2+ Left:2+ Pertinent Results: [**2165-8-28**] Cardiac Cath: 1. Coronary angiography in this right dominant system demonstrated three vessel disease. The LMCA was calcified and had a 90% distal stenosis, which extended into the LAD, resulting in a 80% proximal stenosis. The Ramus intermedius had an 80% stenosis surrounded by aneurysmal dilatation. The LCx had a 90% stenosis at its origin. The OM2 was occluded. The RCA had a 70% distal stenosis. 2. Limited resting hemodynamics revealed mild systemic hypertension with an SBP of 143 mmHg and DBP 68 mmHg. [**2165-8-29**] Echo: PRE-BYPASS: The left atrium is moderately dilated. No spontaneous echo contrast is seen in the left atrial appendage. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The descending thoracic aorta is mildly dilated. There are three aortic valve leaflets. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. POST-BYPASS: For the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine and was being A paced. 1. Biventricular function is normal 2. Aortic contours appear intact post decannulation. 3. Other findings are unchanged [**2165-8-29**] Carotid U/S: Right ICA stenosis <40%. Left ICA stenosis <40%. [**2165-9-3**] 03:04AM BLOOD WBC-6.7 RBC-3.15* Hgb-10.3* Hct-29.2* MCV-93 MCH-32.6* MCHC-35.2* RDW-16.2* Plt Ct-165# [**2165-8-26**] 03:50PM BLOOD WBC-5.3 RBC-3.53* Hgb-12.1* Hct-34.1* MCV-97 MCH-34.2* MCHC-35.4* RDW-14.3 Plt Ct-155 [**2165-8-30**] 04:45AM BLOOD PT-13.4 PTT-29.2 INR(PT)-1.1 [**2165-8-26**] 03:50PM BLOOD PT-13.5* PTT-27.5 INR(PT)-1.2* [**2165-9-3**] 03:04AM BLOOD Glucose-99 UreaN-41* Creat-1.7* Na-140 K-3.7 Cl-100 HCO3-30 AnGap-14 [**2165-8-26**] 03:50PM BLOOD Glucose-111* UreaN-32* Creat-1.5* Na-137 K-4.1 Cl-102 HCO3-24 AnGap-15 Brief Hospital Course: On [**8-28**], during the night after his cardiac cath, Mr.[**Known lastname **] developed recurrent chest pain and ECG changes:*- new ST depressions in V2 - V4 which resolved when his chest pressure was relieved with SL Nitro and morphine. He was transferred to the CCU where he had an intra-aortic balloon pump placed as a bridge to surgery. On [**2165-8-29**], he was taken urgently to the operating room where he underwent coronary artery bypass graft x 3(Left internal Mammary artery grafted to Left anterior Descending/Saphenous vein grafted to Ramus/Posterior Descending Artery).Cross Clamp time= 51 minutes.Cardiopulmonary Bypass Time= 70 minutes. Please see Dr[**Last Name (STitle) 5305**] operative report for further details. Mr.[**Known lastname **] [**Last Name (Titles) 8337**] the procedure well and was transferred in critical but stable condition to the CVICU. The Intraortic balloon pump was removed on post-op day one. POD#2 he was weaned from sedation, awoke neurologically intact and extubated. Of note, his rhythm went into atrial fibrillation, treated medically optimizing Beta-Blocker, and it converted to sinus rhythm. All lines and drains were discontinued in a timely fashion. Mr.[**Known lastname **] continued to progress and was transferred to the telemetry floor for further care. Physical therapy consulted and evaluated him for strength and mobility. The remainder of his postoperative course was essentially uneventful. He was cleared by Dr.[**Last Name (STitle) 914**] for discharge to rehab on POD# 5, where he will have therapy to increase strength, enduranance, and activities of daily living. All follow up appointments were advised. Medications on Admission: Atenolol 50mg daily, Hydrochlorothiazide 12.5mg daily, Lantus 80-100 units daily, Humalog 30 units three times a day, Lisinoprol 80mg daily, Flomax 0.4mg daily, Aspirin 81mg daily, Multivitamin daily, Omego 3 fatty acids Discharge Medications: 1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 2. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours). 7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 8. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for temp. 10. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 11. Insulin Lispro 100 unit/mL Solution Sig: One (1) Subcutaneous As directed. 12. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). 13. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 14. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital 11851**] Healthcare - [**Location (un) 620**] Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3 Hypertension Type 2 diabetes mellitus Prostate cancer Spinal stenosis for which he received steroid injections Past Surgical History: s/p Left Knee Discharge Condition: Good Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. In the event that you have drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 1504**]. 2) Report any fever greater then 100.5. 3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) No lotions, creams or powders to incision until it has healed. You may shower and wash incision. Gently pat the wound dry. Please shower daily. No bathing or swimming for 1 month. Use sunscreen on incision if exposed to sun. 5) No lifting greater then 10 pounds for 10 weeks from date of surgery. 6) No driving for 1 month or while taking narcotics for pain. 7) Call with any questions or concerns. Followup Instructions: [**Hospital Ward Name 121**] 6 in 2 weeks for wound check Dr. [**Last Name (STitle) 914**] in 4 weeks, [**Telephone/Fax (1) **], please call for an appointment Dr. [**First Name (STitle) 216**] in [**2-8**] weeks Cardiologist in [**3-12**] weeks Completed by:[**2165-9-3**] ICD9 Codes: 2724, 2749, 5859, 2859
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Medical Text: Admission Date: [**2103-12-16**] Discharge Date: [**2103-12-21**] Date of Birth: [**2047-1-31**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2641**] Chief Complaint: seizures Major Surgical or Invasive Procedure: none History of Present Illness: 56 yo M with PMH of alcohol abuse and alcohol withdrawal seizures who presents s/p seizures at home. Patient is Spanish speaking only so most of history obtained from his wife and some from patient as well. . Patient says he drinks vodka but says he last drink was Monday (6 days prior to presentation). His wife confirms she believes this is true. She reports that she came home from work yesterday and the patient had a black eye on the right which he told her was from a fall. He also may have vomited yesterday although this history is not clear. Then today she and her daughter witnessed him seizing. Whole body shaking with all limbs moving. No loss of bowel or bladder continence. Lasted about one min then stopped. Then started again for another min. She reports he was confused and did not know who she was afterwards. She called EMS to bring him to the ED. She reports he had this about 6 months ago and was told it was from alcohol use. She also reports that he has not been eating well secondary to his esophageal stricture which was recently dilated by GI here. . In the ED, his initial vital signs were T 98.7, BP 131/80, HR 86, RR 18, O2sat 100% RA. He was given potassium, magnesium, banana bag and ativan per CIWA scale (about 6-8mg total). Neurology was consulted in the ED as well. He had a trauma work up for CT c-spine, head and maxillary/mandible all of which were negative for fracture. CXR was unchanged with no acute process. He was sent to the ICU for further care. Past Medical History: -ETOH abuse c/b withdrawal seizures -Chronic liver disease c/b pancytopenia-f/up unclear -esophageal stricture recently dilated by Dr. [**Last Name (STitle) 174**] [**Name (STitle) 31040**] c/b pneumothoraces in [**2094**]. He completed antibiotic regimen per notes. Social History: The patient immigrated from [**Country 7192**] in [**2078**]. Married with daughters. Smokes cigars. Drinks at vodka per him and his wife, at least a pint a day. Prior notes comment on rum as well. Family History: unknown Physical Exam: General: thin, malnurished male in NAD, but tremulous. Not diaphoretic. HEENT: Has hematoma and ecchymosis over right eye which is shut. PERRL, anicteric sclera. non-injected conjunctiva. OP clear but dry MM CV: RRR soft 1/6 SEM but distant heart sounds Lungs: CTAB no w/r/r Abdomen: +BS, soft, NTND Ext: no e/c/c Neuro: difficult to assess given language difficulty. Strength seems full throughout. no neck tenderness with FROM. +asterixis. Toes mute. Reflexes in tact. Pertinent Results: [**2103-12-16**] 10:09AM BLOOD WBC-6.9 RBC-3.71* Hgb-12.7* Hct-36.2* MCV-97 MCH-34.1* MCHC-35.0 RDW-12.7 Plt Ct-114* [**2103-12-16**] 10:09AM BLOOD Neuts-70.8* Lymphs-22.9 Monos-5.6 Eos-0.2 Baso-0.5 [**2103-12-18**] 03:21AM BLOOD PT-13.4 PTT-48.8* INR(PT)-1.2* [**2103-12-16**] 10:09AM BLOOD Glucose-169* UreaN-9 Creat-0.6 Na-137 K-2.7* Cl-89* HCO3-35* AnGap-16 [**2103-12-16**] 10:09AM BLOOD ALT-21 AST-70* LD(LDH)-329* CK(CPK)-219* AlkPhos-124* TotBili-2.2* [**2103-12-16**] 10:09AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG . Head CT [**2103-12-16**]: The study is limited due to motion artifact. There is no intracranial mass lesion, hydrocephalus, shift of normally midline structures, major vascular territorial infarct, or intracranial hemorrhage. The [**Doctor Last Name 352**]-white matter differentiation is preserved. The study is limited due to motion artifact for the evaluation of the orbits; however, no displaced fracture is identified. There is a large right periorbital hematoma. The ocular globes appear intact. . CT Mandible, Sinus [**2103-12-16**]: The cribriform plate appears intact. The nasal septum is mildly deviated to the right. There is a small air-fluid level in the right maxillary sinus. No acute fracture is identified. Right periorbital soft tissue hematoma is seen. . CT C-Spine [**2103-12-16**]: There is no prevertebral soft tissue swelling. The alignment is maintained without spondylolisthesis. No acute fracture is identified. The odontoid process is intact. Multilevel degenerative changes, worse at the level of C5-6 and C6-7. The visualized lung apices demonstrate a left apical bleb. Bilateral apical pleural thickening. The visualized paranasal sinuses demonstrate minimal opacification of the right maxillary sinus. Soft tissue density in both external auditory canals may represent cerumen. Clinical correlation is recommended. . Chest X-ray [**2103-12-16**]: 1. Small nodular opacities within the left mid lung field, which were present on the previous chest CT, may be slightly improved. Findings may represent small airways infection or aspiration. 2. Post-surgical changes, right lung. . Barium Swallow [**2103-12-21**] (preliminary read): No esophageal diverticulum seen. Narrowing of distal esophagus with holdup of 13 mm barium tablet, without holdup of barium. No dysmotility or reflux seen. . Pending studies at the time of discharge: Final read of Barium swallow study Brief Hospital Course: 1. SEIZURES Mr. [**Known lastname **] was admitted to the MICU after having 2 witnessed seizures in the setting of alcohol withdrawal. He said that it had been 6 days since his last drink and had a history of seizures 6 months prior in the setting of alcohol withdrawal. His ETOH level was negative on tox screen. Neurology was consulted in the ED and recommended and outpatient EEG. He was put on a CIWA protocol and given Diazepam PO to treat his withdrawal. He required IV Ativan initially to control his symptoms but then was given PO Diazepam. His withdrawal sytmptoms were controlled and he had no witness seizures during this hospital stay. He was given thiamine, folate and a multivitamin and was put on a PPI. He was transferred to the medicine floor on [**2103-12-19**]. He continued to have no seizures for the remainder of his hospital course. He was scheduled for outpatient neurology follow-up and will be called by the EEG lab regarding scheduling of an outpatient EEG. . 2. ALCOHOL ABUSE Mr. [**Known lastname **] was given IV Ativan initially for withdrawal and this was later changed to PO Diazepam. He required no further benzodiazepines after [**2103-12-19**]. He was seen by the addiction social worker who suggested inpatient rehab program but he preferred to seek help at outpatient treatment centers and was given a list of programs prior to discharge. He was advised not to drink alcohol. His liver function tests were normal through his hospital course. . 3. DYSPHAGIA Mr. [**Known lastname **] had a history of dysphagia and prior EGDs with dilation. Several prior biopsies had shown no evidence of cancer. On admission he stated that he had dysphagia to thick meats such as steak. He was evaluated by a barium swallow study which showed hold-up of a 13mm barium tablet but no hold-up of the liquid barium and no diverticulum. His outpatient gastroenterologist, Dr. [**Last Name (STitle) 174**] was contact[**Name (NI) **] and suggested outpatient follow-up for this problem with another EGD and possibe sugerical referral in the future. Mr. [**Known lastname **] was given an appointment to see Dr. [**Last Name (STitle) 174**] in [**Month (only) 404**]. He was evaluated by speech and swallow who stated that he had no difficulty in swallowing above the epiglottis. He was advised not to eat steak and to seek medical attension if he had pain with swallowing or the feeling of food getting stuck in his throat. He was advised to seek medical attention if he could not maintain his weight properly with foods. . 4. PROPHYLAXIS Mr. [**Known lastname **] was put on SC heparin for DVT prophylaxis, a PPI and a bowel regimen during his hospital course. He was given a prescription for a PPI as an outpatient. . Prior to discharge, Mr. [**Known lastname **] was evaluated by PT who recommended outpatient PT for [**2-25**] more days and ambulation with a cane, as the patient was not entirely steady on his feet. Medications on Admission: none Discharge Medications: 1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. 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:*0* 5. Outpatient Physical Therapy Diagnosis: Alcohol Withdrawal, ambulate with LRAD, 1-2 visits Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: 1. Alcohol Withdrawal Seizures . Secondary Diagnoses: 2. Dysphagia 3. Alcohol Abuse 4. Fatty Liver Disease Discharge Condition: afebrile, hemodynamically stable Discharge Instructions: You were admitted to the hospital with seizures in the setting of alcohol withdrawal. You were given benzodiazepines to treat your withdrawal symptoms. Your symptoms improved and you did not require benzodiazepines any longer prior to discharge. You were evaluated by neurology for your seizures who felt that they were due to alcohol withdrawal and you should have outpatient follow-up. You had an x-ray to evaluate your esophagus during this admission. . You were started on a multivitamin, thiamine and folate during this admission. You should continue to take these at home and can buy them over-the-counter. You should take also take a proton-pump inhibitor. . You had an esophageal barium swallow study to evaluate your dysphagia. You should follow-up with Dr. [**Last Name (STitle) 174**] for this as described below. . You should follow-up with Neurology with an EEG and appointment with Dr. [**Last Name (STitle) 2340**] as described below. The EEG will be scheduled by Neurology and they will contact you on monday to schedule this. You should follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] regarding treatment for your alcoholism and further care. You were provided with phone numbers for outpatient substance abuse treatment centers on discharge. . You should call your doctor or come to the emergency room for any fevers > 100.4, chills, night sweats, seizures, weakness or numbness in any parts of your body, severe headache, vision changes, vomiting, abdominal pain or any other symptoms that concern you. Please call Dr.[**Name (NI) 31041**] office if you have any difficulty swallowing or feeling of food getting stuck in your throat. Followup Instructions: Provider: [**Name10 (NameIs) 1382**] [**Name11 (NameIs) 1383**], MD Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2103-12-31**] 10:30 Provider: [**Name10 (NameIs) **] [**Last Name (STitle) **] & DR [**Last Name (STitle) 8618**] Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2104-1-16**] 2:00 . Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 174**] (Gastroenterology) [**2103-1-27**] at 1:45pm. Rhabb building [**Location (un) 453**]. [**Telephone/Fax (1) 463**] ICD9 Codes: 2875
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Medical Text: Admission Date: [**2128-10-30**] Discharge Date: [**2128-11-16**] Date of Birth: [**2076-2-29**] Sex: F Service: Surgery, Purple Team HISTORY OF PRESENT ILLNESS: The patient is a 52-year-old female, status post right cephalic vein port placement and laparoscopic-assisted jejunostomy tube placement on [**2128-10-29**]. The patient presented on [**2128-10-30**] with nausea, vomiting, and abdominal pain. The pain was described as being in the midabdomen and occurs in waves. The pain began last night. It was only somewhat relieved by Roxicet. PAST MEDICAL HISTORY: Past medical history is significant for esophageal cancer which was diagnosed approximately two weeks prior. PAST SURGICAL HISTORY: Past surgical history as described above. MEDICATIONS ON DISCHARGE: Medications included Prevacid, Roxicet, multivitamin, and calcium. FAMILY HISTORY: Family history is significant for a mom with ovarian cancer. PHYSICAL EXAMINATION ON PRESENTATION: On examination, the patient was noted to have a temperature of 98.9, pulse was 76, blood pressure was 148/70, respiratory rate was 16, and was saturating 98% on room air. She appeared to be in discomfort and nauseated. Her head, eyes, ears, nose, and throat examination was significant for extraocular movements which were intact. Pupils were equal, round, and reactive to light and accommodation. There was no icterus demonstrated. The oropharynx demonstrated mucous membranes were dry. She was clear to auscultation bilaterally. Heart rate was regular in rate and rhythm without any associated murmurs, rubs, or heart sounds. Her abdomen was distended, tympanitic, with percussion tenderness near the incision. Bowel sounds were hypoactive. Extremities had trace edema bilaterally. PERTINENT LABORATORY DATA ON PRESENTATION: Laboratories obtained at the time indicated white blood cell count was 8.5, hematocrit was 51.3, platelets were 508. Her Chemistry-7 demonstrated sodium was 138, potassium was 4.2, chloride was 98, bicarbonate was 29, blood urea nitrogen was 13, creatinine was 0.6, and blood glucose was 112. Her liver function tests were normal. RADIOLOGY/IMAGING: A KUB obtained in the Emergency Room indicated free air consistent with her laparoscopic operation. It also demonstrated gastric dilatation and one small air/fluid level in the midabdomen. HOSPITAL COURSE: The patient was admitted to the Purple Surgery Service and treated with antiemetics, and medication, as well as intravenous hydration for possible postoperative ileus. On hospital day two, she was noted to have increasing amounts of gastric dilatation and increasing amounts of discomfort, starting at approximately 11 o'clock that afternoon. She was subsequently taken to the operating room for re-exploration and revision of her jejunostomy tube placement. Please see the Operative Note per Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **] for details of this operation. Notably, during the course of this operation her course was complicated by a aspiration upon anesthesia induction. Approximately 2 liters of gastric content was estimated to have entered the lungs and was rapidly suctioned out; however, attempts at extubation failed, and the patient was ultimately transferred to the Intensive Care Unit with a presumed diagnosis of acute respiratory distress syndrome secondary to her aspiration. On [**2128-10-31**], the patient was maintained intubated in the Intensive Care Unit. On postoperative day one, the patient was converted to a prone position in the Intensive Care Unit to help improve her respiratory status. This gradually improved. The patient was returned to a supine position on postoperative day two. She was gradually weaned from the ventilator over the next several days until she was extubated on postoperative day eight. On postoperative day seven, Pseudomonas pneumonia was grown from her tracheal tube. She was started on ceftazidime and Zosyn that was ultimately converted from Zosyn to ciprofloxacin. Tube feeds were started on postoperative day eight and were brought to goal by postoperative day thirteen. The patient was transferred to the floor on [**2128-11-12**]. Just prior to discharge to the floor, it was noted that she had swelling in her right arm. An ultrasound was undertaken to rule out deep venous thrombosis. A thrombus was seen within the distal jugular vein; consistent with deep venous thrombosis from the right brachial vein to the subclavian. The patient was started on a heparin drip at that time, and over the next several days was converted toward Coumadin. At the time of discharge, however, she was not therapeutic on the Coumadin; potentially from interference from the antibiotics she was on, so the patient was ultimately discharged on Lovenox. On the final day of the patient's admission, her port was accessed. She was discharged home on tube feeds at 120 cc per hour times 15 hours. She was given oxygen therapy; predominately because of anxiety that she was dealing with over feelings of air hunger. She was also given Lovenox injections. All of this was accomplished through the aid of a visiting nurse who was going to help the patient with delivery of medications, the Lovenox injections, and the tube feeds, as well as assisting with monitoring Coumadin in concert with the local physician. CONDITION AT DISCHARGE: Condition on discharge was stable. DISCHARGE STATUS: Discharge status was to home. DISCHARGE DIAGNOSES: 1. Esophageal cancer. 2. Status post jejunostomy tube placement and port placement complicated by small-bowel obstruction requiring re-exploration and jejunostomy tube revision, complicated by acute respiratory distress syndrome subsequent to aspiration. MEDICATIONS ON DISCHARGE: (Discharge medications included) 1. Enoxaparin sodium 60 mg subcutaneously q.12h. 2. Warfarin 5 mg q.d. (crushed and given per jejunostomy tube) 3. Roxicet elixir 5 cc to 10 cc per jejunostomy tube q.4-6h. as needed. 4. Ranitidine 150 mg per jejunostomy tube (as an elixir). 5. Sertraline HCl 50 mg per jejunostomy tube q.d. 6. Colace elixir 100 mg per jejunostomy tube b.i.d. 7. Albuterol 4 puffs inhaled q.4-6h. as needed. 8. Tube feeds were also given with Impact full strength with fiber at 120 cc per hour. DISCHARGE DISPOSITION/INSTRUCTIONS: Dressing changes were to be done every day on the jejunostomy tube site per [**Hospital6 407**]. An oxygen tank was also to be provided to the patient. At the time of discharge, the patient was again receiving tube feeds at the above-mentioned rates over the above-mentioned times and was tolerating this without problems. She was also taking full liquids at the time of discharge. DISCHARGE FOLLOWUP: Follow-up plans included seeing Dr. [**Last Name (STitle) **] in approximately one to two weeks. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 6066**] Dictated By:[**Last Name (NamePattern1) 1752**] MEDQUIST36 D: [**2128-11-16**] 16:49 T: [**2128-11-16**] 15:41 JOB#: [**Job Number 22150**] ICD9 Codes: 5070
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Medical Text: Admission Date: [**2122-1-16**] Discharge Date: Date of Birth: [**2122-1-16**] Sex: M Service: NEONATALOG HISTORY OF PRESENT ILLNESS: [**First Name5 (NamePattern1) 3613**] [**Last Name (NamePattern1) 52868**] is the former 3.785 kilogram product of a 41 week gestation pregnancy born to a 35-year-old G1, P0, now P1 mother. Prenatal screens were unremarkable except for a positive group beta-strep status. Antepartum course was unremarkable. There was an echogenic focus seen on a prenatal ultrasound in the cardiac region and alpha fetal protein was within normal limits. Rupture of membranes occurred on the day of delivery. The mother was taken to cesarean section for a nonreassuring fetal heart rate tracing. The infant emerged vigorous with Apgars of 9 at 1 minute and 9 at 5 minutes. He was admitted to the Neonatal Intensive Care Unit for a sepsis evaluation with less than four hours of treatment prior to delivery. PHYSICAL EXAM ON ADMISSION TO THE NEONATAL INTENSIVE CARE UNIT: Weight 3.785 cubic grams, length 21 inches, head circumference 35.5 cm. General: Non-dysmorphic infant with mild respiratory distress. Oxygen saturation less than 90% in room air. Head, eyes, ears, nose and throat: Anterior fontanel open and flat, symmetric facial features, palate intact, nares grossly patent, neck supple. Lungs: Clear and equal bilaterally. Good chest excursion. Cardiovascular: Grade 2/6 systolic ejection murmur, audible along left sternal border. Pulses equal throughout. Abdomen: Soft, nontender, nondistended, no masses. Genitourinary: Descended testes bilaterally, normal male genitalia. Anus patent. Spine straight. Normal sacrum. Extremities: Moving all, hips stable. HOSPITAL COURSE: By systems including pertinent laboratory data: 1. Respiratory: [**Doctor First Name 3613**] required nasal cannula O2 through the first 36 hours of life. He has been on room air since 9 p.m. on [**2122-1-17**]. His tachypnea resolved. At the time of transfer, he is breathing comfortably in the 30s and 40s with oxygen saturation greater than 94%. 2. Cardiovascular: Due to the murmur and the prenatally identified echogenic cardiac focus, [**Doctor First Name 3613**] had a cardiac evaluation. Four limb blood pressures were within normal limits. He passed a hyperoxia test. An electrocardiogram was normal. The murmur resolved within 24 hours and is not audible at the time of transfer. 3. Fluid, electrolytes and nutrition: Due to his respiratory distress, [**Doctor First Name 3613**] was initially NPO. Enteral feeds were started on day of life one and he has been ad lib, feeding and breast feeding. Weight on the day of transfer is 3.68 kilograms. 4. Infectious Disease: Due to the unknown etiology of the respiratory distress, and the less than four hour antepartum prophylaxis for group beta strep, [**Doctor First Name 3613**] was evaluated for sepsis. A white blood cell count was 13,500 with a differential of 46% polys, 4% bands. Intravenous ampicillin and gentamicin were started. Cultures were no growth at 47 hours with the intention to discontinue the antibiotics at 48 hours if the culture remained negative. 5. Hematology: Hematocrit at birth was 48.8%. 6. Neurology: [**Doctor First Name 3613**] has maintained a normal neurological exam and there were no neurological concerns at the time of transfer. 7. Sensory/audiology: Hearing screening has not yet been performed. CONDITION OF DISCHARGE: Good. DISCHARGE STATUS: Transfer to the Newborn Nursery. The primary pediatrician is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Hospital3 43346**], [**Location 4288**], [**Numeric Identifier 52869**]. Phone number is [**Telephone/Fax (1) 40499**]. CARE RECOMMENDATIONS AT THE TIME OF DISCHARGE: 1. Feeding ad lib, breast feeding. 2. No medications with expected discontinuation of the ampicillin and gentamicin within the hour. 3. State newborn screen: Not as yet sent and no immunizations administered thus far. 4. Hearing screen prior to discharge to home. DISCHARGE DIAGNOSES: 1. Respiratory distress, secondary to retained fetal lung fluid and resulting transient tachypnea of the newborn. 2. Suspicion for sepsis ruled out. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 37237**], M.D. [**MD Number(1) 37238**] Dictated By:[**Last Name (un) 52870**] MEDQUIST36 D: [**2122-1-18**] 01:27 T: [**2122-1-18**] 13:42 JOB#: [**Job Number 52871**] ICD9 Codes: V053, V290
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Medical Text: Admission Date: [**2131-1-11**] Discharge Date: [**2131-1-23**] Date of Birth: [**2079-2-3**] Sex: M Service: [**Hospital1 3253**] CHIEF COMPLAINT: Hematemesis. HISTORY OF PRESENT ILLNESS: The patient is a 51 year old male with hep C cirrhosis, HIV, former IV drug user, who presents with one week of nausea, fatigue, progressive lightheadedness, culminating in progressively frequent black tarry stools. Over the last eight hours prior to admission had multiple episodes of emesis with clots, bright red blood, bilious material. Denies overt retching, but states he filled a quart container with dark blood, followed by an episode of bilious emesis. Increased lethargy, dark stools. Came to the emergency department for evaluation. In the E.D. his vitals were temperature 98, blood pressure 101/48, respiratory rate 12. He received two units of packed red blood cells and 3 liters of normal saline. In the emergency department he continued to vomit times three, filling urinal basins with blood. NG lavage did not clear after 250 cc of saline. PAST MEDICAL HISTORY: Hepatitis C. Portal hypertension gastropathy. Last EGD in [**2130-6-7**]. History of GI bleed in the past likely secondary to portal gastropathy and [**Doctor First Name **]-[**Doctor Last Name **] tear. HIV diagnosed in [**2120**]. Was on HAART. Last CD4 count was 300, viral load 1000. RPR positive. Type 2 diabetes mellitus. MEDICATIONS ON ADMISSION: Combivir 50 mg p.o. b.i.d., Kaletra 3 mg p.o. b.i.d., Aldactone 50 mg p.o. q.day, glyburide, lactulose 30 cc p.o. t.i.d. ALLERGIES: No known drug allergies. SOCIAL HISTORY: He is married with two children. Prior heroin and cocaine IV drug use. Remote tobacco use. No alcohol. PHYSICAL EXAMINATION: On admission temperature 96.4, pulse 98, blood pressure 126/64, respiratory rate 20, O2 sat 100% in room air. In general, drowsy, arousable. HEENT exam: pupils equal, round and reactive to light and accommodation. Mucous membranes moist. Neck flat JVP, supple. Cardiovascular exam regular rate and rhythm, normal S1, S2, 2/6 systolic ejection murmur left upper sternal border. Lungs clear to auscultation bilaterally. Abdomen soft, nondistended, nontender. Some mild epigastric fullness. Extremities trace pedal edema, dry and cool. Neurological exam cranial nerves II-XII intact, alert and oriented times three times three. Skin no palmar erythema, no visible open lesions. LABORATORY DATA: On admission [**Known lastname **] blood count 6.9, hematocrit 19, platelets 84. Sodium 122, potassium 6.8, BUN 33, creatinine 1.2, chloride 97, bicarbonate 21, glucose 87. PT 24, INR 3.7. Blood gas pH 7.42, bicarb 26, PO2 104. EKG normal sinus rhythm at 96, normal axis and intervals, [**Street Address(2) 4793**] depressions in 2, 3 and aVF, 1/[**Street Address(2) 1766**] depressions in V4 through V6, 1/[**Street Address(2) 1766**] elevation in aVR. Chest x-ray no infiltrates, no effusion. Right subclavian sitting in left brachycephalic vein. Small right apical pneumothorax. IMPRESSION: The patient is a 51 year old male with hep C cirrhosis who presents with upper GI bleed. HOSPITAL COURSE: 1. GI. Patient was typed and crossed for four units and was transfused in the MICU, given octreotide and Protonix IV. Was given FFP and vitamin K. Esophagogastroduodenoscopy was performed by the gastroenterology service which showed three lesions (1) [**Doctor First Name **]-[**Doctor Last Name **] tear; (2) esophageal ulcers secondary to candidiasis; (3) portal gastropathy. Patient was kept NPO for three days and no further evidence of bleeding with no intervention done on EGD. Clear liquids were started and were advanced slowly to a house diet with low protein. Patient's hematocrit gradually climbed to the 33 to 35 range where it remained stable. One further episode of melena occurred one day after discharge from the medical intensive care unit. However, hematocrit was stable and there was no further melena and only small amounts of trace bright red blood from the rectum with bowel movements. 2. Liver. Patient initially had asterixis on admission. Was given lactulose to titrate to bowel movements three to four per day and had improvement in his mental status as well as his asterixis. On discharge patient is continuing on two to three times a day of lactulose and no longer has any asterixis and his mental status has improved significantly. 3. Infectious disease. HIV was initially on HAART. Will be holding this while an inpatient secondary to GI irritation. However, he will be restarted on these medications prior to discharge. There was evidence also of a urinary tract infection secondary to the Foley catheter. The organisms that grew out were Enterococcus, staph aureus. Patient was started on Levaquin and dicloxacillin. Chest x-ray showed some evidence of atelectasis versus pneumonia and patient was continued on Levaquin for this as well. 4. Pulmonary. During central line placement there was a small pneumothorax for which a Heimlich valve was placed, reducing the pneumothorax. However, there was a significant amount of output initially from the Heimlich valve. The fluid was sent for gram stain and culture as well as labs which showed that this was likely an exudative pleural effusion and there was no evidence of infection. The Heimlich valve was pulled and the pneumothorax completely resolved and there was no evidence of reaccumulating pleural effusion or further infection. 5. Cardiovascular. In the setting of the hematocrit drop down to 19, there was a small troponin leak to 2.2, indicating likely subendocardial ischemia or possibly small infarct. However, this was a peak of the troponin and there was no further evidence of acute ischemia. Echocardiogram was performed and showed normal EF and no focal wall motion abnormalities. Patient was started on Lopressor 12.5 mg p.o. b.i.d. for beta blockade peri-MI. 6. Heme. Patient's hematocrit continued to hold stable in the low to mid-30s. Platelets remained in the range of 30 to 40. Likely the thrombocytopenia is due to HIV, however, there is likely some component of cirrhosis related thrombocytopenia as well as low grade DIC. There was no further evidence of bleeding and no platelets were transfused. DISCHARGE DIAGNOSES: 1. Upper GI bleed secondary to [**Doctor First Name **]-[**Doctor Last Name **] tear, esophageal ulcerations, portal gastropathy. 2. HIV. 3. Hep C. 4. Subendocardial MI. 5. Pneumothorax secondary to line placement. 6. Thrombocytopenia. CONDITION ON DISCHARGE: Fair. Patient has been seen by physical therapy and walked, however, it seems there is a significant amount of deconditioning secondary to the hospital stay and patient would benefit from a short stay in acute rehab for improvement of mobility. DISCHARGE MEDICATIONS: 1. Pantoprazole 40 mg p.o. b.i.d. 2. Bumex 1 mg p.o. q.day. 3. Lopressor 12.5 mg p.o. b.i.d. 4. Levaquin 500 mg p.o. q.day. Course to finish on [**2131-1-24**]. 5. Dicloxacillin 250 mg p.o. q.six hours. Course to finish on [**2131-1-28**]. 6. Simethicone 80 mg p.o. q.i.d. p.r.n. 7. Oxycodone 5 mg p.o. q.four to six hours p.r.n. 8. Ursodiol 300 mg p.o. b.i.d. 9. Lactulose 30 cc p.o. q.i.d., titrate to three to four bowel movements per day. 10. Guaifenesin 5 to 10 cc p.o. q.six hours p.r.n. 11. Fluconazole 200 mg p.o. q.day. 12. Nystatin oral suspension 5 cc p.o. q.i.d. 13. Insulin sliding scale. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10621**], M.D. [**MD Number(1) 10622**] Dictated By:[**Doctor Last Name 9869**] MEDQUIST36 D: [**2131-1-21**] 09:38 T: [**2131-1-21**] 09:29 JOB#: [**Job Number **] ICD9 Codes: 5715
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Medical Text: Admission Date: [**2171-3-15**] Discharge Date: [**2171-3-22**] Service: GENERAL HISTORY OF THE PRESENT ILLNESS: The patient is a 74-year-old female with a history of type 2 diabetes mellitus, hypothyroidism, and asthma. The patient was transferred from [**Hospital3 2558**] for evaluation of right-sided abdominal pain. On [**2171-3-13**], the patient had a fever of 101.8. At that time she complained of right upper quadrant abdominal pain for a couple of days. She stated that the pain was only when she moved, not at rest and it was a dull, aching, constant pain, which was nonradiating. There was no relieving or aggravating factors besides movement. The patient also complained of nausea the day prior to admission. This was followed by one bout of emesis after which the nausea resolved. She had a large loose bowel movement the day prior to admission when she was at [**Hospital3 2558**], which was reported as C. difficile negative. PAST MEDICAL HISTORY: 1. Methicillin resistant Staphylococcus aureus of the right foot status post treatment with Vancomycin. 2. Type 2 diabetes mellitus times 20 years. 3. Hypothyroidism. 4. Asthma. 5. No known cardiac history. 6. Schizophrenia. PAST SURGICAL HISTORY: Question as to whether the patient has had an appendectomy. She does have a midline infraumbilical scar. She is also status post metatarsal resections. ALLERGIES: The patient has no known drug allergies. MEDICATIONS ON ADMISSION: 1. Insulin NPH 28 units q.a.m.; 14 units q.p.m. 2. Levoxyl 25 mg q.d. 3. Risperdal 1 mg p.o.q.h.s. 4. Multivitamin, one tablet p.o.q.d. 5. Peri Colace. SOCIAL HISTORY: The patient currently is living in [**Hospital3 7511**], otherwise, she lives at home with her daughter. She has a 100 pack per year tobacco history. PHYSICAL EXAMINATION: Examination on admission was notable for the following: VITAL SIGNS: Temperature 102.1, heart rate 107, blood pressure 120/44, breathing at a rate of 14, 97% on room air. GENERAL: The patient was awake and appropriately responding. CARDIOVASCULAR: Regular rate and rhythm, normal S1 and S2. PULMONARY: Clear to auscultation bilaterally with no wheezes, decreased breath sounds at the bases. ABDOMEN: Examination was notable for a distended, but soft abdomen with right upper quadrant tenderness to palpation with a positive [**Doctor Last Name **] sign. She had some voluntary guarding and decreased bowel sounds. RECTAL: Rectal examination was guaiac negative per the emergency department examination. LABS ON ADMISSION: Labs were notable for a white count of 15.3, hematocrit of 33.8, platelets 259; 87 neutrophils, 5 bands, 5 lymphs. The Chem 7 was within normal limits except for a potassium of 6.9 on the hemolyzed sample, which was repeated and the potassium was 3.6, ALT was 25, AST 58, amylase 121, lipase 10, alkaline phosphatase 110, total bilirubin .4, albumin 2.8. Right upper quadrant ultrasound revealed a thickened gallbladder wall, pericholecystic fluid, no stones, sludge in the gallbladder, no common bile duct dilatation, positive ultrasonographic [**Doctor Last Name 515**]. HOSPITAL COURSE: The patient was admitted to the Surgical Service with a diagnosis of diabetes with acalculus cholecystitis,. After discussion with the family, the plan was to place a cholecystostomy tube by radiology. The patient tolerated the procedure well and had no complications. Post procedure, the patient was on the floor, but noticed to be making decreased urine output. At this point, the patient was transferred to the Surgical Intensive Care Unit for hemodynamic monitoring. The patient's urine output responded to fluid boluses. On hospital day 3 of 2, the patient was felt to be stable to be transferred to the floor. At this time, the patient had been started on Ampicillin, Ceftriaxone, Flagyl, upon admission and these were continued upon her transfer to the floor. On hospital day #3, the patient's diet was advanced to clear diet. Abdominal pain was resolving and the white blood cell count decreased to within normal limits. She also received two units of packed red blood cells for hematocrit of 26.6. Examination was notable on [**3-19**] for increased wheezing. This was felt to either be attributed to asthma or mild fluid overload and, therefore the patient received Lasix with good response. The patient's mild respiratory distress and wheezing then resolved. On hospital day #6, the patient's diet was advanced to a regular diet. The patient was tolerating a regular diet well. The antibiotics were changed on hospital day #7 to Amoxicillin and p.o. Levofloxacin. These were to cover the Enterococcus and sparse gram-negative rods, which were cultured from her initial drainage of the cholecystostomy tube. On [**2171-3-22**], hospital day #8, the patient was felt to be well enough to return to [**Hospital3 2558**]. She was still complaining of right upper quadrant soreness, but she was reporting that her abdomen was overall improving and that she was feeling much better. The patient will be discharged to [**Hospital3 2558**] to finish a 14-day course of Amoxicillin and Levofloxacin p.o. She is to have her cholecystotomy tube flushed with 10 cc normal saline q.8h. and have her inputs and outputs recorded. She is instructed to return to see Dr. [**First Name4 (NamePattern1) 518**] [**Last Name (NamePattern1) 519**] in one week. She is to call his office if she should have issues which arise prior to then. DISCHARGE MEDICATIONS: 1. Insulin NPH 28 units q.a.m., NPH 14 units q.p.m. 2. Levoxyl 25 mg p.o.q.d. 3. Risperdal 1 mg p.o.q.h.s. 4. Multivitamin one per day. 5. Peri-Colace. 6. Amoxicillin 500 mg p.o.t.i.d. 7. Levofloxacin 500 mg p.o.q.d. for a total of 14-day course. DISCHARGE STATUS: The patient is discharged back to [**Hospital3 7511**]. CONDITION ON DISCHARGE: Acalculus cholecystitis status post placement of cholecystostomy tube. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. [**MD Number(1) 521**] Dictated By:[**Last Name (NamePattern1) 9704**] MEDQUIST36 D: [**2171-3-22**] 09:49 T: [**2171-3-22**] 09:54 JOB#: [**Job Number **] ICD9 Codes: 2449
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Medical Text: Admission Date: [**2201-11-17**] Discharge Date: [**2201-11-27**] Date of Birth: [**2133-7-8**] Sex: F Service: SURGERY Allergies: Demerol Attending:[**First Name3 (LF) 4111**] Chief Complaint: Sepsis Major Surgical or Invasive Procedure: None History of Present Illness: 68F with long history of Crohn's disease and multiple operations recently discharged from [**Hospital1 18**] [**2201-11-6**] to [**Last Name (un) 16844**] Acute Rehabilitation Center after long hospitalization for sepsis/enterocutaneous fistulae/enterovesicular fistula. Returns to [**Hospital1 18**] on [**2201-11-17**] for hypotension, abdominal pain, and elevated WBC count at 60K. Past Medical History: 1.Crohn's disease s/p proctocolectomy and s/p total abdominal colectomy, proctectomy, and end ileostomy in [**2187**]. 2.Incarcerated parastomal hernia s/p repair with mesh in [**2198**]. 3.Stenosis of an ileostomy in [**2200**] s/p multiple operations 4.Multiple enterocutaneous fistulas 5.Diabetes Mellitus II 6.Hypertension 7.Depression Social History: Married. No ETOH. Tobacco- stopped 20 years ago Family History: Non-contributory Physical Exam: Initial Physical Exam - [**2201-11-17**] 96.6 100 84/50 18 100% 4LNC Gen: NAD Car: rapid rate, regular rhythm Lungs: CTAB Discharge Physical Exam - 99.2 91 117/67 16 100%RA Gen: NAD Card: RRR Lungs: CTAB Abd: soft, appropriately tender. Ostomy and drainage devices in place. No leak. Neuro: AxOx3 Pertinent Results: Admission Labs ------------------- [**2201-11-17**] 02:15AM BLOOD WBC-69.2*# RBC-3.72* Hgb-11.6* Hct-33.0* MCV-89 MCH-31.1 MCHC-35.1* RDW-16.4* Plt Ct-516* [**2201-11-17**] 02:15AM BLOOD Neuts-78* Bands-14* Lymphs-2* Monos-6 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2201-11-17**] 05:50AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL [**2201-11-17**] 02:15AM BLOOD PT-15.5* PTT-44.7* INR(PT)-1.4* [**2201-11-17**] 02:15AM BLOOD Glucose-143* UreaN-79* Creat-1.3* Na-132* K-5.2* Cl-101 HCO3-17* AnGap-19 [**2201-11-17**] 02:15AM BLOOD ALT-40 AlkPhos-549* Amylase-97 TotBili-0.4 [**2201-11-17**] 02:15AM BLOOD Lipase-31 [**2201-11-17**] 09:21AM BLOOD CK-MB-NotDone cTropnT-0.05* [**2201-11-17**] 02:15AM BLOOD Calcium-6.9* Phos-5.1*# Mg-2.3 [**2201-11-23**] 05:30AM BLOOD calTIBC-191* Ferritn-926* TRF-147* Discharge Labs [**2201-11-24**] 05:44AM BLOOD WBC-6.7 RBC-3.34* Hgb-10.5* Hct-29.9* MCV-89 MCH-31.5 MCHC-35.3* RDW-16.0* Plt Ct-174 [**2201-11-24**] 05:44AM BLOOD Plt Ct-174 [**2201-11-27**] 05:37AM BLOOD Glucose-103 UreaN-15 Creat-0.5 Na-133 K-4.4 Cl-104 HCO3-22 AnGap-11 [**2201-11-27**] 05:37AM BLOOD Calcium-8.0* Phos-3.1 Mg-1.9 Abdominal/Pelvic CT CT ABDOMEN WITH CONTRAST: There is a small bibasilar atelectasis. The visualized heart is unremarkable. The liver enhances homogeneously. The gallbladder appears normal. The pancreas is atrophied. The spleen, stomach appear normal. Percutaneous GJ-tube unchanged. All small bowel loops are diffusely abnormal with multiple sections of small bowel dilation measuring up to 4 cm, but there is no definite evidence for obstruction. Bowel loops are diffusely abnormal and inflamed, and adjacent fat stranding and fluid has increased from [**2201-9-24**]. There is an area of possible rim enhancing fluid collection anteriorly on the right (2:55 that may represent an abscess, but this is difficult to differentiate from the poorly opacified bowel loops. Multiple cutaneous fistulas are again identified. There is no free intra- abdominal air. CT PELVIS WITH CONTRAST: There is air trapped up underneath the gluteal folds. Patient is status post colectomy. The Foley is present within an empty bladder. BONE WINDOWS: The osseous structures are unchanged. No suspicious lesions are identified. IMPRESSION: Diffusely inflammed small bowel loops with increase in adjacent inflammatory stranding and fluid with completx 5 cm right anterior interloop abscess. Multiple enterocutaneous fistulas. No free intra- abdominal air. Repeat imaging with improved contrast opacification of bowel loops would like better characterize abscess if [**Year (4 digits) 10015**] necessary. Brief Hospital Course: [**Known firstname 2048**] [**Known lastname 67256**] was transferred to [**Hospital1 18**] emergency department on [**2201-11-17**] after initial treatment from [**Hospital 487**] Hospital for hypotension, abdominal pain, and elevated WBC count. In the emergency department a left femoral central line was placed after three unsuccessful attempts at the left subclavian. A non-contrast abdominal/pelvic CT scan showed diffusely inflammed small bowel loops; a 5 cm right anterior interloop abscess; multiple enterocutaneous fistulas; and no free intra- abdominal air (see pertinent results for full report). Urinalysis showed 6-10 WBCs, trace leukocytes, and moderate yeast. Her WBC count was 69; BUN 79; Creat 1.3. Cortisol stem test was negative. Chest xray was negative. She was admitted to the surgery service under the care of Dr. [**Last Name (STitle) 957**] and was taken to the ICU. IV fluids and Levophed were continued from OSH, and Linezolid/Imipenem/Flagyl were started for empiric coverage. Her PICC line was removed and sent for culture. Stool cultures were sent for c. difficile. She was placed NPO and her G/J tubes were to gravity. Wound nurses were consulted for ostomy/tube care. She was given Lovenox, SCDs, and prevacid for prophylaxis. At HD 2 her blood pressure, WBC count, and renal function were improving. PRBCs were given for a Hct of 20.6 At HD 3 TPN w/ nephramine was started. Her Hct was stable after 2 units PRBCs. Her stool culture was negative for c. difficile and her PICC line tip culture was negative. The femoral central line was removed after placement of a right IJ catheter. At HD 4 she was much improved. Tube feeds were started and TPN was continued. Her diet was advanced to full liquids at 60ml/hr. Later in the evening she was transferred to the floor. At HD 5 her tube feeds were increased and her TPN was changed to standard amino acids. Urine culture was positive for yeast and she was started on fluconazole. Her linezolid was stopped. At HD 7 she was advanced to a full liquid diet with no volume restrictions, which she tolerated well. Her g-tube remained to gravity. Imipenem was stopped and her flagyl and fluconazole were switched from IV to PO. Levofloxacin was started. WBC count was at 9.8; BUN 19; Creat 0.4. At HD 10 her TPN was discontinued, she was on a soft diet which she enjoyed and was tolerating well. Her tube feeds were advanced and cycled overnight for 12 hours. Her G-tube was clamped. Calorie counts revealed that she was taking in 1894 kcal and 66g protein. At HD 11 she was discharged to [**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 67259**] in [**Location (un) 976**], MA in good condition. She was discharged on a soft diabetic diet and her G-tube was clamped. Her central line was pulled prior to discharge. She was taking 8U Lantus at bedtime and was to be monitored and covered via insulin sliding scale. Her tube feeds were [**2-9**] Impact with Fiber at 60ml/hr cycled at 12 hours. She was to continue her Flagyl and Fluconazole x 1 week and was to remain on the Levofloxacin. She was written to have a Chemistry panel drawn each Monday and faxed. She will follow up with Dr. [**Last Name (STitle) 957**] in 3 weeks. An appointment was made for [**12-18**] at 1:45pm. Medications on Admission: Sulfasalazine 2G tube feeds Lantus 8U SSI Fentanyl 50mcg patch Enoxaparin 40mg Metooprolol 50mg [**Hospital1 **] Lansoprazole 30mg Tylenol 650mg TID Reglan Fludrocortisone 0.1mg Calcium + D Neutraphos Hydromorphone 1mg PRN Discharge Medications: 1. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty (30) mg PO DAILY (Daily): J-tube. 2. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous Q24H (every 24 hours). 3. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 7 days. 4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 5. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 7 days. 6. Hydromorphone 2 mg Tablet Sig: 0.5 Tablet PO Q4-6H (every 4 to 6 hours) as needed for pain. 7. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). 8. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every twelve (12) hours. 9. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 10. Loperamide 1 mg/5 mL Liquid Sig: Two (2) mg PO BID (2 times a day): Non-generic Imodium. 11. Lantus 100 unit/mL Solution Sig: Eight (8) units Subcutaneous at bedtime. 12. Humulin R 100 unit/mL Solution Sig: Per sliding scale Injection Per sliding scale: Insulin SC Sliding Scale- Breakfast, Lunch, Dinner, Bedtime: Regular Glucose Insulin Dose 0-60 mg/dL [**2-9**] amp D50 61-160 mg/dL 0 Units 161-200 mg/dL 3 Units 201-240 mg/dL 6 Units 241-280 mg/dL 9 Units 281-320 mg/dL 12 Units > 320 mg/dL Notify M.D. Discharge Disposition: Extended Care Facility: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 46542**] Center for Rehabilitation and Nursing Discharge Diagnosis: Urinary Sepsis Discharge Condition: Stable Discharge Instructions: Please contact or return if you experience: * Persistent nausea or vomiting * Fever 101 F or greater * Abdominal pain * Removal or misplacement of tubes * Any other concerns Please take medications as prescribed. There will be a dressing at your right neck where you central line was removed on [**2201-11-27**] at 10:30am. This can be removed in 24 hours. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 957**] on [**2201-12-18**] at 1:45pm . Please call ([**Telephone/Fax (1) 376**] to verify or change your appointment. Completed by:[**2201-12-1**] ICD9 Codes: 0389, 5990, 4019
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Medical Text: Admission Date: [**2191-12-20**] Discharge Date: [**2191-12-25**] Date of Birth: [**2118-11-15**] Sex: F Service: ADMITTING DIAGNOSIS: Hilar carcinoma of the lung. DISCHARGE DIAGNOSIS: Hilar carcinoma of the lung, pending pathology, status post right pneumonectomy. CHIEF COMPLAINT: Cough and a cold. HISTORY OF PRESENT ILLNESS: This is a 73 year old African American female who presented to the Emergency Department in early [**Month (only) **] due to cough and some shortness of breath. She had previously been admitted to the hospital for shortness of breath in [**2189**], at which time a chest x-ray was done and said to be normal, and the patient was discharged home on an Albuterol inhaler. She had remained asymptomatic until the aforementioned visit to the Emergency Department, at which time a repeat chest x-ray showed the presence of a large right hilar mass which was associated with volume loss in the right hemithorax, and suggestive of a neoplasm of the lung. She denied having any history of fever, chills, chest pain, nausea, vomiting, constipation or diarrhea. She also denied any history of lower extremity edema. She stated that her appetite had been good, however, she had experienced an approximately ten pound weight loss over the previous two months. A biopsy was performed of her hilar mass which was consistent with a nonsmall cell lung carcinoma. She also underwent a bone scan in a workup for metastases but this did not reveal any such disease. She underwent further imaging with CAT scan of the hilar mass and it was staged as a T3, NO, MO lesion, and was believed to be amenable to primary resection. PAST MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Status post benign breast biopsy in [**2188**], and a lumpectomy in [**2177**]. 4. Cataract disease. MEDICATIONS ON ADMISSION: 1. Diltiazem 180 mg p.o. twice a day. 2. Albuterol meter dose inhaler. 3. Lipitor. 4. Steroid meter dose inhaler. 5. Multivitamin. ALLERGIES: The patient reports an allergy to Penicillin which she states causes swelling, itching, and rash. SOCIAL HISTORY: The patient lives at home alone. She quit smoking one month prior to presentation at the Emergency Department. She does have an extensive tobacco history having smoked two packs per week for forty years. She also drinks alcohol on which she states to be a regular basis. FAMILY HISTORY: Significant for breast cancer and diabetes mellitus in her mother. There is no family history of coronary artery disease. PHYSICAL EXAMINATION: On initial physical examination, she was found to be afebrile with a heart rate of 90 and sinus rhythm and a blood pressure of 110/70. Her height was five feet and her weight was 110 pounds. She was a pleasant 73 year old woman in no acute distress. Her pupils are equal, round, and reactive to light and accommodation. Extraocular movements were intact. The neck was supple with no jugular venous distention. Her carotid arteries were 2+ palpable with no audible bruits. She had no lymphadenopathy. Her heart showed a regular rate and rhythm with normal S1 and S2 heart sounds and no murmurs. The lungs were clear to auscultation bilaterally with good air entry and movement, however, she did have bilateral expiratory wheezing which was quite significant. Examination of her breasts revealed no masses on palpation with no nipple discharge or tenderness. Her abdomen was soft, nontender, nondistended with no hepatosplenomegaly or other palpable masses. Neurologically, she was alert and oriented to person, place and time and motor and sensory systems were grossly intact. Her extremities were warm and dry with palpable pedal pulses and no lower extremities edema. LABORATORY DATA: Her complete blood count done just prior to admission showed a white blood cell count of 7.0 with a hematocrit of 40.4 and platelet count of 469,000. Her chemistries done just prior to admission were significant for a sodium of 138, potassium 2.8. She was also found to have a slightly elevated cortisol level at 24. Preadmission radiologic studies of significance was a chest x-ray performed on [**2191-11-1**], which showed a new right hilar mass. This was further confirmed by CAT scan which showed a large [**Location (un) 21851**] in the right hilum resulting in obstruction of the right upper lobe bronchus and severe compression of the intermediate bronchus. It also showed multiple ill-defined areas of opacity within the right upper lobe. The patient further underwent a bone scan which showed no evidence of bony metastases and a CAT scan of the head which showed no abnormalities. Ventilation perfusion scan was also performed which showed right lung perfusion to be 25% of the total. HOSPITAL COURSE: The patient was admitted to the operating room on [**2191-12-20**], where she underwent a pneumonectomy of the right lung as well as bronchoscopy and a pericardial flap. Please see the operative note for full details of this procedure. The right lung as well as hilar lymph nodes were sent to pathology for further examination. Two chest tubes were placed at the time of surgery, and the patient was transferred to the Post Anesthesia Care Unit in stable condition. The patient was subsequently transferred to the Cardiac Surgery Recovery Unit following continued intubation and a need for Neo-Synephrine to maintain her blood pressure. She was at this time on continuous epidural at 4 cc/hour for pain control. The patient self extubated herself at approximately 6:30 p.m. on postoperative day number zero. She appeared to tolerate this well as she was alert and oriented and breathing fairly comfortably. Her oxygen saturation at the time remained greater than 90%. On postoperative day number one, she was alert and oriented to person, place and time. She was maintaining her heart rate in the 60s to 70s with her Neo-Synephrine drip being titrated to maintain a systolic blood pressure greater than 100. The Neo-Synephrine drip had been able to be shut off for several hours during the night. She began to experience some greater incisional discomfort, at which time her epidural rate was increased to 5 cc/hour. She was encouraged to perform aggressive pulmonary toilet and incentive spirometry with which her oxygen saturations and level of pain improved. She was able to be weaned off her Neo-Synephrine drip completely towards the end of postoperative day number one. Her pain was excellently controlled with her epidural running at a rate of 5 cc/hour. Her relative hypoxia and respiratory acidosis were slowly being corrected through aggressive pulmonary toilet. On postoperative day number two, she was found to be alert and oriented to person, place and time. She was in sinus rhythm. One of her chest tubes was removed at this time which she tolerated without difficulty. She was subsequently transferred to the floor later on postoperative day number two. During the mid afternoon on postoperative day number two, the patient went from a sinus rhythm into rapid atrial fibrillation with a heart rate into the 140s and a systolic blood pressure between 80 and 90. She was given a slow 500 cc bolus of normal saline, and proceeded to convert in and out of atrial fibrillation and sinus rhythm throughout much of the afternoon. She then went into a sustained rapid atrial fibrillation, and an Amiodarone intravenous bolus of 150 mg was given over ten minutes and then infusion of Amiodarone at 1 mg/minute was started. She continued on this overnight and converted her rhythm back to sinus rhythm during the night which she sustained. She was started on oral Amiodarone the following morning, postoperative day number three, at 400 mg twice a day. Her systolic blood pressure slowly improved and came into the 120 to 130 range. She continued to improve remaining in sinus rhythm, and due to her improving blood pressure was restarted on her Diltiazem which she had been on prior to admission. She had excellent pain control and her epidural was quickly weaned. On postoperative day number four, following chest x-ray which showed evidence of only a very slight pneumothorax, her second chest tube was removed. She subsequently had her dural and Foley catheters removed, all of which she tolerated extremely well. During the next day and one half, the patient did very well on the floor, increasing her level of activity with the assistance of physical therapy and the nursing staff. On postoperative day number four, it was felt that the patient was ready for discharge from the hospital. It was felt at this time that due to the extensive number of stairs in her home and the fact that she lived alone that she would benefit from a short stay at a skilled care nursing facility. She was stable and ready for discharge on postoperative day number five, at which time she found a skilled nursing care facility bed. At that time, her physical examination was significant for a temperature of 99.2, heart rate 100 and sinus rhythm, blood pressure 118/70, respiratory rate 18 with an oxygen saturation 99% on two liters of nasal cannula. Her most complete blood count from [**2191-12-24**], showed a white blood cell count of 8.8, hematocrit 33.8 and a platelet count of 469,000. Her electrolytes on [**2191-12-24**], showed a sodium of 136, potassium 4.5, chloride 95, bicarbonate 31, blood urea nitrogen 11, creatinine 0.5, with a blood glucose of 135. Magnesium at the time was 1.9. On physical examination, she was alert and oriented to person, place and time, moving all extremities and following all commands. Her heart showed a regular rate and rhythm with normal S1 and S2, and no murmurs. She had good air entry and movement over the left lung field which was clear to auscultation. Her abdomen was soft, nontender, and nondistended. Her sternotomy incision was healing nicely and her sternum was stable. Her incisions were open to air, clean and dry. Her extremities were warm and well perfused with no evidence of pedal edema. MEDICATIONS ON DISCHARGE: 1. Diltiazem 180 mg p.o. twice a day. 2. Amiodarone 400 mg p.o. twice a day. 3. Acetaminophen 1000 mg p.o. q6hours as needed for pain. 4. Albuterol-Ipratropium inhaler one to two puffs every six hours as needed. DIET: At discharge, her diet was as tolerated. ACTIVITY: Her activity was also as tolerated with probable benefit from some additional skilled care to increase strength and mobility particularly in climbing stairs. DISPOSITION: To the [**Hospital3 537**]. FOLLOW-UP: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 175**]. [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 178**], M.D. [**MD Number(1) 179**] Dictated By:[**Name8 (MD) **] MEDQUIST36 D: [**2191-12-25**] 11:31 T: [**2191-12-25**] 12:03 JOB#: [**Job Number 22485**] ICD9 Codes: 2762, 2720, 4019
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Medical Text: Admission Date: [**2161-2-14**] Discharge Date: [**2161-2-20**] Service: Neurosurgery HISTORY OF PRESENT ILLNESS: The patient is a 77 year-old male who was in his usual state of health until 10 days ago when he fell on the left frontal area on a beach and believes with no loss of consciousness. Since then he has had constant headache, diffuse with no change in character. This A.M. the slow ambulation. He had no incontinence, no visual changes, no nausea or vomiting. They took him to the emergency room at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16558**] Hospital where a head CT scan was done which showed a 1 cm frontal parietal left subdural hematoma with an area of hemorrhage within the subdural hematoma and mild line shift. [**Hospital1 69**] for further management. PHYSICAL EXAMINATION: Blood pressure 165/71, heart rate 69, respiratory rate 16, sat 98% on room air. The patient was awake, alert, in no acute distress. Chest is clear to auscultation bilaterally. Cardiovascular - regular rate and rhythm. Abdomen - nontender, nondistended, positive bowel sounds, neurologically alert, oriented to [**Hospital3 **] [**2161-2-10**]. Speech slightly slurred, follows three step commands. Pupils are equal, round and reactive to light, 3 down to 2.5 mm. EOMs are full. Visual fields are full to confrontation. Face is symmetric. Palate rises symmetrically. Motor strength is normal bulk and tone, right upper extremity with a positive drift. Deltoids [**5-10**], biceps 4+/5, reflexes absent in the lower extremities, 1+ in the upper extremities and toes downgoing bilaterally. LABORATORY DATA: On admission white count was 6.2, creatinine 40, platelet count 277,000, sodium 132, potassium 4.0, chloride 96, CO2 24, BUN 13, creatinine 0.7, glucose 102. HOSPITAL COURSE: The patient went to the operating room on [**2161-2-13**] for left posterior frontal craniotomy for evacuation of his subdural hematoma. In postop the patient was monitored in the surgical Intensive Care Unit. His vital signs were stable. He was afebrile. He was easily aroused but confused. He denied being in the hospital, requiring frequent stimulation to follow commands. His pupils are equal, round and reactive to light. On postoperative day two his mental status improved. He had the drain in place times two days. Repeat head CT scan showed good evacuation. The patient's drain was removed and he was transferred to the regular floor. He was somewhat confused for two to three days on sitters. Sitters were discontinued on [**2161-2-19**] and the patient has been off sitters and oriented times 24 hours. His vital signs have remained stable. His dressings are clean, dry and intact. His is stable. His staples should be removed on postoperative day 10. He was operated on [**2161-2-13**]. He was seen by Physical Therapy and Occupational Therapy and found to require rehab prior to discharge to home. DISCHARGE MEDICATIONS: 1. Dilantin 200 milligrams po tid. 2. Zantac 150 milligrams po bid. 3. Lopressor 25 milligrams po bid. 4. Folate 1 milligram po q day. 5. Thiamine 100 milligrams po q day. 6. Trazodone 25 milligrams po q HS prn. 7. Hydralazine 20 milligrams po q six hours hold for systolic blood pressure less than 110. Hydralazine can be weaned as tolerated keeping blood pressure less than 160. DISCHARGE STATUS: His vital signs remained stable. The patient is afebrile. He will follow up with Dr. [**Last Name (STitle) 1132**] in two to three weeks times with repeat head CT scan at that time. DISCHARGE CONDITION: His condition was stable at the time of discharge. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1133**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2161-2-20**] 11:21 T: [**2161-2-20**] 11:25 JOB#: [**Job Number 16559**] ICD9 Codes: 4019
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Medical Text: Admission Date: [**2103-11-21**] Discharge Date: [**2103-11-22**] Date of Birth: [**2042-2-1**] Sex: F Service: NEUROSURGERY Allergies: Codeine / House Dust / pollen / silk tape Attending:[**First Name3 (LF) 78**] Chief Complaint: Elective admission for coiling Major Surgical or Invasive Procedure: [**2103-11-21**]: Cerebral angiogram with coiling to ophthalmic artery aneurysm and placement of a stent to the cavernous carotid aneurysm History of Present Illness: Elective admission for cerebral angiogram for coiling of the ophthalmic artery aneurysm and stent placement for the cavernous carotid aneurysm. Past Medical History: Hypercholesterolemia, HTN Social History: Lawyer, 1 drink in two weeks, denies tobacco Family History: Sister died of brain aneurysm at age 38 Physical Exam: On admission: nonfocal exam On Discharge: Patient is neurologically intact. She displays some hoarsness when speaking which we attributed to her intubation and was noted to have considerable bruising on the the right side of her toungue. Pertinent Results: [**2103-11-22**] Cerebral Angiogram IMPRESSION: Preliminary Report1. [**Known firstname 25415**] [**Known lastname 106479**] underwent successful re-coiling for short-interval Preliminary Reportre-canalization of the the right PICA aneurysm (likely related to the Preliminary Reportorientation of the aneurysm neck towards the PICA branching angle and high Preliminary Reportdynamic stress on the coil-pack). Preliminary Report2. Coil-embolization of the left ophthalmic segment was performed and was Preliminary Reportuneventful. Preliminary Report3. Treatment of the left cavernous segment broad-based aneurysm was initiated Preliminary Reportby placing a stent that will serve to protect the parent vessel in future coil Preliminary Reportattempts. Preliminary Report4. Note is made of an outpouching from the right distal ophthalmic segment, Preliminary Reportlikely corresponding to an additional aneurysm. Brief Hospital Course: 61F admitted for an elective coiling of the ophthalmic artery aneurysm and stent placement for the cavernous carotid aneurysm. She was placed on Plavix pre-op. Post procedure she was on a heparin drip until 7am on [**2103-11-22**]. Post procedure and prior to discharge she remained neurologically intact. She was however experiencing some voice hoarsness and a hematoma on the right side of her tongue likely form the intubation. She was seen by our anesthesiologist who did not notice any lesions or cuts and will follow up with a phone call to make sure the patient does not develop airway compromise. Medications on Admission: Plavix, lisinopril, ibuprofen, HCTZ, lorazepam, nortriptyline, simvastatin, and Zantac Discharge Medications: 1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 30 days. Disp:*30 Tablet(s)* Refills:*0* 2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*5* 3. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: [**11-19**] Tablets PO Q6H (every 6 hours) as needed for Headache. Disp:*30 Tablet(s)* Refills:*0* 4. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. nortriptyline 25 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 6. lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 7. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 8. ranitidine HCl 150 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Ophthalmic artery aneurysm (unruptured) Cavernous carotid aneurysm (unruptured) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Angiogram with Embolization and/or Stent placement Medications: ?????? Take Aspirin 325mg (enteric coated) once daily. ?????? Take Plavix (Clopidogrel) 75mg once daily. ?????? Continue all other medications you were taking before surgery, unless otherwise directed ?????? You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort. What activities you can and cannot do: ?????? When you go home, you may walk and go up and down stairs. ?????? You may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal). ?????? After 1 week, you may resume sexual activity. ?????? After 1 week, gradually increase your activities and distance walked as you can tolerate. ?????? No driving until you are no longer taking pain medications What to report to office: ?????? Changes in vision (loss of vision, blurring, double vision, half vision) ?????? Slurring of speech or difficulty finding correct words to use ?????? Severe headache or worsening headache not controlled by pain medication ?????? A sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg ?????? Trouble swallowing, breathing, or talking ?????? Numbness, coldness or pain in lower extremities ?????? Temperature greater than 101.5F for 24 hours ?????? New or increased drainage from incision or white, yellow or green drainage from incisions ?????? Bleeding from groin puncture site *SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call our office. If bleeding does not stop, call 911 for transfer to closest Emergency Room Followup Instructions: Please follow-up with Dr [**First Name (STitle) **] in 6 months with an MRI/MRA of the brain. When you call for your appointment this study will be arranged for you. Completed by:[**2103-11-22**] ICD9 Codes: 2720, 4019
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Medical Text: Admission Date: [**2174-3-2**] Discharge Date: [**2174-3-3**] Date of Birth: [**2094-11-22**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**Last Name (NamePattern1) 1167**] Chief Complaint: SOB, VT Major Surgical or Invasive Procedure: Intubation and mechanical ventilation History of Present Illness: 79F w/CHF EF 15% and BiV ICD, COPD, DM presented to OSH from [**Hospital1 1501**] w/dyspnea and hypotension. PT was hospitalized [**1-17**] for dysphagia workup, at that time diuresed for CHF and had episode of VT felt to be provoked by albuterol treatement. Exam, CXR c/w ?CHF exacerbation, no UOP to multiple doses of IV lasix. Also tachycardic w/?VT vs SVT w/aberrancy HR in 130s. Also hyperkalemic to 6.0 at OSH. Decompensated and developed cardiogenic shock - hypotensive to 80s systolic requiring max dobutamine via CVL but still hypotensive with lactate of 8. Got lasix 40mg x2, solumedrol, xanax, nebs and was started on dobutamine prior to transfer. On arrival to [**Hospital1 18**] ER still hypotensive and tachycardic. In ED: ECG showed VT vs afib/svt with aberrancy. Given lidocaine bolus/gtt (avoid amio given ?CHF exacerbation and beta blockade activity of amiodarone) Pt converted to Afib with PVCs after electric cardioversion now in BiV pacing rhythm. HR went down to 100s-110s and BP up to 90s systolic. Pt was started on levophed for continued hypotension, also received 200cc IVF with 100ccs of urine out. Triple lumen IJ was placed and she was intubated in ED with etomidate, rocuonium, for looking "downhill" after 3 attempts requiring bougie for difficult airway. Was able to nswer questions but cold extremities. Transferred to CCU on levophed 0.16, dobutamine 4, lido 2.75, midaz 4, fent boluses prn. Vent settings: AC 400/18 5/60%. Vs prior to transfer - HR:110 O2: 100% BP: 98/73 map 79. Past Medical History: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension 2. CARDIAC HISTORY: systolic CHF with EF 15%, valvular heart disease - unclear specifics - CABG: - PERCUTANEOUS CORONARY INTERVENTIONS: - PACING/ICD: BiV ICD Episode of VT presumed secondary to albuterol 3. OTHER PAST MEDICAL HISTORY: Thalassemia Minor dysphagia arthritic deformities (mobility issues), right club foot h/o hypothyroidism ?COPD Social History: - Tobacco history: prior but quit 25 yrs ago - ETOH: none - Illicit drugs: none other : husband died a few years ago lives alone. Family History: nc, pt intubated/sedated Physical Exam: Expired Pertinent Results: [**2174-3-2**] 03:41AM BLOOD WBC-16.3* RBC-5.47* Hgb-11.6* Hct-39.4 MCV-72* MCH-21.2* MCHC-29.4* RDW-17.2* Plt Ct-277 [**2174-3-2**] 03:41AM BLOOD Neuts-90.6* Lymphs-6.4* Monos-2.2 Eos-0.4 Baso-0.4 [**2174-3-2**] 03:41AM BLOOD PT-23.6* PTT-29.4 INR(PT)-2.3* [**2174-3-2**] 11:57AM BLOOD Glucose-172* UreaN-72* Creat-1.6* Na-125* K-5.6* Cl-89* HCO3-21* AnGap-21* [**2174-3-2**] 04:10AM BLOOD Glucose-86 UreaN-69* Creat-1.5* Na-127* K-5.9* Cl-91* HCO3-20* AnGap-22* [**2174-3-2**] 03:41AM BLOOD Glucose-76 UreaN-68* Creat-1.6* Na-125* K-5.7* Cl-90* HCO3-17* AnGap-24 [**2174-3-2**] 03:41AM BLOOD cTropnT-0.01 proBNP->[**Numeric Identifier **] [**2174-3-2**] 04:10AM BLOOD cTropnT-0.02* [**2174-3-2**] 04:12AM BLOOD Type-[**Last Name (un) **] Rates-16/ Tidal V-400 PEEP-5 pO2-55* pCO2-43 pH-7.32* calTCO2-23 Base XS--3 -ASSIST/CON Intubat-INTUBATED [**2174-3-2**] 03:46AM BLOOD Lactate-6.3* ECHO [**2174-3-2**]: The left atrium is moderately dilated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is dilated. There is severe global left ventricular hypokinesis (LVEF = 15%). Marked left ventricular mechanical dyssynchrony is present. The right ventricular free wall thickness is normal. The right ventricular cavity is dilated with severe global free wall hypokinesis. The aortic valve is not well seen. Significant aortic stenosis is present (not quantified). The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Severe (4+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Severe [4+] tricuspid regurgitation is seen. [In the setting of at least moderate to severe tricuspid regurgitation, the estimated pulmonary artery systolic pressure may be underestimated due to a very high right atrial pressure.] There is no pericardial effusion. Brief Hospital Course: In brief, the patient was transferred to [**Hospital1 18**] for further management of cardiogenic shock. She was intubated in the ED for airway protection. Upon arrival to the CCU, she was ventilating well but requiring high doses of dobutamine and levophed for pressor support. Echocardiogram demonstrated worsening biventricular dilation and global hypokinesis with wide open mitral and tricuspid regurgitation. Cardiac enzymes were relatively flat, suggesting no acute ischemic cause for her cardiogenic shock. Her lactate continued to rise, and in the setting of cardiogenic shock requiring high dose pressor support with an ECHO demonstrating very poor global systolic function with extreme valvular disease, the decision was made in conjunction with the family to make the patient comfort measures only. She passed on [**2174-3-3**] at approximately 3am after terminal extubation with weaning of pressor support. Medications on Admission: allopurinol 100 mg po daily asa 81mg daily atorva 10 mg po daily spironolactone 12.5 mg po daily folic acid 1mg po daily tramadol 25mg po TID flaxseed oil 1 tab daily glipizide 2.5mg daily protonix 20mg daily levothyroxine 75mcg po daily metoprolol 12.5 mg po daily lovenox 30mg sq daily xopenex neb QID prn proair MDI 2 puffs q 2 hours prn bumex 1 mg po daily Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: expired Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired ICD9 Codes: 4271, 2761, 2762, 496, 4240, 2449, 2767, 4280
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Medical Text: Admission Date: [**2145-2-14**] Discharge Date: [**2145-3-4**] Date of Birth: [**2080-7-21**] Sex: M Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2724**] Chief Complaint: Altered Mental Status Major Surgical or Invasive Procedure: None History of Present Illness: 64M with a hx of ETOH abuse, depression, multiple falls who called 911 this morning with vague complaints. Patient initially gave 911 the incorrect address (he gave his childhood address). When EMS arrived to patient's home, he was ambulatory,intoxicated. Per report the patient was combative at the outside hospital and was sedated and intubated in order to obtain a Head CT for a suspected head bleed. Past Medical History: Depression Diverticular bleed in [**2135-10-1**] Social History: Unemployed. Lives alone. Daughter lives nearby. Per daughter, patient has been struggling with depression and ETOH abuse since being unemployed. He was in detox/rehab about a year ago. He has the hx of mixing his antidepressants w/ETOH and hx of falls. Family History: NC Physical Exam: Gen: L eye ecchymosis, facial scratches, intubated, sedated Initial Neuro Exam: No EO, no commands. PERRL 3-2mm, R corneal. BUE attempts to localize, BLE triple flexion. Repeat Neuro Exam off sedation: EO to loud voice, MAE- LUE purposeful, squeezes hands bilaterally, BLE withdraws. Exam at time of Discharge: Nonfocal, neurologically intact. Alert and Oriented to person, place and date. Following commands, Fluent speech. Full strength in all 4 extremities. Upon discharge: alert, oriented x 3,understands reason for hopsital stay, motor full, ambulating in halls Pertinent Results: CT HEAD W/O CONTRAST [**2145-2-14**] Stable right temporal intraparenchymal hemorrhage and subdural hematoma. Slight increase in intraventricular hemorrhage. No significant midline shift. No fracture identified. CT HEAD W/O CONTRAST [**2145-2-15**] Stable appearance of right temporal intraparenchymal hemorrhage as well as intraventricular hemorrhage. Interval decrease in prominence of right cerebellar tentorium density. Brief Hospital Course: 64 y/o M +ETOH and question of fall was taken to OSH where he was combative and aggressive. Patient was intubated and sedated to obtain head CT. Head CT revealed R temporal IPH and patient was transferred to [**Hospital1 18**] for further neurosurgical intervention. On examination without sedation, patient EO to voice, PERRL, BUE purposeful, and w/d BLE. He was admitted to the ICU for monitoring. He was extubated and exam remained stable. On [**2-15**], repeat head CT was stable and cipro was started for a UTI. In afternoon, patient became aggitated and pulled out his foley. He was given ativan and on CIWA scale for possible DTs. Dilantin level corrected was 6, he was given a 500mg bolus of dilantin. His level the following morning improved to 13.7 and he remained on 100mg TID for 10days and then discontinued. He was transferred from the ICU to the stepdown unit and he continued to require ativan per the CIWA scale for his DT's. His neurological exam at this time was eyes open, following commands intermittently, agitated and trying to get OOB. For patient safety, he remained in restraints. On [**2-19**] he was more alert- he was oriented to hospital, city and month but not the year. His hand and wrist restraints were DC'd but he did require a posey as he was continually getting OOB without the help of nursing and was increased fall risk. He was started on PO seroquel on [**2-19**] and this was titrated to 50mg twice daily. His mental status continued to improve and on [**2-22**] he was more awake and oriented to self and year but not to place. Despite up titration of Seroquel, he continued to require restraints for agitated behavior and so Geriatric medicine consult was called for recommendations on [**2-25**]. They recommended to wean the ativan to off over 3 days as well as wean seroquel to off over 2 days. A full lab workup was obtained including B12, TSH, LFTs and these values were all within normal limits. A U/A was consistent with infection and he was started on a 10 day course of ciprofloxacin to finish [**2145-3-6**]. Patient's mental status continued to clear and by [**3-1**] the restraints were no longer needed to maintain patient safety. He was seen in consultation by psychiatry who were very helpful with medication adjustment. He was started on celexa 20 qd (usual dose 60mg qd) but as he was without it for extended period of time this was introdeced at lower dose. Per his daughter he had also been on neurontin 600 [**Hospital1 **], doxepin 100 at bedtime and ativan 0.5mg [**Hospital1 **] - these have not yet been resumed. Multiple attempts were made to contact his psychiatrist but calls have not been returned. (Dr [**Last Name (STitle) **] [**Telephone/Fax (1) 36815**]) Patient was oriented and expressing desire for to focus on addiction issues. Psychiatry recommended psychiatric consult at rehab. PT and OT evaluated the patient and found him appropriate for rehab for cognitive needs. He had follow up head CT on [**2145-3-4**] prior to discharge that showed resolution of all hemorrhage. Medications on Admission: Celexa60 qd, Ativan 0.5mg [**Hospital1 **], neurontin 600 [**Hospital1 **], doxepin 100 hs Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. olanzapine 10 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO DAILY (Daily). 3. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. ciprofloxacin 250 mg Tablet Sig: Two (2) Tablet PO Q12H (every 12 hours): last dose [**2145-3-6**]. 7. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital6 979**] - [**Location (un) 246**] Discharge Diagnosis: Right Intraparenchymal Hemorrhage Delerium Tremens Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: .Take medicine as prescribed. Followup Instructions: Follow-Up Appointment Instructions ?????? Please call ([**Telephone/Fax (1) 2726**] Dr. [**Last Name (STitle) 548**] office as needed for any questions but no formal follow up or CTs are needed. Completed by:[**2145-3-4**] ICD9 Codes: 5990
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Medical Text: Admission Date: [**2160-6-18**] Discharge Date: [**2160-6-22**] Date of Birth: [**2087-2-9**] Sex: F Service: Neurosurgery HISTORY OF PRESENT ILLNESS: The patient is a 73 year old female who was otherwise healthy who started complaining of numbness and weakness of the right arm and leg. It lasted about two weeks. It was discovered that she had a left middle cerebral artery aneurysm and was admitted status post the coiling of the left middle cerebral artery aneurysm on [**2160-6-18**]. She was admitted to the trauma sick unit post coiling. During the procedure it was noted that a small non- occlusive thrombus had formed on an M2 division at its origin near the coil mass and this was treated with intravenous Integrilin with resolution. There were no post- operative neurological deficits noted. PAST MEDICAL HISTORY: Coronary artery disease. MEDICATIONS: 1. Dilantin. 2. Aspirin. 3. Calcitrate. PAST SURGICAL HISTORY: Appendectomy. PHYSICAL EXAMINATION: Alert and oriented times three; blood pressure 126/61; heart rate 60. Chest: Clear to auscultation. Cardiovascular: Regular rate and rhythm. Abdomen: Soft, non-tender, non-distended with positive bowel sounds. Postprocedure: Groin site was clean, dry, and intact with no oozing. Extremities: Positive femoral and pedal pulses with no hematoma. Vital signs: Stable, blood pressure was kept to 100 to 130 and she was stable postprocedure, awake, alert, and oriented times three with no drift, moving all extremities with good strength, smile was symmetric. HOSPITAL COURSE: She was transferred to the regular floor on [**2160-6-20**]. She was in stable condition. On [**2160-6-21**] she was awake, alert, and oriented times three. Her face was symmetric. Her repetition was intact. Her EOMs were full. She had antigravity strength in all extremities. She had no drift. DISCHARGE STATUS: She was discharged to home on [**2160-6-22**] with Aspirin and Plavix. FOLLOW-UP PLAN: She will follow-up with Dr. [**Last Name (STitle) 1132**] in two weeks time. DISCHARGE MEDICATIONS: 1. Plavix 75 mg by mouth once daily. 2. Aspirin 325 by mouth once daily. 3. Dilantin 200 mg by mouth q12 hours. 4. Colace 100 mg by mouth twice a day. 5. Famotidine 20 mg by mouth twice a day. DISCHARGE CONDITION: Stable at time of discharge. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1133**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2160-9-15**] 11:20 T: [**2160-9-16**] 17:54 JOB#: [**Job Number 48049**] ICD9 Codes: 4019
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Medical Text: Unit No: [**Numeric Identifier 66120**] Admission Date: [**2132-3-8**] Discharge Date: [**2132-3-20**] Date of Birth: [**2132-3-8**] Sex: M Service: NB HISTORY: Baby [**Name (NI) **] [**Name2 (NI) 1549**]-[**Known lastname 66121**] is the 2.335 kg product of a 33-week gestation born to a 38-year-old G2, P0 now 1 mother. Prenatal screens: B+, direct COOMBS negative. Hepatitis surface antigen negative. RPR Nonreactive. Rubella immune, GBS unknown. PAST OB HISTORY: Notable for spontaneous abortion in [**2129**] and infertility. PAST MEDICAL HISTORY: Notable for depression on Bupropion and hypothyroidism on levothyroxine. ANTENATAL COURSE: IVF pregnancy, embryo transfer, full fetal survey normal. Pregnancy complicated by pre-term contractions at 30 weeks, responsive to hydration. Experienced premature rupture of membranes on [**2132-3-5**] followed by recurrence of pre-term contractions. Receive a full course of betamethasone and was treated with magnesium sulfate, progressed to labor and eventually to cesarean section for non-reassuring fetal heart rate. There was an intrapartum maternal fever of 103 despite maternal antibiotic prophylaxis from time of premature rupture of membrane. NEONATAL COURSE: The infant was vigorous at delivery, orally and nasally suctioned. Viscus yellow secretions. Dried, subsequent pink and in no distress on room air. Apgar's are 8 and 9 at 1 and 5 minutes respectively. PHYSICAL EXAMINATION: Birth weight 2.335 kg, head circumference 30 cm, leg 46.5 cm. Anterior fontanel soft and flat, nondysmorphic, palate intact. Neck and mouth normal. No nasal flaring. Chest: No retractions. Good breath sounds bilaterally. No adventitious sounds. Cardiovascular: Well perfused, regular rate and rhythm. Femoral pulses normal. S1 and S2 normal, no murmur. Abdomen soft, nondistended. Liver 1 cm below right costal margin, no splenomegaly, no masses, bowel sounds active, anus patent. Genitourinary normal penis. Testes descended bilaterally. Central nervous system: Active, alert and responds to stim. Tone normal and symmetric, moves all extremities. Suck, root, gag intact. Grasp symmetric. Integumentary normal. Musculoskeletal: Normal spine, limbs, clavicles, left hip click noted. HOSPITAL COURSE: Respiratory: [**Doctor First Name **] has been stable on room air since admission. He has not required methylxanthine therapy. Cardiovascular: [**Doctor First Name **] has been hemodynamically stable throughout admission without need for cardiovascular support. Fluid and Electrolytes: His birth weight was 2.335 kg. His discharge weight is 2315 gm. Infant was initially maintained on IVF, and advanced on enteral feeds without difficulty. By the time of discharge, infant was taking E24 ad lib with breast-feeding. GI: Infant experienced hyperbilirubinemia requiring several days of phototherapy, with peak bilirubin was day of life #3 of 10.7/0.3. Hematology: Hematocrit on admission was 51. Infectious Disease: CBC and blood culture obtained on admission. CBC was benign and blood culture remained negative. In light of maternal risk factors suggestive of presumed chorioamnionitis, infant was treated for total of 7 days with ampicillin and gentamicin for presumed sepsis. Lumbar results were within normal limits. Initial CBC was unremarkable, and blood cx was negative. Lumbar puncture performed on antibiotics was unremarkable. Neuro: Infant had been appropriate for gestational age. Hearing screen was performed and passed prior to discharge. CONDITION ON DISCHARGE: Stable. DISCHARGE DISPOSITION: Home. NAME OF PRIMARY PEDIATRICIAN: Dr. [**First Name (STitle) **]. Telephone number is [**Telephone/Fax (1) 43330**]. FEEDS AT DISCHARGE: E24 ad lib in addition to breast feeding. MEDICATIONS: Not applicable. Car seat position screening was performed and passed. State newborn screens have been sent per protocol and have been within normal limits. Infant received hepatitis B vaccine prior to discharge. DISCHARGE DIAGNOSIS: 1. Premature infant born at 33 weeks. 2. Presumed sepsis. 3. Hypoglycemia resolved. 4. Hyperbilirubinemia. [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD MEDQUIST36 D: [**2132-3-14**] 06:58:40 T: [**2132-3-14**] 07:39:53 Job#: [**Job Number 66122**] ICD9 Codes: 7742, V053
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Medical Text: Admission Date: [**2200-9-11**] Discharge Date: [**2200-9-27**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4588**] Chief Complaint: Hypoxemia Major Surgical or Invasive Procedure: None History of Present Illness: Mrs. [**Known lastname 74787**] is an 87 yo woman with paroxysmal atrial fibrillation, h/o stroke with persistent hemiparesis and frequent UTIs [**3-15**] indwelling Foley (placed b/c of sacral decubitus & immobility) who presented today with hypoxemia. . She was recently treated for bronchitis and reported to nursing staff at her NH that she was not feeling well. She reports that she has been having a productive cough for the past 3 days. She remianed afebrile during this course. There was a possible aspiration 3 nights prior per nursing and had coarse rhochi the following day. The day prior to admission her O2 sat on RA was noted to be 82% and she was transferred to the [**Hospital1 18**] ED. . In the ED, her initial VSs were 97.9 86 140/64 24 94% nonrebreather. She received cefepime, vancomycin and levofloxacin. Past Medical History: Paroxysmal A-FIB Stroke [**2198**] with persistent hemiparesis recurrent UTI GIB [**2195**], attributed to ASA. recurrent osteomyelitis of ischium and heel Social History: Pt was previously at [**Hospital 599**] Rehab. Pt her sister lives in [**Hospital3 **] Pt was a former secratary Family History: NC Physical Exam: PE: VSs: Tc & Tm: 98.4, 104-111/40-57, 75-95, 24, 96% facemask 70% Gen: Chronically ill-appearing, very thin, fatigued, contracture on left upper and lower ext. HEENT: Clear OP, ppor dentition MMM NECK: Supple, No LAD, No JVD CV: RR, NL rate. distant S1, S2. No appreciable murmurs, rubs or gallops LUNGS: diffusely ronchorous bilaterally, poor inspiratory effort, prolonged expiratory phase, mildly tachypneic, use of acessory muscles ABD: Soft, NT, ND. NL BS. No HSM EXT: No edema. 2+ DP pulses BL contracture in flexsion on left upper ext and lower ext. Back: 2 stage IV sacral decubitus ulcers NEURO: A&Ox1. left sided facial droop, appears fatigued. Left-sided hemiparesis3/4 relexes in upper ext. Unable to elict lower relfexes Pertinent Results: [**2200-9-11**] WBC-16.2* Hgb-9.1* Hct-29.9* MCV-85 Plt Ct-539* Neuts-82* Bands-0 Lymphs-13* Monos-3 Eos-0 Baso-0 Atyps-2* Metas-0 Myelos-0 [**2200-9-19**] WBC-11.3* Hgb-9.9* Hct-31.9* MCV-83 Plt Ct-532* [**2200-9-11**] PT-15.1* PTT-28.5 INR(PT)-1.3* [**2200-9-19**] PT-19.3* PTT-31.5 INR(PT)-1.8* [**2200-9-11**] Glucose-115* UreaN-26* Creat-0.6 Na-144 K-5.9* Cl-107 HCO3-32 [**2200-9-19**] Glucose-90 UreaN-8 Creat-0.5 Na-139 K-4.3 Cl-104 HCO3-31 [**2200-9-19**] Calcium-8.8 Phos-2.8 Mg-2.0 [**2200-9-17**] 6:32 am SPUTUM Source: Expectorated. GRAM STAIN (Final [**2200-9-17**]): <10 PMNs and <10 epithelial cells/100X field. 1+ (<1 per 1000X FIELD): BUDDING YEAST. QUALITY OF SPECIMEN CANNOT BE ASSESSED. RESPIRATORY CULTURE (Preliminary): ? OROPHARYNGEAL FLORA. YEAST. MODERATE GROWTH. [**2200-9-13**] 11:18 am SPUTUM Source: Endotracheal. **FINAL REPORT [**2200-9-13**]** GRAM STAIN (Final [**2200-9-13**]): [**12-6**] PMNs and >10 epithelial cells/100X field. Gram stain indicates extensive contamination with upper respiratory secretions. Bacterial culture results are invalid. PLEASE SUBMIT ANOTHER SPECIMEN. RESPIRATORY CULTURE (Final [**2200-9-13**]): TEST CANCELLED, PATIENT CREDITED. [**2200-9-11**] 7:20 pm BLOOD CULTURE **FINAL REPORT [**2200-9-17**]** Blood Culture, Routine (Final [**2200-9-17**]): NO GROWTH. [**2200-9-11**] 7:10 pm BLOOD CULTURE SOURCE: VENIPUNCTURE. **FINAL REPORT [**2200-9-17**]** Blood Culture, Routine (Final [**2200-9-17**]): NO GROWTH. Urine Legionella antigen: negative CXR: [**2200-9-11**] IMPRESSION: 1. Opacity in the left mid and lower chest, worrisome for pneumonia. 2. Mild interstitial edema. CXR [**2200-9-16**] IMPRESSION: 1. Mild cephalization of the pulmonary vasculature without evidence for pulmonary edema. 2. Increased right basilar atelectasis, with decreased left basilar and mid lung atelectasis. U/S R Upper Ext [**2200-9-18**] IMPRESSION: Thrombus material seen in the two superficial veins of the right arm which are the right basilic and the right cephalic veins. No evidence of a clot in the deep veins of the right arm. Brief Hospital Course: She was admitted for presumed apiration pneumonia and started on antibiotics. Pt had one witness aspiration event. Her oral meds were held. She then went into A-FIB with rapid ventricular responce. She was transferred to the CCU and started on an amiodarone drip. She went back into sinus rhythm and was transfered back to the floor. There was a concern on the floor for her pressure ulcer that it might have progressed to osteomylitis. A Bone scan was performed which ruled out osteomylitis of the sacrum. Local wound care was provided. However there was still a concern for infection of the pressure ulcer and given the fact that she had an episode of hypotension and fever (100.4) she was started on IV vancomycin and IV cefepime. She remained stable on these antiobiotics. A PICC line was inserted on [**9-26**] for IV antibiotics. Pt. had another episode of aspiration on [**2200-9-26**]. At the time if aspiration her sats dropped to the 80s. Food was immediately suctioned out and deep suctioning was performed. Her diet was changed from soft to puree. Flagyl was added to her antibiotics and it was decided to keep her on a ten day course of antibiotics for her aspiration event. Her Vancomycin, cefepime and flagyl course will be completed on [**2200-10-6**]. Her code status was DNR/DNI. On [**2200-9-27**] she was discharged to [**Hospital 100**] Rehab. Problems: . # Pneumonia: Pt arrived with cough, fevers, and O2 saturations in the 90's on 70% shovel mask. The patient was tachypneic and fatigued, but able to moderately communicate. The CXR showed L mid/lower opacity concernig for pneumona. She was started on broad spectrum antibiotcis: Vancomycin, Cefepime and Ciprofloxacin. The patient had an elevated WBC on admission (16.2) that decreased to 9.6 after antibiotics. The patient continued to have intermittent productive cough and rhonchi, but improved from admission. There was a concern for anaerobes from aspiration and the patient antibiotcs were changed to vancomycin, cefepime and flagyl. Her The patient was also symptomatically managed with nebs Q6 and respiratory care. The blood cultures were pending and the Legionella antigen was negative. She should be monitored and started on treatment if symptoms continue. She comlpeted a course of Levoquin and Flagyl in the hospital. However she aspirated again on [**2200-9-26**], flagyl was added to her antibiotics and it was decided to continue a ten day course of flagyl, vancomycin and cefepime. . # Paroxysmal atrial fibrillation: The patient was found to be in sinus rhythm at admission. Her INR was subtherapeutic on admission (1.4) and her coumadin dose was increased from 1mg daily to 2mg. Her Digoxin and diltiazem was held on admission because she was NPO due to lethargy and aspiration risk, but was restarted the following day. On [**2200-9-14**] her meds were again held because of aspiration risk, but she remained in sinus rhythm. On [**2200-9-15**] at 8:15am she went into A-fib w/ RVR (HR 140-180)and hypotensive 60-70/doppler. She was given 5mg diltazem x 2 and IV fluids. Her pressures remained low and desated into the low 90's. Cardiology was consulted and amiodarone 150mg over 10minutes was started. She remained in a-fib w/ RVR (HR 120-140) and was transferred to the CCU. The family was notified of the transfer and patient status. Pt started on amiodarone drip, given calcium and converted to sinus around noon on [**9-15**]. She was converted to PO amiodarone 100mg and started on PO diltiezem. She remained in sinus and was trasnferred out of the CCU on [**2200-9-17**]. She remained on telemetry and was stable. . # Bacteriuria: The admission UA showed bacteria in her urine, but minimal WBC and no symptoms with a chronic foley. This was most likely due to contamination and the patient was not started additional antibiotics. However, urine culture was sent and the foley was changed. . # Decubitus ulcers: The patient has two Stage III-IV decubitus ulcers. Local wound care was provided and Wound Care Specialist were consulted for treatment. There was some concern that she had osteomylitis or infection of pressure ulcer resulting in early sepsis as she had one episode of hypotension with a temp pf 100.4. She was started on cefepime and Vancomycin. Bone scan on [**9-24**] showed no evidence on increase bone turnover in the sacral area, no evidence of infection. A PICC was placed on [**2200-9-26**] so that she could finish her course of antibiotics (to be completed on [**2200-9-29**]). Medications on Admission: Oxycodone 2.5 mg prn Vitamin C 500 mg daily Albuterol prn Ipratropium prn Senna 2 tabs qhs Warfarin 1 mg daily Vitamin B12 Diltiazem 30 mg qid Docusate daily Furosemide 20 mg qMWF Digoxin 0.0625 mg daily Megestrol 400 mg [**Hospital1 **] MVI Discharge Medications: 1. Docusate Sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2 times a day). 2. Senna 8.6 mg Tablet [**Hospital1 **]: 1-2 Tablets PO BID (2 times a day) as needed. 3. Megestrol 400 mg/10 mL Suspension [**Hospital1 **]: One (1) PO BID (2 times a day). 4. Multivitamin Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 5. Cyanocobalamin 500 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 6. Furosemide 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO QMOWEFR (Monday -Wednesday-Friday). 7. Acetylcysteine 20 % (200 mg/mL) Solution [**Hospital1 **]: 1-10 MLs Miscellaneous Q2H (every 2 hours) as needed for secreations. 8. Amiodarone 200 mg Tablet [**Hospital1 **]: 0.5 Tablet PO DAILY (Daily). 9. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization [**Hospital1 **]: One (1) Neb Inhalation Q6H (every 6 hours) as needed. 10. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) Neb Inhalation Q6H (every 6 hours) as needed. 11. Levofloxacin 250 mg Tablet [**Hospital1 **]: Three (3) Tablet PO Q24H (every 24 hours). 12. Calcium Carbonate 500 mg Tablet, Chewable [**Hospital1 **]: One (1) Tablet, Chewable PO TID (3 times a day) for 2 days. 13. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 14. Metronidazole 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q 8H (Every 8 Hours). 15. Ascorbic Acid 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily) for 10 days. 16. Zinc Sulfate 220 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO DAILY (Daily) for 10 days. 17. Vitamin A 10,000 unit Capsule [**Last Name (STitle) **]: Two (2) Capsule PO DAILY (Daily) for 10 days. 18. Diltiazem HCl 30 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO QID (4 times a day). 19. Warfarin 2 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Once Daily at 4 PM. 20. Acetaminophen 325 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO Q6H (every 6 hours). 21. Nystatin 100,000 unit/mL Suspension [**Last Name (STitle) **]: Five (5) ML PO QID (4 times a day) as needed: please swab mouth. 22. Heparin (Porcine) 5,000 unit/mL Solution [**Last Name (STitle) **]: One (1) Injection TID (3 times a day): please cont while INR is subtherapeutic. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Pneumonia Atrial fibrillation w/ RVR h/o stroke with hemiparesis ([**2198**]) h/o GIB Recurrent UTI Discharge Condition: stable, O2 saturations >90% on 40% shovel mask, normotensive, non-ambulating, awake and alert. Discharge Instructions: It was a pleasure taking care of you while you were in the hospital. You were admitted because you had pneumonia and required supplemental O2. You were treated with antibiotics and improved. You still required 2L of oxygen, but you felt much better then before. Your heart rate also increased and your blood pressure was low so you were sent to the Cardiac Care Unit for close monitoring. You were given medications to slow your heart and fixed your irregular heart rate. You were stablized and your heart rate went back to normal. Please follow the medications shown below. Please follow the appointments shown below. You will return back to your rehab facility and will be followed by your doctors [**Name5 (PTitle) **]. Followup Instructions: You will be discharged to [**Hospital 100**] Rehab, and will be followed by Dr. [**Last Name (STitle) **] and your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 74788**]. ICD9 Codes: 5070, 0389, 4280, 2859
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Medical Text: Admission Date: [**2162-5-1**] Discharge Date: [**2162-5-5**] Date of Birth: [**2106-12-28**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3266**] Chief Complaint: hypotension, hematemesis Major Surgical or Invasive Procedure: EGD on [**5-1**] and repeated [**5-3**] History of Present Illness: 55 M c EtOH cirrhosis, h/o variceal bleed presents with hematemesis x 1 day. After vomiting second time, pt had transient LOC, awoke, and went to sleep. His wife found him pale and called EMS. Presented to OSH where SBP 90's and tachycardic, Hct 22. Transfused 1 units PRBC and IVF, started on octreotide gtt, 80mg IV protonix, then transferred here. SBP on arrival 88 systolic with Hct only 24. Pt c/o lightheadedness but no CP/SOB. In ED, coffee ground emesis. He was given 2 more PRBC, 2U FFP, 2U platelets, erythromycin 250mg, and decreased octreotide gtt to 40. Access is 2 peripheral IV and no central line. NS 1300cc. Continues to vomit dark red blood. No melena. Had EGD in MICU which showed mid-esophageal ulcer, no signs of variceal bleed. Very small varices were seen in the lower esophagus. The pt was continued on octreotide gtt and protonix IV bid, he remained HD stable overnight in the ICU, no further bleeding. Past Medical History: EtOH cirrhosis: Prior variceal bleed in [**2161-5-10**]. In [**1-15**] had upper GIB from ? portal hypertensive gastropathy and not variceal bleed. psoriasis HTN Pancytopenia - suspected EtoH marrow suppression, cirrhosis Inguinal hernia repair '[**59**] Social History: EtOh: 12 beers/day No tobacco Lives with wife in [**Name (NI) **], worked as a meat cutter 32yrs. states sober for 6 wks after his last variceal bleed but started drinking after this because of the stress of his job and caring for his mother and father-in-law Family History: n/c Physical Exam: vs: Tm 100.7 bp 127/55(102-135/36-65) p 64(64-125) rr17, 90-99% 3L Gen: somewhat tired appearing NAD Heent: pale conjunctiva, OP clear, Chest: ctab CV: rrr, no m/r/g Abd: soft, NT, no ascites, no caput medusa. +BS Ext: No c/c/e Neuro: No asterixis Pertinent Results: [**2162-5-1**] 07:59PM HGB-9.2* calcHCT-28 [**2162-5-1**] 07:59PM LACTATE-4.2* [**2162-5-1**] 08:02PM PT-18.7* PTT-31.0 INR(PT)-1.8* [**2162-5-1**] 08:02PM PLT COUNT-30* [**2162-5-1**] 08:02PM MACROCYT-1+ [**2162-5-1**] 08:02PM NEUTS-69.4 LYMPHS-24.9 MONOS-5.6 EOS-0.1 BASOS-0.1 [**2162-5-1**] 08:02PM WBC-3.4* RBC-2.51* HGB-8.8* HCT-24.8* MCV-99*# MCH-34.9* MCHC-35.4* RDW-15.1 [**2162-5-1**] 08:02PM AFP-15.4* [**2162-5-1**] 08:02PM AFP-15.4* [**2162-5-1**] 08:02PM OSMOLAL-345* [**2162-5-1**] 08:02PM TOT PROT-5.3* ALBUMIN-2.7* GLOBULIN-2.6 PHOSPHATE-4.5 MAGNESIUM-1.4* [**2162-5-1**] 08:02PM CK-MB-8 cTropnT-<0.01 [**2162-5-1**] 08:02PM LIPASE-51 [**2162-5-1**] 08:02PM ALT(SGPT)-57* AST(SGOT)-117* LD(LDH)-362* CK(CPK)-533* AMYLASE-88 TOT BILI-1.0 . [**2162-5-5**] 05:07AM BLOOD WBC-3.1* RBC-3.34* Hgb-10.6* Hct-31.2* MCV-93 MCH-31.8 MCHC-34.0 RDW-17.7* Plt Ct-36* [**2162-5-1**] 08:02PM BLOOD Neuts-69.4 Lymphs-24.9 Monos-5.6 Eos-0.1 Baso-0.1 [**2162-5-1**] 08:02PM BLOOD Macrocy-1+ [**2162-5-5**] 05:07AM BLOOD Plt Ct-36* [**2162-5-5**] 05:07AM BLOOD Glucose-121* UreaN-7 Creat-0.7 Na-136 K-3.3 Cl-102 HCO3-28 AnGap-9 [**2162-5-2**] 05:00AM BLOOD ALT-50* AST-91* CK(CPK)-400* TotBili-1.3 [**2162-5-2**] 05:00AM BLOOD Lipase-21 [**2162-5-2**] 05:00AM BLOOD CK-MB-6 cTropnT-<0.01 [**2162-5-5**] 05:07AM BLOOD Mg-1.9 [**2162-5-2**] 05:00AM BLOOD Osmolal-318* [**2162-5-1**] 08:02PM BLOOD AFP-15.4* [**2162-5-1**] 08:02PM BLOOD ASA-NEG Ethanol-157* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2162-5-1**] 08:00PM BLOOD RedHold-HOLD [**2162-5-1**] 07:59PM BLOOD Lactate-4.2* [**2162-5-1**] 07:59PM BLOOD Hgb-9.2* calcHCT-28 . Liver US: IMPRESSION: 1. Nodular cirrhotic liver with small amount of ascites. 2. Normal Doppler waveforms. . EGD [**2162-5-1**]: Impression: Localized ulceation and an adherent clot were seen in the mid esophagus, at 30 cm, likely the source of bleeding. The etiology was likely esophagitis and ulceration. Decompressed varices can not be excluded, although this is an unusual location for variceal bleeding. Very small varices at the lower third of the esophagus Erythema and congestion in the whole stomach compatible with moderate portal gastropathy Old, blood in the fundus Otherwise normal EGD to second part of the duodenum Recommendations: Protonix, octreotide, levofloxacin as per chart recommendations. NPO except medications. No NG tube Most likely with repeat EGD monday, if stable. . EGD [**2162-5-3**]: Impression: Giraffe skin appearance in the fundus and stomach body compatible with portal gastropathy Grade 3 esophagitis in the middle third of the esophagus Recommendations: Protonix 40mg IV BID carafate slurry 1 gram QID continue serial hct. History: alcoholic cirrhosis, history of variceal bleed Brief Hospital Course: A/P: 55 M c EtOH cirrhosis, h/o variceal bleed presents with hematemesis likely [**2-11**] esophageal ulcer rather than varices, per EGD on [**5-1**]. . 1. UGIB: The pt was admitted initially to the ICU given the hematemesis in the setting of cirrhosis. He was monitored in the ICU overnight and remained hemodynamically stable. He did receive 4 units pRBCs and underwent EGD which showed small varices, though suggested an esophageal ulcer as the source of the bleed rather than variceal bleed. The hct was followed several times per day. He had several large bore peripheral IVs. He was continued on protonix 40 IV bid which was changed to oral. Octreotide gtt was stopped after he stabilized his hct. A Repeat EGD on Monday showed no evidence of new bleeding source. His hct had remained stable for 48 hours. He was discharged home in stable condition. Nadolol therapy was started for variceal bleed prevention. Discussions were held with the patient and with his family members present regarding the importance of complete alcohol abstinence. Alcoholics anonymous and family support were encouraged. The patient was also advised to take all of his medicines as directed and to maintain good follow up with his physicians. Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the pcp, [**Name10 (NameIs) **] [**Name (NI) 653**] by phone and was updated. He will follow up with the patient next week. . 2. Cirrhosis: The patient has a known history of alcoholic cirrhosis. Levofloxacin was initially given to cover for possible SBP, although this was stopped when it was clear that there was no ongoing infection. Liver US was performed which showed nodular liver with no evidence of vascular compromise. . 3. EtOH: The patient has not been able to remain abstinent. He states that he was 6 drinks daily. The EtOH level was 157 on [**5-1**]. He was administered valium per CIWA and required only several doses of 5 mg IV over the first couple of days. . 4. FEN: His diet was advanced to full as tolerated after the EGD. . 5. Psychosocial: The patient recieved new that his father passed away during the inpatient stay. He was very saddened and was notably tearful. Social work consult was called. The patient had several family members come visit and provide support. He will follow-up with his pcp. . #Ppx: PPI, vitamins, no hep sc #Code: FULL #Comm: wife #Dispo: pending resolution of acute medical issues. Medications on Admission: nadolol effexor thiamine protonix Discharge Medications: 1. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*qs 1 month Cap(s)* Refills:*2* 2. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*120 Tablet(s)* Refills:*2* 3. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*qs 1 month Tablet(s)* Refills:*2* 4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*qs 1 month Tablet(s)* Refills:*2* 5. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*qs 1 month Tablet(s)* Refills:*2* 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 7. Effexor 75 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 8. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN (as needed). Disp:*qs 1 month qs 1 month* Refills:*0* Discharge Disposition: Home With Service Facility: referral to be made for pyschosocial services Discharge Diagnosis: 1. UGIB 2. Esophageal Ulcer 3. Grade III esophagitis 4. EtOH cirrhosis 5. Anxiety 6. Hypertension 7. Pancytopenia 8. Psoriasis 9. Alcoholism Discharge Condition: Stable hct x 48 hours, tolerating full diet. Ambulating with an 02 saturation of 98%. Discharge Instructions: Please follow-up with your PCP for any problems with chest pain, shortness of breath, black stools, bloody stools, abdominal pain, or any other concerns. Followup Instructions: Wednesday, [**6-23**] at 3:10 with Dr. [**Last Name (STitle) **] in the liver clinic on [**Hospital Ward Name 517**] on [**Location (un) **]. Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) **] Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2162-6-23**] 3:10 Arrange follow-up appointment with you ophthalmologist for futher evaluation of left eye. ICD9 Codes: 4019
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Medical Text: Admission Date: [**2125-11-9**] Discharge Date: [**2125-11-24**] Date of Birth: [**2050-1-26**] Sex: F Service: MEDICINE Allergies: Demerol / Codeine Attending:[**First Name3 (LF) 2279**] Chief Complaint: altered mental status Major Surgical or Invasive Procedure: chest tube placement intubation History of Present Illness: Mrs. [**Known lastname **] is a 75 year old woman with a history of Afib s/p ablation,HTN,DM, spinal stenosis, with recent hospitalization for osteomyelitis who presents with altered mental status and worsening tremor. She had been discharged from [**Hospital1 **] following hospitalization from presumed sepsis and hypotension on [**2125-11-5**] to rehab. On the evening of [**11-9**] a moonlighter was called for increasing agitation. It is unclear at what point she received 0.5mg of ativan. The patient was confused (oriented x1) with a question of increasing tremor and possibly slurred speech and was transferred to [**Hospital1 **] for concern of seizures v. sepsis with AMS. . In ED tachy to 110s, SBP 110s and required a 0.7L fluid bolus with resolution of BP to 130s, but remained tachy to low 100s. A CT ab/pelvis revealed a fluid collection on her left flank. No PE was noted. She continued to receive Vanc/flagyl and got a dose of zosyn, with admission for further work up. . ROS was negative for chest pain, syncope or presyncope, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Patient did not have any other complaints. She reported that her tremor has been present since she was in her 20s, related to a medication effect. . This am on the floor she was intermittently oriented to place and month but sometimes thinking she was stranded without her car and needing help. She did complain of anxiety once, calling for help, and was verbally calmed down then noted to be tachycardic to the 140s. Cardiology was consulted, with carotid massage x 2 performed, with return to normal sinus rythm. [**Name (NI) **] son notes that her speech is significantly more garbled in the last two to three days than previously. She began to have difficulty speaking status post extubation during the previous ICU stay, but her speech has become progressively worse. He confirms that the patient has had a baseline tremor, thought to be due to a medication effect 20 years ago. By the time the son visited the patient in the late morning, her tremor had improved, though it did intermittently worsen when the patient became more anxious. Son also noted that pt had intermittently stared off into space and been less responsive for a few minutes, then would return to conversation. Past Medical History: PAST MEDICAL HISTORY: Atrial fibrillation s/p ablation, not on coumadin Iron-deficiency anemia Gastritis per EGD, [**2124**] Insulin-dependent diabetes mellitus c/b neuropathy, retinopathy Lumbar stenosis, s/p L5-S1 laminectomy (age 40) Hypertension Hyperlipidemia DJD Tremor Steatohepatitis Depression PAST SURGICAL HISTORY: Cataract surgery Carpal tunnel release bilaterally Tonsillectomy Appendectomy Cholecystectomy Social History: Patient currently lives in a house in [**Location (un) **], Mass. She lives with her husband. She is now retired but formerly worked in medical records at [**Hospital **] Hospital. She denies EtOH, tobacco, and other drugs. Mrs. [**Known lastname **] reports attempting to maintain a diabetic diet, but admits to not being as good about it as she should be. She reports exercising by doing chores around the house. Family History: Diabetes II Physical Exam: On admission VS - 97.5 (98.8 rectally), 120/60, 110, 24, 100 % 2L Gen: Tremor worse with movement. HEENT: Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. CV: S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. Chest: Decreased BS, worse on L. Abd: Soft, NTND. No HSM or tenderness. Ext: + edema b/l, pitting. Skin: midline surgical scar on back. At the bottom of scar, small opening, small amount of bleeding when instpected with Q-tip, no tracking noted. Neuro: CNII-XII intact. Strength diffusly [**2-25**]. Sensation intact. She is awake, alert, oriented to self only. Responds to questions and some long term memory intact. Patient able to recal 1 object at 5 minutes. Difficulty with finger to nose b/l. Changes at discharge: 1+ bilateral foot edema, trace bilateral lower extremity edema, alert and oriented x 3, answering questions appropriately Pertinent Results: ============ Radiology ============ CT Torso [**11-9**] 1. No pulmonary embolus or acute aortic abnormality. 2. 2.2 x 2.0 cm fluid and air collection in the subcutaneous tissues of the left lateral abdominal wall that could reflect post-operative seroma, but abscess cannot be excluded. 3. No evidence large fluid collection surrounding spinal fixation hardware in the lumbar spine, although artifact obscures fine detail and evaluation is suboptimal. 4. Cirrhotic liver with ascites. 5. Bilateral pleural effusions, moderate on the left and small on the right with adjacent atelectasis. 6. Atherosclerotic disease. CT Head [**11-10**] IMPRESSION: Limited study due to patient motion. Within this limitation, no acute intracranial abnormalities identified. Repeat study [**11-10**] Several rounded areas of hypodensity are seen within the left frontal region seen on axial images only that are likely areas of volume averaging, however, peripheral areas of infarction cannot be entirely excluded, and if of clinical concern, a repeat examination or MR can be performed. No evidence of hemorrhage. MR [**Name13 (STitle) 430**] [**11-11**] IMPRESSION: 1. No definite acute infarction. 2. Mild-to-moderate dilatation of the lateral ventricles, with features as described above and slightly out of proportion to the prominence of the cerebral sulci; while this can relate to volume loss, associated communicating hydrocephalus/NPH cannot be completely excluded. To correlate clinically ============ Neurology ============ EEG [**11-13**] This is a normal routine EEG in the waking and drowsy states. Note is made by technician of intermittent left leg shaking without obvious epileptiform discharges or EEG correlate seen during that time. Due to technical difficulties, video was unavailable for review. No focal, lateralized, or epileptiform features were noted during this recording. Note is made of a tachycardia of 108 bpm in a single EKG channel. 24 hour EEG [**11-18**] This 24 hour video EEG telemetry capture no electrographic seizures. There were no clear focal or lateralizing epileptiform features. The background showed a slightly disorganized alpha theta rhythm which would be normal for advanced age. =========== Cytology ============ Pleural fluids [**11-14**] NEGATIVE FOR MALIGNANT CELLS. ============ Cardiology ============ Stress test [**11-12**] No anginal symptoms or ischemic ST segment changes to pharmacologic stress. Appropriate blood pressure response with flat heart rate response to Persantine infusion. Nuclear report sent separately. TTE [**11-14**] The left atrium is mildly dilated. Left ventricular wall thicknesses and cavity size are normal. There is mild regional left ventricular systolic dysfunction with focal hypokinesis of the basal half of the inferior wall and mid-inferior septum and inferolateral walls. The remaining segments contract normally (LVEF = 50 %). The estimated cardiac index is normal (>=2.5L/min/m2). Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Mild to moderate ([**11-24**]+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is mild pulmonary artery systolic hypertension. There is an anterior space which most likely represents a fat pad. Compared with the prior study (images reviewed) of [**2125-11-5**], regional left ventricular systolic function is now improved. The estimated pulmonary artery systolic pressure is now higher. =========== Micro =========== [**2125-11-13**] 7:38 pm MRSA SCREEN: No MRSA isolated. [**2125-11-24**] Urine culture: YEAST. 10,000-100,000 ORGANISMS/ML ============== Labs ============== Admission Labs [**2125-11-9**] 06:00PM BLOOD WBC-8.5 RBC-3.35* Hgb-9.3* Hct-30.2* MCV-90 MCH-27.9 MCHC-30.9* RDW-18.7* Plt Ct-366 [**2125-11-9**] 06:00PM BLOOD Neuts-83.5* Lymphs-9.4* Monos-6.4 Eos-0.5 Baso-0.2 [**2125-11-9**] 06:00PM BLOOD PT-16.0* PTT-31.4 INR(PT)-1.4* [**2125-11-9**] 06:00PM BLOOD Glucose-109* UreaN-13 Creat-1.2* Na-145 K-3.7 Cl-108 HCO3-29 AnGap-12 [**2125-11-9**] 06:00PM BLOOD ALT-20 AST-32 CK(CPK)-54 TotBili-0.5 [**2125-11-9**] 06:00PM BLOOD CK-MB-NotDone cTropnT-0.04* [**2125-11-9**] 06:00PM BLOOD CK-MB-NotDone cTropnT-0.04* [**2125-11-9**] 06:00PM BLOOD Albumin-3.1* Calcium-8.3* Mg-1.3* Discharge labs: WBC-7.2 RBC-3.59* Hgb-10.6* Hct-33.2* MCV-93 MCH-29.4 MCHC-31.8 RDW-18.0* Plt Ct-324 Glucose-179* UreaN-17 Creat-1.1 Na-141 K-4.3 Cl-99 HCO3-33* AnGap-13 Calcium-8.9 Phos-3.7 Mg-1.8 Brief Hospital Course: 75 year old woman with a history of Afib s/p ablation, HTN, DM, spinal stenosis, with recent hospitalization for osteomyelitis who presents with altered mental status and worsening tremor. She had been discharged from [**Hospital1 **] following hospitalization from presumed sepsis and hypotension on [**2125-11-5**] to rehab. On the evening of [**11-9**] a moonlighter was called for increasing agitation. It is unclear at what point she received 0.5mg of ativan. The patient was confused (oriented x1) with a question of increasing tremor and possibly slurred speech and was transferred to [**Hospital1 **] for concern of seizures v. sepsis with AMS. On the day of admission, patient was transferred to the MICU for an episode of unresponsiveness on the floor. The patient rapidly improved in regards to her mental status upon admission to the MICU. CT head and MRI were negative, and Neuro felt this event was likely toxic/metabolic in nature. She was called out to the floor where an EEG was performed and negative. She underwent diagnosistc thoracentesis which was transudative in nature on [**11-12**]. Post-thoracentesis CXR detected a left hemidiaphagm and repeat film several hours later was performed while the patient was having another episode of shaking. She became unresponsive and was noted to have shallow breathing. The xray technicians at the patient's side were unable to palpate a pulse so CPR was initiated and a code was called. Code team immediately noted that patient was in A fib, and CPR was stopped. Patient at this time was awake but delirious. Her oxygen saturation began to plummet and decreased breath sounds were noted on the left side. CXR revealed a large hydrothorax, and patient was transferred back to the MICU. A chest tube was placed and blood tinged sanguinous fluid returned. Patient was intubated for airway protection. Patient remained in the MICU from [**11-12**] through [**11-18**]. While in the MICU she was extubated on [**11-14**]. She required pressors from [**11-12**] through [**11-15**]. Her hypotension was felt to be due to hypovolemia secondary to dramatic chest tube fluid output. Chest tube drained between 2 and 4 L per day of ascitic fluid from presumed hepatic hydrothorax. Cardiac enzymes were slightly elevated, but consistent with her level of renal dysfunction and was felt not to have ACS. She had several TTEs which showed improving systolic function from EF 35 to 50%. The patient required 2 untis of PRBC transfusion in the unit and multiple albumin bags for resuscitation. Thoracic surgery was consulted on [**11-16**] for assistance on hydrothorax management, and they advised no surgical intervention. Instead the chest tube was placed to waterseal on [**11-17**] and diuresis was initiated with lasix drip per thoracic surgery recommendations. A diaphragmatic defect was not felt to be responsible. The patient was able to maintain her pressures, and she tolerated diuresis with these maneuvers. Her course in the MICU was also complicated by intermittent episodes of sinus tachycardia to has high as 140s bpm which responded transiently to carotid massage. Her sinus tach was felt to be due to [**Last Name (un) 3041**] shifts and anxiety. She was transferred out of the MICU on [**11-18**]. No clear cause for her change in mental status was found while in the MICU. A repeat EEG was again negative, and Neurology once again felt that this was likely multifactorial toxic/metabolic insults in the setting of acute on chronic renal failure, liver disease, chf, dm and hypoxia from chronic pleural effusions. Back on the medical floor, she continued to improve. # Altered mental status: Her altered mental status was likely related to medication side effects or hepatic encephalopathy. Her Elavil was decreased for possible anticholinergic side effects. If her mental status worsens, suggest changing patient over to nortripytline and checking levels. # Tachycardia: Her sinus tachycardia improved after adding metoprolol back to her medication regimen. # Anemia: She had a hematocrit drop while in the MICU without clear source and was guaiac negative. After 2 units pRBCs on [**11-15**], her hematocrit was stable. # Osteomyelitis: Patient is on long term vanco/metronidazole since previous hospitalization for L2 osteo and is followed by ID as an outpatient. She is to continue vancomycin until [**2125-12-16**] and flagyl until [**2125-12-20**]. # Mild systolic congestive heart failure: She was diuresed as above. Patient's most recent EF 50%. # NASH Cirrhosis: She was seen by hepatology during this admission. She had a low MELD. Patient was started on aldactone and diuresed as above. She is to follow-up with the liver center as an outpatient. # Inverted nipple noted on exam: Patient will need follow up with PCP for this issue. # DM: She was continued on an insulin sliding scale. # Communication: daughter [**Name (NI) **] [**Telephone/Fax (1) 40153**], son [**Name (NI) **] [**Telephone/Fax (1) 40152**], [**Name2 (NI) **] [**Telephone/Fax (1) 40154**] Full code Medications on Admission: Per last D/C sum: Acetaminophen 325 mg prn q6 Amitriptyline 75mg qHS Bisacodyl 10 mg dailr prn Docusate Sodium 100 mg [**Hospital1 **] prn Ferrous Sulfate 325 mg (65 mg Iron) daily Furosemide 40 mg daily Heparin SC 5,000 Units TID Lidocaine 5 %(700 mg/patch) daily prn Megestrol 40 mg TID Metoprolol Tartrate 25 mg [**Hospital1 **] Metronidazole 500 mg q8 Miconazole Nitrate 2 % Powder [**Hospital1 **] Pantoprazole 40 mg Daily Sennosides [**Hospital1 **] prn Simvastatin 40 mg daily Trifluoperazine 2 mg daily Vancomycin 500 mg IV Q 24H Insulin SS Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 3. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily): 12 hours on and 12 hours off. 5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day): Hold for SBP<100, HR<60 . 6. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day): Hold for > 4 BM per day . 7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for skin irritation. 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 9. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours): Continue until [**2125-12-20**]. 11. Vancomycin 750 mg Recon Soln Sig: One (1) dose Intravenous once a day: Until [**2125-12-16**]. 12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 13. Amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 14. Trifluoperazine 2 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Hold for SBP<100 . 16. Furosemide 10 mg/mL Solution Sig: Sixty (60) milligrams Injection [**Hospital1 **] (2 times a day). 17. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 18. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever or pain: Do not exceed 2grams daily. 19. Lantus 100 unit/mL Solution Sig: Ten (10) units Subcutaneous at bedtime. 20. Insulin Please continue humalog insulin sliding scale as attached. 21. Heparin (Porcine) 5,000 unit/mL Syringe Sig: 5000 (5000) units Injection three times a day. 22. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO once a day: last day [**2125-12-8**] . Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Altered mental status Urinary tract infection Hydrothorax Osteomyelitis Cirrhosis Discharge Condition: Level of Consciousness:Alert and interactive (but intermittent as patient may wx and wane) Activity Status:Ambulatory - requires assistance or aid (walker or cane) Mental Status:Confused - sometimes (waxes and wanes but alert and oriented currently) Questionable hospitalization delirium Discharge Instructions: You were admitted to the hospital for confusion. During your hospital stay, you had 2 episodes of decreased responsiveness prompting stays in the intensive care unit. We suspect your first episode was from medications causing sedation and that your second episode was from difficulty breathing because you had fluid accumulating around your left lung. You improved after draining the fluid with a cathether and taking medications to clear the fluid from your body. You were stable to be discharged to a rehab facility to work on regaining your strength. Please follow-up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 40075**]. The following changes were made to your medications: Decreased Elavil from 75mg to 25mg as it may have worsened your confusion Increased lasix to 60mg IV twice a day. This will be tapered to meet your goal Ins and Outs Increased vancomycin to 750mg for therapeutic level Decreased metoprolol from 25mg [**Hospital1 **] to 12.5mg [**Hospital1 **] Started fluconazole 200 mg daily for fungus in your urine for 14 days (last day [**2125-12-8**]) Started Lactulose 30mg TID and aldactone to help control your liver cirrhosis. Started full dose aspirin for your atrial fibrillation Stopped megace Followup Instructions: Please follow-up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 40075**]. You can call [**Telephone/Fax (1) 40076**] to schedule an appointment. Please follow-up with Dr. [**Last Name (STitle) 497**] in the liver center. You will be called about appointment scheduling but if you do not hear from them, please call ([**Telephone/Fax (1) 1582**]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2285**] ICD9 Codes: 5849, 5990, 5180, 2760, 5715, 4280, 4168, 4240, 3572, 4019, 2859
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Medical Text: Admission Date: [**2197-9-16**] Discharge Date: [**2197-12-27**] Date of Birth: [**2197-9-16**] Sex: M Service: Neonatology HISTORY: Baby boy [**Known lastname 68869**], twin No. 1, was born weighing 718 grams, the product of a 24 and 6/7 weeks gestation pregnancy. He was born to a 34-year-old G2, P0, now 2 mother. Maternal history was notable for short cervix with cerclage placement prenatally. Prenatal screens - blood type O positive, antibody negative, HbSAg negative, RPR nonreactive, rubella immune, GBS unknown. This infant was born by cesarean section after unstoppable preterm labor. The infant emerged with a weak cry, was brought to the warmer, given some positive pressure ventilation and intubated in the delivery room. PHYSICAL EXAMINATION: Anterior fontanel open and flat. Coarse breath sounds bilaterally with good breaths bilaterally. Positive red reflexes bilaterally. No murmur. normal S1S2. Normal pulses. Soft, nondistended, no masses. Moved all extremities equally. Pink and well perfused. Three-vessel cord, patent anus. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: RESPIRATORY: The infant had respiratory distress syndrome on admission to the NICU and was intubated and received surfactant therapy x2. He remained ventilated with conventional ventilation until [**2197-10-11**], which is day of life 25 when he required high frequency ventilation at that time for sepsis issues. Within 24 hours he returned to conventional ventilation. In the setting of his chronic lung disease, he was started on Lasix on DOL #42 ([**10-28**]), receiving Lasix every Monday, Wednesday and Friday. He extubated to CPAP on [**2197-11-7**], day of life 52, successfully weaned to nasal cannula on [**2197-11-27**], which is day of life 73. He weaned to room air on [**2197-12-17**], and has remained stable on room air since that time. He has had no apnea or bradycardia issues for well over a week. He was given caffeine citrate from [**2197-11-19**], through till [**2197-10-17**], at which time caffeine was discontinued due to increased heart rate. Caffeine was never restarted thereafter. Currently, he is receiving Lasix every Monday, Wednesday and Friday. He had been receiving KCl as well but this was discontinued on [**12-20**] and his most recent Cl on [**12-26**] was 106 with a K of 5.5. The infant will be followed for chronic lung disease by Dr. [**First Name4 (NamePattern1) 487**] [**Last Name (NamePattern1) 37305**] at [**Hospital3 1810**] and has a follow- up appointment on [**1-5**]. CARDIOVASCULAR: The infant presented with symptoms of PDA on [**2197-9-17**], at which time indomethacin was given. A post-indomethacin echocardiogram on [**2197-9-19**] showed that that the ductus was closed. Followup echocardiogram was done on [**2197-10-3**], due to re-presentation, which showed a small 1 mm PDA. No indomethacin was given at that time. Two further echocardiograms have been done, both in [**Month (only) 359**] (23 and 26th) due to persistent murmurs. Both of those showed a very tiny PDA, neither of which was treated with Indocin. The infant has been hemodynamically stable and at this time does not have a murmur and has normal heart rate and blood pressure. No further issues. He does not have a murmur at the time of discharge. The infant did present with a brief period of supraventricular tachycardia on [**2197-10-17**], at which time caffeine citrate was discontinued and no urther episodes have been observed. FLUIDS, ELECTROLYTES AND NUTRITION: IV fluids were initiated on admission to the NICU and changed to total parental nutrition over the next few days. An umbilical arterial catheter was placed and a double lumen umbilical venous line was also placed on admission. The infant was started on enteral feedings on [**2197-9-21**], with a slow feeding advance and achieved full enteral feedings. A PICC line was placed on [**2197-9-23**]. The double lumen UVC was discontinued at that time. Enteral feedings were advanced and the infant achieved full enteral feedings by [**2197-9-30**]. Enteral feedings were then further concentrated to caloric density of breast milk 30 calorie per ounce with Beneprotein. The infant had an episode of abdominal distention with an abnormal KUB and was treated for 14 days for medical necrotizing enterocolitis which was started on [**2197-10-10**]. The KUB subsequently normalized and the infant was restarted on enteral feedings on [**2197-10-27**]. Feedings advanced without an incident. Currently, he is feeding PO ad lib of 26 calorie breast milk mixed as breast milk with 4 calories of Similac powder per ounce and 2 calories of corn oil per ounce. The infant's most recent weight is 2810 grams. He is gaining well. He is taking approximately 3 ounces every 4 hours enterally. Most recent set of electrolytes were done on [**2197-12-26**], and the results are Na=138, K=5.5, Cl=106, HCO3=23. His most recent head circumference is 34 cm, most recent length is 48 cm, both done on [**2197-12-26**]; at present he is 10 to 25th percentile for weight, 50 to 75th percentile for head circumference, and 25th to 50th percentile for length. He is on daily multivitamins, 1 ml per day. Renal: On [**2197-12-26**], renal ultrasound was performed which showed bilateral calcifications in both kidneys, consistent with chronic lasix use. GASTROINTESTINAL: The infant did have a period of medical necrotizing enterocolitis that was discussed under fluid, electrolytes and nutrition as above, treatment from [**2197-10-10**], through [**2197-10-27**]. The infant did have hyperbilirubinemia with a peak bilirubin level of 3.8/ 0.3 and did receive a total of 8 days of phototherapy. HEMATOLOGY: The patient's blood type is A positive, DAT negative. The infant has received numerous blood product transfusions, and in total has received 5 transfusions of packed red blood cells with the most recent transfusion being on [**2197-10-28**]. The infant is on elemental iron, ferrous sulfate at 0.5 ml PO daily. Most recent hematocrit was 36 on [**2197-12-12**], with a reticulocyte count of 8.1%. INFECTIOUS DISEASE: CBC and blood culture were screened on admission to the NICU. The infant had a white blood cell count of 5.1 with 29 polys, yielding an ANC of 1479. There was no left shift. The infant received 48 hours of ampicillin and gentamycin initially which were subsequently discontinued when the blood culture remained negative at that time. The infant had a sepsis evaluation done on [**2197-9-29**], at 13 days of life due to clinical instability. CBC at that time was normal but the blood culture grew staph epidermidis bacteremia. The infant was started on vancomycin and gentamycin and given a 7-day course of antibiotics at that time. At the end of that course of antibiotics, the infant presented with medical necrotizing enterocolitis and that was on [**2197-10-10**]. The antibiotic therapy was switched to Zosyn to treat for medical necrotizing enterocolitis at that time. The infant received 12 days of Zosyn therapy which was changed on [**2197-10-21**], to vancomycin, gentamycin and clindamycin when a blood culture grew positive at that time for gram positive cocci. CBC at that time was not shifted on [**2197-10-10**]. The infant received an additional 7 days of antibiotics which were subsequently discontinued on [**2197-10-27**]. The infant had a yeast diaper rash and was treated with miconazole powder from [**2197-10-21**], through till [**2197-10-29**]. There have been no further infectious disease issues. NEUROLOGY: The infant has had numerous cranial ultrasounds done on [**2197-9-18**], [**2197-9-25**], [**2197-10-16**], [**2197-12-21**], all within normal limits. SENSORY: Hearing screen was performed and the infant passed in both ears. OPHTHALMOLOGY: The infant has had numerous ophthalmological examinations. The initial examination was done on [**2197-10-30**], and the most recent ophthalmologic examination was [**2197-10-26**]. The infant did have mild ROP but has progressed to mature eyes on [**2197-10-26**], and the plan is for follow up with ophthalmology in 9 months after discharge. PSYCHOSOCIAL: [**Hospital1 18**] social worker has been involved with the family. If there are any concerns, she can be reached at [**Telephone/Fax (1) 56048**]. CONDITION ON DISCHARGE: Good. DISCHARGE DISPOSITION: Home with the parents. NAME OF PRIMARY PEDIATRICIAN: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] from [**Location (un) **]. CARE RECOMMENDATIONS: 1. Ad lib PO feedings of breast milk 26 calorie per ounce made as breast milk with 4 calorie per ounce of Similac powder and 2 calories per ounce of corn oil. 2. Medications: Elemental iron 0.5 ml per day. Daily multivitamin drops 1 ml per day, Lasix 5.5 mg which equals 0.6 ml once daily on Mondays, Wednesdays and Fridays. 3. Car seat positioning. The infant was tested in the infant car seat and did not pass in an upright position. It was recommended that the infant be discharged in an infant car bed in a supine position. 4. State newborn screens: Numerous state newborn screens have been sent and the most recent screen is normal. 5. Immunizations received: The infant received Pediarix vaccine on [**2197-11-19**], pneumococcal vaccine on [**2197-11-20**], Synagis on [**2197-12-25**]. 6. Immunizations Recommended: Synagis RSV prophylaxis should be continued monthly through [**Month (only) 958**]. Influenza immunization is recommended annually in the fall for all infants once they reach 6 months of age. Before this age and for the first 24 months of the child's life, immunization against influenza is recommended for household contacts and out of home caregivers. Follow up appointment is recommended with the pediatrician on [**2187-12-29**]. Also followup appointment on [**1-5**] at 1 p.m. with Dr. [**Last Name (STitle) 37305**], from pediatric pulmonology at [**Hospital3 18242**]. VNA referral after discharge. Early intervention follow up and Infant [**Hospital **] Clinic at [**Hospital3 1810**]. DISCHARGE DIAGNOSES: 1. Prematurity born at 24 and 6/7 weeks gestation. 2. Twin No. 1, respiratory distress syndrome, resolved 3. Rule out sepsis. 4. Patent ductus arteriosus, resolved 5. Necrotizing enterocolitis, resolved 6. Staph epidermidis bacteremia, resolved 7. Chronic lung disease. 8. Hyperbilirubinemia, resolved 9. Anemia of prematurity. 10. Retinopathy of prematurity, resolved. 11. Left hydrocele. 12. Bilateral renal calcifications Lasix-induced [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 56662**] Dictated By:[**Name8 (MD) 68870**] MEDQUIST36 D: [**2197-12-26**] 22:22:26 T: [**2197-12-27**] 02:27:30 Job#: [**Job Number 68871**] ICD9 Codes: 769, 7742
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Medical Text: Admission Date: [**2167-11-9**] Discharge Date: [**2167-11-18**] Date of Birth: [**2114-5-14**] Sex: F Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 668**] Chief Complaint: HCV cirrhosis Major Surgical or Invasive Procedure: Liver transplant [**2167-11-9**] History of Present Illness: 53-y.o. female with HCV cirrhosis s/p TIPS is called in for potential liver transplantation. Patient was recently hospitalized [**Date range (1) 87949**] for hepatic encephalopathy and treated with PO and PR lactulose. Per daughter, Pt has been at baseline since being discharged two days ago: able to converse and perform daily activities of living. Although her mental status was normal yesterday, pt complained of weakness and "not feeling well." This morning, she woke up confused and unoriented. Denies fever, chills, nausea, vomiting, cough, dysuria, SOB or CP. Most of history is obtained through her daughter and HCP as pt is minimally conversant. Past Medical History: - HCV: Dx [**2166**]; she is infected with G3A genotype. She has no history of UGIB or varicies. She has no history of IDU or transfusions. - DM-2 - Asthma: never required hospitalization or intubation - Migraine headaches - history of Gallstones - ? peripheral vascular disease - Cirrhosis - Diuretic refractory ascites s/p TIPS [**2167-3-25**] - HCC s/p RFA ablation Social History: She has 2 children and 2 grandchildren ages 15 and 18. They have no pets, she does not garden or keep indoor plants. She has worked in a local store as a stockperson. Not working. From [**Male First Name (un) **] and moved here 40 yrs ago. . She was born in [**Male First Name (un) 1056**]. While there, she worked in assembly lines, stores, and other manual labor jobs; She left [**Male First Name (un) 1056**] over 40 years ago, and lived first in [**Location (un) 7349**] then NJ with her present husband. They moved to [**State 87856**] over 1 year ago. Family History: There is no known family history of liver disease or liver cancer. She has 6 brothers and 5 sisters; her father died when she was 17 (ETOH abuse) and her mother is alive and living in [**Name (NI) 108**] now. Physical Exam: T: 97.3 P: 82 BP: 127/43 RR: 18 O2sat: 96% on RA General: awake, alert, follows commands, NAD, oriented to person, oriented to place after much encouragement HEENT: NCAT, EOMI, icteric sclera Heart: RRR Lungs: normal excursion, no respiratory distress Abdomen: obese, soft, NT, ND, no fluid wave Extremities: WWP, 2+ pedal edema Skin: multiple ecchymotic areas on both arms Neuro: moves all extremities Studies: Serum electrolytes: pending CBC: pending CT head [**2167-11-2**] showed: No acute intracranial process. Brief Hospital Course: 53-y.o. female HCV cirrhosis admitted for liver transplantation. Upon admission, she was lethargic and was given lactulose/rifaximin. Ammonia level was 128. She underwent liver transplant and ventral hernia repair on [**2167-11-9**]. Surgeon was Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Please refer to operative note for details. 3 JPs were placed (posterior to liver, under hilum and subcutaneous at hernia repair). Drains were non-bilious. She was sent to the SICU postop and was extubated the next day. LFTs increased postop day 1. Liver duplex was wnl. Mental status was improved from preop. LFTs continued to trend down. She was sent out of SICU on postop day 2. Diet was slowly advanced and tolerated. Insulin was given for hyperglycemia due to steroids. [**Last Name (un) **] was consulted and ordered 75/25 pen. Vital signs remained stable. Lasix was given for low urine output and edema. Creatinine increased on postop day 2, up to 1.5 from 2 then improved daily. Immunosuppression consisted of Cellcept which was well tolerated, steroid taper and Prograf that was started on postop day 1. Doses were adjusted per trough. She did well with medication teaching and self administration of insulin with assist of family members. VNA Greater RI 1-[**Telephone/Fax (1) 87950**] was arranged to assist with JP drain care (in hernia bed). Nsg anf PT services were requested. Medications on Admission: Ciprofloxacin 250 mg daily, clotrimazole 10 mg troche 5x daily, metformin 500 mg [**Hospital1 **], glimepiride 1 mg daily, rifaximin 550 mg [**Hospital1 **], esomeprazole 40 mg daily, furosemide 20 mg daily, spironolactone 50 mg daily, lactulose 10 g/15 mL x 30 mL TID, tramadol 50 mg Q6H PRN pain, ropinirole 0.5 mg daily, ferrous sulfate 300 mg daily, docusate sodium 100 mg [**Hospital1 **], polyethylene glycol 17 g PO BID PRN constipation, fleet enema PRN constipation, vitamin D-2 50,000 unit Qweek. Allergies: NKDA. Discharge Medications: 1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 2. prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): follow taper schedule. 3. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 5. valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 7. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours). 8. Humalog Mix 75-25 KwikPen 100 unit/mL (75-25) Insulin Pen Sig: Forty (40) units Subcutaneous once a day. Disp:*30 pens* Refills:*4* 9. Humalog Mix 75-25 KwikPen 100 unit/mL (75-25) Insulin Pen Sig: Twenty Five (25) units Subcutaneous at bedtime: take at dinner. 10. valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). 12. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 13. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. 14. Breeze 2 Test Strips Strip Sig: One (1) Miscellaneous four times a day. Disp:*1 box* Refills:*2* 15. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO once a week. 16. Kayexalate Powder Sig: Fifteen (15) grams PO 15 gm(s) by mouth As directed Only take if directed by transplant team . Disp:*1 bottle* Refills:*2* Discharge Disposition: Home With Service Facility: visiting nurse services of greater RI Discharge Diagnosis: HCV cirrhosis Asthma DM II Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: -Visiting Nurses services of Greater [**Doctor Last Name 792**]have been arranged -Please call the Transplant Office [**Telephone/Fax (1) 673**] if you have any of the following: fever (101 or greater), shaking chills, nausea, vomiting, inability to take any of your medications, jaundice, increased abdominal/incision pain, incision redness/bleeding/drainage or diarrhea/constipation. -You will need to have blood drawn every Monday and Thursday for lab monitoring at Quest lab or Lab provider recommended by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 23170**], RN -Please empty and record abdominal drain output. Bring record of drain output to next Transplant appointment -Do not lift anything heavier than 10 pounds. No straining -You may shower Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2167-11-26**] 3:40 Completed by:[**2167-11-19**] ICD9 Codes: 5849, 5715, 2875
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Medical Text: Admission Date: [**2144-10-11**] Discharge Date: [**2144-10-26**] Date of Birth: [**2126-11-21**] Sex: M Service: TRA HISTORY OF PRESENT ILLNESS: The patient is a 17 year old male with gunshot wound to the chest and back. Initially, he was seen at an outside hospital. The patient had bilateral chest tubes placed at that time. He was initially alert and oriented times three but now complaining of bilateral lower extremity paralysis. He is not withdrawing to pain. The patient was found to have five bullet wounds. He had four units of packed red blood cells prior to his transfer and was intubated at the outside hospital. The patient was hemodynamically stable upon transfer. PAST MEDICAL HISTORY: None. MEDICATIONS AT HOME: None. ALLERGIES: None. SOCIAL HISTORY: Unknown. The patient lives at home with two sisters. PHYSICAL EXAMINATION: The patient has a temperature of 96.6; heart rate of 110; blood pressure 96/70; respiratory rate of 20; saturating 94 percent on room air. Physical examination: The patient is sedated and paralyzed. Heart is regular rate and rhythm. Chest is coarse bilaterally. The patient has one sternal bullet wound; one in the left posterior axillary line; two in the right posterior axillary line and one in the left thigh posteriorly. Abdomen is distended. His extremities are warm. He has bilateral late palpable pulses. His back has no step-off. HOSPITAL COURSE: The patient was taken directly to the operating room for exploration, at which time an exploratory laparotomy was performed. A splenectomy was performed. The patient also had a repair of a left diaphragmatic injury and repair of a liver laceration. This was performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. The patient was admitted at that time and sent to the Intensive Care Unit for observation. The patient was placed on a Solu-Medrol protocol. He was also seen by the orthopedic spine service. The orthopedic spine service had intention to perform surgical intervention on his back; however, it was deemed important to make sure that the patient was stable from a hemodynamic standpoint and held on surgery. The patient did receive perioperative Cefotetan. He was also left intubated for a prolonged period of time. It became evident early in the patient's stay that the patient's white blood cell count began to increase. The patient was pan cultured as well as his lines removed and changed. The only thing found was a hemophilus pneumonia which was treated for seven days with Levofloxacin. Meanwhile, his white blood count continued to increase, which has presumably been secondary to splenectomy as no other source has been identified nor is there is any source apparent on physical examination or complaint of the patient. The patient did receive a bronchoscopy which showed blood and clots in the right middle lobe of the bronchus of his lung, although no clear injury was found. The patient required a thoracic consult as the patient had a prolonged air leak in one of his right chest tubes. It was believed that once the patient was off positive pressure ventilation, that this air leak would resolve. The patient was finally taken back to the operating room and had a decompression and T10 to L2 fusion of his vertebra by the ortho spine service. The patient tolerated that procedure well as well. After that procedure, the patient began his vent weaning and, as expected, once he had been weaned down adequately, the patient's air leak began to decrease. The patient was started on tube feeds while intubated. He was also given diuretics to help him down load his edema, as he had quite a bit of fluid on board from the multiple surgeries and the resuscitation. Over the course of the next few days, the patient was successfully extubated. His nasogastric tube was removed and he was started on a regular diet. This was a prolonged course increasing his p.o. intake, as the patient did not have much interest in food. During all of the patient's critical care management, multiple family visits were made by his team of physicians to discuss different aspects of the patient's care and it was evident that the mother is in denial of the patient's likely permanence of paraplegia, however, is on board with the patient going to rehabilitation. Prior to leaving the Intensive Care Unit, the patient had his left chest tube and one of his right tubes removed. While on the floor, the final chest tube was removed as pneumothorax was seen as stable on his chest x-ray and believed to be scarred into place. No air leak was evident at that time. While on the floor, the patient was seen by physical therapy. He was also plugged into case management for placement issues. At that time, it was decided that the patient was appropriate for transfer to rehabilitation. At that time, the patient again spiked a temperature and was worked up thoroughly. His blood and urine were cultured. Chest x-ray was performed. Urinalysis was performed. The patient was looked over thoroughly for sources of an infection, although no source was found. His chest x-ray looked better than it ever had. His urinalysis was negative and nothing grew on culture. It is believed that his high white count is secondary to splenectomy and will resolve on its own. The patient did tolerate p.o. and is passing stool and gas freely. It is now [**2144-10-26**] and the patient is being discharged in good condition to a rehabilitation facility. DISCHARGE MEDICATIONS: 1. Tylenol prn. 2. Dulcolax prn. 3. Colace 100 mg p.o. twice a day. 4. Ativan 1/2 mg q. 4 hours prn anxiety. 5. Reglan 10 mg p.o. q 8 hours. 6. Milk of Magnesia 30 mg p.o. q. Six hours prn. 7. Percocet as pain. 8. Pepcid 20 mg p.o. twice a day. 9. Heparin 5000 units subcutaneous three times a day. 10. Ambien 5 mg p.o. q h.s. prn. DISCHARGE DIAGNOSES: 1. T11 burst fracture of the spine, status post vertebral fusion. 2. Bilateral pneumothoraces, status post chest tube placement. 3. Liver laceration, status post repair. 4. Splenic laceration, status post splenectomy. 5. Diaphragm injury, status post repair. 6. Exploratory laparotomy. 7. Hemophilus influenza pneumonia. 8. Left thigh gun shot wound. 9. Multiple chest gunshot wounds. 10. Blood loss anemia. 11. Hypocalcemia. 12. Hypomagnesemia. 13. Paraplegia. 14. Anxiety. DISCHARGE DIET: House diet as tolerated. The patient should be given Boost for breakfast, lunch and dinner. The patient was given hemophilus influenza pneumococcal and meningococcal vaccines prior to discharge. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5732**], [**MD Number(1) 5733**] Dictated By:[**Last Name (NamePattern1) 3956**] MEDQUIST36 D: [**2144-10-26**] 12:09:07 T: [**2144-10-26**] 12:44:05 Job#: [**Job Number 60159**] ICD9 Codes: 2851
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Medical Text: Admission Date: [**2133-9-22**] Discharge Date: [**2133-9-26**] Date of Birth: [**2072-6-13**] Sex: F Service: MEDICINE Allergies: Gatifloxacin / Penicillins / Ciprofloxacin / Bactrim Attending:[**First Name3 (LF) 10842**] Chief Complaint: DKA, UTI Major Surgical or Invasive Procedure: none History of Present Illness: 61F w/ PMH DM, CKD (Cr 1.5-1.8), HTN, with recent hospitalization for DKA/UTI now presenting to ED from PCP with persistent dysuria, nausea and chills. She was discharged on cefuroxime based on prior history of pan-sensitive proteus/ecoli. During that hospitalization, she was noted to have elevated blood glucose, increased anion gap, and ketones in urine reflective of DKA thought to be precipitated by the UTI. She initially received IV insulin and was transitioned to a SC regimen. She was discharged on [**9-18**] and notes that that the nausea and chills returned the following day despite taking cefuroxime [**Hospital1 **] as directed. She experiences dysuria and myalgias. No hematuria. No back pain. No recorded fevers. Poor po intake x3 days. In the ED, initial VS were 96 91 146/100 20 97% ra. She received 2L NS, 4mg IV zofran, and ciprofloxacin 400mg IV x1 for UTI (59 wbc, lg leuks, 300 protein, 1000 glu on UA) . She was noted to have AG of 17 and glucose in the 300s, so was given 10U regular insulin and started on insulin ggt at 2u/hr. Lactate was 2.8. K+ was elevated to 6.3 but hemolyzed, and was 4.5 on green top. WBC was elevated to 12.6 from 7.7 on last d/c. Pt admitted to MICU for insulin ggt requirement. Access is 2 PIVs. Of note, ED reports that she appears more somnelent/lethargic on transfer. Past Medical History: 1. DM2: insulin-dependent may be Type 1 -followed by [**Hospital **] Clinic -c/b recurrent ulcers, urosepsis -Charcot deformity 2. s/p amputation of L 2nd & 3rd toe 3. chronic ulcer of R pretibia 4. hx of MRSA foot [**3-/2125**] 5. HTN 6. PVD 7. hypercholesterolemia 8. Anemia, ? ACD, baseline low 30s 9. Hematemesis in [**2125**] thought to be [**1-15**] small [**Doctor First Name 329**] [**Doctor Last Name **], EGD ulcer in GE junction Social History: The patient lives with her husband and has a 10 year old child. She works at the Causeway VA as a secretary. She smokes 10 cigs per day x 40 years. No ETOH and drugs. Family History: Mother had DM2, died of diabetes related coma Father has DM2, still alive Several family members on paternal side with DM2 No FH of CAD, MI, or cancer. Physical Exam: ADMISSION PHYSICAL EXAM: Vitals: T: 98.5, 188/95, 98, 14, 96% RA General: obese female lying in bed, somnelent, but [**Last Name (un) **]/oriented and answering questions HEENT: dry MM, OP clear, EOM intact, rosy face Neck: supple, JVP not elevated, no LAD CV: distant heart sounds but regular, no murmurs Lungs: distant breath sounds, but clear bilaterally Abdomen: obese, NT/ND, BS+ GU: foley Ext: warm, well perfused, 1+ pulses, chronic venous stasis changes and bilateral erythema of the shins with open ulcers, multiple toe-amputations Neuro: moving all extremities, A/O x2 (didn't have date right), but lethargic DISCHARGE PHYSICAL EXAM VS: T97.6 BP 156/60 HR 75 RR 18 O2 sat 98% (RA) GEN Alert, oriented, no acute distress HEENT NCAT MMM EOMI sclera anicteric, OP clear, poor dentition NECK supple, no JVD, no LAD PULM Good aeration, CTAB no wheezes, rales, ronchi CV RRR normal S1/S2, no mrg ABD soft obese NT ND normoactive bowel sounds, no r/g EXT warm, well perfused, 1+ distal pulses, chronic venous stasis changes and bilateral erythema of lower extremities, multiple toe-amputations NEURO CNs2-12 intact, motor function grossly normal Pertinent Results: ADMISSION LABS [**2133-9-22**] 07:00PM BLOOD WBC-12.6*# RBC-5.18 Hgb-16.1*# Hct-48.8* MCV-94 MCH-31.0 MCHC-32.9 RDW-13.6 Plt Ct-289 [**2133-9-22**] 07:00PM BLOOD Neuts-89.7* Lymphs-6.5* Monos-2.8 Eos-0.3 Baso-0.6 [**2133-9-22**] 07:00PM BLOOD Glucose-354* UreaN-29* Creat-1.3* Na-133 K-5.9* Cl-97 HCO3-19* AnGap-23* [**2133-9-22**] 07:00PM BLOOD ALT-18 AST-46* AlkPhos-113* TotBili-0.7 [**2133-9-22**] 07:00PM BLOOD Lipase-16 [**2133-9-22**] 07:00PM BLOOD Albumin-4.2 Calcium-9.8 Phos-5.0*# Mg-1.8 [**2133-9-22**] 08:05PM BLOOD Osmolal-313* [**2133-9-23**] 01:37AM BLOOD Type-[**Last Name (un) **] pO2-93 pCO2-44 pH-7.36 calTCO2-26 Base XS-0 Comment-GREEN TOP [**2133-9-22**] 07:11PM BLOOD Glucose-347* Na-133 K-9.9* Cl-101 calHCO3-22 [**2133-9-22**] 07:00PM URINE Color-Straw Appear-Hazy Sp [**Last Name (un) **]-1.010 [**2133-9-22**] 07:00PM URINE Blood-SM Nitrite-NEG Protein-300 Glucose-1000 Ketone-10 Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-LG [**2133-9-22**] 07:00PM URINE RBC-5* WBC-59* Bacteri-FEW Yeast-RARE Epi-1 TransE-<1 [**2133-9-23**] 06:32PM URINE CastHy-15* Discharge: [**2133-9-26**] 08:33AM BLOOD WBC-8.9 RBC-3.88* Hgb-12.0 Hct-36.3 MCV-94 MCH-31.1 MCHC-33.2 RDW-14.0 Plt Ct-259 [**2133-9-26**] 08:33AM BLOOD Glucose-141* UreaN-31* Creat-1.5* Na-143 K-4.1 Cl-106 HCO3-26 AnGap-15 [**2133-9-25**] 07:35AM BLOOD ALT-13 AST-17 AlkPhos-89 TotBili-0.3 [**2133-9-25**] 07:35AM BLOOD Calcium-8.4 Phos-4.1 Mg-1.7 [**2133-9-24**] 08:00AM BLOOD CK-MB-5 cTropnT-0.01 [**2133-9-23**] 04:00PM BLOOD CK-MB-4 cTropnT-0.02* MICRO: URINE CULTURE [**9-22**] URINE CULTURE (Final [**2133-9-23**]): MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH SKIN AND/OR GENITAL CONTAMINATION. URINE CULTURE (Final [**2133-9-25**]): YEAST. >100,000 ORGANISMS/ML.. IMAGING: [**9-23**] FINDINGS: In comparison with the study of [**9-16**], there is again enlargement of the cardiac silhouette. There is better penetration of the image, so that there is no evidence of pulmonary vascular congestion at this time. The lateral view is limited due to extensive scattered radiation related to the size of the patient. No acute focal pneumonia. Brief Hospital Course: Brief Course: Ms. [**Known lastname 35127**] is a 61 year old female admitted with diabetic ketoacidosis (DKA) likely exacerbated by gastroparesis and UTI. Active Issues: # DKA: Patient presented with blood sugars in the 300s along with anion gap metabolic acidosis and ketones in the urine. She was maintained on an insulin drip and transitioned to subcutaneous insulin when her anion gap closed. She tolerated this well and was able to eat. Her precipitant was initially thought to be due to cellulitis of the left lower leg. Her outpatient provider reported that her leg looked much more infected than previously in clinic 1 week prior. We consulted podiatry about her leg to try to debride the chronic ulcers and get culture data, but they did not think that the ulcers warranted debridement. We felt the her leg exam was more consistent with venous stasis changes than cellulitis. She endorsed dysuria, however repeated urinalyses and urine cultures showed contaminated from normal flora and yeast. We treated the patient with 4 days of 1V ceftriaxone, based on prior culture date. Her CXR was negative and her EKG was at baseline. She did have a severe candidiasis of the intertriginous region of her groin which may have contributed to her DKA. We treated her with miconazole and a dose of fluconazole. [**Last Name (un) **] was consulted to help transition to outpatient insulin regimen. # Nausea and vomiting: Has been chronic for several months and has prompted several admissions to the hospital for symptomatic management. Likely also contributes to her DKA. She was started on metoclopromide empirically and phenergan prn. She has never had a work-up for gastroparesis but her symptoms would fit with this and would help explain her difficult to control blood sugars. She was discharged on metoclopramide and should follow up with her PCP about continuing this medication. A gastric emptying study can be considered as an outpatient. # HTN: Patient hypertensive to the 170s-180s even after restarting her home losartan and hydrochlorothiazide. Thus, she was started on labetalol 200 mg [**Hospital1 **]. She will follow up with her PCP about further HTN management. # Lower extremity ulcers: Chronic appearing, likely secondary to peripheral vascular disease and diabetes. Has element of chronic venous stasis which can be confused with cellulitis but she did not have evidence on exam of real cellulitis. # Flattened affect: Had a recent head CT which was negative, her neurologic exam was non-focal. She is slow to answer questions and has a flattened affect which is likely her baseline. Her nortriptyline was held initially but restarted on discharge. # Yeast infection: Likely in setting of poor glycemic control. Was given miconazole powder and treated with 1 dose of fluconazole. # Chronic kidney disease: Stable. On admission Cr 1.3, within recent baseline. Medications were renally dosed. Transitional Issues: 1. Codes Status: DNR/DNO 2. Communication: patient 3. Medication Changes: -CHANGE your Humalog sliding scale according to the attached sheet -START Labetolol for your high blood pressure -START Metoclopramide for your gastroparesis. But please follow up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1147**] to see if you should continue this medicine long term. 4. Pending studies: fungal urine culture 5. Follow up: PCP, [**Name10 (NameIs) **], Podiatry Medications on Admission: 1. Hydrochlorothiazide 25 mg PO DAILY 2. Losartan Potassium 50 mg PO DAILY 3. Nortriptyline 150 mg PO HS 4. Pantoprazole 40 mg PO Q24H 5. Rosuvastatin Calcium 20 mg PO DAILY 6. Vitamin D 50,000 UNIT PO MONTHLY 7. cefUROXime 500 mg [**Hospital1 **] 8. Detemir 70 Units Bedtime Discharge Medications: 1. Hydrochlorothiazide 25 mg PO DAILY 2. Losartan Potassium 50 mg PO DAILY 3. Rosuvastatin Calcium 20 mg PO DAILY 4. Nortriptyline 150 mg PO HS 5. Pantoprazole 40 mg PO Q24H 6. Vitamin D 50,000 UNIT PO MONTHLY 7. Detemir 70 Units Bedtime 8. Labetalol 200 mg PO BID hold for systolic blood pressure < 130 RX *labetalol 200 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 9. Metoclopramide 10 mg PO QIDACHS RX *metoclopramide HCl 10 mg 1 tablet by mouth QIDACHS Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) **] Discharge Diagnosis: Primary: DKA UTI Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Clear and coherent. Discharge Instructions: Dear Ms. [**Known lastname 35127**], It was a pleasure taking care of you at [**Hospital1 18**]. You were admitted because you weren't feeling well and your glucose level was found to be very high, and you were in DKA. We were able to control your blood sugar and we made some adjustments to your insulin regimen. You also were found to have a UTI which may have been the same infection as your last admission that never fully resolved. You were treated with antibiotics through your veins. Please make the following changes to your medications: -CHANGE your Humalog sliding scale according to the attached sheet -START Labetolol for your high blood pressure -START Metoclopramide for your gastroparesis. But please follow up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1147**] to see if you should continue this medicine long term. Please call [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 3146**] [**Location (un) 4628**] Services at [**Telephone/Fax (1) 35130**] to arrange a home health aid that can help with bathing and wound care. Followup Instructions: Please follow up with the following appointment: Department: PODIATRY When: MONDAY [**2133-9-28**] at 8:00 AM With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 542**], DPM [**Telephone/Fax (1) 543**] Building: Ba [**Hospital Unit Name 723**] ([**Hospital Ward Name 121**] Complex) [**Location (un) **] Campus: WEST Best Parking: [**Street Address(1) 592**] Garage Name: [**Last Name (LF) **], [**First Name3 (LF) **]. MD Location: [**Last Name (un) **] DIABETES CENTER Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 3402**] Appointment Monday [**2133-9-28**] 10:00am Department: ADULT MEDICINE When: THURSDAY [**2133-10-1**] at 4:00 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 12175**], MD [**Telephone/Fax (1) 6662**] Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site Completed by:[**2133-9-27**] ICD9 Codes: 5990
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Medical Text: Service: CARDIAC S. Date: [**2181-11-22**] Surgeon: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3113**] HISTORY OF THE PRESENT ILLNESS: This is a 77-year-old retired anesthesiologist visiting the family from [**State 531**], who was admitted to [**Hospital1 36651**] after the patient noted rales in his chest with chest pressure. In the ER the patient was found to be in acute pulmonary edema. The patient was treated with Morphine, sublingual nitroglycerin, Lasix, and aspirin, with subsequent bradycardia and hypotension. Hemodynamic stability returned after IV fluids. The EKG in the ER showed 2-mm to 3-mm ST depression in leads V4 through V6, as well lead 2. Subsequent EKGs showed 5-mm ST depression in leads V2 through V6 and leads 2, 3, and AVF. The patient was admitted to the hospital for cardiac catheterization. PAST MEDICAL HISTORY: 1. Coronary artery disease. 2. Hypertension. 3. Hypercholesterolemia. 4. Benign prostatic hypertrophy. 5. Status post cataract surgery. PREOPERATIVE MEDICATIONS: 1. Toprol XL 100 mg p.o.q.d. 2. Accupril 20 mg p.o.q.d. 3. Aspirin 325 mg p.o.q.d. 4. Pravachol 10 mg p.o.q.d. 5. Cardura 8 mg p.o.q.d. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAMINATION: Initial physical examination revealed the pulse 85; blood pressure 104/64; oxygen saturation 94% on four liters nasal cannula. GENERAL: The patient's general appearance is comfortable. NECK: Elevated JVP at 9-cm. CHEST: Crackles bilaterally 2/3rds of the way up, right greater than left. CARDIOVASCULAR: Normal S1 and S2; 2/6 systolic murmur at the apex. EXTREMITIES: Dorsalis pedis pulses are 2+ bilaterally. Extremities are without edema.; ABDOMEN: Positive bowel sounds, soft, and nontender. LABORATORY DATA: Data revealed the following: White blood cell count 8.0; hematocrit 38.3; platelet count 130; Chem 7 sodium 139; potassium 3.8; chloride 101; bicarbonate 29; BUN 25, creatinine 1.1; blood sugar 151; PT 12.9; PTT 30.2. Chest x-ray showed severe pulmonary edema, asymmetrical, right greater than left. HOSPITAL COURSE: The patient was taken to the Cardiac Catheterization Laboratory on [**2181-11-16**]. Cardiac catheterization showed EF of 45% with anterior-wall hypokinesis, 70% LAD lesion, 100% old left circumflex lesion, 80% PDA lesion, 1+ MR. The patient underwent echocardiogram on [**2181-11-16**], which showed a mildly dilated left atrium, depressed left ventricular function with global left ventricular hypokinesis, 1+ AR, 1+ MR. The patient remained in the Coronary Care Unit for diuresis and monitoring. The patient was taken the operating room on [**2181-11-19**] with Dr. [**Last Name (STitle) **]. The patient underwent a CABG times three, LIMA to the LAD, SVG to RCA, SVG to OM. The patient was transferred to the Intensive Care Unit in stable condition on Dopamine infusion at 5 mcg/kg per minute. Please see operative note for further details. The patient was weaned and extubated from mechanical ventilation on his first postoperative evening. Dobutamine infusion was weaned off with the cardiac index greater than three. The patient was transferred from the Intensive Care Unit to the floor on postoperative #1. The patient's chest tubes were removed on postoperative day #1. The patient began working with physical therapy. On postoperative day #2, the patient was able to ambulate 500 feet and climb one flight of stairs without any assistance. The patient was cleared for discharge by the Physical Therapy Department. On postoperative day #3, the patient was cleared for discharge to home with his daughter. On postoperative day #3, the patient was noted to be mildly tachycardiac with rates in the 90s to 100s, sinus rhythm. The patient's hematocrit, at that time, was 23.4. This was discussed with Dr. [**Last Name (STitle) **]. The patient was hemodynamically stable and not symptomatic from his anemia. It was decided to discharge the patient on his current dose of Lopressor. The patient is to followup in one week for adjustment of medications, as necessary. CONDITION ON DISCHARGE: Temperature maximum 99; temperature current 99.1; pulse 93 sinus rhythm with occasional PVCs; blood pressure 126/76; room air oxygen saturation 97%. The patient's weight on [**2181-11-22**] was 73.5 kg. The patient's preoperative weight was 69 kg. The patient is neurologically intact. Cardiovascular: Regular rate and rhythm, positive rubs, no audible murmur. Respiratory rate: Breath sounds are clear bilaterally. GI: The patient has positive bowel sounds. Abdomen: Soft, nontender, nondistended. The patient is tolerating a regular diet. The patient has trace lower extremity edema. Sternal incision staples are intact. The wound is clean, dry, and intact. There is no erythema or drainage noted. The patient's appendectomy site is clean and dry without erythema or drainage noted. LABORATORY DATA: Data revealed the following: White blood cell count 8.8; hematocrit 23.4; platelet count 129. The Chem 7 revealed sodium 140, potassium 4.2, chloride 103, bicarbonate 31, BUN 15, creatinine 0.8. DISCHARGE DIAGNOSES: 1. Status post coronary artery bypass graft. 2. Hypertension. 3. Hypercholesterolemia. 4. Benign prostatic hypertrophy. 5. Status post cataract surgery. DISCHARGE MEDICATIONS: 1. Lopressor 50 mg p.o.b.i.d. 2. Pravachol 10 mg p.o.q.h.s. 3. Niferex 150 mg p.o.q.d. 4. Colace 100 mg p.o.b.i.d. 5. Lasix 20 mg p.o.q.d. times two weeks. 6. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o.q.d. times two weeks. 7. Aspirin 325 mg p.o.q.d. 8. Ibuprofen 400 to 600 mg p.o., q.4-6h., p.r.n. The patient inquired about restarting his Cardura, which he was on preoperatively for benign prostatic hypertrophy. The patient was told that he should wait several days before resuming the medication to ensure that his blood pressure and hemodynamics remained stable on his current medication regimen. The patient is to followup with Dr. [**Last Name (STitle) **] in three to four weeks. The patient is to return to the Clinic in two weeks for wound check and staple removal. The patient is to followup with his cardiologist in three to four weeks at home. [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3113**] Dictated By:[**Last Name (NamePattern1) 3870**] MEDQUIST36 D: [**2181-11-22**] 10:51 T: [**2181-11-22**] 10:51 JOB#: [**Job Number 36652**] ICD9 Codes: 4280, 4240, 4019, 2720
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Medical Text: Admission Date: [**2189-7-15**] Discharge Date: [**2189-7-17**] Date of Birth: [**2130-5-18**] Sex: F Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 78**] Chief Complaint: headache Major Surgical or Invasive Procedure: [**2189-7-15**] Right craniotomy resection of right temporal tumor History of Present Illness: [**Known firstname 553**] [**Known lastname 100149**] is a pleasant 59-year-old right-handed female who presents with a brain tumor, which was diagnosed last Wednesday. She had a significant headache and imbalance since [**6-30**] and an MRI scan of the brain showed the right temporal lobe lesion and a right occipital lobe mass. She also had a chest x-ray which showed a right upper lobe mass. At this point, her MRI scan of the brain shows a fairly large brain tumor located in the right temporal lobe which measures at least 4 cm with mass effect and right uncal herniation. At this point, this scan is already a week old and I feel that she would have progressed. I did schedule her for surgery tomorrow and I advised her that surgery should be done at the earliest. She, however, would like a second opinion from [**Hospital1 4601**] and will get back to us after her second opinion. At this point, I have also started her on Keppra given the risk of seizures and as a preoperative adjunct therapy. Past Medical History: Past medical history is significant for bipolar disorder. Social History: Social History: She is divorced and lives alone. Her father died at age 82. She works part-time as a waitress and she has been smoking for the past 40 years. Her mother has a history of meningioma and uncle had a brain tumor. Family History: NC Physical Exam: On examination, her blood pressure was 140/80, heart rate was 80 per minute. She is awake, alert, excitable, oriented x3. Her pupils are equal and reacting to light. Extraocular movements are full. Facial sensation and movement is symmetric. Her palate elevation is symmetric. Shoulder shrug with good strength bilaterally. Tongue is in the midline. Her motor strength is [**3-21**] in all 4 extremities. Reflexes were [**12-20**]. Her gait and coordination was normal. PHYSICAL EXAM UPON DISCHARGE: non focal incision- sutures c/d/i Pertinent Results: [**7-15**] MRI BRAIN: IMPRESSION: Right temporal hyperintense mass and unchanged from prior study. Examination performed for surgical planning. [**7-15**] CT Head: IMPRESSION: 1. Immediately status post right frontotemporal craniotomy and resection of the relatively large right temporal lobar mass, with expected post-surgical changes in the region. 2. Small amount of intra- and extra-axial blood in the resection bed, without organized collection or significant mass effect. 3. Superimposed on the preexistent vasogenic edema, there is a rounded low-attenuation region, immediately deep to the resection cavity; while re-expansion of the subjacent temporal [**Doctor Last Name 534**] is likely, a contribution of small post-operative infarct at this site is an additional consideration. [**7-16**] MRI Brain: Brief Hospital Course: Patient was admitted to Neurosurgery on [**2189-7-15**] and underwent the above stated procedure. Please review dictated operative report for details. Patient was extubated without incident. She was transfered to the SICU. CT head showed no hemorrhage. She was neurologically stable on [**7-16**] and was transfered to the floor. MRI imaging showed good resection. She was seen by physical therapy for discharge planning. They recommended discharge home. Now DOD, patient is afebrile, VSS, and neurologically stable. Patient's pain is well-controlled and the patient is tolerating a good oral diet. Pt's incision is clean, dry and intact without evidence of infection. Patient is ambulating without issues. She is set for discharge home in stable condition and will follow-up accordingly. Medications on Admission: Medications currently are bupropion, dexamethasone, ergocalciferol, paroxetine, penicillin, triamcinolone, coenzyme Q10, flaxseed oil, and multivitamin. Discharge Medications: 1. Acetaminophen 325-650 mg PO Q6H:PRN fever, pain, headache 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 3. Docusate Sodium (Liquid) 100 mg PO BID 4. Famotidine 20 mg PO BID RX *famotidine [Acid Controller] 20 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 5. LeVETiracetam 1000 mg PO BID RX *levetiracetam [Keppra] 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*2 6. Multivitamins 1 TAB PO DAILY 7. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone [Oxecta] 5 mg 1 tablet(s) by mouth q4hrs prn Disp #*60 Tablet Refills:*0 8. Paxil CR *NF* (PARoxetine HCl) 12.5 mg Oral daily * Patient Taking Own Meds * 9. Wellbutrin XL *NF* (buPROPion HCl) 150 mg ORAL QAM * Patient Taking Own Meds * 10. Cephalexin 1000 mg PO Q12H Duration: 5 Days RX *cephalexin 500 mg 2 capsule(s) by mouth twice a day Disp #*10 Capsule Refills:*0 11. Dexamethasone 2 mg po q6h Duration: 1 Days RX *dexamethasone 1 mg taper tablet(s) by mouth taper Disp #*22 Tablet Refills:*0 12. Dexamethasone 2 mg po q12 Duration: 2 Days Start: After 2 mg tapered dose. 13. Dexamethasone 1 mg po q12 Duration: 2 Days Start: After 2 mg tapered dose. 14. Dexamethasone 1 mg po q24 Duration: 2 Days Start: After 1 mg tapered dose. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: right temporal mass Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: ?????? Have a friend/family member check your incision daily for signs of infection. ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? You may wash your hair only after sutures have been removed. ?????? You may shower before this time using a shower cap to cover your head. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. ?????? You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. ?????? Clearance to drive and return to work will be addressed at your post-operative office visit. ?????? Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? Fever greater than or equal to 101?????? F. Followup Instructions: Follow-Up Appointment Instructions ?????? Please return to the office in [**5-26**] days(from your date of surgery) for removal of your sutures and a wound check. This appointment can be made with the Nurse Practitioner. Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you live quite a distance from our office, please make arrangements for the same, with your PCP. ?????? You have an appointment in the Brain [**Hospital 341**] Clinic on [**2189-8-10**] @ 4pm. The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 516**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone number is [**Telephone/Fax (1) 1844**]. Please call if you need to change your appointment, or require additional directions. Completed by:[**2189-7-17**] ICD9 Codes: 3051
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Medical Text: Admission Date: [**2119-9-8**] Discharge Date: [**2119-9-17**] Service: MICU HISTORY OF PRESENT ILLNESS: The patient is an 83-year-old gentleman with a history of chronic obstructive pulmonary disease, also with a history of hypertension and chronic obstructive pulmonary disease, who had the sudden onset of shortness of breath at approximately 4 p.m. today that was refractory to his usual inhalers. Per Emergency Medical Service notes, no chest pain or recent illnesses. His systolic blood pressure was 240/120, respiratory rate was 30, and his oxygen saturation was 92% on a nonrebreather. En route to [**Hospital 882**] Hospital the patient was given, nitroglycerin, Ativan, and supplemental oxygen. At [**Hospital 882**] Hospital the patient was noted to be diaphoretic but could communicate. Improved breathing to 100% on nonrebreather. Initial arterial blood gas was 7.18/100/499 on 100% nonrebreather and was electively intubated despite the clinical improvement. Vital signs revealed the patient's blood pressure was 220/100, his respiratory rate was 32 to 40, and his oxygen saturation was 92% on nonrebreather. The patient's white blood cell count was 18 with 2 bands. His hematocrit was 45. His bicarbonate was 37. Creatine phosphokinase and troponin levels were negative. Electrocardiogram there showed sinus tachycardia. No ST changes. Orogastric tube and Foley catheter were placed and showed poor urine output. The patient was given intravenous Lasix. A chest x-ray was consistent with chronic obstructive pulmonary disease. The patient had blood cultures, urine cultures, and sputum cultures sent. The patient was given intravenous Levaquin 500 mg, intravenous Solu-Medrol 125 mg total, Ativan 7 mg, and approximately 7 liters of normal saline. A repeat arterial blood gas was 7.28/73/118. The patient was transferred to [**Hospital1 188**] Emergency Department where he arrived intubated and sedated He was afebrile. The patient's blood pressure was 91/65, tachycardic to 120, his heart rate was 97, his respiratory rate was 14, and his oxygen saturation was 94% on an FIO2 of 0.4. His chest x-ray showed no acute infiltrates. The patient was given 500 mg intravenous Flagyl and 2 mg of Ativan, and his ventilator was set synchronized intermittent mandatory ventilation pressure support 5, positive end-expiratory pressure 5, volume 600, rate 14, and FIO2 of 0.4. Arterial blood gas was 7.32/58/112. Thick tan secretions were obtained. Of note, the patient is normally cared for at the [**Hospital6 50626**] Center, and his medical records there are more detailed. PAST MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease. 2. Hypertension. 3. Diastolic heart failure. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: 1. Hydrochlorothiazide. 2. Colace. 3. Tylenol. 4. Atrovent. 5. Albuterol. 6. Prednisone. 7. Theophylline. 8. Potassium. FAMILY HISTORY: SOCIAL HISTORY: The patient lives [**Location (un) 6409**] with his wife of many years. An extensive history of smoking. The patient has not drank alcohol in many years. PHYSICAL EXAMINATION ON PRESENTATION: In general, the patient was intubated and sedated. The patient's temperature was 95.8 degrees Fahrenheit, his heart rate was 102, his blood pressure was 108/71, his respiratory rate was 14, and his oxygen saturation was 100%. Head, eyes, ears, nose, and throat examination revealed pupils 2 mm and equally reactive. Neck examination revealed no lymphadenopathy. Cardiovascular examination revealed a regular rate and rhythm. First heart sounds and second heart sounds were very distant. No murmurs, rubs, or gallops. Pulmonary examination revealed clear to auscultation anteriorly and laterally. No wheezes. Abdominal examination revealed the abdomen was obese, moderately distended, with midline surgical scars. Extremity examination revealed the extremities were warm. There was trace bilateral edema. No clubbing. Neurologic examination revealed the patient was intubated and sedated. Skin examination revealed no lesions or rashes. PERTINENT LABORATORY VALUES ON PRESENTATION: Laboratories on admission revealed the patient's white blood cell count was 18.2, his hematocrit was 45.7, and his platelets were 512. Differential revealed neutrophils of 82, lymphocytes of 10, bands of 3. His INR was 1.7. His partial thromboplastin time was 29.7. Sodium was 141, potassium was 4.2, chloride was 97, bicarbonate was 37, blood urea nitrogen was 20, creatinine was 0.6, and his blood glucose was 202. Total protein was 7.3. His albumin was 4. His total bilirubin was 0.3, his alkaline phosphatase was 71, his AST was 30, and his ALT was 33. Creatine kinase was 95. Troponin T was less than 0.01. PERTINENT RADIOLOGY/IMAGING: A chest x-ray revealed endotracheal tube was in place, biapical bolus, diaphragmatic flattening, bibasilar atelectasis, small bilateral pleural effusions. Electrocardiogram revealed sinus tachycardia at 120 beats per minute. Normal axis. Early repolarization. Normal intervals. Inferolateral T wave flattening. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: The patient is an 83-year-old gentleman with hypercarbic respiratory failure in the setting of a chronic obstructive pulmonary disease exacerbation complicated by diastolic heart failure, hypertension, and a pneumonia. 1. RESPIRATORY FAILURE ISSUES: The patient was intubated for respiratory acidosis and hypoxemia for retained secretions most likely due to a chronic obstructive pulmonary disease exacerbation. Several trials have been made to optimize his blood pressure and heart rate which were unsuccessful and then being able to extubate him upon awakening. The patient had very labile hypertension where his systolic blood pressures would go from the 120s to 130s and all the way up to the 200s. The patient was started on Lopressor and removed all of his diltiazem to control his heart rate, and the patient was started on captopril to control his blood pressure. Trials using diltiazem drips and nitroglycerin to control his blood pressure and heart rates were unsuccessful. On [**9-16**], the patient became profoundly hypotensive, so at this time the cardiac medications were being held. The patient has been receiving fluid boluses with target central venous pressures of 12. 2. PNEUMONIA ISSUES: The patient grew out Staphylococcus aureus (coagulase-positive) from two sputum cultures which at this time is being treated with a course of oxacillin for 14 days. The patient is currently on day four. 3. CHRONIC OBSTRUCTIVE PULMONARY DISEASE/BRONCHITIS ISSUES: the patient was continued on Solu-Medrol, Atrovent, and albuterol for his chronic obstructive pulmonary disease and bronchitis flare. He received a 7-day course also of Levaquin, but no pathogens were grown out except the Staphylococcus aureus from his sputum, for which he was placed on oxacillin. 4. MILD CONGESTIVE HEART FAILURE ISSUES: The patient had an echocardiogram which showed the left ventricular cavity size was normal and regional left ventricular wall motion was normal. His overall ejection fraction was greater than 55%. The aortic root was moderately dilated. The tricuspid and aortic valves were structurally normal. Trivial mitral regurgitation. Therefore, the patient was felt to be in diastolic heart failure and optimizing of his blood pressure and heart rate were attempted to be obtained before extubation so that he would try to prevent flash pulmonary edema which we thought might be leading to him having wheezes rather than just his chronic obstructive pulmonary disease exacerbation. 5. HYPOTENSION ISSUES: On [**9-16**], the patient became profoundly hypotensive. It was felt to be unclear whether he was volume depleted or had been septic. Blood cultures were sent and were still pending. The patient received several fluid boluses with goals of obtaining a central venous pressure of 12, and his hypertensive medications were held. CONDITION AT DISCHARGE: The patient was still intubated and in the Medical Intensive Care Unit. This is an interval Discharge Summary. The patient is currently hypotensive from an unclear etiology. DISCHARGE STATUS: The patient is still in the Medical Intensive Care Unit at [**Hospital1 69**]. MEDICATIONS ON DISCHARGE: Deferred. DISCHARGE INSTRUCTIONS/FOLLOWUP: Deferred. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3090**], M.D. [**MD Number(1) 3091**] Dictated By:[**Name8 (MD) 26705**] MEDQUIST36 D: [**2119-9-16**] 13:34 T: [**2119-9-16**] 14:21 JOB#: [**Job Number 50627**] ICD9 Codes: 4280, 5849, 4019
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Medical Text: Admission Date: [**2184-7-28**] Discharge Date: [**2184-8-10**] Date of Birth: [**2119-1-21**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: chest pain, SOB Major Surgical or Invasive Procedure: AVR(#21mm CE Magna)/MVR(#29mm St.[**Male First Name (un) 923**] Epic)/TV repair (#28mm CE MC3ring)/Coronary Artery Bypass Grafting x 4(Left internal mammary artery grafted to left anterior descending/Saphenous vein grafted to Diag/OM2/PDA)-[**2184-8-2**] History of Present Illness: Mr. [**Known lastname 24481**] is an Italian-speaking 65 yo male with HTN and 50+ pack-year smoking history who has not been seen by a physician [**Name Initial (PRE) **] 1.5 years, presented to the ED with 1 day of SOB, diaphoresis and CP. He began to feel diaphoretic and short of breath while at work as [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]. When the symptoms did not resolve with rest, he left work early and went home. There, he describes feeling CP that he describes as "squeezing," [**8-13**], non-radiating and not relieved with rest, which led him to take an ambulance to the ED. He reports frequent SOB and occasional CP on exertion at baseline for at least the past year, which he says normally resolves with rest, although he does endorse occasional SOB at rest. He attributes these symptoms to his age and smoking. He also notes a chronic cough over the past year, which he attributes to his smoking, and denies any recent worsening of the cough. EKG showed inferior Q waves, TWI and ST depressions. CXR showed pulmonary edema anmd and CEs were elevated with troponin 3.13. He was loaded with plavix 600mg, received one full dose ASA and started on heparin gtt. He was sent to the cath lab for angiography which showed severe LM/3VD. A Swan-Ganz catheter was placed and showed low cardiac index (1.4). A TTE was performed in the cath lab which revealed inferior and inferoseptal hypokinesis, normal RV function, significant AS, 4+ MR, 3+TR, LVEF 35% and moderate pulmonary HTN. An IABP was placed. Dr.[**Last Name (STitle) 914**] was consulted for coronary revascularization and valvular replacement. Past Medical History: 1. CARDIAC RISK FACTORS: Hypertension, Dyslipidemia, +tobacco 2. CARDIAC HISTORY: none 3. OTHER PAST MEDICAL HISTORY: -Patient denies any other PMH but per OMR, h/o PUD. HTN Erectile Dysfunction no medical care for many years Social History: He is [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] in [**Location (un) 4310**] and lives with his wife in [**Location (un) 686**]. -Tobacco history: 1-1.5ppd for 30+ years, still smoking -ETOH: social Family History: -Mother with a "large heart" from a young age, died of heart disease at 66 -Father diagnosed with DM2 in his 50s, died at 74 -Brother with CVA, liver disease diagnosed in his 50s Physical Exam: VS: T= 99.8 BP= 114/63 HR= 87 RR= 23 O2 sat= 96% 2L NC GENERAL: WDWN Male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with 5cm JVP, but with bed flat due to IABP. CARDIAC: RR, with mechanical sounds. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB anteriorly, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. +BS. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ PT 2+ DP by doppler Left: Carotid 2+ PT 2+ DP by doppler Pertinent Results: CXR [**2184-7-28**]: Single AP chest radiograph without comparison shows moderate interstitial pulmonary edema. The heart size is probably top normal. There is no pneumothorax or large pleural effusions. IMPRESSION: Moderate interstitial pulmonary edema. . EKG [**2184-7-28**], 10:48:24: sinus tachycardia at 110 bpm with some LAD, normal intervals, notable for Q waves in II, III, aVF; deep TWI in II, III, aVF; 1mm STD in I, aVL. . 2D-ECHOCARDIOGRAM: The left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. There is mild regional left ventricular systolic dysfunction with near akinesis of the inferior and inferoseptal walls. The remaining segments contract normally (LVEF = 35 %). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] Right ventricular chamber size and free wall motion are normal. [Intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation.] The aortic valve leaflets are moderately thickened. Significant aortic stenosis is present (not quantified - ? Mild-moderate)). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Severe (4+) mitral regurgitation is seen. Moderate to severe [3+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Normal left ventricular cavity size with regional systolic dysfunction c/w CAD. Severe mitral regurgitation. Moderate pulmonary artery systolic hypertension. Moderate to severe tricuspid regurgitation. If clinically indicated, a TEE would be able to better identify a potential mechanical problem with the mitral valve (I.e., flail leaflet or partial papillary muscle rupture as the cause of the mitral regurgitation). CAROTID U/S ([**7-29**]): Impression: Right ICA stenosis <40%. Left ICA stenosis <40%. [**2184-8-10**] 05:30AM BLOOD WBC-11.1* RBC-3.68* Hgb-10.2* Hct-31.2* MCV-85 MCH-27.8 MCHC-32.8 RDW-15.4 Plt Ct-320 [**2184-7-28**] 10:28AM BLOOD WBC-13.8* RBC-4.80 Hgb-12.5* Hct-38.2* MCV-80* MCH-26.1* MCHC-32.7 RDW-14.0 Plt Ct-266 [**2184-8-10**] 05:30AM BLOOD PT-19.1* INR(PT)-1.7* [**2184-7-28**] 10:28AM BLOOD PT-15.2* PTT-25.6 INR(PT)-1.3* [**2184-8-9**] 05:25AM BLOOD Glucose-100 UreaN-27* Creat-0.9 Na-138 K-4.3 Cl-100 HCO3-30 AnGap-12 [**2184-7-28**] 10:28AM BLOOD Glucose-134* UreaN-22* Creat-1.1 Na-134 K-4.6 Cl-98 HCO3-22 AnGap-19 Brief Hospital Course: 65yo Italian-speaking male was taken to the operating room and underwent AVR(#21mm CE Magna)/MVR(#29mm St.[**Male First Name (un) 923**] Epic)/TV repair (#28mm CE MC3ring)/Coronary Artery Bypass Grafting x 4(Left internal mammary artery grafted to left anterior descending/Saphenous vein grafted to Diag/OM2/PDA)-[**2184-8-2**]. Cross clamp time= 192 minutes. Cardiopulmonary bypass time=230 minutes. Please refer to Dr[**Last Name (STitle) 5305**] operative report for further details. He tolerated the procedure well and was transferred to the CVICU in critical but stable condition requiring multiple pressors and Milrinone to optimize cardiac output.The intra-aortic balloon pump, placed preop, was discontinued on POD#1.He awoke neurologically intact and was extubated on POD#2. Drips were weaned off. Lines and tubes were discontinued in a timely fashion.Beta-blocker and diuresis was initiated. He continued to progress and was transferred to the step down unit for further monitoring on POD#5. Dental was consulted regarding Mr.[**Known lastname 24482**] ill-maintained lower teeth. Amoxicillin was empirically initiated and recommended to continue until dental extraction is completed as an outpatient. Coumadin was started for low dose anticoagulation secondary to the double tissue valves and tricupsid ring. On day of discharge, Coumadin was held and the patient's daughter was instructed that Mr.[**Known lastname 24481**] should hold off taking Coumadin until the dental procedure is complete. Once Coumadin is restarted, it is to be continued for 2 months. Dr.[**Last Name (STitle) **], Cardiology, will follow the INR/Coumadin dosing. The remainder of his postoperative course was essentially uneventful. On POD# 8, Mr.[**Known lastname 24481**] was cleared by Dr.[**Last Name (STitle) 914**] for discharge to home with VNA. All follow up appointments were advised. Medications on Admission: Medications at home: Enalapril 10 mg daily Viagra 50mg PRN Discharge Medications: 1. Aspirin 81 mg [**Last Name (STitle) 8426**], Delayed Release (E.C.) Sig: One (1) [**Last Name (STitle) 8426**], Delayed Release (E.C.) PO DAILY (Daily). Disp:*60 [**Last Name (STitle) 8426**], Delayed Release (E.C.)(s)* Refills:*2* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. Atorvastatin 80 mg [**Last Name (STitle) 8426**] Sig: One (1) [**Last Name (STitle) 8426**] PO DAILY (Daily). Disp:*60 [**Last Name (STitle) 8426**](s)* Refills:*2* 4. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours). Disp:*60 Packet(s)* Refills:*2* 5. Warfarin 1 mg [**Last Name (STitle) 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] Once Daily at 4 PM: **Do not resume until Dental procedure completed. Than x 2months. Disp:*90 [**Last Name (Titles) 8426**](s)* Refills:*2* 6. Ranitidine HCl 150 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO BID (2 times a day): x 2 months (while on Coumadin). Disp:*60 [**Last Name (Titles) 8426**](s)* Refills:*2* 7. Oxycodone-Acetaminophen 5-325 mg [**Last Name (Titles) 8426**] Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*45 [**Last Name (Titles) 8426**](s)* Refills:*0* 8. Furosemide 80 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO DAILY (Daily). Disp:*60 [**Last Name (Titles) 8426**](s)* Refills:*2* 9. Carvedilol 12.5 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO BID (2 times a day). Disp:*60 [**Last Name (Titles) 8426**](s)* Refills:*2* 10. Amoxicillin 250 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours): Continue until Dental procedure completed. Disp:*90 Capsule(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: CAD MR [**First Name (Titles) **] [**Last Name (Titles) **] s/p CABG/AVR/MVR/TVr HTN Erectile Dysfunction Discharge Condition: good Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Please shower daily including washing incisions, no baths or swimming Monitor wounds for infection - redness, drainage, or increased pain Report any fever greater than 101 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams, lotions, powders, or ointments to incisions No driving for approximately one month No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: ***Your chest CT scan showed some small nodules. This should be followed up with a repeat scan in 6 weeks to ensure that the nodules have improved. You can arrange this through your primary care doctor or when you follow-up with your cardiologist.*** Dr [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], please call for appointment ([**Telephone/Fax (1) 7976**]in 1 week Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**3-9**] weeks ([**Telephone/Fax (1) 62**]) please call for appointment **Please have dental extractions done as soon as can be arranged **Dr.[**Last Name (STitle) **] to follow INR/Coumadin dosing (once resumed after dental extractions)x 2months, than Coumadin to be discontinued Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse ([**Telephone/Fax (1) 3071**]) Completed by:[**2184-8-10**] ICD9 Codes: 4280, 5859, 2859, 412, 4168, 3051
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Medical Text: Admission Date: [**2111-3-9**] Discharge Date: [**2111-3-16**] Date of Birth: [**2034-3-11**] Sex: M Service: CARDIAC SURGERY CHIEF COMPLAINT: Shortness of breath. HISTORY OF PRESENT ILLNESS: The patient is a 76 year-old male with a history of insulin dependent diabetes who was admitted to outside hospital on [**2111-3-6**] following a cardiac catheterization showing a ______ and three vessel coronary artery disease. The patient has been hemodynamically stable and chest pain free since the catheterization. Chest x-ray on admission showed a left lower lobe mass versus atelectasis. CT scan on [**3-7**] showed superficial opacity at the left lung base measuring 2.5 cm at maximum diameter. The patient was seen by pulmonary and infectious disease who felt that the patient's coronary artery disease should be addressed primarily and follow up CT scan in one month. The patient is now transferred to [**Hospital1 69**] for evaluation of coronary artery bypass graft. PAST MEDICAL HISTORY: 1. Noninsulin dependent diabetes mellitus. 2. Status post colectomy for colon cancer in the year [**2107**]. 3. Irritable bowel syndrome. 4. Hiatal hernia status post right inguinal hernia repair. 5. Status post right hydrocele removal. SOCIAL HISTORY: Lives with wife. Retired electrician. The patient smokes one to two cigars per week for the past four or five years. Quit 24 years ago. The patient denies use of alcohol. ALLERGIES: No known drug allergies. MEDICATIONS: 1. Asacol 800 mg po t.i.d. 2. Lopressor 12.5 mg po b.i.d. 3. Enteric coated aspirin 325 mg po q day. 4. Glucotrol 20 mg po q.d. 5. Regular insulin sliding scale. 6. Metformin at home. REVIEW OF SYSTEMS: The patient denies chest pain, fevers or chills, nausea, vomiting, abdominal pain, melena, denies hematochezia, denies dysuria. PHYSICAL EXAMINATION: Temperature 97. Blood pressure 120/70. Heart rate 80. Respiratory rate 18. Satting 96% on room air. The patient is alert and oriented and in no acute distress. Extraocular movements intact. Pupils are equal, round and reactive to light. The patient had no lesions in the mouth. The patient's head was normocephalic, atraumatic. Examination of the neck revealed no lymphadenopathy. No JVD. No bruits. Chest was clear to auscultation bilaterally. Heart revealed a regular rate and rhythm without any murmurs, rubs or gallops. Examination of the abdomen revealed soft, nontender, nondistended abdomen. No hepatosplenomegaly. No splenomegaly. The patient had a surgical scar in the right lower quadrant. The patient's extremities had no clubbing, cyanosis or edema. The patient had 2+ pulses bilaterally, femoral, popliteal, dorsalis pedis and posterior tibial. Cranial nerves II through [**Doctor First Name 81**] were grossly intact. Extremities sensory and motor were intact. LABORATORY: White blood cell count on admission was 10.9, hematocrit 37.3, platelets 521, INR 1.1, sodium 139, potassium 4.3, chloride 101, bicarb 29, BUN 26, creatinine 1, glucose 192. HOSPITAL COURSE: The patient was admitted to the Cardiac Surgery Service and underwent coronary artery bypass graft times three. The patient had a left internal mammary coronary artery to the left anterior descending coronary artery, saphenous vein graft to obtuse marginal, saphenous vein graft to posterior descending coronary artery. On postoperative day number one the patient was extubated and remained afebrile with stable vital signs. On postoperative Vancomycin and on insulin drip to control the glucose. Otherwise the patient was doing well. On postoperative day number two the patient continued to do well. The patient was completely weaned off all drips. The patient was put back on home regimen for glucose control. He remained afebrile with stable vital signs. The patient continued to do well and was transferred to the floor. Overnight the patient had a bout of delirium. The patient had a sitter and was put on low dose Haldol. On postoperative day number three the patient continued to do well. The patient was on Lopressor 50 mg b.i.d. and remained afebrile with stable vital signs. The patient had good urine output. The patient's wire was removed and the patient was continued with a sitter for confusion. On postoperative day number four the patient continued to have bouts of confusion, although improved. Urinalysis was negative. The patient remained afebrile with stable vital signs. Physical therapy worked with the patient. A standing dose of Haldol was stopped and put on Captopril and obtained a PA and lateral chest x-ray, which revealed small pleural effusion. No pneumo. On postoperative day number five the patient continued to do well. The patient had eight beats of ventricular tachycardia overnight, which was asymptomatic. EP was consulted who recommended to replete the electrolytes and to do regular follow up with patient's cardiolgoist since the patient has no history of myocardial infarction or signs of ischemia on electrocardiogram. The patient continued to do well. On postoperative day number six the patient had no complaints. Remained afebrile with a blood pressure of 149/76 and a pulse of 80. The patient's Metoprolol was increased to 75 b.i.d. The patient was taking good po and making good urine. The patient was discharged to home. CONDITION ON DISCHARGE: Good. DISPOSITION: Discharged to home. FINAL DIAGNOSES: 1. Status post coronary artery bypass graft. 2. Coronary artery disease. 3. Status post colectomy for colon cancer in [**2107**]. 4. Noninsulin dependent diabetes mellitus. 5. Irritable bowel syndrome. 6. Hiatal hernia status post right inguinal hernia repair. 7. Status post right hydrocele removal. 8. Lung nodule on x-ray. FO[**Last Name (STitle) 996**]P PLANS: Please follow up with Dr. [**Last Name (Prefixes) **] in four weeks. Please follow up with primary care physician and Dr. [**Last Name (STitle) 1655**] in one to two weeks. DISCHARGE MEDICATIONS: 1. Aspirin 325 mg po q.d. 2. Colace 100 mg po b.i.d. 3. Asacol 800 mg po t.i.d. 4. Glipizide 20 mg po q day. 5. Metformin 1000 mg po q.a.m., 500 mg po q.p.m. 6. Captopril 6.725 mg po t.i.d. 7. Percocet one to two tabs po q 4 to 6 hours. 8. Lopressor 75 mg po b.i.d. 9. Sliding scale insulin. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Last Name (NamePattern1) 3118**] MEDQUIST36 D: [**2111-3-16**] 09:06 T: [**2111-3-16**] 09:22 JOB#: [**Job Number 52591**] ICD9 Codes: 9971, 4271, 2930, 3051
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Medical Text: Admission Date: [**2130-4-25**] Discharge Date: [**2130-4-29**] Date of Birth: [**2055-11-16**] Sex: F Service: MEDICINE Allergies: Codeine / Crestor / Lipitor / Fosamax Attending:[**First Name3 (LF) 134**] Chief Complaint: Nausea, diaphoresis Major Surgical or Invasive Procedure: Cardiac catheterization PCI to RCA History of Present Illness: 74F with hx of recent right TKR on Lovenox presents with STEMI. She states that around 4:30am, she had been up watching TV and didn't feel herself. She walked to the bathroom and found herself very pale and diaphoretic. She started feeling dizzy and nauseous. BP checked by the nurses and found to be 60/40 with a heart rate of 40. EMS was called and on arrival, did EKG that showed 2mm ST elevations in II, III, aVF. She was given ASA 325mg and NTG x 1 and transferred to [**Hospital1 18**]. On arrival to the ER, she received 600mg plavix and was started on integrillin and heparin gtts. Vitals were stable at 12/69 with heart rate of 98, satting 96% on 2L. Of note, pt only notes slight chest pressure on the way the hospital. In the ER, she was noted to have transient Wenckebach, with heart rate of 42. . Pt was take to the cath lab, arriving at 6:15am. There she was found to have a totally occluded RCA and a cypher stent was placed. LVgram showed an EF of 55%. right heart cath showed RA mean of 17mmHg, RV 47/11 with end diastolic of 20mmHg, PAP 46/18 (33) and wedge of 23; CO 3.11 (CI 1.74) . On arrival to the CCU, pt felt well, no chest pain, shortness of breath, pain. . On ROS, pt denies PND, orthopnea, lower ext swelling. She normally exercises daily, swimming one mile per day (but not since [**Month (only) 404**] due to her knee). She wears O2 at night due to sleep apnea and chronic hypoxia due to her hernia (lung did not expand following her hernia surgery). Also with recent pain in right ankle, treated as cellulitis with keflex and then ceftriaxone when it failed to improve. now much better Past Medical History: 1. Asthma 2. sleep apnea, on CPAP at home 3. Morgagni hernia s/p repair [**2128-9-7**]. 4. HTN 5. s/p TIA 10 years ago 6. recurrent R ear herpes, R Bell's palsy 7. s/p TAH 8. bladder diverticula 9. s/p Right Total Knee Arthroplasty (Replacement) [**2130-4-11**] 10. PVC's (followed by Dr. [**Last Name (STitle) 911**], on lopressor) Social History: Currently at [**Hospital **] rehab s/p knee replacement. Retired nurse. Husband retired family pratice physician. [**Name10 (NameIs) **] tobacco, ethanol, or IVDU. Family History: Father had first MI at age 39, died of MI at age 68 Physical Exam: temp 97.5, BP 118/57, HR 78, R 18, O2 100% on 3L Gen: Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. Neck: Supple with JVP of 10cm. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. distant sounds, no murmurs Chest: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Pressure dressing in place in left groin Ext: left lower ext cool with palp pulses; right lower ext warm, 1+ edema, palp pulses; no erythema; TKR scar c/d/i Skin: No stasis dermatitis, ulcers, scars, or xanthomas. . Pulses: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ Pertinent Results: Initial EKG (at 5:30a) demonstrated NSR at 65 bpm, normal axis, prolonged PR, ST elevations in II, III, and aVF (4mm in III, 3mm in II and aVF) with 1mm ST elevation in V1, ST depressions in I, aVL. Right sided EKG showed 2mm ST elevation in V4 . EKG following cath showed NSR at 80, nl axis, small Q waves in III, aVF . 2D-ECHOCARDIOGRAM performed on [**12/2129**] demonstrated: LA is normal in size. No ASD or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. Mild symmetric LVH with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). AV leaflets (3) are mildly thickened but aortic stenosis is not present. No AR. MV appears structurally normal with trivial MR. [**Name13 (STitle) **] mitral valve prolapse. Mod PA systolic hypertension. There is a trivial/physiologic pericardial effusion. . CARDIAC CATH performed on [**2130-4-25**] demonstrated: LVgram: EF 55%, mild MR [**Name13 (STitle) **] normal with modest calcification LAD: modest calcification with mild luminal irregularities LCx: non-dominant vessel with mid-segment 80% lesion in AVG RCA: dominant vessel with mid-segment 99% lesion with noted thrombus s/p 3.0 x 18 cypher stent; final residual was 0% with normal flow . L groin US [**4-25**]: Communicating with the left common femoral artery, there is a 2.1 x 2.2 x 1.2 cm pseudoaneurysm that contains two-third of thrombosed clot with a one- third residual lumen with flow. A 0.3 cm neck is visualized communicating with the common femoral artery. . L groin US [**4-27**]: Scans through the left groin now show a residual hematoma measuring 2.4 x 2.8 x 1.1 cm. There is no flow within the hematoma, and there has been complete thrombosis of the previously shown pseudoaneurysm. . RLE US [**4-25**]: 1. No evidence of deep venous thrombosis in the right lower extremity 2. [**Hospital Ward Name 4675**] cyst within the right popliteal fossa. . TTE [**2130-4-29**]: There is mild regional left ventricular systolic dysfunction with basal inferior hypokinesis (EF 50-55%). The other segments appear to contract well, although they are only visualized in the short-axis view. The right ventricular cavity is mildly dilated. There is focal hypokinesis of the apical free wall of the right ventricle. IMPRESSION: Mild regional left and right systolic dysfunction, c/w CAD. Technically limited study. Compared with the prior study (images reviewed) of [**2130-1-9**], left and right ventricular regional systolic dysfunction are new. Brief Hospital Course: 74F with hx of HTN who presents with dizziness, diaphoresis and nausea found to have acute inferior STEMI due to totally occluded RCA now s/p cypher stent. Course c/b groin hematoma. . 1) CAD/STEMI: The patient initially had symptoms of dizziness, diaphoresis, nausea, she was found to be hypotensive and EMS was called. The initial EKG demonstrated ST elevations in inferior leads II, III, an aVF. A right sided EKG showed ST elevations on V4r indicating a likely RV infarct. She was given ASA, plavix, heparin and integrillin and taken urgently to the cath lab. She was found to have 2VD with a 90% lesion in the distal LAD and a 95% occlusion of the mRCA. A cypher stent was deployed to the mRCA lesion. She was monitored in the CCU given risk of hypotension and bradycardia following RV infarct. She was asymptomatic following catheterization. She remained hemodynamically stable. She was continued on ASA and plavix which she will need for 1 year. Her integrillin was stopped due to a groin hematoma as discussed below. Once her groin hematoma stablized she was restarted on lovenox. The patient has a know allergy to lipitor and crestor, therefore, she was started on pravastatin as this statin has a lower occurence of side effects. She tolerated this well. Initially her antihypertensives were held in light of her low cardiac output and recent wenckebach. When her cardiac profile improved, she was restarted on her beta-blocker, aspirin, and plavix. She has an outpatient appointment with her cardiologist to follow up. . 2) Groin hematoma: Post-cath the patient was noted to have a left groin hematoma so her integrillin was stopped. A stat groin US showed a small 2x2cm pseudoaneurysm that was [**1-14**] thrombosed. A pressure dressing was applied and her hematoma remained stable. Her hematocrit was stable at 24 (down from baseline of 35), the patient refused transfusion. A second groin US showed no flow in the pseudoaneurysm and complete thrombosis. A residual hematoma was noted and stable. . 3) Rhythm: In the [**Last Name (LF) **], [**First Name3 (LF) **] EKG was significant for Wenckebach. This resolved, she remained in NSR on telemetry. . 4) Pump: During her cardiac catheterization she was noted to have depressed cardiac function in the setting of her MI. The LVgram showed a EF 55%, CO 3.11, and wedge of 23. A repeat echo showed new, mild regional left and right systolic dysfunction and an EF of 50-55%. However, the study was technically limited and an outpatient Echo with contrast has been ordered. . 5) HTN: At home the pt was on cozaar, hctz and lopressor. During her inpatient stay her medications were adjusted, she as discharged on lower doses of her beta blocker and cozaar and her HCTZ was discontinued since her blood pressure was well controlled without it. Her BP meds should be uptitrated or restarted as needed as an outpatient. . 6) Elevated blood glucose: The patient's blood glucose was noted to be elevated. A HbA1c was high normal at 5.7. Her elevated glucose could be stress induced. However, this could also indicate new glucose intolerance. This should be followed as an outpatient. She was maintained in house on a RISS. . 7) Cellulitis: Mrs. [**Known lastname **] had evidence of cellulitis of the RLE. She was started on ceftrioxone with good results and completed her course of antibiotics prior to discharge. An US of the lower extremities was done and showed no DVT. . 8) Leukocytosis: On presentation to the CCU, the patient had a WBC count of 14, this was likely due to cellulitis or inflammation from her MI. She completed her course of ceftrioxone during her stay and her WBC count continued to trend down. She had a low grade fever of 100, CXR was performed that was negative for an acute process and UA showed increased WBC but no bacteria. Her fever was attributed to likely atelectasis. . 9) FEN: cardiac diet . 10) PPX: SQ heparin, bowel reg . 11) Access: PIV . 12) Code: full . 13) Comm: daughter [**Name (NI) **] [**Name (NI) 96045**] [**Telephone/Fax (1) 96046**] Medications on Admission: * Lovenox 40mg qd * Keflex 500mg tid x 10 days (d/c'd [**4-22**]) * ceftriaxone 1gram qd (first day [**4-22**], last day [**4-26**]) * oxybutynin 2.5mg [**Hospital1 **] * metoprolol 75mg [**Hospital1 **] * colace/senna * fluticasone 1spray to nostrils daily * advair 100/50 [**Hospital1 **] * HCTZ 25mg qd * Cozaar 100mg qd * MVI * omeprazole 40mg qd * tylenol as needed * oxycodone 10mg q4hrs prn Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 4. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) injection Subcutaneous DAILY (Daily) for 4 days. Disp:*4 injection* Refills:*0* 5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 6. Oxybutynin Chloride 5 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 7. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Dilaudid 2 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain for 5 days. Disp:*20 Tablet(s)* Refills:*0* 9. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 10. Fluticasone 50 mcg/Actuation Aerosol, Spray Sig: One (1) Spray Nasal DAILY (Daily). 11. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Discharge Worksheet-Discharge Diagnosis-Finalized:[**Last Name (LF) **],[**Name8 (MD) **], MD on [**2130-4-29**] @ 1536 Primary: myocardial infarction groin hematoma right total knee replacement asthma hypertension PVC's secondary: sleep apnea on CPAP at home Morgagni hernia s/p repair [**2128-9-7**] recurrent R ear herpes, R Bell's palsy TAH bladder diverticula Discharge Condition: Tolerating POs. Hemodynamically stable. Chest pain free. Discharge Instructions: You had a myocardial infarction and were emergently taken to the cardiac catheterization lab. There you were found to have a blocked coronary artery. A drug eluting stent was placed in the artery. You will need to take plavix every day for at least 1 year (to be discussed with your cardiologist). Do not miss one dose. . You also developed a pseudoaneurysm at your catheter site, this is now resolved. . ACTIVITY: 50% partial weight bearing only to operative leg. Unlocked [**Doctor Last Name **] Brace to right leg whenever out of bed. CPM machine advance as tolerated. Brace not needed for CPM use and must be kept off in bed to prevent skin breakdown. No strenuous exercise or heavy lifting. . Your diuretic HCTZ has been held and you are on a lower dose of your Cozaar and beta blocker since your blood pressure has been well controlled. Your PCP [**Name Initial (PRE) **]/or cardiologist should increase and restart your blood pressure medications as needed. . You have prescribed the oral pain medicine dilaudid to be taken only if you experience severe pain since you developed itching to your previous pain medication oxycodone. Please avoid excessive use of this strong pain medicine. . If you experience any fevers, chills, chest pain, shortness of breath or other worrisome symptoms please seek medical attention. Followup Instructions: Your ultrasound study of the heart (echocardiogram) was limited. Thus, you should have an echocardiogram with contrast (called Definity) done within 1-2 weeks after discharge before you will see your cardiologist Dr. [**Last Name (STitle) 911**]. An order has been placed for this study. Please make an appointment by calling the echo lab at ([**Telephone/Fax (1) 19380**] on Monday. Please call Dr.[**Name (NI) 5786**] office at [**Telephone/Fax (1) 920**] if there are any problems with scheduling this important study. . Please follow up with: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**], MD Phone:[**Telephone/Fax (1) 920**] Date/Time:[**2130-10-23**] 1:40 note: Dr.[**Name (NI) 5786**] office will contact you for an earlier appointment (you should follow up with him within 2 weeks from now). . Please follow up with your primary care physician [**Last Name (NamePattern4) **] [**12-13**] weeks. [**Last Name (LF) **],[**First Name3 (LF) **] L. [**Telephone/Fax (1) 3393**] - During your stay, your blood glucose was slightly elevated, you may be developing glucose intolerance. This should be followed by your primary care physician. . Please also follow up with orthopedic surgeon Dr. [**Last Name (STitle) **] (his office number is ([**Telephone/Fax (1) 5238**]) on [**5-5**] at 12.45PM, [**Location (un) **] [**Hospital Ward Name 23**] Bldg, [**Hospital Ward Name **]. . Please also follow up with: Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2130-5-5**] 12:45 ICD9 Codes: 4019, 2724
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Medical Text: Admission Date: [**2121-12-12**] Discharge Date: [**2121-12-14**] Date of Birth: [**2043-10-18**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 8487**] Chief Complaint: bright red blood per rectum Major Surgical or Invasive Procedure: Colonoscopy with placement of endoclips on [**2121-12-12**] Transfused 3 units pRBCs. History of Present Illness: 78 yr old gentelman with h/o HTN, DM, hypercholesterolemia, CRI (baseline creatinine [**1-28**]), arthritis, Zenker's diverticulum, gout who presents with complaint of bright red blood per rectum. The patient underwent colosnoscopy with polypectomy on [**2121-12-4**]. He was doing well after the procedure until the day of admission, [**2121-12-12**], when he began to have BRBPR. He had a total of [**6-2**] episodes of painless bright red rectal bleeding. He was otherwise asymptomatic. He denied CP, palpitations, SOB, tachycardia, pre-syncopy, LH, nausea, vomiting, diaphoresis. He has been taking aspirin 325 mg po qd and Plavix. In the ED the patient was found to be hypotensive: BP 70/30, but responded quickly to NS boluses. Hct was 29.8 on admission but decreased to 26.9 two hours later (baseline 37). The patient was initially admitted to ICU for close hemodynamic monitoring. He was made NPO, anti-platelet agens and BP meds were held and he was briefly on DDAVP. He was transfused 3 units of pRBCs. Colonoscopy on [**2121-12-12**] identified a site of bleeding in the transverse colon at the previous polypectomy site and this was managed with endoclips. The patient was then transferred to the regular medicine floor. At the time of transfer to the floor he was asymptomatic. Denied fever/chills, N/V, CP, SOB, dizziness/LH. Had not had a BM since colonoscopy. He was tolerating clears well. Past Medical History: 1. Type II DM 2. HTN 3. CRI (baseline creatinine [**1-28**]) 4. Hemorrhoids 5. Zenker's diverticulum 6. Bilateral carotic stenosis, s/p unilateral CEA 7. PVD 8. OA 9. ? Gout 10. Basal cell skin ca [**27**]. Hypercholesterolemia Social History: Retired history professor [**First Name (Titles) **] [**Last Name (Titles) **]. Tob: 65 pack-year, quit 20 years ago. Regular EtOH. Family History: Non-contributory Physical Exam: 96.1 69 161/47 16 100% RA General: pleasant, hard of hearing, appears his stated age, NAD, alert and oriented x3 HEENT: NC, AT, sclera non-icteric, conjunctiva pale, EOM intact, PERRL, mmm, OP clear NECK: no LAD, no thyromegaly, supple PULM: CTA bilaterally CV: regular, nl S1S2, no m/g/r Abd: +BS, soft, NT, ND Extr: no c/c/e Neuro: no focal deficits Pertinent Results: Labs on admission: [**2121-12-12**] 12:25PM BLOOD WBC-6.9 RBC-3.13* Hgb-10.0* Hct-29.8* MCV-95 MCH-32.0 MCHC-33.6 RDW-15.3 Plt Ct-203 [**2121-12-12**] 12:25PM BLOOD Neuts-54.7 Lymphs-39.3 Monos-4.3 Eos-1.2 Baso-0.5 [**2121-12-12**] 12:25PM BLOOD Glucose-222* UreaN-78* Creat-2.8* Na-137 K-4.9 Cl-107 HCO3-17* AnGap-18 [**2121-12-13**] 02:23AM BLOOD ALT-8 AST-11 AlkPhos-52 TotBili-0.6 [**2121-12-13**] 02:23AM BLOOD Calcium-7.9* Phos-5.3* Mg-2.1 Labs at discharge: [**2121-12-14**] 06:25AM BLOOD WBC-4.7 RBC-3.33* Hgb-10.3* Hct-30.6* MCV-92 MCH-31.0 MCHC-33.8 RDW-16.4* Plt Ct-174 [**2121-12-14**] 06:25AM BLOOD Glucose-170* UreaN-50* Creat-2.1* Na-139 K-4.7 Cl-112* HCO3-18* AnGap-14 [**2121-12-14**] 06:25AM BLOOD Calcium-8.3* Phos-3.5# Mg-2.2 Brief Hospital Course: 1. GI bleed secondary to polypectomy while on aspirin and Plavix. The patient was admitted to the intensive care unit. The patient was made NPO and was initially supported with pRBCs transfusions (total of 3 units over hospital stay) and DDAVP. ASA and Plavix (for carotid artery stenosis) were held. GI and surgery were consulted. The patient underwent colonoscopy on [**2121-12-12**] which identified active bleeding in transverse colon at the site of previous polypectomy. Endo clips were placed with good hemostasis. The patient was then gradually restarted on clear and then on low residue diet. At the time of discharge, he had a stable HCT, was asymptomatic, and was tolerating low residue diet without difficulties. He was instructed to avoid NSAIDs, aspirin and Plavix for one week after the intervention. He will continue with low residue diet for one week. The patient was instructed to follow up in the clinic for BP check after the discharge prior to resuming HCTZ and Lasix. He will also have his CBC checked to confirm stable HCT. This plan was also discussed with the patient's daughter. 2. Diabetes: Glycemic control was maintained with FS checks and ISS. The patient was resumed on his outpatient regimen of oral hypoglycemics on the day of discharge. 3. CRI (baseline creatinine [**1-28**]: Creatinine has remained at baseline during hospitalization. 4. HTN: BP medications were held initially given active hemorrhage. The patient was restarted on his BP medications on the day of discharge except for HCTZ and Lasix. His SBP was low normal on the day of discharge. He was instructed not to resume HCTZ and Lasix until he consults his primary care physician after BP check in the clinic next week. 5. Meningioma: The patient was unaware of meningioma found on a recent head MRI. The patient will f/u with neurosurgery Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] as an outpatient. 6. Carotid stenosis: The patient will f/u with US in 3 months with vascular ([**Numeric Identifier **]). 7. Prophylaxis: PPI, pneumonitis 8. FEN: Patient was initially NPO. He was then restarted on clears which was then advanced to low residue diet. He tolerated regular consistency diet without difficulty. 9. Code: full Medications on Admission: List of current medications reviewed with the patient: Plavix 75 mg po qd ASA 325 mg po qd Lasix 40 mg po bid (dose he is currently taking per patient) Accupril 10 mg po qd Allopurinol 100 mg po qd (does not take) Pravachol 30 mg po qd Valium 5 mg q8h prn Zantac 150 mg po qd Salsalate 500 mg po bid Inderal 80mg po bid Sodium bicarbonate tabs Glipizide 5 mg po qd HCTZ 25 mg po qd Ambien prn Tylenol prn Discharge Medications: 1. Pravastatin Sodium 10 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): PLease do not take until you are seen by a health care provider. 4. Propranolol HCl 80 mg Capsule, Sustained Action 24HR Sig: One (1) Capsule, Sustained Action 24HR PO BID (2 times a day). 5. Glipizide 5 mg Tab, Sust Release Osmotic Push Sig: One (1) Tab, Sust Release Osmotic Push PO DAILY (Daily). 6. Quinapril HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Sodium Bicarbonate 650 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day: Please do not start until [**2121-12-19**]. . 9. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day: Please do not start until [**2121-12-19**]. 10. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day: Do not start until seen by a health care provider in the clinic next week for BP check. 11. HCTZ Sig: 25 mg once a day: Do not start until seen by a health care provider in the clinic next week for BP check. 12. Outpatient Lab Work CBC please have done on [**2121-12-16**]. Please have the results called to Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 1921**]. Please follow up on the results with Dr. [**Last Name (STitle) **]. 13. Salsalate 500 mg Tablet Sig: One (1) Tablet PO three times a day. Discharge Disposition: Home Discharge Diagnosis: 1. Lower gastrointestinal bleed from polypectomy 2. Hypotension secondary to gastrointestinal hemorrhage 3. Diabetes 4. Chronic renal insufficiency Discharge Condition: Stable. Patient asymptomatic. Ambulating without difficulties. Tolerating regular consistency diet. Hematocrit stable. Discharge Instructions: Please avoid medications that affect your platelets (aspirin, alleve, motrin, and other NSAIDs) and Plavix for 7 days after your colonoscopy. You then may resume taking aspirin and Plavix on [**2121-12-19**] as before. Please do not take Lasix and HCTZ until you are seen in the clinic early next week, have your blood pressure checked and are told by a primary care physician to restart diuretics. Please eat low residue (low fiber) diet for 7 days. Please call you doctor immediately or return to the hospital if you start having blood in stool, become dizzy, lightheaded, or have other worrisome symtpoms. Please have CBC drawn in the lab on [**2121-12-16**]. Follow up with Dr. [**Last Name (STitle) **] or another health care provider regarding the results. Followup Instructions: 1. Please call ([**Telephone/Fax (1) 1300**] to schedule an appointment with your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] early next week. 2. Provider: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 5500**], M.D. Where: [**Hospital6 29**] ORTHOPEDICS Phone:[**Telephone/Fax (1) 1113**] Date/Time:[**2122-1-6**] 11:30 3. Provider: [**First Name4 (NamePattern1) 247**] [**Last Name (NamePattern1) 248**], MD Where: [**Hospital6 29**] [**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2122-3-24**] 10:40 4. Please call ([**Telephone/Fax (1) 108593**] and schedule an appointment with Dr. [**First Name (STitle) **] in neurosurgery regarding meningioma that was found on CT scan. 5. Please call ([**Telephone/Fax (1) 88**] to schedule appointment with Dr. [**First Name (STitle) **] to follow up on the management of meningioma. Completed by:[**2122-1-3**] ICD9 Codes: 5789, 4019, 2749
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Medical Text: Admission Date: [**2150-6-22**] Discharge Date: [**2150-7-2**] Date of Birth: [**2080-8-7**] Sex: M Service: CARDIOTHORACIC Allergies: Iodine-Iodine Containing Attending:[**First Name3 (LF) 922**] Chief Complaint: Asymptomatic ascending Aneurysm Major Surgical or Invasive Procedure: [**2150-6-25**] Redo sternotomy, replacement of ascending aorta and hemiarch using deep hypothermic circulatory arrest with a 30-mm Vascutek Dacron tube graft. History of Present Illness: This is a 69-year-old gentleman with history of rheumatic heart disease status post mechanical AVR and MVR in [**2137**], who currently presents for evaluation of stable ascending thoracic aortic aneurysm, estimated on recent MRA as measuring 6.2 cm in its maximal dimension. This has been stable on serial echocardiograms measurements as well as compared to prior MRA obtained in [**2149-9-7**]. He remains asymptomatic. Past Medical History: Ascending Aortic Aneurysm PMH: - Chronic Systolic Congestive Heart Failure - History of Rheumatic heart disease - Hypertension - Atrial fibrillation - Colonic adenomas - ?Osteoporosis - BPH - Remote CVA was noted on brain CT and MRI [**2132**] (R thalamic) Past Surgical History - s/p mechanical AVR (#29 Carbomedics) and MVR (#31 carbomedics) in [**2137**] - Laparoscopic right colectomy complicated by anastomotic bleed requiring exploratory laparoscopy [**2149-9-7**] - Appendectomy - Bilateral Shoulder - Left Foot Bunion Social History: Lives with: Wife Occupation: Retired construction worker Tobacco: 5 cigars per month ETOH: nightly Glass of wine with dinner Family History: Father had valvular heart disease. Mother had [**Name2 (NI) 499**] CA Physical Exam: Pulse: 87 Resp: 16 O2 sat: 99% B/P Right: 105/73 Left: 117/73 Height: 69 inches Weight: 200 lbs General: WDWN male in no acute distress Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [] Irregular [x] Murmur - crisp mechanical clicks Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema - none Varicosities: None [x] Neuro: Grossly intact Pulses: Femoral Right: 2 Left: 2 DP Right: 1 Left: 1 PT [**Name (NI) 167**]: 1 Left: 1 Radial Right: 2 Left: 2 Carotid Bruit Right: none Left: none Pertinent Results: [**2150-6-25**] Intra-op TEE Conclusions PRE-CPB: The left atrium is moderately dilated. The pt is in atrial fibrillation. No thrombus is seen in the left atrial appendage. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. The LV chamber is severely dilated. Overall left ventricular systolic function is severely depressed (LVEF= 25-30%) with the inferior wall appearing more hypokinetic than other wall segments. Right ventricular chamber size and free wall motion are normal. The aortic root is moderately dilated at the sinus level. The ascending aorta is severely dilated. While the entire visualized ascending aorta appears dilated, there appears to be a focal outpouching at the level just below the RPA. There are simple atheroma in the descending thoracic aorta. No thoracic aortic dissection is seen. A bileaflet mechanical aortic valve prosthesis is present. There appear to be three small paravalvular leaks, two in the area near the interatrial septum, and one next to the area by the pulmonary valve. The prosthetic valve appears to be well-seated with normal leaflet motion. A bileaflet mitral valve prosthesis is present. The normal washing jets of this mechanical prosthesis is seen. The valve appears to be well-seated. Occasionally, one leaflet is slower than the other to close, possibly due to poor LV contractility. POST-CPB: The patient is now on Epi, Phenylephrine, and Milrinone infusions. The LV EF appears improved on inotropic support, estimated EF is 40-50%. The inferior wall still appears to be more hypokinetic than other wall segments. The bioprothetic valves continue to show appropriate function. The aortic valve paravalvular leaks remain unchanged from pre-op. The peak gradient across the aortic valve is 20mmHg, and the mean gradient is 9mmHg with a CO of 7. There is no evidence of aortic dissection. Dr. [**Last Name (STitle) 914**] was notified in person of the results at the time of study. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Name8 (MD) 17792**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2150-6-25**] 18:44 Radiology Report CHEST (PA & LAT) Study Date of [**2150-6-30**] 7:24 PM Final Report: PA and lateral upright chest radiographs were reviewed in comparison to [**2150-6-28**] and several prior studies dating back to [**2148**]. The cardiomegaly is unchanged, including both left and right ventricle. Two replaced valves are noted, unchanged since the prior examination. The small amount of right pleural effusion is unchanged. Anterior mediastinal air with small air-fluid level noted on the lateral view are redemonstrated with the air-fluid level potentially representing small loculated anterior pneumothorax in combination with post-surgery air in the mediastinum. Small amount of pneumopericardium cannot be excluded laterally, although it might represent summation of shadows. Continued followup is recommended. Post-sternotomy wires appear intact. The study and the report were reviewed by the staff radiologist. DR. [**First Name (STitle) 17414**] [**Name (STitle) 17415**] DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**] Discharge Labs: [**2150-7-1**] 04:10AM BLOOD WBC-5.1 RBC-2.91* Hgb-9.7* Hct-27.7* MCV-95 MCH-33.4* MCHC-35.1* RDW-14.2 Plt Ct-201 [**2150-7-1**] 04:10AM BLOOD Plt Ct-201 [**2150-7-1**] 04:10AM BLOOD UreaN-16 Creat-0.8 Na-133 K-4.1 Cl-98 Admission labs: [**2150-6-22**] 04:47PM PT-15.6* PTT-27.7 INR(PT)-1.4* [**2150-6-22**] 04:47PM PLT COUNT-139* [**2150-6-22**] 04:47PM WBC-4.1 RBC-3.78* HGB-13.0* HCT-36.5* MCV-97 MCH-34.4* MCHC-35.6* RDW-13.3 [**2150-6-22**] 04:47PM %HbA1c-5.7 eAG-117 [**2150-6-22**] 04:47PM ALBUMIN-4.3 MAGNESIUM-2.0 [**2150-6-22**] 04:47PM ALT(SGPT)-16 AST(SGOT)-23 LD(LDH)-322* ALK PHOS-47 TOT BILI-0.5 [**2150-6-22**] 04:47PM GLUCOSE-95 UREA N-24* CREAT-0.8 SODIUM-139 POTASSIUM-4.8 CHLORIDE-105 TOTAL CO2-29 ANION GAP-10 Brief Hospital Course: The patient was a direct admission to the operating room on [**2150-6-25**] where the patient underwent replacement of ascending aorta and aortic hemiarch. Please see the operative report for details. In summary he had: Redo sternotomy, replacement of ascending aorta and hemiarch using deep hypothermic circulatory arrest with a 30-mm Vascutek Dacron tube graft, catalog number [**Serial Number 102644**], lot number [**Serial Number 102645**], serial number [**Serial Number 102646**]. His CARDIOPULMONARY BYPASS TIME was 119 minutes, with a CROSSCLAMP TIME of 75 minutes, and CIRCULATORY ARREST TIME of 18 minutes. He tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. POD 1 found the patient extubated, alert and oriented and breathing comfortably. The patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. Beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. The patient was transferred to the telemetry floor for further recovery. Chest tubes and pacing wires were discontinued without complication. Heparin was initiated as a bridge to coumadin for his mechanical valves. The patient was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on POD #7 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. The patient was discharged on to home with VNA services, in good condition with appropriate follow up instructions advised. Medications on Admission: Warfarin 6 mg Daily (last dose [**2150-6-19**]) Alendronate 70 mg Daily; Carvedilol 6.25 mg [**Hospital1 **]; Eplerenone 50 mg Daily; Flomax 0.4 mg Daily; Benicar daily; Calcium + Vit D Daily; Magnesium Discharge Medications: 1. potassium chloride 20 mEq Packet Sig: One (1) Packet PO once a day for 5 days. Disp:*5 Packet(s)* Refills:*0* 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. aspirin 81 mg [**Hospital1 8426**], Delayed Release (E.C.) Sig: One (1) [**Hospital1 8426**], Delayed Release (E.C.) PO DAILY (Daily). Disp:*60 [**Hospital1 8426**], Delayed Release (E.C.)(s)* Refills:*2* 4. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). Disp:*60 Capsule, Ext Release 24 hr(s)* Refills:*2* 5. carvedilol 12.5 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2 times a day). Disp:*60 [**Hospital1 8426**](s)* Refills:*2* 6. alendronate 70 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO 1X/WEEK (ONCE PER WEEK). Disp:*30 [**Hospital1 8426**](s)* Refills:*2* 7. oxycodone 5 mg [**Hospital1 8426**] Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*50 [**Hospital1 8426**](s)* Refills:*0* 8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 9. warfarin 10 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO ONCE (Once) for 1 doses. Disp:*1 [**Hospital1 8426**](s)* Refills:*0* 10. furosemide 20 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO DAILY (Daily). Disp:*5 [**Hospital1 8426**](s)* Refills:*0* 11. warfarin 2.5 mg [**Hospital1 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] once a day: INR goal= 3-3.5 for double mechanical valves. Disp:*180 [**Last Name (Titles) 8426**](s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 1110**] VNA Discharge Diagnosis: Ascending Aortic Aneurysm PMH: - Chronic Systolic Congestive Heart Failure - History of Rheumatic heart disease - Hypertension - Atrial fibrillation - Colonic adenomas - ?Osteoporosis - BPH - Remote CVA was noted on brain CT and MRI [**2132**] (R thalamic) Past Surgical History - s/p mechanical AVR (#29 Carbomedics) and MVR (#31 carbomedics) in [**2137**] - Laparoscopic right colectomy complicated by anastomotic bleed requiring exploratory laparoscopy [**2149-9-7**] - Appendectomy - Bilateral Shoulder - Left Foot Bunion Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments: Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**], [**2150-7-8**] 10:15 Surgeon Dr. [**Last Name (STitle) 914**] [**Telephone/Fax (1) 170**], [**2150-7-21**] 1:30 Cardiologist Dr. [**Name (NI) **], [**Telephone/Fax (1) 62**], [**2150-7-30**] 11:00 Please call to schedule the following: Primary Care Dr. [**Last Name (STitle) 7726**],[**First Name3 (LF) 177**] A. [**Telephone/Fax (1) 7728**] in [**5-12**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Labs: PT/INR Coumadin for mechanical AVR and MVR Goal INR 3-3.5 First draw day after discharge:[**2150-7-3**] Then please do INR checks Monday, Wednesday, and Friday for 2 weeks then decrease as directed by Dr. [**First Name (STitle) **] Results to fax- [**Telephone/Fax (1) 3341**] Completed by:[**2150-7-2**] ICD9 Codes: 4168, 4019, 4280, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6153 }
Medical Text: Admission Date: [**2187-4-12**] Discharge Date: [**2187-5-3**] Date of Birth: [**2133-11-27**] Sex: M Service: SURGERY Allergies: Penicillins Attending:[**First Name3 (LF) 1384**] Chief Complaint: Acute Renal Failure Major Surgical or Invasive Procedure: None History of Present Illness: Pt is a 53 year old man with HCV cirrhosis, complicated by recurrent ascites, SBP, encephalopathy, and portal hypertensive gastropathy who is being sent in by the liver center after yesterday's labs showed an elevated creatinine. Unfortuantely, the lab work is not available in our system. . He has had multiple admissions in the past six months for acute on chronic renal failure. His urine lytes are usually c/w with pre-renal azotemia. Renal U/S have showed no hydronephrosis. He typically improves with fluids, midodrine and octreotide. With renal failure, he has also had several episodes of hyperkalemia. . His most recent admission was from [**Date range (1) 84789**] for ARF, hyperkalemia, and refractory ascites. He had 9 L paracentesis on [**2187-4-5**]. Pt has no complaints since his discharge on Friday. He denies any change in urine output, dysuria. He has not been taking any medications other than prescribed--no NSAIDS. His wife only noticed his tremors worsened today. . ROS: (+) Diarrhea with lactulose (-) Denies fever, chills, night sweats. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Past Medical History: Hepatitis C diagnosed [**2177**] - viral load 335k [**11/2186**] - recurrent/refractory ascites requiring frequent paracenteses - history of hepatic encephalopathy - portal gastropathy without esophageal varices HepB coreAb positive, surface Ag negative [**11/2186**] Low back pain s/p disc surgery [**2178**], [**2180**] Radial right wrist fx at the end of [**11-10**] after fall Hemachromatosis, HETEROZYGOUS FOR THE C282Y MUTATION Spur cell hemolytic anemia -[**2187-4-19**] piggyback liver transplant Social History: He is married and lives with his wife. [**Name (NI) **] is not working currently. Stopped smoking 6-7 months ago. Smoked 1 PPD since age 15. No alcohol in 2 years. Multiple tattoos. His wife organizes his medications. Family History: His father had ETOH cirrhosis. No history of kidney problems. Physical Exam: Vitals: T: 98.1, P: 87, BP: 119/75, R: 18, SaO2: 100RA General: Awake, alert and oriented x3, refused to do MOYB but did them forwards, NAD. HEENT: NC/AT, no scleral icterus noted, MMM Neck: supple, no LAD Pulmonary: Lungs CTA bilaterally Cardiac: RRR, nl. S1S2, no M noted Abdomen: positive bowel sounds, soft, nontender, distended but not tense. Extremities: 1+ pedal edema to knees bilaterally Skin: spider angiomas on chest, maculopapular rash on abdomen Neurologic: sl asterixis Pertinent Results: [**2187-5-3**] 06:30AM BLOOD WBC-9.0 RBC-3.19* Hgb-9.8* Hct-30.1* MCV-95 MCH-30.7 MCHC-32.5 RDW-16.4* Plt Ct-232 [**2187-4-28**] 06:30AM BLOOD PT-11.7 PTT-26.7 INR(PT)-1.0 [**2187-5-3**] 06:30AM BLOOD Glucose-79 UreaN-42* Creat-2.0* Na-137 K-5.4* Cl-111* HCO3-19* AnGap-12 [**2187-5-3**] 06:30AM BLOOD ALT-30 AST-21 AlkPhos-346* TotBili-2.4* [**2187-5-3**] 06:30AM BLOOD Calcium-9.3 Phos-4.6* Mg-1.6 Brief Hospital Course: 53 y.o. man with HCV cirrhosis, complicated by recurrent ascites, SBP, encephalopathy, and portal hypertensive gastropathy was admitted with recurrent acute on chronic renal failure that was managed with albumin, midodrine, and octreotide after paracentesis. Cr slightly improved to 2.6. Lactulose and rifaxamin were continued. Cipro was continued for sbp prophylaxis. On [**2187-4-19**], a liver donor became available and he underwent piggyback liver transplant. Surgeon was Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**]. Induction immunosuppression was given (solumedrola and cellcept). Five liters of ascites were removed. There was a size mismatch between the donor (smaller)and recipient bile duct. This was adjusted for by cutting a slit on top of the donor liver, using interrupted 5-0 PDS to accomplish a biliary anastomosis. Two drains were placed in the usual locations (posterior to liver and hilar area). Postop, he was transferred to the SICU for management. VRE rectal screen was positive. He experienced a lot of pain on top of his chronic back pain and required large amounts of narcotics. On postop day 1, he was extubated and resumed his home doses of oxycontin. Re-intubation for pulmonary edema was required on postop day 4. He was also found to have myocardial stunning from the stress of surgery. BNP was 39,512. Cardiology was consulted. Cardiac enzymes were negative. Diuresis and metoprolol were given. No cardiac event occurred and he was eventually extubated. Chest CT was negative for PE and notation was made of bilateral pleural effusions. Hepatic vasculature was patent. On [**4-23**], TTE demonstrated EF of 30%. There was moderate regional left ventricular systolic dysfunction with infero-lateral and apical akinesis, trace MR and borderline pulmonary artery systolic HTN. He was extubated on [**4-25**]. Of note, JP drains had large bilious outputs requiring albumin and fluid replacement. LFTs increased initially with t. bilirubin peaking at 12 then decreasing. Liver duplex demonstrated patent hepatic vasculature, but suboptimal visualization of the inferior vena cava, no intrahepatic biliary ductal dilation and a small amount of ascites. On [**4-26**], ERCP was performed noting extravasation of contrast from the biliary anastomosis was seen, with contrast tracking along the JP drain. A 10cm 8 French stent was placed. LFTs then continued to improve with JP drain outputs dropping and appearing non-bilious. He was transferred out of the SICU on [**4-28**] to the Med-[**Doctor First Name **] unit where he continued to do well. Diet was advanced and tolerated. Glucoses were elevated requiring NPH daily with intermittent sliding scale regular insulin. Lateral JP was removed on [**5-2**]. Lateral JP creatinine was 2.3 with serum bili of 2.7. The medial JP remained in place. PT worked with him noting impulsivity and need for a rolling walker. He was cleared for home with home PT thru VNA. Medication teaching was done and he did fairly well with reinforcement. Insulin administration and glucoses checks were reviewed. He required assist from his wife for management of this. This plan was for VNA services to provide monitoring/instruction. Immunosuppression consisted of cellcept 1 gram [**Hospital1 **] that was well tolerated. Steroids were tapered to 20mg daily per protocol and Prograf which was started on postop day 0 was adjusted per trough levels. On the day of discharge, Prograf trough was 10.9. Prograf was decreased to 4mg [**Hospital1 **]. Creatinine increased postop to 3.6 after CT, but gradually decreased to 1.8. On the day of discharge, creatinine was 2.0 and potassium was 5.4. He was instructed to follow a carbohydrate consistent, 2gram potassium diet. He was discharged to home with VNA of Southeastern MA ([**Telephone/Fax (1) 80441**]). He had resumed his home dose of oxycontin 80mg tid with prn oxycodone 10mg approximately 3-4 times a day for breakthru pain. Medications on Admission: Oxycodone 40 mg Tablet Sustained Release 12 hr Sig: Two (2) Tablet Sustained Release 12 hr PO Q8H (every 8 hours). Oxycodone 5 mg Tablet Sig: Two (2) Tablet PO Q6H as needed for pain. Lactulose 10 gram/15 mL Syrup Sig: 30-60 MLs PO TID Midodrine 5 mg Tablet Sig: One (1) Tablet PO TID Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO BID Magnesium Oxide 400 mg Tablet daily Sucralfate 1 gram Tablet Sig: One (1) Tablet PO BID Pantoprazole 40 mg Tablet, Delayed Release daily daily Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). Thiamine 100 daily Ergocalciferol (Vitamin D2) 50,000 unit Capsule Sig: One (1) Capsule PO 1X/WEEK (SA). Clotrimazole 10 mg 5 times a day Discharge Medications: 1. Prednisone 5 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily): follow taper. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 5. Oxycodone 40 mg Tablet Sustained Release 12 hr Sig: Two (2) Tablet Sustained Release 12 hr PO Q8H (every 8 hours). 6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 7. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 8. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*42 Tablet(s)* Refills:*0* 9. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 11. Sulfamethoxazole-Trimethoprim 400-80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Tacrolimus 5 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 13. NPH Insulin Human Recomb 100 unit/mL Suspension Sig: Ten (10) units Subcutaneous once a day. Disp:*1 bottle* Refills:*2* 14. Insulin Regular Human 100 unit/mL Solution Sig: follow printed scale Injection four times a day. Disp:*1 bottle* Refills:*2* 15. Outpatient Lab Work STAT Labs: cbc, chem 10, alt, ast, alk phos, t.bili, trough prograf Fax results to [**Hospital1 18**] [**Telephone/Fax (1) 697**] attention [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 8147**] RN 16. insulin syringes NPH qd and prn sliding scale regular Low dose syringe with 25-26 gauge needle supply: 1 box refill: 1 Discharge Disposition: Home With Service Facility: VNA of Southeastern Mass. Discharge Diagnosis: HCV cirrhosis s/p liver transplant [**2187-4-19**] pulmonary edema, resolved myocardial stunning, resolved hyperglycemia on steroids Chronic back pain Discharge Condition: Mental Status: Clear and coherent Level of Consciousness: Alert and interactive Activity Status: Ambulatory - requires assistance or aid (walker or cane)-impulsive with activities/walking Discharge Instructions: Please call the Transplant Office [**Telephone/Fax (1) 673**] if you have any of the warning signs listed below You will need to get labs drawn every Monday and Thursday Empty and write down drain output. Bring record of drain outputs to next transplant office appointment Apply dry gauze to your drain daily Check your blood sugars prior to meals and give insulin as directed on sliding scale No driving while taking pain medication You may shower No heavy [**Last Name (un) 37604**]/straining Followup Instructions: Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2187-5-7**] 8:00 Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2187-5-14**] 10:30 Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2187-5-24**] 10:00 Completed by:[**2187-5-3**] ICD9 Codes: 5845, 9971, 4280, 5859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6154 }
Medical Text: Admission Date: [**2182-3-9**] Discharge Date: [**2182-4-5**] Service: MEDICINE Allergies: Allopurinol Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Respiratory failure and hypotension; transferred from OSH Major Surgical or Invasive Procedure: CVL from OSH [**2182-3-8**] PICC line placement Tracheostomy placement Intubation - [**2182-3-9**]; reintubation on [**2182-3-13**]; reintubation on [**2182-3-30**] Bronchoscopy [**2182-3-13**] Arterial line placement History of Present Illness: 86 yo M w/history of CVA, right hemiparesis, obtunded at baseline, bilateral AKA presents with respiratory failure and hypotension. The patient was sent to [**Hospital1 882**] after an apparent aspiration even last night, with SaO2 87% on RA and coarse breath sounds bilaterally. The patient had sats 87-94% on 4L and was treated with Levo/Flagyl and nebs. At 4:30 pm the patient was found with decreased responsiveness, diaphoretic with vitals of 96.4, 110, 28, 63/41. The patient was placed on a NRB and sent to the [**Hospital1 882**] for further evaluation. A chest x-ray showed a multilobar pneumonia, for which he was given one dose of Zosyn and Vancomycin. His pressure was noted be as low as 50/30, and a right subclavian line was placed. He wsa started on levophed and dopamine and additionally received one 0.5mg dose of Atropine for bradycardia. He was transferred to [**Hospital1 18**] for further managment. In the [**Hospital1 18**] ED, his pressures were maintained on both pressors initially, but dopamine was discontinued due to HR 100-110. He was found to have a multilobar pneumonia, and an initial lactate of 4.5 (improved to 3.5 with IVF). WBC 28.6, 29% Bands. Blood cultures were sent and vancomycin 1 g IV was given. Levaquin was not used due to QTc 0.450. An EKG revealed ST elevations laterally. Interventional cardiology was consulted, but the patient was not felt to be an appropriate catheterization candidate. The patient was also found to be strongly guaiac positive, with a Hct 25.0 and therefore, no heparin was given. He was transfused 1 unit PRBC. His urinalysis was grossly positive. Additonal abnormal labs included: Na: 130, Cr: 1.5, ALT: 55, AST: 97, LDH: 305, AP: 208, Tbili: 2.7, Albumin: 2.0, INR 1.3. Upon arrival to the ICU the patient is maintained on Levophed only with MAP > 60. An a-line was placed in the patient's right arm. Past Medical History: #. Aspiration pneumnonia #. C. Diff complicated by sepsis [**2181-11-21**] #. Multiple admissions for sepsis related to UTI/pneumonia/sacral decubitus ulcers #. s/p CVA with R hemiparesis (arms contracted) #. PVD s/p bilateral AKA #. Seizure Disorder #. Dementia #. Diabetes II #. Anemia #. MRSA colonization #. Hypernatremia #. cataracts #. contracted hips #. Stage IV Sacral decubitus ulcers #. Fistula #. ETOH Social History: Unobtainable Family History: Unobtainable Physical Exam: General: Patient is intubated, appears chronically ill. Patient's lower extremities surgically missing, hips severely flexed HEENT: NCAT, EOMI, +ETT Neck: right subclavian line Chest: Lung sounds relatively [**Name2 (NI) **] with few course expiratory breath sounds Cor: Tachycardic, regular Abdomen: thin, firm but not rigid. Patient flexes with deep palpation of abdomen. + BS, hyperactive Back: stage IV decubitus ulcer at sacrum/coccyx level, stage II decubitus ulcer with several necrotic foci on right buttock, Extremities: bilateral AKA Pertinent Results: [**2182-3-9**] 08:53PM WBC-28.6* HGB-8.3* HCT-25.0* MCV-100* MCH-33.4* MCHC-33.3 RDW-14.9 NEUTS-62 BANDS-29* LYMPHS-5* MONOS-4 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 PLT SMR-NORMAL PLT COUNT-248 PT-15.2* PTT-42.4* INR(PT)-1.3* GLUCOSE-99 UREA N-61* CREAT-1.5* SODIUM-130* POTASSIUM-4.9 CHLORIDE-101 TOTAL CO2-15* ANION GAP-19 ALBUMIN-2.0* CALCIUM-7.1* PHOSPHATE-4.3 MAGNESIUM-2.1 ACETONE-NEG cTropnT-0.37* CK-MB-25* MB INDX-3.0 LIPASE-17 ALT(SGPT)-55* AST(SGOT)-97* LD(LDH)-305* CK(CPK)-836* ALK PHOS- 208* TOT BILI-2.7* URINE BLOOD-LG NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN- SM UROBILNGN-1 PH-5.0 LEUK-MOD URINE RBC->50 WBC-21-50* BACTERIA-MANY YEAST-NONE EPI-0 LACTATE-4.6* TYPE-ART PO2-404* PCO2-37 PH-7.27* TOTAL CO2-18* BASE XS--8 INTUBATED-INTUBATED CXR: 1. Bibasilar opacities likely representing a combination of small effusions and passive atelectasis and/or pneumonia. 2. Moderate central pulmonary arterial enlargement suggestive of underlying pulmonary hypertension. ECG: Sinus tachycardia with premature atrial contractions. ST segment elevation in leads V3-V5 is non-specific. Clinical correlation is suggested. Low QRS voltage in the limb leads. No previous tracing available for comparison. [**2182-3-30**]: CT chest IMPRESSION: 1. Bilateral large layering nonhemorrhagic pleural effusion with associated compressive atelectasis. 2. Diffuse patchy opacities involving both upper lobes could represent infectious or inflammatory process. 3. Calcified pleural plaques. 4. Small liver hypodensity, too small to be fully characterized. 5. No evidence of cavitary lesion. [**2182-4-3**]: Xray to confirm PICC line (prelim read): IMPRESSION: Uncomplicated ultrasound and fluoroscopically guided single-lumen Vaxcel PICC line placement via the left brachial venous approach. Final internal length is 44 cm, with the tip positioned in SVC. The line is ready to use. ECHO: The left atrium and right atrium are normal in cavity size. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is low normal (LVEF 50%). The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. Brief Hospital Course: A/P: 86 year old Male with history of aspiration pneumonia who presents with respiratory failure and hypotension. . #. Hypoxic Respiratory failure: His respiratory failure was thought most likely secondary to aspiration/hospital acquired pneumonia. He received Zosyn at the OSH prior to transfer to [**Hospital1 18**], in the [**Hospital1 **] ER he received vanc. Coverage was broadened for potential multiple sources. Over his course of stay, he was treated with Linezolid (VRE/MRSA), Cefepime (Pseudomonas), Cipro (gram negative), Azithro, PO Vanc/IV Flagyl; as well as transiently with Tobramycin for GNR based on sensitivities. However, per ID recs, tailored down to course of Meropenem & oral vancomycin (for history of C.diff). During his course, his sputum grew GNRs and MSSA and blood cultures grew Klebsiella pneumoniae. Legionella antigen was negative. He was extubated on [**3-12**] and reintubated on [**3-13**] with increased work of breathing. He continued antibiotic treatment and was diuresed once blood pressure allowed. This allowed for successful extubation on [**3-27**]. Patient was made DNR during this admission, though per his HCP (niece) he was to be reintubated which he was on [**2182-3-30**] for respiratory distress and increased work of breathing. The patient also grew out multidrug resistant Klebsiella from his sputum during his hospitalization. His antibiotics were discontinued with the exception of his oral vancomycin, which he should continue until [**2182-4-18**] prophylactically for a history of C. Difficle sepsis. . #. Hypotension: Pt has multiple reasons for hypotension requiring pressors. His hypotension was felt most likely distributive secondary to sepsis given his elevated WBC and bandemia with multiple potential sources including aspiration pneumonia, UTI, sacral decubitus ulcer, C. Diff. Patient may have also had contribution of cardiogenic shock given evolving MI and was at risk for hypovolemia given guaiac+ stool with low Hct. He was monitored with arterial line and pressors were continued. He received aggressive fluid/pressor resuscitation to maintain pressures. He had a total of 6 units of RBCs throughout hospital course to maintain oxygen delivery. He improved with treatment of sepsis and pressors were discontinued. . #. STEMI: The patient was noted to have ST elevations in V3-V5. He was seen by cardiology in ED, and thought not to be a cardiac cath candidate. Given guaiac positive stool, a heparin gtt not started. He has received ASA daily. Throughout his hospital course, he has been transfused to maintain hematocrit in the upper 20's. Troponin trended down from admit level of 0.37. Echo was slightly poor quality, but with EF 50%, possible WMA, 1+ MR. Beta blocker started once hypotension improved. . #. Anemia: The patient was found to be guaiac positive in ED and was originally transfused 1 unit of PRBC for his anemia. His source is most likely GI, however given acute illness, overall prognosis, and general stability he did not have endoscopy or colonoscopy during this admission. His hematocrit was monitored and he required a total of 6 units this admission with appropriate bumps. At this point, the patient has transfusion dependent anemia. He was transfused PRN throughout his course to maintain a hematocrit greater than 24. B12 and folate levels were checked, which were both within normal limits. Please continue to monitor his hematocrit Q three days and transfuse as needed. . #. Acute renal failure: The patient developed acute renal failure in setting of acute illness, possible ATN. His creatinine peaked at 2.4 and has prgressively trended down to normal. His renal function improved with treatment of underlying illness. . #. Decubitus ulcers with fistulization: Wound care was consulted and recommendations followed for extensive wounds. Please continue wound care recs per the page one. . #. s/p CVA with R hemiparesis (arms contracted): The patient was continued on aspirin for stroke prevention. . #. Seizure Disorder: The patient was continued on his original anti-epileptic medications. Please continue these medications as prescribed. . #. Dementia: The patient is demented at baseline. His mental status did not appear to change during his hospital course. . #. Diabetes II: The patient was continued on a sliding scale. Please continue his sliding scale per the included sheet. Medications on Admission: Meds (on discharge from last hospitalization [**2181-11-23**]) 1. omeprazole 40 mg po qd 2. folate 1 mg po qd 3. vitamin C 1 tab po bid 4. zinc 220 mg po qd 5. vitamin A 5000 units po qd 6. Magnesium oxide 400 mg po bid 7. Neurontin 200 mg po bid 8. Multivitamin 5 mL po qd 9. Neutra-phos one packet po bid 10. KCl 20 mEq po qd 11. Dilantin suspension 75 po tid 12. vancomycin 250 mg po qid x10 days (now discontinued) 13. chlorhexadine rinse 0.12% [**Hospital1 **] ------- Meds from med list from Nursing Home 1. omeprazole 20 mg via g-tube qd liquid antacid q6h prn GI upset MOM 30 ml via g-tube for constipation acetaminophen 325 2 tabs via g-tube q4hours . Allergies: Allopurinol Discharge Medications: 1. Acetaminophen 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q6H (every 6 hours) as needed for fever or pain. 2. Chlorhexidine Gluconate 0.12 % Mouthwash [**Hospital1 **]: Fifteen (15) ML Mucous membrane [**Hospital1 **] (2 times a day): While pt is on mechanical ventilation. 3. Aspirin 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 5. Heparin Flush (10 units/ml) 2 mL IV PRN line flush PICC, heparin dependent: Flush with 10mL Normal Saline followed by Heparin as above daily and PRN per lumen. 6. Morphine Sulfate 2 mg IV Q4H:PRN pain for dressing changes 7. Furosemide 40 mg Tablet [**Last Name (STitle) **]: Three (3) Tablet PO DAILY (Daily). 8. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO BID (2 times a day). 9. Phenytoin 100 mg/4 mL Suspension [**Last Name (STitle) **]: Seventy Five (75) mg PO TID (3 times a day). 10. Calcium Carbonate 500 mg Tablet, Chewable [**Last Name (STitle) **]: One (1) Tablet, Chewable PO TID (3 times a day). 11. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette [**Last Name (STitle) **]: [**12-19**] Drops Ophthalmic PRN (as needed). 12. Insulin Regular Human 100 unit/mL Solution [**Month/Day (2) **]: Pls see attached sheet Injection ASDIR (AS DIRECTED). 13. Vancomycin Vancomycin Oral Liquid 125 mg PO Q6H until [**2182-4-18**], then discontinue Discharge Disposition: Extended Care Facility: [**Hospital3 105**] Northeast - [**Location (un) 38**] Discharge Diagnosis: Primary: Multilobar pneumonia with respiratory failure requiring tracheostomy ST elevation myocardial infarction Chronic anemia Secondary: s/p CVA with right sided hemiparesis Stage IV sacral decubitus ulcers Peripheral vascular disease s/p bilateral AKA Seizure disorder NOS Dementia Type II Diabetes Bilateral cataracts Contracted hips Fistula Discharge Condition: Stable Discharge Instructions: You were admitted to the hospital with respiratory failure and low blood pressure. While you were in the hospital, you required intubation to help you breath. Because you were unable to be weaned off the ventilator, a tracheostomy was performed. You were also treated with antibiotics for a pneumonia. . While you were in the hospital, you also had a heart attack. Cardiology felt medical management was most appropriate so you were treated with medications which were continued during your hospitalization. Followup Instructions: You will be followed by physicians at the rehabilitation facility. You can also follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5351**] at [**Telephone/Fax (1) 608**]. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] ICD9 Codes: 5070, 5990, 5849, 2761, 5789, 2859, 2767
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6155 }
Medical Text: Admission Date: [**2190-9-1**] Discharge Date: [**2190-9-15**] Service: MEDICINE Allergies: Codeine / Pneumovax 23 / Lescol Attending:[**First Name3 (LF) 759**] Chief Complaint: abd pain, chills Major Surgical or Invasive Procedure: ERCP Laprascopic Cholecystectomy History of Present Illness: Pt is a [**Age over 90 **]yoW who presented from [**Hospital3 **] facility with chills/fever and ruq abd pain for 2 days. Denies diarrhea, but has had nausea w/o vomitting. Denies CP/SOB/HA/rash/dysuria/myalgias/ back pain. . She was taken to [**Hospital1 18**] [**Location (un) 620**] where she was febrile to 103.2, found to have elevated LFTs, CT with likely cholangitis. . She was transferred to [**Hospital1 18**] ED and taken to ERCP, where sphincterotomy performed, several stones extracted from CBD, stent placed. Several stones where noted to remain, exiting from the cystic duct. In the ERCP suite she was treated with ampicillin and gentamycin. Past Medical History: HTN COPD Hypothyroid hx of gallstones Stress incontinence Anxiety Social History: Married and lives at [**Hospital3 **] with her husband. Was able to ambulate with a walker prior to admission. Was not on any home oxygen. Denies current tobacco/alcohol/IVDA. Has a ~15 pack year history of smoking (5 cig/day from teens to [**2157**]). Family History: nc Physical Exam: Vital Signs: T:97BP:120/68 HR:62 RR:14 O2 Sat:99%2L . GEN: no jaundice . HEENT -Head/Neck: Anicteric sclera. Head is symmetric and atraumatic. Neck has full range of motion and cervical, occipital, and supraclavicular lymph nodes are nonpalpable and nontender. -Eyes: PERRL, EOM are intact . Respiratory: CTA bl. . Cardiovascular: RRR nl s1s2 no mrg . Abdominal: soft, mild RUQ tenderness, hypoactive bs . Neurologic: CN 2-12 intact . Extremities: bl legs markedly tender to palpation, no edema, no erythema . Back: no cva tenderness, no spinal or paraspinal point tenderness Pertinent Results: [**2190-9-1**] 10:03AM LACTATE-2.9* [**2190-9-1**] 09:40AM GLUCOSE-140* UREA N-14 CREAT-1.1 SODIUM-141 POTASSIUM-3.8 CHLORIDE-106 TOTAL CO2-26 ANION GAP-13 [**2190-9-1**] 09:40AM ALT(SGPT)-271* AST(SGOT)-220* ALK PHOS-216* AMYLASE-44 TOT BILI-1.9* [**2190-9-1**] 09:40AM LIPASE-29 [**2190-9-1**] 09:40AM ALBUMIN-3.6 CALCIUM-8.5 PHOSPHATE-2.3* MAGNESIUM-2.1 [**2190-9-1**] 09:40AM WBC-7.9 RBC-4.16* HGB-12.5 HCT-36.1 MCV-87 MCH-30.1 MCHC-34.7 RDW-13.6 [**2190-9-1**] 09:40AM NEUTS-91.4* BANDS-0 LYMPHS-5.9* MONOS-2.4 EOS-0.1 BASOS-0.2 [**2190-9-1**] 09:40AM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2190-9-1**] 09:40AM PLT SMR-LOW PLT COUNT-148* [**2190-9-15**] 06:20a 138 104 12 102 AGap=10 4.0 28 1.0 Ca: 8.2 Mg: 1.9 P: 2.5 ALT: AP: Tbili: Alb: AST: LDH: 214 Dbili: TProt: [**Doctor First Name **]: Lip: Other Blood Chemistry: Hapto: Pnd 87 8.6 9.0 543 26.3 [**2190-9-13**] 3:00p Free-T4:1.2 Other Blood Chemistry: CRP: 186.8 New Reference Ranges As Of [**2189-6-26**];Low Risk <1.0, Average Risk 1.0-3.0, High Risk >3.0 (But <10.0) SED-Rate: 93 [**2190-9-13**] 10:31a Color Straw Appear Clear SpecGr 1.010 pH 8.0 Urobil Neg Bili Neg Leuk Neg Bld Neg Nitr Neg Prot Tr Glu Neg Ket Neg RBC 0 WBC 0 Bact None Yeast None Epi 0 [**2190-9-10**] 06:00a TSH:11 [**2190-9-6**] 08:21a ALT: AP: Tbili: Alb: AST: LDH: Dbili: TProt: [**Doctor First Name **]: Lip: 19 [**2190-9-4**] 12:50a TNT,CP,CPMB ADDED 135AM,[**2190-9-4**] MB: 5 Trop-*T*: 0.02 Comments: Ctropnt > 0.10 Ng/Ml Suggests Acute Mi Other Blood Chemistry: proBNP: 7662 Reference Values Vary With Age, Sex, And Renal Function;At 35% Prevalence, Ntprobnp Values; < 450 Have 99% Neg Pred Value; >1000 Have 78% Pos Pred Value;See Online Lab Manual For More Detailed Information [**2190-9-2**] 05:36a Other Urine Chemistry: Osmolal:627 [**2190-9-1**] 09:40a N:91.4 Band:0 L:5.9 M:2.4 E:0.1 Bas:0.2 . [**9-1**] ERCP ERCP: Ten ERCP images were obtained by Dr. [**Last Name (STitle) 6745**]. Cholangiogram demonstrates a dilated common duct with numerous filling defects. By report a sphincterotomy was performed and stones were extracted. Residual impacted stones were observed and a biliary stent was placed. . [**9-7**] CXR: AP single view of the chest obtained with the patient in semi-erect position is analyzed in direct comparison with a similar study obtained [**9-6**]. The bilateral pleural effusions remain practically unchanged. Heart size as before. No new parenchymal infiltrates are seen, and the accessible lung fields demonstrate unchanged pulmonary vasculature. . [**9-6**] ECHO: Conclusions: The left atrium is mildly dilated. The right atrium is moderately dilated. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). Regional left ventricular wall motion is normal. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. . EKG [**9-8**]: NSR 68, nl intervals, TWI in II/III, no ST changes. . [**9-8**] CXR HISTORY: [**Age over 90 **]-year-old woman with low oxygenation. IMPRESSION: AP and lateral chest compared to [**9-6**] and 12: Moderate bilateral pleural effusion, right greater than left, has increased slightly on the right. Mild-to-moderate enlargement of the cardiac silhouette is more pronounced. There could be a component of pericardial effusion. Aside from relaxation atelectasis at the lung bases, there is no focal pulmonary abnormality, though there is pulmonary vascular engorgement. . [**9-12**] CXR Compared with [**2190-9-11**], no significant change is detected. Again seen are small bilateral pleural effusions, with underlying collapse and/or consolidation. There is cardiomegaly, with an unfolded aorta. No CHF is identified. Aside from the bases, no focal infiltrate is identified. IMPRESSION: No significant change compared with one day earlier. Bilateral pleural effusions with underlying collapse and/or consolidation. Lungs otherwise grossly clear. Background COPD noted. . [**9-13**] CT OF THE ABDOMEN WITH IV CONTRAST: There are bibasilar effusions with adjacent areas of compressive atelectasis. The right effusion is moderate in size. There is a stent in the common bile duct, with associated pneumobilia centrally, but there is no intra- or extrahepatic biliary ductal dilatation. No focal liver lesions are identified. The patient is status post cholecystectomy. The spleen, pancreas, and adrenal glands are within normal limits. There is a 3.6 cm diameter hypoattenuating lesion in the lower pole of the left kidney with relatively high density. This may represent a cyst with hemorrhage, but is not fully characterized here. There is a large hiatal hernia. Apparent wall thickening of the distal colon is probably due to underdistension. The stomach, small and large, bowel, are unremarkable. There is no evidence of obstruction. There is no lymphadenopathy or free air or fluid. There is a partly saccular infrarenal abdominal aortic aneurysm with maximal diameter of the aorta of 3.2 cm. There are extensive vascular calcifications as well. There are fairly large calcifications in the mesentery in the pelvis. These may represent unusual phleboliths. There is no free fluid. BONE WINDOWS: There is marked leftward convex scoliosis of the mid lumbar spine with degenerative change but no suspicious lytic or blastic lesions. IMPRESSION: 1. Bilateral effusions, right greater than left. 2. Bibasilar opacities which are more suggestive of atelectasis than pneumonia. 3. Stent in the common bile duct with associated pneumobilia. Cholangitis cannot be excluded by this study but there is no parenchymal abnormality in the liver or evidence of biliary ductal dilatation or enhancement to raise the possibility based on the CT. 4. Large left-sided renal cystic lesion. This may represent a renal cyst with hemorrhage but an ultrasound could be performed to confirm. 5. Abdominal aortic aneurysm. 6. Status post cholecystectomy. . [**9-14**] CT Chest FINDINGS: There are bilateral pleural effusions, moderate on the right, small on the left. There is associated bilateral compressive basal atelectasis. There is centrilobular emphysema predominantly in both upper lobes. Fine detail is obscured by motion artifact. Adjacent to the area of centrilobular emphysema in the right upper lobe, there is a focal area of bronchiectasis and bronchial thickening. No mass is appreciated, but small lesions may be below the detection threshold given the motion artifact. Emphysematous changes are also seen in the lower lobes but partially obscured by the pleural effusion. Pleural effusion extends into the right major fissure. There is mild cardiomegaly. No pericardial effusion is seen. Atherosclerotic calcifications are seen within the coronary arteries, aorta, and the origin of great vessels. The airways appear patent to the level of the subsegmental bronchi. Non-contrast images through the upper abdomen demonstrate a stent in the common bile duct with associated pneumobilia. A hypoattenuating exophytic lesion arising from the left kidney is incompletely visualized. Significant motion artifact obscures details in the right kidney. There is a moderate to large hiatal hernia. BONE WINDOWS: No suspicious lytic or blastic lesions are seen. Thoracic scoliosis with significant associated degenerative changes is noted. IMPRESSION: 1. Centrilobular emphysema, with predominance in both upper lobes. 2. Focal area of bronchial thickening and bronchiectasis posteriorly in the right upper lobe. An infectious process including tuberculosis cannot be excluded. 3. Bilateral pleural effusions, right greater than left with associated compressive atelectasis at the lung bases. 4. Mild cardiomegaly with severe coronary artery atherosclerotic calcifications. 5. Large hiatal hernia. 6. Hypoattenuating lesion arising from the left kidney, better visualized on the CT of [**9-13**]. 7. Partial visualization of common bile duct stent and pneumobilia better visualized on CT of [**2190-9-13**]. 8. Moderate to severe thoracic scoliosis and degenerative changes. Brief Hospital Course: [**Age over 90 **] yo F with HTN, hypothyrodisim, and COPD who presented to [**Hospital1 **] [**Location (un) 620**] with fevers, elevated LFTs, and CT abd concerning for cholangitis. She was transferred to [**Hospital1 18**] for ERCP with sphincerotomy and stent placement ([**9-1**]). She was then taken for a lap ccy ([**9-3**]). Post op she was noted to be increasingly somnolent in the setting of pain control post op with lack of spontaneous breathing. Given narcan. Transfered to the [**Hospital Unit Name 153**]. She was placed on unasyn for abx coverage post op in the [**Hospital Unit Name 153**]. [**Hospital Unit Name 153**] course notable for improvement in mental status. She was transferred to the SICU for hypotension and low UOP. She was called out of the SICU to the floor but then returned to the SICU for resp distress, satting 91% on 6L. An ABG showed 7.51/73/30, concerning for resp alkalosis. A CXR on [**9-6**] showed ? new infiltrate. She was placed on levoquin 250mg and flagyl. She returned to the floor with a fever to 101.2 on [**9-7**], sats remained in the low 90's on [**1-29**] L NC. She desatted to 93% on 4L with activity with PT. . She was transferred to the medicine service on [**9-9**] for further management before discharge to [**Hospital1 1501**]. Hospital course on medicine as follows: . # Hypoxia: Likely a mixed picture due to PNA/ COPD exacerbation vs CHF (diastolic dysf w/ nl EF). Pt had a fever to 101.1 ([**9-6**]-->[**9-7**]) with a prod cough and CXR suggestive of an infiltrate. In addition, her prior exam suggested vol overload. In someone with exisiting COPD, these two additional ailments would compromise her pulmonary status. By discharge, she had a minimal O2 req (2L) and was afebrile >24 hrs with decreased SOB. a. for PNA: likely nosocomial as this happened in-house. --switched from levoquin to piperacillin/taz as she spiked through the Levo. Will continue a 7 day course. . b. for CHF: in mild decompensated CHF. Likley [**1-28**] vol overlaod during surgery as well as from hypoixa causing HTN/increased afterload and susequent pulm edema. She was diuresed > 4 L and her respiratory status improved. -- her Is=Os X several days so no standing furosemide was continued, she will be dishcarged on 10 mg fuosemide prn if weight increases or I > O . #) L ankle pain: She complained of L ankle pain on ambulation. It continues to be edematous (L >R) mildly TTP on lateral aspect of L ankle with minimal erythema. XR did not show an acute fracture. Rheum consult did not feel that her ankle was the source of her fever and there was not an effusion to be tapped. . #) Urinary retention: foley was replaced [**1-28**] urine output. Likely [**1-28**] retention or urethral inflammation. - continue foley for now; recommend attempts at d/c in NH . #) Mouth pain: [**1-28**] dry mouth/cracked lips. - magic mouthwash, tylenol prn . #) Normocytic Anemia: likely 2/2 blood loss from surgery and serial phlebotomy. Her hematocrit was 36 on admission and 26 on discharge. There was no evidence for hemolysis. She did not receive any transfusions during her hospital course. . #) Hypothyroidism: TSH was found to be elevated at 11, so her levothyroxine dose was increased to 75 mcg q day. - her TSH should be re-checked in 3 weeks. . #) HTN: continued metoprolol. BP well-controlled during hospital stay. . #) FEN: low-sodium diet, replete lytes prn . #) Prophylaxis: sc heparin, PT consult . #) Code Statue: Full, confirmed with patient on [**9-9**] . #) Contact: [**Name (NI) **] [**Name (NI) **] [**Name (NI) 68317**] ([**Telephone/Fax (1) 68318**] . #) Dispo: d/c to The Crossing with IV antibiotics and continuous O2 - she will need re-evaluation of her AAA in 6 months - f/u with PCP [**Last Name (NamePattern4) **] 2 weeks. . Medications on Admission: levoxyl 50 mcg qd oxazepam 15 mg tid prevacid 30 mg qd metoprolol 25 mg [**Hospital1 **] Carafate Vit C Calcium Discharge Medications: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed. 3. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 4. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation q4-6h prn as needed for shortness of breath or wheezing. 5. Oxazepam 15 mg Capsule Sig: One (1) Capsule PO tid prn as needed for anxiety or insomnia. 6. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 7. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Oxazepam 10 mg Capsule Sig: One (1) Capsule PO BID PRN () as needed for anxiety. 9. Piperacillin-Tazobactam 2.25 g Recon Soln Sig: One (1) Recon Soln Intravenous Q6H (every 6 hours) for 4 days. 10. Levothyroxine Oral 11. Outpatient Lab Work Please check CBC on Monday, [**9-20**]. 12. Outpatient Lab Work Please check TSH in 3 weeks 13. Furosemide 20 mg Tablet Sig: [**12-28**] Tablet PO q day prn as needed for Intake > Output or increasing daily weight. Discharge Disposition: Extended Care Facility: [**Location (un) 1036**] - [**Location (un) 620**] Discharge Diagnosis: Ascending Cholangitis Cholelithiasis Pneumonia COPD HTN Hypothyroidism Stress incontinence Urinary retention Discharge Condition: Hemodynamically Stable Discharge Instructions: Please take all medications as instructed. There were several changes made to your current medications regimen. If you experience any nausea, vomiting, lightheadedness, chest pain, shortness of breath, or any other concerning symptoms please seek medical attention immediately. Followup Instructions: Please follow-up with your primary care doctor within 2 weeks of discharge. . Please re-check TSH in 3 weeks. . Please check daily weights. If I > O in 24 hrs, please give furosemide 10 mg po. . Please make a follow-up appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (Surgeon) within the next 3 weeks. Tel ([**Telephone/Fax (1) 9000**]. . She will need repeat imaging in 6 months to follow her AAA. ICD9 Codes: 486, 496, 4280, 5185, 5119, 2851, 4019, 2449
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6156 }
Medical Text: Admission Date: [**2155-4-25**] Discharge Date: [**2155-4-27**] Date of Birth: [**2079-8-1**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 443**] Chief Complaint: groin hematoma Major Surgical or Invasive Procedure: Cardiac catheterization with 2 Cypher stents to RCA and LAD History of Present Illness: 75F with HTN, ex smoker who developed substernal chest pressure and discomfort and burping. Patient went to [**Hospital3 **] hospital where an EKG noted TWI on EKG, serial Troponins of 0.05, 0.43, 0.28, and ECHO showed an EF of 40%. Patient was transferred to [**Hospital1 18**] for catheterization for symptoms of unstable angina & MI. . Patient underwent catheterization this am with the following intervention: Cypher stent to the RCA and Cypher stent to the LAD. . Post cath the patient felt nauseous, lightheaded, was found to have SBP in 70's. Patient was bleeding from the groin, pressure was held for 45 minutes. Hct @ 11:00 am was 28, baseline Hct is 34. Past Medical History: Other Past History: HTN Dyslipidemia Rheumatoid Arthritis s/p CCY s/p cataract removal Osteoporosis Social History: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. . Family History: There is no family history of premature coronary artery disease or sudden death Physical Exam: Blood pressure was 108/48 mm Hg while seated. Pulse was 79 beats/min and regular, respiratory rate was 18 breaths/min. Generally the patient was well developed, well nourished and well groomed. The patient was oriented to person, place and time. The patient's mood and affect were not inappropriate. . There was no xanthalesma, there were pale conjunctiva. There was no pallor or cyanosis of the oral mucosa. The neck was supple with JVP of 1cm. The carotid waveform was normal. There was no thyromegaly. The were no chest wall deformities, scoliosis or kyphosis. The respirations were not labored and there were no use of accessory muscles. The lungs were clear to auscultation bilaterally with normal breath sounds and no adventitial sounds or rubs. . Palpation of the heart revealed the PMI to be located in the 5th intercostal space, mid clavicular line. There were no thrills, lifts or palpable S3 or S4. The heart sounds revealed a normal S1 and the S2 was normal. There were no rubs, murmurs, clicks or gallops. . The abdominal aorta was not enlarged by palpation. There was no hepatosplenomegaly or tenderness. The abdomen was soft nontender and nondistended. The extremities had no pallor, cyanosis, clubbing or edema. There were no abdominal, femoral or carotid bruits. Inspection and/or palpation of skin and subcutaneous tissue showed large R-sided groin hematoma extending proximally to the umbilical ligamet and distally to the upper thigh. There was no stasis dermatitis, ulcers, scars, or xanthomas. . Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1 PT 1 Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 1+ Pertinent Results: Imaging: CT PELVIS W/O CONTRAST [**2155-4-25**] 1:39 PM IMPRESSION: Extensive superficial soft tissue stranding consistent with blood dissecting around the fat planes and muscles in the right inguinal region extending mid way down the right thigh without discrete collection identified. No retroperitoneum hematoma. . FEMORAL VASCULAR US [**2155-4-25**] 1:37 PM IMPRESSION: 1. Infiltration of the subcutaneous soft tissues of the right groin consistent with hematoma formation. 2. No evidence of pseudoaneurysm or arteriovenous fistula. . C.CATH Study Date of [**2155-4-25**] COMMENTS: 1. Coronary angiography of this right dominant system demonstrated 2 vessel coronary artery disease. The LMCA and LCx had no angiographically apparent flow-limiting disease. The LAD had a 90% eccentric stenosis after S1. The RCA had a subtotal occlusion of the mid-vessel. 2. Limited resting hemodynamics revealed normal systemic arterial pressure with a BP of 121/65 mmHg. 3. Successful PCI/stent to mid LAD with a 2.5x13mm Cypher stent deployed to 14atms. Normal flow and no residual stenosis. 4. Successful PCI/stent to mid RCA with a 2.5x13mm Cypher stent postdilated with a 2.5mm Quantum Maverick balloon. Normal flow with no residual stenosis. 5. Delayed failure of Angioseal closure device with development of large groin haematoma which was stabilized with manual compression. FINAL DIAGNOSIS: 1. Two vessel coronary artery disease. 2. Successful PCI/stent to mid LAD with a Cypher stent. 3. Successful PCI/stent to mid RCA with a Cypher stent. 4. Delayed failure of Angioseal closure device stablized with manual compression. . ECHO Study Date of [**2155-4-26**] Conclusions: The left atrium is elongated. Left ventricular wall thicknesses and cavity size are normal. There is mild regional left ventricular systolic dysfunction with hypokinesis of the mid- and distal anterior septum (in the distribution of the LAD). The apex is probably hypokinetic, but is not fully visualized. The other segments contract normally. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Mild regional left ventricular systolic dysfunction, consistent with coronary artery disease. Mild pulmonary hypertension. . Micro: None . Labs: [**2155-4-25**] 11:06AM BLOOD Hct-28.2* [**2155-4-25**] 12:54PM BLOOD Hct-34.5* [**2155-4-26**] 04:21AM BLOOD WBC-8.7 RBC-3.74* Hgb-11.3* Hct-33.6* MCV-90 MCH-30.2 MCHC-33.6 RDW-17.4* Plt Ct-171 [**2155-4-27**] 04:04AM BLOOD WBC-9.5 RBC-3.46* Hgb-10.6* Hct-31.3* MCV-90 MCH-30.6 MCHC-33.9 RDW-17.4* Plt Ct-177 [**2155-4-25**] 12:51PM BLOOD Glucose-135* UreaN-15 Creat-0.8 Na-139 K-3.6 Cl-108 HCO3-24 AnGap-11 [**2155-4-25**] 09:16PM BLOOD CK(CPK)-950* [**2155-4-26**] 04:21AM BLOOD CK(CPK)-884* [**2155-4-25**] 09:16PM BLOOD CK-MB-18* MB Indx-1.9 cTropnT-0.10* [**2155-4-26**] 04:21AM BLOOD CK-MB-15* MB Indx-1.7 cTropnT-0.09* [**2155-4-25**] 12:51PM BLOOD Calcium-7.1* Phos-2.7 Mg-1.6 [**2155-4-26**] 04:21AM BLOOD Albumin-3.3* Calcium-7.0* Phos-2.8 Mg-2.4 [**2155-4-27**] 04:04AM BLOOD Calcium-8.3* Phos-2.1* Mg-2.2 [**2155-4-26**] 04:21AM BLOOD Cortsol-19.8 Brief Hospital Course: 75F with NSTEMI at OSH, admitted to CCU with R groin hematoma with hypotension s/p catheterization. . #. Right Groin Hematoma - Patient with groin hematoma not susceptible to compression. Patient also hypotensive, thus was started on Dopamine gtt and given a total of 3U of pRBC for intravascular support. Patient remained on the dopamine for <24 hours as her BP stabilized. With imaging, (official results above) patient did not have an RP bleed, or pseudoaneurysm/fistulazation femoral vessels. Vascular Surgery assessed the patient and with the imaging, was not deemed to be a surgical candidate. Clinically the patient stabilized quickly and her Hct remained stable upon discharge. . #. CAD - Patient was continue plavix/ASA, and a statin was started. cardiac enzymes were cycled and objectively the patient did not have myocardial ischemia. #. Pump - Patient was restarted on Atenolol 50' prior to discharge without event. #. Rhythm - Patient monitored on telemetry without event. . #. Rheumatoid Arthritis - Patient restarted on Prednisone 2.5' prior to discharge. . . After discussion with the patient and the medical staff, all were in agreement that [**Known firstname **] [**Known lastname **] was a suitable candidate for discharge. Medications on Admission: Plavix 75 qd ASA 325 mg qd HCTZ 25 [**Hospital1 **] Inderal 80 mg [**Hospital1 **] PPI 40 qd Hydroxychloroquine 200 qd Lisinopril 20 qd Norvasc 10 qd Prednisone 2.5 mg qd Folate Discharge Medications: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. Hydroxychloroquine 200 mg Tablet Sig: One (1) Tablet PO once a day. 5. Prednisone 2.5 mg Tablet Sig: One (1) Tablet PO once a day. 6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day. 8. FOSAMAX 70 mg Tablet Sig: One (1) Tablet PO once a week. 9. Methotrexate Sodium 5 mg Tablet Sig: One (1) Tablet PO once a week. 10. Calcium 500 mg Tablet Sig: One (1) Tablet PO twice a day. 11. Glucosamine 500 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Home Discharge Diagnosis: Non-ST elevation MI c/b groin hematoma Discharge Condition: Stable to be discharged home. Discharge Instructions: Please take all medications as indicated below. Your hydrochlorothiazide(HCTZ), and Lisinopril are being held. Please do not take these medications until instructed by your cardiologist. We have started a new medication called Atenolol 50mg to replace your Inderal. This is to be taken once daily. We have also started a new medication called Lipitor (Atorvastatin) at a dose of 80mg, which is also to be taken once daily. Continue to take all of your other medications as you were previously doing. You had two stents placed in your heart. You must take Aspirin everyday for the rest of your life and Clopidegrel (Plavix) everyday for at least the next 9 months. If you are not able to take this medication for any reason, you must contact your cardiologist immediately. If you develop chest pain, shortness of breath, lightheadedness, fainting or passing out, fever, pain in your groin, or any other concerning symptoms, please call your doctor or report to the nearest ER. Followup Instructions: Please call Dr. [**Last Name (STitle) 5686**] (your cardiologist) at [**Telephone/Fax (1) 11554**] on Tuesday to schedule follow up in the next week so that your blood pressure can be checked and your Lisinopril can be restarted. Please follow up with your primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 23873**] 1-2 weeks after discharge. Call [**Telephone/Fax (1) 23874**] to schedule that appointment. Completed by:[**2155-4-30**] ICD9 Codes: 4019
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Medical Text: Admission Date: [**2139-5-26**] Discharge Date: [**2139-6-4**] Date of Birth: [**2090-7-7**] Sex: M Service: HISTORY OF PRESENT ILLNESS: The patient is a 48 year-old man with a history of CREST syndrome times 25 years and a more recent history of dyspnea on exertion worsening over the past several months. The patient was admitted to the hospital in late [**2139-2-21**] and diagnosed with severe pulmonary hypertension by echocardiogram and right heart catheterization, which showed a pulmonary artery pressure of 86 and a pulmonary capillary wedge pressure of 19. The patient was discharged on [**3-31**] on Bosentan 62.5 mg twice a day as well as Lasix. He took the Bosentan for a month without relief, then stopped for ten days due to loss of insurance and then restarted at 125 mg twice a day. The patient notes that he did not fill his Lasix prescription following the [**Month (only) 958**] discharge and did not check his daily weights. Over several days after restarting the Bosentan the patient noted increasing dyspnea on exertion, shortness of breath, bilateral peripheral lower extremity edema, paroxysmal nocturnal dyspnea, and increasing orthopnea. He was referred to the Emergency Department where he was admitted for the initiation of continuous infusion Flolan treatment, which had previously been planned for a week after the time of his deterioration. REVIEW OF SYSTEMS: At the time of admission revealed severe right digital pain in the right upper extremity secondary to Raynaud's. The patient denies fevers or chills, nausea and vomiting, chest pain, abdominal pain, change in bowel habits, melena or bright red blood per rectum. PAST MEDICAL HISTORY: 1. CREST syndrome diagnosed 25 years ago. The patient has a history of digital ulcers secondary to Raynaud's phenomenon and is status post right laparoscopic sympathectomy in [**2138-9-21**] without symptomatic relief. 2. Gastroesophageal reflux disease with esophageal stricture. 3. Pulmonary hypertension first noted on echocardiogram in [**2135**] and recently diagnosed as described in the history of present illness. The patient is on 4 liters of home O2. 4. Mild restrictive lung disease with a decreased DLCO. 5. History of upper gastrointestinal bleed. 6. Status post left hernia repair. ALLERGIES: The patient notes nausea and vomiting with morphine and codeine and itching with Percocet. PHYSICAL EXAMINATION ON ADMISSION TO THE FLOOR: Vital signs temperature 98.9. Pulse 73. Blood pressure 108/48. Respirations 15. O2 sat 92% on room air. The patient was alert and oriented times three and complaining of digital pain. He was in no acute distress. The pupils are equal, round and reactive to light. Extraocular movements intact. His mucous membranes are moist with telangiectasias. There was no cervical lymphadenopathy. The patient did have jugulovenous distention to about 16 cm. Lung examination revealed diffuse mild crackles throughout bilaterally with resonant percussion. Heart examination showed a regular rate and rhythm with a normal S1 and a split S2 with a loud P2. There was also a 2 out of 6 systolic ejection murmur heard best at the left upper sternal border. Extremity examination revealed no clubbing or cyanosis. The patient did have 1+ edema in the lower extremities bilaterally to the mid calf level. The calves were discolored with multiple brownish red indurated nodular lesions, which were nontender. The upper extremities had significant digital ulceration on digits one through four of the right hand. Neurological examination was notable for intact cranial nerves and intact strength and sensation in the upper and lower extremities bilaterally. LABORATORY DATA ON ADMISSION: White blood cell count 6.7, hematocrit 34.9, platelet count 211. Electrolytes sodium 139, potassium 4.0, chloride 103, bicarbonate 25, BUN 18 and creatinine 1.2 with a glucose of 94. Admission electrocardiogram showed normal sinus rhythm, T wave inversion in 1, 2, and 3 with poor R wave progression and T wave inversion in V1 through V5. There were also new T wave inversions in 2, 3 and AVF. HOSPITAL COURSE: The patient was admitted to the MICU on [**5-26**]. He was ruled out for myocardial infarction and diuresed with Lasix. A Swan-Ganz catheter was placed and the Flolan was started on [**5-27**]. A Hickman catheter was placed by general surgery on [**5-29**] and the patient was called out of the MICU to the medical floor. The Flolan was titrated to 9 nanograms per kilogram per minute with moderate flushing, headache and nausea. These side effects were treated with Compazine and Vicodin. A Flolan dose of 10 nanograms per kilogram per minute was attempted on [**6-1**], but was decreased back to 9 nanograms per kilogram per minute due to hypotension to 90/45. The patient did note improvement in his dyspnea on exertion in the days following the Flolan initiation. An outside agency provided Flolan teaching for the patient's sister who will prepare the Flolan at home. A Flolan nurse will visit the home daily in the week following discharge. Also during this admission pain service was consulted regarding the patient's digital ulcer pain. The pain was treated with Oxycontin with Vicodin for breakthrough. Oxycontin was increased from 30 b.i.d. to 30 t.i.d. on [**6-1**], but was changed to 40 b.i.d. on [**6-4**] secondary to increased sedation. In addition, on [**6-3**] the patient complained of severe throat pain and pharyngeal edema and exudate were noted on examination. A culture was sent and Amoxicillin was started for a presumed strep throat. The patient was discharged to home in stable condition. DISCHARGE STATUS: Good. DISCHARGE DIAGNOSES: 1. CREST syndrome. 2. Pulmonary hypertension. DISCHARGE MEDICATIONS: 1. Flolan 9 nanograms per kilogram per minute intravenous infusion. 2. Oxygen 4L by NC 3. Furosemide 60 mg po q.d. 4. Coumadin 1 mg po q.h.s. 5. Oxycontin 40 mg po b.i.d. 6. Vicodin one to two tablets po q 6 hours as needed for pain. 7. Lorazepam 0.5 mg po t.i.d. 8. Prazosin 1 mg po t.i.d. 9. Diltiazem SR 480 mg po q.d. 10. Compazine 10 mg po q six hours prn nausea. 11. Pantoprazole 40 mg po b.i.d. 12. Sucralfate 1 gram po q.i.d. 13. Ferrous sulfate 325 mg po q.d. FOLLOW UP PLANS: The patient is to follow up within the next two weeks with Dr. [**Last Name (STitle) **] in Pulmonology, Dr. [**Last Name (STitle) **] his primary care physician, [**Name10 (NameIs) **] Dr. [**Last Name (STitle) **] his rheumatologist. These appointments have been scheduled for him. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 103528**] Dictated By:[**First Name3 (LF) 103529**] MEDQUIST36 D: [**2139-6-4**] 03:49 T: [**2139-6-10**] 09:27 JOB#: [**Job Number 103530**] ICD9 Codes: 4168, 4280
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Medical Text: Admission Date: [**2200-1-8**] Discharge Date: [**2200-1-24**] Date of Birth: [**2200-1-8**] Sex: F HISTORY OF PRESENT ILLNESS: [**Location (un) 16284**] is a 33 5/7 weeks gestation triplet #2 delivered pre-term due to progressive pregnancy-induced hypertension. The mother is a 34 year old gravida 2, para 3. Prenatal screens: blood type 0 positive, B surface antigen negative and Group Beta Streptococcus status unknown. In [**Last Name (un) 5153**] fertilization conception with triamniotic trichorionic triplets, estimated date of confinement [**2200-2-21**]. This pregnancy was complicated by pre-term labor at 24 weeks gestation treated with a complete course of Betamethasone at that time and magnesium sulfate for one month. The mother developed pregnancy-induced hypertension, headache and delivered by cesarean section under general anesthesia (due to inadequate epidural analgeisa) on [**2200-1-8**] at 33 5/7 weeks gestation. This triplet emerged with spontaneous cry and required only blow-by oxygen for resuscitation. Apgar scores were 8 at one minute and 8 at five minutes. The infant was transferred to the Newborn Intensive Care Unit secondary to prematurity. PHYSICAL EXAMINATION: Vital signs revealed temperature 98.1 rectally, heartrate 140, respiratory rate 64, blood pressure 57/25 with a mean arterial pressure of 38, oxygen saturation of 97%. Birthweight was 1525 gm, (15th percentile), length was 43 cm, (30th percentile) and head circumference 29 cm (15th percentile). Overall appearance is consistent with known gestational age, nondysmorphic. Anterior fontanelle is soft, open and flat. Red reflex present bilaterally. Palates intact. Breathsounds clear and equal. Heart is regular rate and rhythm without murmur. Abdomen is benign without hepatosplenomegaly. No masses. Three vessel umbilical cord. Normal female genitalia for gestational age, back and extremities normal. Skin pink and well perfused. Alert and comfortable with appropriate tone and strength for gestational age. HOSPITAL COURSE: Respiratory - [**Location (un) 16284**] has been room air since her delivery. She has had no issues with apnea of prematurity and no Methylxanthines were required. Cardiovascular - [**Location (un) 37871**] blood pressure has been stable since her admission to the Newborn Intensive Care Unit. No fluid boluses or support with vasopressors were required. Fluid, electrolytes and nutrition - Enteral feedings were started on day of life 1 of premature Enfamil 20 calorie with iron. The volume was advanced to 150 cc/kg/day by day of life #6 without incident and caloric density was advanced to a maximum of 26 cal/oz. Her blood glucoses remained stable throughout her hospitalization. Discharge weight is 1685 grams . Discharge length 43 cm. Discharge head circumference 30 cm cm. Gastrointestinal - Peak bilirubin on day of life #3 was 8.6 with a direct of 0.3. She was started on single phototherapy at that time. Phototherapy was discontinued on day of life #7 and rebound bilirubin on day of life 9 was 5.7. Hematology - [**Location (un) 16284**] did not require any transfusions with blood products throughout her hospitalization. Infectious disease - Complete blood count with differential and blood culture was not drawn upon admission to the Newborn Intensive Care Unit as there were no sepsis risk factors and delivery was strictly for maternal reasons. The infant has been well and has not shown any signs of infection. Neurology - Head ultrasound was not indicated for this 33 [**4-15**] weeker. Sensory - Hearing screen was performed with automated auditory brain stem responses on [**1-13**] and she passed in both ears. Ophthalmologic screening was not performed given her gestational age. Psychosocial - [**Hospital6 256**] social work has been involved with the family. The contact social worker can be reached at [**Telephone/Fax (1) **]. CONDITION AT DISCHARGE: [**Location (un) 16284**] is stable, tolerating full ad lib feedings. Temperature stable, in open crib and no apnea of prematurity. DISCHARGE DISPOSITION: To home with parents. PRIMARY CARE PEDIATRICIAN: Dr. [**Last Name (STitle) **] of [**Hospital 620**] Pediatrics, phone [**Telephone/Fax (1) 37814**]. CARE RECOMMENDATIONS: Feeds at discharge - The infant is being discharged on ad lib demand feedings of 26 calorie Enfamil enriched to 26 calories by concentration and 2 calories of corn oil per oz. Medications - Ferinsol 0.15 ml PO once daily. State newborn screening status - The last newborn screen was sent on [**1-22**] and no abnormal results have been reported. Immunizations - [**Location (un) 16284**] has not received any immunizations at this time. Synagis respiratory syncytial virus prophylaxis should be considered from [**Month (only) 359**] through [**Month (only) 547**] for infants who meet any of the following three criteria: 1. Born at less than 32 weeks; 2. Born between 32 and 35 weeks with plans for daycare during respiratory syncytial virus season, with a smoker in the household or with preschool siblings; or 3. With chronic lung disease. Influenza immunization should be considered annually in the fall for preterm infants with chronic lung disease once they reach six months of age. Before this age the family and other caregivers should be considered for immunization against influenza to protect the infant. Follow up - A follow up appointment with Dr. [**Last Name (STitle) **] has been scheduled for [**1-24**]. DISCHARGE DIAGNOSIS: 1. Prematurity at 33 5/7 weeks 2. Hyperbilirubinemia [**Doctor Last Name **] [**Last Name (NamePattern5) 36094**], M.D. [**MD Number(1) 36095**] Dictated By:[**Name8 (MD) 37391**] MEDQUIST36 D: [**2200-1-23**] 16:33 T: [**2200-1-23**] 16:43 JOB#: [**Job Number 37872**] ICD9 Codes: 7742
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Medical Text: Admission Date: [**2178-7-8**] Discharge Date: [**2178-7-11**] Service: NMED Allergies: Penicillins Attending:[**First Name3 (LF) 5018**] Chief Complaint: Left-sided weakness Major Surgical or Invasive Procedure: Intubation and mechanical ventilation History of Present Illness: Patient is an 82 year-old Russian-speaking woman with a history of coronary artery disease and hypertension who presents with sudden onset left-sided weakness. Pt went to bed at 11pm the night prior to admission and was normal at that time. This morning at 6am, husband woke up and found patient had been incontinent of stool. He reports she was "not making any sense" when speaking, unclear if the difficulty was due to slurring of words vs inappropriate word usage. She was able to sit up, but then fell out of bed, with inability to use her left side. EMS was called, and the patient was brought to the [**Hospital1 18**] ED. On arrival in the ED, SBP was ~190, and she was seen to have spontaneous movement on the right but not the left. She had no gag reflex and son[**Name (NI) 7884**] respirations, and she was paralyzed and intubated for airway protection. Head CT was consistent with early R MCA ischemic stroke, and pt was admitted to the neurology ICU service. ROS: Per patient's family, she does have occasional dyspnea on exertion, unable to characterize further. Past Medical History: 1. Coronary artery disease, s/p myocardial infarction ~5 yrs ago. Has not ever had cardaic cath. 2. Hypertension 3. High cholesterol Social History: Lives with husband. [**Name (NI) **] one son and daughter-in-law, both of whom speak English. Per family, patient was fully independent. No history of tobacco or EtOH use. Family History: Unclear, though son doesn't think there is history of stroke Physical Exam: T 96.0 BP 169-175/39-45 HR 70-81 Vent: SIMV/PS 450x16, PEEP 5, FiO2 0.4 General: Appears stated age, intubated, seems calm HEENT: NC/AT Sclera anicteric. Lungs: Clear to auscultation anterolaterally on right, decreased and coarse breath sounds on left CV: RRR, nl S1, S2, no murmur. 2+ carotids without bruit Abd: Soft, nontender, normoactive bowel sounds Extr: No edema Neurologic Examination: Mental Status: Intubated, awake, follows some commands in Russian (see below) Cranial Nerves: Does not open eyes to command. Does not blink to confrontation. Pupils small (~1mm), but equal, round and briskly reactive to light, bilaterally. Unable to do fundoscopic exam due to small size of pupils. Does not move eyes to command. Difficult to assess facial symmetry given ETT. Does not open mouth or protrude tongue to command. Motor: Normal bulk bilaterally. Tone decreased in left upper extremity, increased in left lower extremity, normal on right. No fasiculations, no tremor. Moves right arm and leg spontaneously and to command; can show thumb, squeeze hand and let go, move foot. Strength roughly intact on right. Does not move left side spontaneously nor to command. Sensation was intact to light touch on right. Does grimace, move right side and slightly withdraw on left to painful stimuli on left. Toes were downgoing on right, upgoing on left Pertinent Results: Labs on admission: WBC-11.5* HGB-12.8 HCT-39.6 MCV-96 PLT COUNT-222 PT-12.6 PTT-26.1 INR(PT)-1.1 GLUCOSE-143* UREA N-30* CREAT-1.1 SODIUM-143 POTASSIUM-5.3* CHLORIDE-105 TOTAL CO2-26 CALCIUM-9.1 PHOSPHATE-3.3 MAGNESIUM-2.1 CHOLEST-154 TRIGLYCER-106 HDL CHOL-47 CHOL/HDL-3.3 LDL(CALC)-86 Cardiac enzymes were normal. UA was normal. NON-CONTRAST HEAD CT [**7-8**]: No acute intra or extra-axial hemorrhage or hydrocephalus. There is a dense MCA sign on the right, particularly in the region of the bifurcation. Furthermore, there is narrowing of the right cerebral hemispheric sulci and there is loss of [**Doctor Last Name 352**]-white matter differentiation in the insular and frontal and temporal cortex on the right. The findings are consistent with an early right MCA distribution infarction. Remaining brain shows evidence of volume loss and chronic microvascular infarction. MRI/MRA [**7-9**]: Large right MCA infarction with no definite involvement of the basal ganglia. Susceptibility artifact is present in infarct, indicating interval hemorrhage into the area. There is edema which flattens the right lateral ventricle. There is minimal shift of midline structures to the left. Additionally, there are patchy areas of increased FLAIR and T2 signal in the left cerebral hemisphere. This may reflect chronic microvascular infarction. MRA of the circle of [**Location (un) 431**] is limited, but there is diminished or no flow in the right Sylvian middle cerebral branches and there also appears to be diminished left anterior cerebral arterial flow. The vertebral arteries are only partially in view. Brief Hospital Course: Assessment: 82F with histroy of HTN, hypercholesterolemia, presents with acute onset left hemiparesis, with possible aphasia versus dysarthria. Based on her initial physical exam, cranial nerves seemed relatively intact, though cannot gauge extraocular movements, making a brainstem localization less likely. Therefore, lesion is likely cerbral peduncles or higher. Inability to open eyes to command, when she can move right arm and leg to command, raises possibility of oculomotor apraxia, which would suggest involvement of right parietal lobe. Unfortunately, because patient was intubated on arrival in ED, language function, as well as attention could not be fully assessed, and ability to follow commands has to be taken in the context of sedatives as well. It was unclear if she has any neglect. Given her stool incontinence, initial differential diagnosis was stroke, likely in the right MCA distribution, vs [**Doctor Last Name 555**] paralysis secondary to seizure, though patient has no known seizure disorder. Given findings on CT however, R MCA ischemic infarct is the most likely diagnosis. Hospital Course: Pt was admitted to the neuro service with acute right MCA infarct. She was not a candidate for TPA because she was outside the 3-hour window. She was initally managed with continued ASA, and maintenance of her systolic blood pressure between 140 and 200. MRI imaging the next day revealed the very large size of the infarct, with involvement of nearly all of the cortical territory of the MCA. As she had been taking ASA at home, aggrenox was added. Initially, patient did well and was able to be extubated on [**7-9**]. She continued to follow commands. On [**7-9**] she also developed fever with chest x-ray with possible infiltrate and she was started on levofloxacin. Unfortunately, the very large size of the infarct resulted in significant and severe cerebral edema, and by [**7-10**] her mental status worsened. She developed a right, fixed, midposition pupil secondary to the edema affecting her brainstem. Given the severity of the infarct, it was unlikely that she would have a meaningful neurological recovery. A family meeting was held on [**7-10**], and it was decided to make the patient comfort measures only. Patient died at 6:45am on [**7-11**]. Family declined post-mortem examination. Medications on Admission: Lipitor 10, atenolol 50, ASA, clonazepam 0.5 Discharge Medications: None Discharge Disposition: Extended Care Facility: Funeral home Discharge Diagnosis: Large right middle cerebral artery infarction, complicated by cerebral edema and herniation Likely aspiration pneumonia Airway compromise, requiring intubation, resolved Discharge Condition: Deceased [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**] ICD9 Codes: 5070, 4019, 2720, 412
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Medical Text: Admission Date: [**2108-10-26**] Discharge Date: [**2108-10-29**] Date of Birth: [**2031-9-28**] Sex: M Service: HISTORY OF PRESENT ILLNESS: The patient is a 77-year-old gentleman with an extensive history of coronary artery disease (status post multiple myocardial infarctions) who was transferred from an outside hospital for cardiac catheterization. The following history is per the patient's daughter; as the patient only speaks Portuguese. She reports that the patient had increasing shortness of breath with exertion over the week prior to admission. At 1 o'clock a.m. on the morning of admission, the patient awoke from sleep with acute shortness of breath. He decided to present to an outside hospital. At approximately 7 o'clock a.m., while driving to the hospital, the patient developed chest pain. At the outside hospital, the patient was pain free after receiving oxygen. He was found to have a troponin of 76.3, a creatine kinase of 501, and a CK/MB of 20.8. The patient was given a heparin bolus, and the decision was made to transfer the patient to [**Hospital1 69**] for cardiac catheterization. At that time, the heparin was discontinued and the patient was started on Integrilin. Other laboratories from the outside hospital included a potassium of 3.9, creatinine of 1.4, and a hematocrit of 39. His arterial blood gas at the outside hospital was 7.46/38/69 on 3 liters nasal cannula. Electrocardiogram revealed sinus tachycardia at approximately 110 beats per minute. Axis was approximately was 30 degrees. The patient had poor R wave progression. There were a few changes from previous studies. PAST MEDICAL HISTORY: 1. Hypertension. 2. Type 2 diabetes mellitus. 3. Hypercholesterolemia. 4. Status post myocardial infarction times two; (a) In [**2102-5-16**], the patient had a posterior/inferior myocardial infarction with a cardiac catheterization showing 70% left anterior descending artery, 98% left circumflex, and diffuse right coronary artery disease. The patient had stenting of the left circumflex and the right coronary artery. (b) In [**2103-4-15**], the patient had an inferoseptal myocardial infarction with cardiac catheterization showing 70% stenosis in the middle of the left anterior descending artery, 40% stenosis in the second diagonal, and 70% in-stent restenosis in the left circumflex which was intervened on. (c) A redo catheterization in [**2103-5-16**] showed diffuse proximal and mid disease in the left anterior descending artery which was stented. (d) the patient subsequently underwent redo catheterization in [**2104-2-15**] when he was found to have left anterior descending artery 50% narrowing prior to the stent, the left circumflex stent was widely patent, and the right coronary artery stent was widely patent. 5. Peripheral vascular disease. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: 1. Lopressor 50 mg by mouth twice per day. 2. Pepcid 40 mg by mouth once per day. 3. Neurontin 100 mg by mouth three times per day. 4. Lasix 40 mg by mouth once per day. 5. Lipitor 10 mg by mouth once per day. 6. Moexipril 15 mg by mouth once per day 7. Xanax 0.5 mg by mouth twice per day. 8. Glyburide 5 mg by mouth twice per day. SOCIAL HISTORY: The patient is a pleasant Portuguese-speaking gentleman who is married and lives with his wife. [**Name (NI) **] is a retired box maker. The patient has an extensive tobacco history of one pack per day for approximately 60 years. He quit smoking in [**2102**]. No history of alcohol or drug abuse. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination on admission revealed his temperature was 99 degrees Fahrenheit, his blood pressure was 103/59, his heart rate was 78, his respiratory rate was 22, and his oxygen saturation was 96% on 4 liters nasal cannula. In general, the patient was a mildly obese male in no acute distress with labored breathing. Head, eyes, ears, nose, and throat examination revealed pupils were equal, round, and reactive to light. Extraocular movements were intact. The mucous membranes were moist. Neck examination revealed increased jugular venous pulsation at approximately 12 mm to 14 cm at 30 degrees. Positive right carotid bruit. Cardiovascular examination revealed normal first heart sounds and second heart sounds. A regular rate. There was a [**3-22**] crescendo-decrescendo murmur with radiation to the axilla. The lungs were clear to auscultation anteriorly. There were bibasilar crackles. No wheezes. The abdomen was soft, nontender, and nondistended. Positive bowel sounds. No hepatosplenomegaly. Extremity examination revealed 1 to 2+ pitting edema to the patellas bilaterally. Dorsalis pedis pulses were 2+ bilaterally. PERTINENT LABORATORY VALUES ON PRESENTATION: Laboratories on admission revealed his white blood cell count was 10.9, his hematocrit was 35.6, and his platelets were 197. His prothrombin time was 13.4, his partial thromboplastin time was 39.3, and his INR was 1.2. His sodium was 137, potassium was 4.3, chloride was 101, bicarbonate was 27, blood urea nitrogen was 22, creatinine was 1.4, and his blood glucose was 285. His calcium was 9, his magnesium was 1.5, and his phosphorous was 3.4. Creatine kinase was 370. CK/MB was 14. Troponin was 3.72. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: 1. CARDIOVASCULAR ISSUES: Cardiac catheterization revealed two patent left anterior descending artery overlapping stents. The left circumflex was patent with very distal upper branch disease and a large first obtuse marginal. The right coronary artery and the AV groove was patent including proximal stents. There was an eccentric 40% mid right coronary artery lesions. The left anterior descending artery was stented with a 3.25 X 18 cypher, and the right coronary artery was stented with a 3 X 13-mm Hepacoat stent. The patient received 20 mg of intravenous Lasix in the Catheterization Laboratory with approximately 700 cc of urine output. Following the catheterization, the patient completed an 18-hour course of Integrilin. Throughout the admission, he was also continued on an aspirin, Plavix, an ACE inhibitor, a beta blocker, and a statin. (a) Rhythm: The patient was in a sinus rhythm throughout the admission. He was monitored continuously on telemetry. (b) Myocardium: The patient had a congestive heart failure exacerbation on admission to the hospital with increasing shortness of breath, lower extremity edema, and exercise intolerance over the week prior to admission. He had a good diuresis in the Catheterization Laboratory following 40 cc of intravenous Lasix. The patient continued to have a good diuresis over the first one day of admission. His shortness of breath resolved, and he felt much better. The patient had previously had a poor left ventricular ejection fraction of 20% to 30% on previous echocardiograms. Therefore, a repeat echocardiogram was performed on [**2108-10-29**]. This revealed a mildly dilated left atrium. The right atrium was normal in size. The left ventricular cavity was severely dilated. There were multiple left ventricular wall motion abnormalities including; mid anterior/akinetic, mid anterior septal/akinetic, mid inferoseptal/akinetic, mid inferior/akinetic, mid inferolateral/akinetic, anterior apex/akinetic, septal apex/akinetic, inferior apex/akinetic, lateral apex/akinetic, and apex/dyskinetic. The right ventricular chamber size and free wall motion were normal. The aortic root was mildly dilated as was the ascending aorta. There was no aortic valve stenosis. There was trace aortic regurgitation. Mild-to-moderate 1 to 2+ mitral regurgitation was seen. There was borderline pulmonary artery systolic hypertension. The estimated left ventricular ejection fraction was less than 20%. Given the patient's history of multiple myocardial infarctions and very decreased left ventricular ejection fraction, pacemaker placement was discussed. It was determined that this would not be done as an inpatient, but the patient was to follow up with Electrophysiology. 2. TYPE 2 DIABETES MELLITUS ISSUES: The patient was continued on an insulin sliding-scale throughout his admission with good blood sugar control. 3. RENAL ISSUES: The patient's creatinine was slightly elevated at 1.4 prior to catheterization. Following catheterization, he received intravenous hydration and Mucomyst times two. Subsequently, his creatinine decreased and was 1.3 at the time of discharge. 4. HYPERCHOLESTEROLEMIA ISSUES: The patient was continued on a statin throughout his admission. 5. HYPERTENSION ISSUES: The patient was continued on his ACE inhibitor and beta blocker. He had good blood pressure control throughout the admission. 6. PULMONARY ISSUES: Following diuresis on admission, the patient's shortness of breath greatly improved. On the day of discharge, he was saturating in the mid 90% range on room air. In addition, he was able to walk around the unit without becoming short of breath. CONDITION AT DISCHARGE: Condition on discharge was stable. DISCHARGE STATUS: The patient was discharged to home. DISCHARGE DIAGNOSES: 1. Type 2 diabetes mellitus. 2. Hypercholesterolemia. 3. Hypertension. 4. Peptic ulcer disease. MEDICATIONS ON DISCHARGE: 1. Aspirin 325 mg by mouth once per day. 2. Plavix 75 mg by mouth once per day. 3. Famotidine 40 mg by mouth once per day. 4. Gabapentin 100 mg by mouth three times per day. 5. Atorvastatin 10 mg by mouth once per day. 6. Alprazolam 0.5 mg by mouth twice per day. 7. Moexipril 15 mg by mouth once per day 8. Toprol-XL 50 mg by mouth once per day. 9. Glyburide 5 mg by mouth twice per day. 10. Lasix 40 mg by mouth once per day. 11. Nitroglycerin 0.3 mg sublingually one tablet as needed (for chest pain). DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The patient was instructed to follow up with primary care physician (Dr. [**Last Name (STitle) **] who also manages the patient's cardiac issues in approximately one week. 2. The patient was instructed to follow up Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on [**2108-10-28**] at 1 o'clock p.m. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4582**], M.D. [**MD Number(1) 4992**] Dictated By:[**Name8 (MD) 18812**] MEDQUIST36 D: [**2108-10-31**] 14:58 T: [**2108-11-3**] 06:56 JOB#: [**Job Number 18813**] ICD9 Codes: 4280, 4019, 2720
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Medical Text: Unit No: [**Numeric Identifier 58391**] Admission Date: [**2176-6-28**] Discharge Date: [**2176-7-5**] Date of Birth: [**2176-6-28**] Sex: M Service: NB HISTORY: Baby [**Name (NI) **] [**Known lastname **] twin II is a 2.5 kilogram product of a 34 [**3-13**] week gestation born to a 42 year old gravida V, para I mom. This pregnancy was a dichorionic diamniotic twins gestation. Prenatal screens: A positive, antibody negative, RPR nonreactive, rubella immune, hepatitis B negative and GBS unknown. This pregnancy was complicated by unstoppable preterm labor. This infant was born by cesarean section for failure to progress, emerged with Apgar scores of 8 and 8, was given positive pressure ventilation in the delivery room. EXAMINATION ON ADMISSION: Weight was 2.5 kilograms, 75th percentile, head circumference 33 cm, 75th percentile, length 49 cm, 98th percentile. Normocephalic, atraumatic, anterior fontanelle open and flat. Palate intact. Red reflex present bilaterally. Neck supple Chest symmetric, intercostal retractions with intermittent grunting. Lungs clear bilaterally. Cardiovascular: Regular rate and rhythm, no murmur, femoral pulses 2+ bilaterally. Abdomen soft with active bowel sounds, no masses or distention. GU demonstrates normal male testes bilaterally palpable. Spine midline, no sacral dimple. Anus patent. Hips stable. Clavicles intact. Neurologic appropriate for gestational age. HOSPITAL COURSE BY SYSTEMS: Respiratory: Initially required nasal CPAP for mild respiratory distress syndrome. Was transitioned to room air on day of life one and has been stable on room air since then. Has had no episodes of apnea, bradycardia of prematurity. Cardiovascular: Baby was cardiovascularly stable throughout hospital course. Fluids and electrolytes: Birth weight was 2.5 kilograms. He was initially started on 80 cc per kilogram per day of D10W. His discharge weight was 2.340 kilograms. He is ad lib feeding special care formula. Gastrointestinal: Peak bilirubin was on [**7-3**] of 15.6/0.3. Photo therapy was initiated. Photo therapy was discontinued on [**7-5**] at 6 A.M. and his bilirubin level was 8.7 at that time and it is currently 8.3/0.2 ten hours after photo therapy was discontinued. Hematology: Hematocrit on admission was 55.5. Has not required any blood transfusions during this hospital course. Infectious disease: CBC and blood culture were obtained on admission. CBC was benign. Antibiotics were discontinued at 48 hours with negative blood culture. Neurologic: Appropriate for gestational age. Audiology: Hearing screen was performed and infant passed both ears. CONDITION ON DISCHARGE: Stable. DISCHARGE DISPOSITION: Home to parents. Name of primary pediatrician is Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], telephone number is [**Telephone/Fax (1) 58389**]. FU bilirubin to be performed tomorrow at [**Hospital1 18**]. FEEDS AT DISCHARGE: Continue ad lib feeding of mother's milk or [**Doctor Last Name **] 20. MEDICATIONS: Ferinsol, Vidaylin Car seat position screening was performed and the infant passed. State Newborn screens have been sent per protocol and have been within normal limits. Infant has not received hepatitis B vaccine. DISCHARGE DIAGNOSES: Preterm twin number II born at 34 4/7 weeks gestation. Mild respiratory distress syndrome. Hyperbilirubinemia. Status post rule out sepsis with antibiotics. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 55750**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2176-7-5**] 16:59:45 T: [**2176-7-5**] 17:32:35 Job#: [**Job Number **] ICD9 Codes: 7742, V290, V053
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Medical Text: Admission Date: [**2127-1-9**] Discharge Date: [**2127-1-29**] Date of Birth: [**2082-8-14**] Sex: M Service: MEDICINE Allergies: Nafcillin / Ciprofloxacin Attending:[**First Name3 (LF) 5755**] Chief Complaint: Cough Major Surgical or Invasive Procedure: Central line placement History of Present Illness: 44 yo male with hx of asthma, EtOH and tobacco who presented with SOB and fever to OSH found to have RML PNA requiring intubation now complicated by pancreatitis, drug rash and acure renal failure. Pt was admitted [**12-29**] for cough, anorexia, fever and hemoptysis. CXR on admission showed RML PNA and was started empirically on azithromycin and ceftriaxone. He was also noted to be in ARF and was hydrated with improvement to creatinine 1.1. He became more hypoxic and tachycardic on [**12-30**] and was intubated. He was started on solumedrol due to severe wheeze. Over the past 5-6 days his creatinine has continued to climb and then stabilized at 4.2. During this period his hematocrit has also dropped to 25.2 from 39.7. He was started on tube feeds but these were discontinued after an episode of high residuals and emesis on [**1-3**]. Amylase and lipase were found to be elevated at 212 and 310 with RUQ U/S revealing gallbladder wall thickening with sludge and and hypoechoic areas of the pancreas concerning for pancreatitis. On [**1-8**] sputum cx revealed MSSA with influenza negative so antibiotics were changed to nafcillin which resulted in diffuse rash so this was changed again to vancomycin. Due to continued clinical decline pt was transferred for further management. Of note pt did receive Zosyn per ID consulation at OSH but not noted on DC summary. Past Medical History: Asthma EtOH Smoking amputation of left 5th distal phalanx hemmorhoidectomy Social History: Lives with brother. Used to work dispatching oil truck but currently unemployed. Drinks 1 sick pack/day of beer with no hx of withdrawal seizures or DT's. 15 pack year smoking history. Family History: Unable to obtain Physical Exam: Vent AC at 700/18 Fio2 50% PEEP 5 satting 98% with PIPS 42 Gen-diaphoretic HEENT-PERRL, MMM, no elev JVP Hrt-tachy RR, nS1S2 no MRG Lungs-diffuse rhonchi with poor air movement throughout Abd-soft, NT, mod distended, liver 3cm below costal margin, hypoactive BS Extrem-2+ rad and dp pulsed, 2+ edema to knees bilat Neuro-sedated, hyperreflexic biceps and patellae bilat, legs flaccid Skin-diffuse maculopapular rash Pertinent Results: [**2127-1-9**] 10:12PM TYPE-ART TEMP-36.9 RATES-20/6 TIDAL VOL-500 PEEP-10 O2-50 PO2-78* PCO2-60* PH-7.30* TOTAL CO2-31* BASE XS-1 -ASSIST/CON INTUBATED-INTUBATED [**2127-1-9**] 10:06PM URINE HOURS-RANDOM UREA N-759 CREAT-50 SODIUM-35 [**2127-1-9**] 10:06PM URINE OSMOLAL-397 [**2127-1-9**] 10:06PM URINE BLOOD-LGE NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2127-1-9**] 10:06PM URINE RBC-226* WBC-3 BACTERIA-NONE YEAST-NONE EPI-0 [**2127-1-9**] 10:06PM URINE EOS-NEGATIVE [**2127-1-9**] 08:25PM TYPE-ART TEMP-36.9 RATES-14/2 TIDAL VOL-500 PEEP-10 O2-60 PO2-123* PCO2-71* PH-7.25* TOTAL CO2-33* BASE XS-1 -ASSIST/CON INTUBATED-INTUBATED [**2127-1-9**] 08:25PM O2 SAT-98 [**2127-1-9**] 06:19PM estGFR-Using this [**2127-1-9**] 06:19PM ALT(SGPT)-25 AST(SGOT)-20 LD(LDH)-342* ALK PHOS-53 AMYLASE-79 TOT BILI-0.3 [**2127-1-9**] 06:19PM LIPASE-97* [**2127-1-9**] 06:19PM CALCIUM-8.4 PHOSPHATE-5.1* MAGNESIUM-2.4 [**2127-1-9**] 06:19PM TRIGLYCER-168* [**2127-1-9**] 06:19PM VANCO-17.9 [**2127-1-9**] 06:19PM WBC-12.6* RBC-2.78* HGB-8.4* HCT-25.4* MCV-92 MCH-30.4 MCHC-33.2 RDW-14.4 [**2127-1-9**] 06:19PM PLT COUNT-479* [**2127-1-9**] 06:19PM PT-13.5* PTT-36.4* INR(PT)-1.2* . C DIFF NEGATIVE X 3 . SPUTUM GRAM STAIN (Final [**2127-1-23**]): >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND CLUSTERS. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). RESPIRATORY CULTURE (Final [**2127-1-25**]): HEAVY GROWTH OROPHARYNGEAL FLORA. . BLOOD CX: NO GROWTH . PLEURAL FLUID CULTURE: GRAM STAIN (Final [**2127-1-11**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2127-1-14**]): NO GROWTH. ANAEROBIC CULTURE (Final [**2127-1-17**]): NO GROWTH. FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. ACID FAST SMEAR (Final [**2127-1-13**]): NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. ACID FAST CULTURE (Pending): . BAL: GRAM STAIN (Final [**2127-1-9**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. RESPIRATORY CULTURE (Final [**2127-1-12**]): OROPHARYNGEAL FLORA ABSENT. ENTEROBACTER CLOACAE. 10,000-100,000 ORGANISMS/ML.. This organism may develop resistance to third generation cephalosporins during prolonged therapy. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. For serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROBACTER CLOACAE | CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S IMIPENEM-------------- <=1 S LEVOFLOXACIN---------- 1 S MEROPENEM-------------<=0.25 S PIPERACILLIN---------- <=4 S TOBRAMYCIN------------ <=1 S LEGIONELLA CULTURE (Final [**2127-1-16**]): NO LEGIONELLA ISOLATED. POTASSIUM HYDROXIDE PREPARATION (Final [**2127-1-10**]): Test cancelled by laboratory. PATIENT CREDITED. This is a low yield procedure based on our in-house studies. if pulmonary Histoplasmosis, Coccidioidomycosis, Blastomycosis, Aspergillosis or Mucormycosis is strongly suspected, contact the Microbiology Laboratory (7-2306). IMMUNOFLUORESCENT TEST FOR PNEUMOCYSTIS CARINII (Final [**2127-1-10**]): PNEUMOCYSTIS CARINII NOT SEEN. FUNGAL CULTURE (Final [**2127-1-23**]): NO FUNGUS ISOLATED. ACID FAST SMEAR (Final [**2127-1-10**]): NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. VIRAL CULTURE (Preliminary): No Virus isolated so far. . INFLUENZA, [**Last Name (un) **] LEGIONELLA: NEGATIVE Admission CXR Severe cavitary pneumonia of the right middle and upper lobes. . Renal Ultrasound The right kidney measures 12.6 cm. The left kidney measures 12.2 cm. There is no evidence of hydronephrosis, nephrolithiasis, or renal mass. Cortical medullary differentiation is well preserved. The bladder is decompressed secondary to a Foley catheter. . CT CHEST W/O CONTRAST [**2127-1-21**]: FINDINGS: The conglomerate of large cavities in the right upper lobe is smaller, 12.7 x 6.6 cm today, previously 13.7 x 8.2 cm, and contains less debris/soft tissue. Adjacent loculated pneumothorax has decreased in size. Peripheral consolidation located anterior to the right major fissure measures 20 x 13 mm, was 35 x 31 mm. Cavitary lesion in the left apex measuring 18 x 13 mm was 23 x 16 mm, now fluid filled. Peribronchial inflammation throughout remaining of both lobes is new, for instance in the left lower lobe (3, 50). Impaction and/or narrowing of the right upper lobe, bronchus intermedius, right middle lobe, and right lower lobe bronchus has resolved. There are no endobronchial lesions. Small right pleural effusion has decreased in size. There is no left pleural effusion. Trace of pericardial effusion is stable. Paratracheal, subcarinal, and carinal lymph nodes have decreased in size, for instance a 14- mm carinal lymph node was 16 mm. Cardiac size is normal. Moderate atherosclerotic calcification is present in the LAD. There are no bone findings of malignancy. The upper abdomen is unremarkable. IMPRESSION: Clearing necrotizing right upper lung pneumonia, resolved right bronchial obstruction, decreasing small, loculated right pneumothorax and small to moderate right pleural effusion, . New or increased mild peribronchial infiltration in both lungs may be due aspiration of purulent material. . MRI EXAM OF THE BRAIN AND MRA OF THE CIRCLE OF [**Location (un) **] (for flaccid paralysis): IMPRESSION: Partly degraded MRI exam due to repeated motion artifact and also partly related to the patient's intubated status. No acute territorial infarcts could be demonstrated on diffusion images. Scattered T2 hyperintense foci along the cerebral white matter seen only on FLAIR images. Bilateral mastoiditis of uncertain chronicity. Followup is suggested based on clinical grounds. MRA OF THE CIRCLE OF [**Location (un) **]: IMPRESSION: Unremarkable MRA exam of the circle of [**Location (un) 431**]. . MR C SPINE (for flaccid paralysis): IMPRESSION: Moderately degraded exam due to motion artifact and the patient's intubated status. Left paracentral herniation seen at C6-C7 level encroaching over the left exiting C7 nerve root. Mild-to-moderate foraminal stenosis at C5-C6 level. Right-sided facet effusion at C3-C4 level. Questionable T2 hyperintense signal involving the cervical cord at C4-C5 level, possibly artifactual in nature. Repeat T2-weighted sagittal images would be helpful for further evaluation of cord signal. . RIGHT UPPER EXTREMITY ULTRASOUND (for right UE swelling): IMPRESSION: 1. No son[**Name (NI) 493**] evidence of DVT in the right upper extremity. The most distal aspect of the right subclavian vein as it enters into the brachiocephalic vein was not visualized. 2. Small-caliber, but patent right internal jugular vein. . CT TORSO W/O CONTRAST [**2127-1-10**]: CT OF THE CHEST: There is a large multiloculated relatively thin walled cavitary lesion involving the right upper lobe measuring roughly 13.7 x 8.2 cm. There are what appears to be air- fluid levels within it. It is difficult to determine whether there is pleural invasion. An adjacent region of consolidative in the right upper lobe (3:27) measures 3.5 x 3.1 cm. Debris is seen within the right main stem bronchus. The trachea and left segmental bronchi are clear. A smaller cavitary lesion is seen in the left upper lobe, measuring 2.3 x 1.6 cm. Multiple small ground- glass opacities are also seen, particularly in the left upper lobe in a tree-in-[**Male First Name (un) 239**] pattern. There are additional consolidative nodular opacities, for example, in the left lower lobe (3:38) measuring 16 x 12 mm and in the right upper lobe measuring 8 mm in diameter. Multiple small paratracheal lymph nodes are seen, which do not meet criteria for pathologic enlargement. No axillary lymphadenopathy is appreciated. There is no cardiomegaly. There is a trace amount of pericardial fluid. There is a left-sided moderate pleural effusion of simple fluid attenuation. A left-sided central venous catheter tip terminates in the central brachiocephalic vein. A nasogastric tube tip is in the antrum of the stomach. An endotracheal tube tip is in the region of the thoracic inlet. CT OF THE ABDOMEN: On this non-contrast study, the liver, gallbladder, adrenal glands, spleen, pancreas, kidneys, and loops of bowel appear unremarkable. Multiple small retroperitoneal lymph nodes do not meet criteria for pathologic enlargement. There is no ascites. Nonspecific perinephric stranding is seen bilaterally. CT OF THE PELVIS: A Foley catheter is within the bladder lumen. The prostate, seminal vesicles, rectum, and pelvic loops of bowel appear unremarkable. There is no pathologic pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. There is dependent superficial subcutaneous edema consistent with anasarca. OSSEOUS STRUCTURES: No concerning lytic or sclerotic lesions are identified. IMPRESSION: 1. Large cavitary right upper lobe lesion and smaller left upper lobe cavitary lesion with additional foci of ground glass as well as consolidative opacities in both lungs consistent with multifocal pneumonia. Moderate right- sided pleural effusion. Debris in the right-sided bronchi. 2. No drainable fluid collections or areas concerning for inflammation in the abdomen or pelvis. Brief Hospital Course: # Leukocytosis: Patient's initial leukocytosis resolved with treatment of his pneumonia. He then developed diarrhea and abdominal cramping with a rising wbc, concerning for c diff versus viral gastroenteritis. C diff negative x 3 and his symptoms are improving. He is tolerating po without precipitating pain/cramps. He will follow-up with his PCP [**Last Name (NamePattern4) **] 2 days to reassess his symptoms and recheck his wbc. If still symptomatic, would treat empirically with flagyl +/- send c diff toxin B. Of note, urinalysis negative and no other new signs/symptoms of infection. White blood cell count prior to discharge ranged from 12 to 13. . #. Cavitating MSSA pneumonia with also enterobacter in sputum: Patient was initially intubated at an outside hospital on [**12-30**]. He was successfully extubated on [**1-14**]. On BAL, while intubated, he was found to have pan-sensitive enterobacter cloacae and had MSSA in sputums from the outside hospital. ID was consulted and followed throughout his hospital stay. He was treated with 10 days of gram negative coverage (cefepime, then FQ) for the enterobacter and will complete 4 weeks of IV vancomycin, followed by an yet-to-be-determined course of po clindamycin for the MSSA. He is scheduled for a follow-up chest CT and ID follow-up to determine the course of his clindamycin. He was weaned off the steroids started at the outside hospital. He received nebs and will continue inhalers at home. Of note, interval CT during his hospital stay showed some improvement. His blood cultures remained negative. He underwent a thoracentesis which appeared exudative but was not consistent with an empyema. Additional work-up included, urine legionella antigen, influenze DFA, PPD, and AFB smear, all of which were negative. He also had a negative HIV antibody test in house. Please note, patient is due for a trough on [**2127-1-30**] and vancomycin dose will be adjusted prn based on this level. . # Anasarca: Patient developed swelling in his feet, ankles, hands, and sacral area in the setting of a urine protein/creatinine ratio of 0.4 and likely protein wasting enteropathy in the setting of his GI symptoms. His albumin was 2.3 on the day of discharge. He is on ensure supplements to aid. Will need PCP [**Name9 (PRE) 702**] to confirm proteinuria resolves. . # Drug Rash: Patient was transferred with history of drug rash to nafcillin. He then developed a rash at [**Hospital1 18**] to ciprofloxacin. Dermatology was consulted. The rash resolved without mucousal involvement with discontinuation of the cipro. . #. Acute renal failure: On admission, patient had creatinine of 4. Urine sediment suggested acute tubular necrosis. He was also noted to have positive urine eos and likely had a component of acute interstitial nephritis related to his drug reactions. His creatinine on the day of discharge was down to 1.6. He is making good urine and his lytes have been stable. . # Delerium: Suspect multifactorial: steroids, icu psychosis, resolving prolonged infection, benzo withdrawal. This resolved after steroids were weaned and patient began to improve. MRI head showed no evidence of stroke. At discharge he is back to baseline mental status. . # Flaccid weakness: The patient had flaccid paralysis noted bilaterally upper and lower extremitites on [**2127-1-13**]. Head and C-spine MRI were unremarkable. This resolved off steroids and with weaning of sedatives. He is now ambulatory again and was cleared by PT for discharge to home with continued PT to improve his strength. . #. Hypertension: Antihypertensives adjusted for improved blood pressure control (see discharge medications). . #. Pancreatitis: Resolved soon after admission. Suspect possibly due to high doses of propofol. Triglycerides were 168. Right upper quadrant ultrasound [**2127-1-17**] was unremarkable. CT abdomen did not show any evidence of fluid collections. . # Anemia: Suspect due to chronic disease. Ferritin 1149. Folate/B12/hapto were normal. Patient received 3 units of blood while in house. Patient did have one guaic positive stool in the setting of his diarrhea. Per patient he is due for his follow-up c-scope and will discuss this with his PCP. . # Access: PICC in place . # Code: Full . # Dispo: Patient discharged to home (staying with his parents) with services. Medications on Admission: Albuterol Flovent Norvasc Benazepril/HCTZ 20/12.5 Discharge Medications: 1. Outpatient Lab Work Please draw CBC with differential, potassium, BUN, creatinine, and magnesium on [**2127-1-31**] and call results to Dr. [**First Name (STitle) **],[**First Name3 (LF) **] L., phone: [**Telephone/Fax (1) 71298**] 2. Outpatient Lab Work Please draw vancomycin trough on [**2127-1-30**] and call results to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9404**], phone: ([**Telephone/Fax (1) 4170**] 3. VANCOMYCIN 750 mg IV q24h Dispense: 9000 mg Refills: none 4. Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff Inhalation [**Hospital1 **] (2 times a day). Disp:*1 inhaler* Refills:*2* 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 7. Metoprolol Tartrate 50 mg Tablet Sig: 2.5 Tablets PO TID (3 times a day). Disp:*225 Tablet(s)* Refills:*2* 8. Hydralazine 25 mg Tablet Sig: Three (3) Tablet PO Q6H (every 6 hours). Disp:*360 Tablet(s)* Refills:*2* 9. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 10. Multivitamin Tablet Sig: One (1) Tablet PO once a day. 11. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation Q4-6H (every 4 to 6 hours) as needed for shortness of breath or wheezing. Disp:*1 inhaler* Refills:*2* 12. Combivent 103-18 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation four times a day. Disp:*1 inhaler* Refills:*0* 13. Clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO every six (6) hours for 1 months: START THIS AFTER YOU HAVE COMPLETED THE COURSE OF VANCOMYCIN. Disp:*120 Capsule(s)* Refills:*0* 14. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day for 1 months. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 15. Advair Diskus 250-50 mcg/Dose Disk with Device Sig: One (1) INH Inhalation twice a day. Disp:*1 inhaler* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 511**] Home Therapy Discharge Diagnosis: primary: MSSA cavitating pneumonia viral gastroenteritis drug rash acute renal failure acute pancreatitis secondary: history of hypertension Discharge Condition: good: afebrile, tolerating po Discharge Instructions: Please call your doctor or go to the emergency room if you experience temperature > 101, worsening shortness of breath or cough, vomiting or worsening diarrhea, or other concerning symptoms. Please take an ensure supplement two to three times per day for the next 2 weeks. You are allergic to penicillins and fluoroquinolones (levofloxacin, ciprofloxacin). Please avoid ibuprofen as this can affect your kidneys. Followup Instructions: Please call to schedule a follow-up chest CT on [**2127-2-21**]. Phone: [**Telephone/Fax (1) 327**] Please follow-up with the infectious disease doctor below: Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Doctor Last Name 9406**] Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2127-2-25**] 11:30 Location: [**Hospital1 18**], [**Hospital Unit Name **] ([**Last Name (NamePattern1) 71299**] Please follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5395**] (works with your primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) on Friday, [**2127-1-31**] at 10:45 AM to have your infection cell count checked, to have your kidney function checked, to discuss scheduling a colonoscopy, and for a routine follow-up. Phone: [**Telephone/Fax (1) 71298**]. ICD9 Codes: 5119, 5845, 3051, 4019, 2859
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Medical Text: Admission Date: [**2169-8-25**] Discharge Date: [**2169-9-14**] Date of Birth: [**2169-8-25**] Sex: M Service: NEONATOLOG HISTORY OF PRESENT ILLNESS: This interim summary covers the dates of [**2169-8-25**], through [**2169-9-14**]. Baby [**Name (NI) **] [**Known lastname **] is a now 20-day-old ex-33-3/7 week 2.105 kilogram baby who was born to a 33-year-old G3, P2, Mom via cesarean section. Mom's prenatal screens include B positive, Rubella immune, RPR nonreactive, hepatitis B surface antigen positive and unknown GBS status. Her pregnancy was unremarkable until preterm labor. Mom had had prior cesarean section and, therefore, had repeat surgery. There was no maternal fever documented and as such Mom did not receive antibiotic prior to delivery. Cesarean section notable for slightly difficult extraction of shoulder in the DR. [**Last Name (STitle) 51600**] fluid was also noted to be bloody at the time of delivery with question of malabruption. Resuscitation unremarkable with spontaneous cry. Apgars were 8 and 8 at one and five minutes respectively. PHYSICAL EXAMINATION: 98.3, 150, 50's, blood pressure 56/38. Accu-Chek 73. Birth weight 2105 grams. Head circumference 31 cm. Length 45 cm. HEENT: Facial bruising, nondysmorphic, no cleft lip or palate. Cardiovascular: Regular rate and rhythm, no murmur. Pulses equal. Lungs: Occasional grunting. Air exchange adequate bilaterally. Abdomen soft, non-tender, no masses palpable. Liver 1 cm below costal margin. Genitourinary: Normal external male genitalia with testes descended bilaterally. Neuro: Normal tone. Moro present and equal. Suck present. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: 1. Respiratory: Patient originally had mild respiratory distress requiring CPAP for approximately 24 hours. After that time he was easily weaned to room air and has not had additional issues from a respiratory standpoint. This includes an absent apnea or bradycardias. However, of recent (in the last 24 hours) patient was noted to have some duskiness with feed. He had originally been taken off of oximetry but this has been resumed to further follow symptoms. 2. Cardiovascular: [**Known lastname 915**] has remained stable from a cardiovascular standpoint without concerns of murmur. 3. Fluids, Electrolytes and Nutrition: Patient originally was supported on total parenteral nutrition with gradual advancement of feeds. He originally started gastric feeds on day of life four. Feeds were gradually advanced with achievement of full feeds on day of life eight. We have currently been feeding [**Known lastname 915**] with breast milk 24 Kcals, both p.o. and p.g. However, at this point he takes only about 50% of his feeds orally. [**Known lastname 915**] has been demonstrating good weight gain on this feeding regimen with most recent weight on day of life 20 ([**9-14**]) of 2.43 kilograms. 4. Gastrointestinal: As briefly mentioned above, there have been some concerns for dusky spells with feeding in the past 24 hours. However, nobody has ever described that [**Known lastname 915**] chokes, gags or sputters with feeds. From a bilirubin standpoint, [**Known lastname 915**] had a prolonged course of hyperbilirubinemia with phototherapy originally initiated on day of life two. [**Known lastname 12340**] peak bilirubin was reached on day of life five at 14.0. He gradually declined but ultimately required phototherapy through day of life ten. A rebound bilirubin on day of life 12 was 11.0. At time of dictation patient still appears moderately jaundiced. . With his prolonged course of hyperbilirubinemia, a repeat bilirubin will be obtained tomorrow morning. 5. Infectious Disease: [**Known lastname 915**] had a 48 hour rule out sepsis with ampicillin and gentamicin. Blood culture remained negative for this period of time. [**Known lastname 12340**] [**Last Name (NamePattern1) 21206**] is known to be hepatitis B surface antigen positive. For this reason he was given both a hepatitis B vaccine as well as HBIG after delivery. No additional issues from an infectious disease standpoint. 6. Neurology: The patient does not meet criteria for screening head ultrasound. 7. Sensory: Patient will still need hearing screen prior to discharge. He does not fit criteria for ophthalmology examination. PRIMARY PEDIATRICIAN: [**Hospital3 **] Health Center, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2262**], M.D. CARE/RECOMMENDATIONS: A. Feeds at interim: Breast milk 24 Kcal at 150 cc/kg/day p.o. or p.g. B. Medications: None. C. Car seat positioning: Pending. D. State Newborn Screen: Sent. E. Immunizations Received: Hepatitis B on day of life zero ([**2169-8-25**]). INTERIM DIAGNOSES: 1. Prematurity at 33-3/7 weeks. 2. Respiratory distress, resolved. 3. Rule out sepsis, resolved. 4. Maternal hepatitis B infection. DR.[**Last Name (STitle) **],[**Doctor Last Name **],[**Doctor Last Name **] 50-470 Dictated By:[**Last Name (NamePattern1) 51601**] MEDQUIST36 D: [**2169-9-14**] 16:34 T: [**2169-9-14**] 16:30 JOB#: [**Job Number 51602**] ICD9 Codes: 769, 7742, V290
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6164 }
Medical Text: Admission Date: [**2154-7-15**] Discharge Date: [**2154-7-19**] Date of Birth: [**2092-10-7**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2387**] Chief Complaint: mental status and vision changes Major Surgical or Invasive Procedure: cardiac catheterization on [**7-16**] History of Present Illness: 61 yo F with CAD s/p MI, DM, PVD, RCA stenosis, and CRI who was admitted for elective cardiac catheterization and transferred post-cath for mental status and vision changes. The patient was referred for cardiac catheterization after abnormal stress testing prior to planned carotid endarterectomy. She was admitted yesterday for post-cath hydration. She received [**Month/Year (2) **], plavix, heparin bolus, and integrillin during the procedure. Cardiac cath showed CO 4.67, CI 2.50, PCW 12, PA 24/13, RV 25/5. Cath showed 80% occlusion of LAD, s/p stent in LIMA - LAD. . Post cath she was noted to be confused and complained of new loss of vision. The Stroke service was urgently consulted. Integrillin gtt was stopped. Head CT showed a lesion concerning for R occipital CVA. She underwent MRI/MRA demonstrating patency of the arterial circulation. . On exam she denies vision changes (diplopia, eye pain, photophobia). She has no memory of the morning's events (cath, CT or MRI, vision problems). She reports nausea and frontal headache. She denies chest pain, SOB, abdominal pain. Past Medical History: PMH: HTN, CAD, s/p MI '[**34**], NIDDM, hypothyroidism PSH: CABG with harvest B saphenous veins Social History: previous smoker / quit 10 years ago no alcohol lives with husband Family History: Father, brother died of MI at age 47 Mother MI in 70s Sister died of MI at age 39. Physical Exam: Vitals: 98.6F HR 75 BP 149/79 RR 10 97 RA weight 84 kg Gen: awake, oriented x 2, pleasant, c/o mild headache. exam limited due to patient laying flat post-cath HEENT: PERRL/EOMI, anicteric sclera. OP clear, MMM Neck: supple, 2+ carotid pulses, no carotid bruits appreciated. unable to assess JVD. CV: RRR, distant S1, S2. Pulm: clear anteriorly Abd: +BS, soft, ND/NT Ext: warm, 1+ DP/PT b/t. L toes with erythema, no skin breaks, mild tenderness to palpation. no edema b/t, no calf tenderness. R groin without hematoma, 1+ femoral pulse. Neuro: A & O x 2, CN II-XII grossly intact, except for inferior field defect to Left eye. mild agnosia. 4+ strength in UE/LE. 3+reflexes in LUE, nl in RUE and LLE (unable to assess RLE due to post-cath monitoring). sensation intact. neg Romberg. down-going Babinskis b/t. Pertinent Results: [**2154-7-15**] 09:21PM PT-11.3 PTT-26.9 INR(PT)-1.0 [**2154-7-15**] 09:21PM PLT COUNT-226 [**2154-7-15**] 09:21PM WBC-7.9 RBC-4.02* HGB-12.7 HCT-35.9* MCV-89 MCH-31.6 MCHC-35.3* RDW-13.1 [**2154-7-15**] 09:21PM CALCIUM-9.6 PHOSPHATE-3.3 MAGNESIUM-2.3 [**2154-7-15**] 09:21PM GLUCOSE-135* UREA N-31* CREAT-1.5* SODIUM-142 POTASSIUM-3.9 CHLORIDE-107 TOTAL CO2-23 ANION GAP-16 EKG: NSR, rate 80. nl intervals. Q waves in III, aVF, slight L axis. Poor R-wave progression . Cardiac Cath [**7-16**]: CO 4.67, CI 2.50, PCW 12, PA 24/13, RV 25/5. 80% occlusion of LAD, s/p stent in LIMA -> LAD. . CT Head [**7-16**]: Findings suggestive of ischemic event involving the right occipital lobe with perfusion in that area. There is also possibly involvement of the left occipital lobe. old lacune disease. . echo: per report, moderate depression of LV fx, distal septal inferior hypokinesis. . Brief Hospital Course: A/P: 61 yo F with CAD s/p MI, DM, PVD, RCA stenosis, and CRI who was transferred post-elective cath for mental status and vision changes, now s/p R post occipital stroke. The following issues were investigated during this hospitalization: . # CVA: Likely thromboembolic in setting of cardiac catheterization and not thought to be due to ICA stenosis. Since she had already received [**Last Name (LF) 13860**], [**First Name3 (LF) **], Plavix during her catheterization, tPA administration was thought to be too risky (and perhaps not needed). Integrillin was stopped on transfer to the CCU and the stroke/neurology team continued to follow her progress. Initially, she was disoriented and had a left inferior field vision cut. Otherwise, her vision was intact. She was also febrile to 101.9. Blood and urine cultures show no growth to date and CXR was unremarkable. She was given Tylenol and started on empiric treatment with Levaquin, mostly for PNA and UTI organisms, since fever can worsen a stroke. She continued to be afebrile 2 days after her initial fever and since cultures showed no growth, Levaquin was d/c'd. A SBP goal of 140-180 was set by the stroke team to provide adequate perfusion of the brain in the setting of a stroke. However, despite fluid boluses and holding anti-hypertensive medications, her SBP never went above 130. Pt was only able to tolerate Trendelenberg for a few hours before becoming nauseous and vomiting. No other interventions were made. An EEG showed no seizure activity. Pt's orientation and memory slowly improved and she was d/c'd with Aspirin and Plavix. Per PT and OT consults, patient will need 24 hour supervision at home, which her husband is able and willing to provide. . # CVS: Patient had an abnormal outpatient stress Echo and was referred to [**Hospital1 18**] for a cardiac catheterization which revealed an 80% occlusion of LAD. She received a stent in LIMA -> LAD. While in the unit, she had an echo which showed a normal EF. She was discharged on [**Hospital1 **], Plavix and Lipitor. Her beta-blocker and ace-inhibitor were held since her blood pressure seemed to be well-controlled and since the recommendations of the stroke team was to allow for better perfusion of her brain with a higher BP. She was d/c'd on her outpatient beta-blocker dose. . # PVD:`Pt. has a history of 80-90% RCA stenosis for which she has already been evaluated as an outpatient. [**Hospital1 **] surgery was aware that the patient was in-house. They recommend that the patient continue with the current plan of follow-up as an outpatient and eventual carotid endarterectomy. . # DM: During this hospitalization, patient's Metformin was held because of concern for lacic acidosis in the setting of CRI and being post-cath. Her FS were well-controlled on a regular insulin finger stick. HbA1C is 7. On discharge, she was sent out on her outpatient doses of Glipizide and Glucophage. . # CRI: Patient's creatinine was maintained at baseline during this hospitalization and was not an active issue. . # Hypothyroidism: Pt. was maintained on outpatient dose of Synthroid Medications on Admission: Clopidogrel 75 mg qday ecAspirin 325 mg qday Coreg 3.125 [**Hospital1 **] Fosinopril 10 mg qday Glucophage 1,000 mg po bid Synthroid 125 mcg PO qday Glipizide 10 mg [**Hospital1 **] Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Fosinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. 6. Glucophage 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 7. Glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day. 8. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Right Occipital Stroke Coronary Artery Disease Diabetes Mellitus Carotid stenosis Peripheral [**Hospital1 **] disease Discharge Condition: Stable Discharge Instructions: Please call your physician or call 911 if you experience a change in vision, severe headache, slurred speech or sudden weakness, chest pain, shortness of breath, fevers, numbness, weakness, leg pain, leg/foot ulcers or other concerning symptoms. Followup Instructions: Provider: [**Name10 (NameIs) 17562**], [**Name11 (NameIs) 487**] MD Date/Time: [**2154-7-29**] 9:30 AM. You will need to get a referral from Dr. [**Last Name (STitle) 17562**] for your appointment with neurology on [**8-13**]. Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY (NHB) Date/Time: [**2154-7-31**] 1:45 Provider: [**First Name11 (Name Pattern1) 5445**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5446**], DPM Phone:[**Telephone/Fax (1) 543**] Date/Time:[**2154-7-31**] 3:40 Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone: [**Telephone/Fax (1) 2394**] [**2154-7-31**] AT 1:00 PM Provider: [**Name10 (NameIs) **], [**Name11 (NameIs) **], MD Neurology Phone: ([**Telephone/Fax (1) 7394**] Time/Date: [**2154-8-13**] at 1:30 PM on the [**Location (un) **] of the [**Hospital Ward Name 23**] Building, [**Hospital Ward Name 516**] of [**Hospital1 69**] ICD9 Codes: 5859, 2449
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Medical Text: Admission Date: [**2187-8-8**] Discharge Date: [**2187-8-17**] Service: MED Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 30**] Chief Complaint: Increased shortness of breath and malaise Major Surgical or Invasive Procedure: Cardiac catherization and stent in RCA, LMCA, and LAD History of Present Illness: Pt is an 80 y/o M with a h/o metastatic poorly differentiated squamous cell CA, GERD who presented to [**Hospital **] hospital with 2-3 days of increasing SOB and fatigue, saying he was "gasping" for air by the time he got to the hospital. Over the days prior to admission, he complained of exacerbations of his "reflux" that seemed to be worse with urination/defecation, not worse with eating or supine position. At [**Hospital1 **], had elevate CK, MB, TnI and a CXR indicating possible pneumonia and mild CHF and was started on B-blocker, nitro drip, ASA, lasix, ceftazidime/azithromycin. His OSH echo showed 35-40% EF, septal/apical/inf wall hypokinesis, mild MR, trace TR. A CT of his torso showed mediastinal LAD, hilar LAD, B/L pleural effusions, multiple pleural calcifications c/w prior asbestos exposure, B/L LL infiltrates, RUL infiltrate, and a R inguinal fluid collection. A cath two days after admission showed 80% left main disease, extensie three vessel disease, prompting a transfer to [**Hospital1 18**]. At [**Hospital1 18**], pt had a cath with cypher and hepacoat stenting of RCA, PTCA to LAD and LCx with hepacoat in LAD and distal LM, hepacoat to ostium of LM. Pt's post cath course was complicated by two episodes of fever up to 101-102 with new diarrhea, RUL and RLL opacities. Also, pt has bilateral pleural effusions, L>R, s/p left thoracentesis that does not support empyema, though with pleural fluid appearing transudative in nature. Past Medical History: 1.)Metastatic poorly differentiated squamous cell carcinoma 2.)GERD 3.)Arthritis 4.)BPH Social History: The patient is a retired bartender who lives alone, has a 40 pack year history, and quit smoking in [**2175**]. Family History: non-contributory Physical Exam: tm 101.0/tc 98.6, bp 78/45->94/60, hr 67 63-68, rr 18, spo2 96% ra gen- awake, a&o M, healthy appearing, looks own age, NAD HEENT- no scleral icterus/injection, op clear, poor dentition (1 tooth), dry mucosa neck- supple, v-wave jugular pulsation, no lad, no thyromegaly cv- rrr, s1s2, 2/6 systolic murmur loudest over ao region pul- good bilat air movement, rales in both bases L>>R, bronchial breath sounds in RUL abd- soft, NT, nabs, no organomegaly extrm- no c/c/e, warm, well perfused, r groin with 3x4cm firm painless mass with 1x1cm ulceration, nontender, no pus expressed, no erythema, left groin at cath site, no hematoma, no erythema neuro- a&ox3, fluent coherent speech, approriate affect, cn II-XII intact, motor [**4-25**] all extrm Pertinent Results: [**2187-8-8**] 12:50PM PT-13.3 PTT-34.2 INR(PT)-1.1 [**2187-8-8**] 12:50PM PLT COUNT-320 [**2187-8-8**] 12:50PM WBC-11.3* HGB-11.2* HCT-33.1* MCV-81* [**2187-8-8**] 12:50PM ALBUMIN-3.1* CALCIUM-8.7 PHOSPHATE-3.6 MAGNESIUM-2.2 [**2187-8-8**] 12:50PM ALT(SGPT)-18 AST(SGOT)-24 LD(LDH)-324* CK(CPK)-70 ALK PHOS-77 TOT BILI-0.8 [**2187-8-8**] 12:50PM GLUCOSE-90 UREA N-12 CREAT-0.7 SODIUM-139 POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-28 ANION GAP-12 [**2187-8-8**] CK 70 Trop 0.8 [**2187-8-16**] 11:18AM BLOOD WBC-10.8 RBC-4.35* Hgb-11.6* Hct-36.1* MCV-83 MCH-26.7* MCHC-32.2 RDW-13.9 Plt Ct-530* [**2187-8-16**] 11:18AM BLOOD Glucose-153* UreaN-13 Creat-0.9 Na-141 K-3.8 Cl-105 HCO3-29 AnGap-11 [**2187-8-15**] 06:50AM BLOOD calTIBC-191* Ferritn-473* TRF-147* [**2187-8-15**] 06:50AM BLOOD Calcium-9.1 Phos-2.8 Mg-2.2 Iron-11* [**2187-8-8**] 12:50PM BLOOD CK-MB-NotDone cTropnT-2.3* [**2187-8-9**] 04:55PM BLOOD CK-MB-NotDone cTropnT-3.12* FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA [**2187-8-13**] 2:55 pm PLEURAL FLUID GRAM STAIN (Final [**2187-8-13**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2187-8-16**]): NO GROWTH. ANAEROBIC CULTURE (Preliminary): NO ANAEROBES ISOLATED. Blood cultures -- No growth to date Brief Hospital Course: 1.)CAD -- Pt was admitted with three vessel disease and severe left main disease. Pt was considered to not be a surgical canidate given functional status and metasatic squamous cell CA. A cath was performed on [**8-9**]: LM 60-80% ostial, 80% distal; LAD 99% ostial, o/w diffuse; LCx 50% ostial, 80% mid; RCA 80% ostial, prox, & mid; Cypher & hepacoat x3 to mid RCA w/20% residual; hepacoat x2 to LM/LAD w/no residual. Pt tolerated procedure well. He was started on routine post-cath medications, including ASA, metoprolol, ACEI, statin, and Plavix. Once the patient was on the floor, he was noted to be mildly hypotensive with systolics in the 80's (mentating well, producing urine) with a Cr of 1.2, so his ACE-I was held, with plans to restart as an outpatient. His sbp responded quickly to 250cc of normal saline, coming up to 110-120, where it remained for the rest of his stay. Pt had no chest pain or SOB for the rest of the admission, no abnormalities on telemetry, and was considered stable for discharge. 2.)CHF -- Pt initially diuresed with lasix and ACEI started for afterload reduction. Pt had echo at OSH which showed EF of 35-40%. However, given hypotension and Cr of 1.2, his ACE-I was held, and he was kept 0.5-1.0 liters positive for two days with no compromise of respiratory status, as it was felt he was hypovolemic. Following this, his fluids were kept even. He had bilateral pleural effusions that were tapped, and the analysis was most consistent with a transudate, no empyema, no malignant cells seen on cytologic exam. 3.)Azotemia -- His Cr bumped to 1.2 with a BUN of 29 and a FeNa of 0.2%. Given the clinical findings and lab values, he was felt to be dry and the azotemia secondary to a prerenal etiology. His Cr trended down with fluids to 1.0. 4.)Fever -- Pt spiked a fever two days after cath. Diagnostic possibilities included pneumonia, infected pleural effusion, R. groin abscess secondary to a metastatic nodal site, and diarrhea/C difficile. His blood and pleural fluid cultures were negative, his pleural fluid analysis had a pH of 7.46 making empyema unlikely, and his R. groin swelling had no pain, erythema, or pus. An ultrasound of the right groin showed a fluid collection that could represent a hematoma or an abscess; surgery evaluated the right groin lesion and felt that it was unlikely to be infected. His C. diff assay came back positive. He was treated for the two most likely items on this differential, the pneumonia and C. diff diarrhea, with levofloxacin for the pneumonia and metronidazole for the diarrhea. By discharge, he'd been afebrile for greater than 48 hours. 5.)Squamous cell carcinoma -- Initially diagnosed [**2187-6-21**] by excisional bx at [**Hospital **] hospital, CT torso at [**Hospital1 **] showed necrotic mass in right groin. Pt has had little work-up, but wants to be followed at [**Hospital1 18**]. He was seen by Onc while an inpatient and will be followed by Dr. [**Last Name (STitle) **]. A CT w/ constrast showed bilateral pleural effusions with consolidation in the right lower lobe, representing a pneumonia, an ill-defined nodular lesion in the medial portion of the left upper lobe measuring 2 cm in diameter, associated with extensive mediastinal and hilar lymphadenopathy, multiple ill-defined patchy opacities with possible cavitations in left upper lobe, with underlying bilateral pulmonary edema(these ill-defined opacities can be a part of pneumonia, or pulmonary edema, or can be septic emboli, or metastases), multiple calcified pleural plaques suggesting asbesto exposure, and GB stones. [**Hospital1 **] will be contact[**Name (NI) **] to send over pathology slides and films. 6.)Anemia -- Lab results came back with low Fe and TIBC and elevated ferritin, making chronic disease/inflammation anemia the most likely possibility. This is probably related to his squamous cell carcinoma. Medications on Admission: Flomax Xanax Protonix Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QD (once a day). 2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO QD (once a day). 3. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD (once a day). 4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 12 days. 5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 12 days. 6. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO once a day. Discharge Disposition: Extended Care Facility: [**Location (un) 4480**] [**Hospital 4094**] Hospital - [**Location (un) 1110**] Discharge Diagnosis: Primary: 1. NSTEMI 2. LMCA and three vessel coronary artery disease. 3. Stenting of the LMCA/LAD - Stenting of the RCA - PTCA of the LCX. (see comments below). 4. Systolic CHF, EF ~ 40%. 5. RUL and LLL Pneumonia. 6. Squamous Cell Cancer of the penis with right inguinal metastasis. 7. Right groin complex mass measuring approximately 6.8 cm x 4 cm x 7 cm, with echogenic material and septations. 8. Diarrhea. 9. Pre-renal azotemia. 10. Microcytic Anemia. 11. Bilateral density calcified pleural plaques, suggesting asbestos exposure. 12. Right sided pleural effusion - transudate. 13. COPD. PCI: Right Dominant circulation, severe LMCA and three vessel coronary disease, LMCA had a 60% ostial and 80% distal stenosis. The LAD had a 99% ostial lesion and had diffuse moderate disease throughout. The LCX had a 50% ostial lesion and an 80% mid lesion in the AVG LCX. The RCA had serial ostial, proximal and mid lesions up to 80%. Stenting of the LMCA/LAD was performed with overlapping 4.0 x 8 mm and 3.0 x 18 mm Hepacoat stents. Kissing PTCA of the LMCA/LAD/LCX was performed with two 3.0 mm balloons. PTCA of the mid LCX was performed with a 2.5 mm balloon. Stenting of the RCA was peformed with a 3.0 x 33 mm Cypher (mid) and a 3.5 x 23 mm Hepacoat (ostial). Discharge Condition: Fair Discharge Instructions: Pleasw return to the emergency department for chest pain, shortness of breath, fever/chills, changes in mental status. Take medications as prescribed. You have two medications that it is crucial to take: aspirin and Plavix (clopidogrel) -- please take these medications every day as directed. Do not stop them unless explicitly directed to by your cardiologist. Follow-up as below. Please check your weight every day to see if you are retaining fluids. If your weight increases by two pounds, take 40mg of Lasix. If by five pounds, take 40mg of lasix, once in the morning and once in the evening. Followup Instructions: Please call your PCP to arrange an appointment to be seen with one to two weeks of discharge from the hospital. You have an appointment with Dr. [**Last Name (STitle) **], your oncologist, on [**Month (only) **] the seventh at 1:00pm in the [**Hospital 23**] clinic building on the ninth floor. For questions, call [**Telephone/Fax (1) 6161**]. You have an appointment with a cardiologist, Dr. [**First Name (STitle) 437**], on [**Month (only) **] the eight at 9:30am in the [**Hospital 23**] Clinic building on the seventh floor. For questions, please call [**Telephone/Fax (1) 62**]. ICD9 Codes: 4280, 5119, 486
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Medical Text: Admission Date: [**2170-1-18**] Discharge Date: [**2170-2-2**] Date of Birth: [**2129-6-22**] Sex: M Service: MEDICINE Allergies: Aspirin / Hydralazine / Pyridium / Bactrim / Nitrofurantoin / Dapsone / Quinine / Quinidine / Methylene Blue Attending:[**First Name3 (LF) 19193**] Chief Complaint: fatigue, poor PO intake, abdominal discomfort Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname 1557**] is a 40-year-old man with medical history of [**First Name8 (NamePattern2) **] [**Last Name (Prefixes) 93502**] disease (glycogen storage disease) who presented with fatigue, poor PO intake, and abdominal pain. Per his father, [**Name (NI) **] has not been doing well since he completed alpha interferon at the end of [**10/2169**] for treatment of his liver adenomas. He has been more exhausted and his PO intake has been extremely poor. He denies any fevers, chills, chest pain, shortness of breath, or diarrhea. The patient does admit to increasing bilateral lower extremity edema over the past 2 weeks. His BS's have been difficult to control at home since he is not always compliant with his cornstarch due to fatigue. Given his constellation of symptoms he was recommended to go to the ED by his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 16258**]. Initial vitals in the ED were T 98.1, BP 118/65, HR 107, RR 27, O2 sat 100% RA. Initial labs revealed a leukocytosis of 25 and lactate of 13. Patient was initially started on D10W with close monitoring of his blood sugars which was then changed to 1/2 NS given his lactic acidosis. He was also given Zosyn 3.375gm IV and Ceftriaxone 1gm IV. Repeat labs showed an increase in WBC to 45.3 and lactate of 16. He was transferred to MICU for closer monitoring. His Hct was noted to be 18. . Mr. [**Known lastname 1557**] also underwent a CT scan abd/pelvis in ED which showed a possible ruptured adenoma. Patient's family did not want any further procedures to be done. Of note, the patient was recently admitted in mid-[**Month (only) 404**] for anemia and was admitted for blood transfusions. Past Medical History: 1)[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] disease 2)s/p porto-caval shunt 3)Anemia Social History: Lives independently in [**Location (un) 745**]. No current tobacco, alcohol, or IVDA. Family History: Brother passed away from complications of [**First Name8 (NamePattern2) **] [**Last Name (Prefixes) 93502**] diease. Physical Exam: ADMISSION EXAM: T 97.0 BP 129/67 HR 116 RR 25 O2 sat 100% RA Gen: Patient appears acutely ill, severely cachectic, older than stated age HEENT: MMM Heart: Sinus tachycardia, no audible m,r,g Lungs: CTAB, no crackles Abdomen: Markedly distended, hard to palpation, visible veins. Extremities: [**1-30**]+ bilateral pitting edema, 1+ DP/PT pulses Pertinent Results: ADMISSION LABS: WBC-25.0*# RBC-2.43*# HGB-5.4*# HCT-20.4* MCV-84 NEUTS-78* BANDS-2 LYMPHS-8* MONOS-11 EOS-0 BASOS-0 PT-17.6* PTT-37.2* INR(PT)-1.6* GLUCOSE-19* UREA N-39* CREAT-0.6 SODIUM-142 POTASSIUM-4.3 CHLORIDE-93* CO2-12* ALT(SGPT)-73* AST(SGOT)-514* ALK PHOS-4623* TOT BILI-3.0* LIPASE-702* CALCIUM-10.4* PHOSPHATE-2.5* MAGNESIUM-2.5 TRIGLYCER-364* LACTATE-13.0* . IMAGING STUDIES: 1)Cxray ([**1-18**]): No evidence of pneumonia. No acute cardiopulmonary abnormalities. 2)CT abd/pelvis ([**1-18**]): 1. Massively enlarged liver with innumerable heterogenous masses most consistent with adenomas. Extraluminal pooling of contrast are concerning for active intra- tumoral hemorrhage in the most inferiorly located tumor mass in the right hepatic lobe. Minimal normal appearing liver parenchyma remains. A targeted ultrasound of this area is recommended for further evaluation of possible intra- tumoral hemorrhage vs. venous lakes. 2. Marked tumor neovascularity within the liver, especially the left lobe which is near completely replaced with tumor. Hepatocellular carcinoma within these areas cannot be excluded. 3)RUQ U/S ([**1-18**]): Well-defined, focal hypoechoic areas which show slow internal flow within the most inferior right-sided hepatic mass most likely represent internal venous lakes Brief Hospital Course: Mr. [**Known lastname 1557**] is a 40-year-old man with history of glycogen storage disease who presented with worsening fatigue, poor PO intake, and abdominal discomfort. . * Glycogen storage disease: AG metabolic acidosis on presentation, secondary to hypoglycemia. Patient was admitted to the MICU. Infusion of D10W then D10 1/2NS was started, and as hypoglycemia resolved, his lactate acidosis improved. The regimen was discussed with his specialist, Dr. [**Last Name (STitle) **]. Goal blood sugar is between 70-100. As he started the cornstarch the D10 gtt was weaned off. When patient was hypoglycemic he was encouraged to eat small meals. By discharge lactate had decreased from a peak of 15 to 6.6. Due to loose stools, the patient could not tolerate cornstarch for several days, but by discharge diarrhea had resolved, and the patient had been taking cornstarch for 2 days, with stable fingersticks. . * Leukocytosis: Patient initially presented with WBC of 25. No apparent source of infection was identified. CXR and urinalysis were unremarkable. Abdominal CT revealed no abscess. Blood and urine cultures were negative. He was empirically started on Zosyn on admission which was stopped after 48 hours because of no evidence for an active infection. When he developed loose stools later in the hospital course, metronidazole was started for presumed C. diff and completed by discharge. C. diff came back negative. The WBC trended down but remained elevated at 15 by discharge. Patient was afebrile during hospitalization. . * Recent diarrhea: with persistent leukocytosis. He was empirically treated with a short course of metronidazole. C. diff came back negative. Stool studies were unremarkable, and no clear cause was found. The diarrhea gradually improved, allowing the patient to better absorb the cornstarch by discharge. . * Anemia: Mr. [**Known lastname 1557**] had extensive workup in the past. Concern for anemia of chronic disease, in setting of hepatic adenomas. The patient's Hct was 18 on admission, and he subsequently received pRBCs to increase Hct to high 20s. . * Hepatic adenomas: known multiple adenomas per CT scan report. Family declined further work-up at this time. . * Elevated LFTs/coagulopathy: presented with elevated ALT/AST/alk phos, likely in setting of extensive hepatic adenomas. INR remained elevated around 1.6-1.7, suggesting underlying synthetic dysfunction. . * LE and scrotal edema: likely from low albumin, and with infusion of IVF during hospital stay. . * Code: Full Medications on Admission: Allopurinol 300mg PO daily Cornstarch Discharge Medications: 1. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Powder in Packet Sig: One (1) Powder in Packet PO TID (3 times a day). Disp:*90 Powder in Packet(s)* Refills:*2* 2. Allopurinol 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). Disp:*45 Tablet(s)* Refills:*2* 3. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed. 4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Ferrous Gluconate 300 mg (35 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Dextrose (Diabetic Use) 300 mg Tablet Sig: 2-4 Tablets PO PRN (as needed) as needed for FS < 60. 9. Corn Starch (Bulk) Powder Sig: see comment Miscellaneous q4 (): 45 gm at 6am, 10am, 2pm, 6pm; 55 g at 10pm, 2am . Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary diagnosis: lactic acidosis Secondary diagnosis: glycogen storage disease Discharge Condition: Stable Discharge Instructions: You presented to [**Hospital1 18**] with fatigue, abdominal discomfort, and poor appetite. You were found to have hypoglycemia (low blood sugar) and lactic acidosis, consistent with your glycogen storage disease. You refused infusion of D10 1/2NS for glucose control. Cornstarch was started then stopped due to diarrhea. Work-up for the diarrhea revealed no apparent cause. You were empirically treated with an antibiotic called metronidazole. Your diarrhea improved, and the cornstarch was restarted, the dextrose infusion was discontinued, and your blood sugar remained stable. Please take your medications as instructed. If you develop any fevers, chills, shortness of breath, chest pain, recurrent diarrhea, or any other symptoms that concern you, please call your doctor or go to the nearest Emergency Room. Followup Instructions: Please call your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 16258**], [**Telephone/Fax (1) 19196**], for a follow-up appointment within two weeks. ICD9 Codes: 2762, 5789
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Medical Text: Admission Date: [**2165-11-25**] Discharge Date: [**2165-12-9**] Date of Birth: [**2109-2-8**] Sex: F Service: CARDIOTHORACIC Allergies: Erythromycin Base / Penicillins / Claritin / Lipitor / Latex Attending:[**First Name3 (LF) 922**] Chief Complaint: paroxysmal atrial fibrillation Major Surgical or Invasive Procedure: Bilateral thoracoscopic mini-Mazes, left atrial appendage ligation [**11-27**] History of Present Illness: This 56 year old white female has a several year history of paroxysmal atrial fibrillation. She has continued this despite multiple medication trials. She self referred for evaluation of surgical ablation and was admitted for surgery. Past Medical History: paroxysmal atrial fibrillation s/p DCCV seizure disorder hypertension chronic hyponatremia hyperlipidemia glaucoma obesity s/p R knee surgery s/p L elbow surgery s/p bladder resusupension Social History: The patient is a special education teacher. non smoker, denies ETOH use Family History: noncontributory Physical Exam: Admission: Alert and oriented, exam nonfocal. lungs- clear Cor- AF at 95 BPM, w/o murmur Extremeties- well perfused, palplable pulses, trace edema. Abd- obese, benign. discharge: General: well appearing obese female in NAD VS: 97.9, 114/69, 80SR, 18, 99% on roomair Chest: CTAB Incisions: bilateral thoracotomy incisions both c/d/i without erythema or drainage COR: RRR, no murmur or rub ABD: large, round, soft, NT, ND, +BS Extrem: warm and well perfused, no edema Pertinent Results: Indication: Left ventricular function. Right ventricular function. Acidosis post Maze procedure ICD-9 Codes: 424.0, 424.2 Test Information Date/Time: [**2165-11-28**] at 14:55 Interpret MD: [**Name6 (MD) **] [**Name8 (MD) **], MD Test Type: Portable TEE (Complete) Son[**Name (NI) 930**]: Doppler: Full Doppler and color Doppler Test Location: West SICU/CTIC/VICU Contrast: None Tech Quality: Adequate Tape #: 2009W000-0:00 Machine: Vivid i-5 Sedation: (See comments below for other sedation.) Patient was monitored by a nurse throughout the procedure Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Ejection Fraction: >= 55% >= 55% Findings 40 mg of Propofol was given. LEFT ATRIUM: No spontaneous echo contrast in the body of the LA. RIGHT ATRIUM/INTERATRIAL SEPTUM: PFO is present. LEFT VENTRICLE: Overall normal LVEF (>55%). No resting LVOT gradient. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal descending aorta diameter. No atheroma in descending aorta. AORTIC VALVE: Normal aortic valve leaflets (3). No masses or vegetations on aortic valve. No AS. Trace AR. MITRAL VALVE: Normal mitral valve leaflets. No mass or vegetation on mitral valve. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was monitored by a nurse [**First Name (Titles) **] [**Last Name (Titles) 9833**] throughout the procedure. The patient was under general anesthesia throughout the procedure. No TEE related complications. Conclusions No spontaneous echo contrast is seen in the body of the left atrium. A patent foramen ovale is present. Overall left ventricular systolic function is 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. No masses or vegetations are seen on the aortic valve. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are structurally normal. No mass or vegetation is seen on the mitral valve. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. IMPRESSION: Normal biventricular systolic function. Stretched patent foramen ovale is present. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**Name6 (MD) **] [**Name8 (MD) **], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2165-11-28**] 18:03 [**2165-12-9**] 07:10AM BLOOD WBC-9.7 RBC-3.74* Hgb-11.7* Hct-32.8* MCV-88 MCH-31.5 MCHC-35.9* RDW-13.2 Plt Ct-425 [**2165-12-7**] 08:00AM BLOOD PT-41.9* INR(PT)-4.6* [**2165-12-8**] 11:00AM BLOOD PT-23.2* INR(PT)-2.2* [**2165-12-9**] 07:10AM BLOOD PT-17.0* INR(PT)-1.5* [**2165-12-6**] 04:52AM BLOOD PT-35.1* INR(PT)-3.7* [**2165-12-9**] 07:10AM BLOOD Glucose-109* UreaN-13 Creat-0.6 Na-135 K-3.9 Cl-97 HCO3-26 AnGap-16 Brief Hospital Course: She was admitted 2 days prior to surgery for heparinization off coumadin. She was taken to the operating room on [**11-27**] where bilateral thoracoscopic mini-Mazes with left atrial appendage ligation was performed. She tolerated the procedure well and was transferred to the ICU in stable condition. She weaned from the ventilator and was extubated on POD 2 after her metabolic acidosis/respiratory failure cleared. A TEE was performed on POD 1 to demonstrate no cardiac pathology. Paravertebral blocks were administered on [**11-28**] for pain control with good results. She was kept in the ICU for pulmonary care and ready for transfer to the floor on POD 5 ([**12-2**]). Amiodarone, beta blockers and antiinflammatory medications were administered to maintain sinus rhythm and control post operative inflammatory response. However on POD# 6 pt developed Afib, flutter which was rate controlled. Coumadin was resumed at home dose of 5 mg but INR rose to 5.6- coumadin was held and d/c was post-poned. That evening she went into atrial flutter and her lopressor was increased. On post-operative day 9 she was electively cardioverted to sinus rhythm. INR normalized and the patient was maintained on lower doses of coumadin than previously due to concommitant amiodarone administration. She continued to progress and she was ready for discharge to rehab on POD # 12 where she will undergo further conditioning to increase strength, endurance and activities of daily living. All follow up appointments were advised. Medications on Admission: Keppra 1500mg [**Hospital1 **] Tegretol XR 400mg [**Hospital1 **] Diltiazem SR 180mg/D Ativan 0.5 mg/D ASA 325mg/D Lopressor 150mg TID Coumadin 5mg/D Xalantan 0.05% ophth. 1 gtt OU qHS Pantoprazole 40mg/D 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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 5. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 6. Carbamazepine 100 mg Tablet Sustained Release 12 hr Sig: Four (4) Tablet Sustained Release 12 hr PO BID (2 times a day). 7. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed. 10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): 400mg 2x/day for 1 week, then 200mg 2x/day for 1 week, then 200mg/day until further instructed. Disp:*120 Tablet(s)* Refills:*0* 11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed. Disp:*qs * Refills:*0* 12. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. Tablet(s) 13. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). 14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 15. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**11-15**] Puffs Inhalation Q6H (every 6 hours) as needed. 16. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig: 15-30 MLs PO QID (4 times a day) as needed. 17. Warfarin 1 mg Tablet Sig: .5 Tablet PO once a day: .5mg alternating with 0mg for goal INR 2-2.5 (atrial fibrillation). Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: paroxysmal strail fibrillation s/p bilateral thoracoscopic mini-Mazes, left atrial appendage ligation hypertension obesity seizure disorder hyperlipidemia glaucoma endometriosis s/p bladder resuspension s/p R knee surgery s/p L elbow surgery s/p appendectomy Discharge Condition: good Discharge Instructions: shower daily, no baths or swimming no lotions, creams or powders to incisions no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks report any redness of, or drainage from incisions report any fever greater than 100.5 report any weight gain greater than 2 pounds a day or 5 pounds a week take all medications as directed Followup Instructions: Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) wound clinic in 2 weeks Dr. [**Last Name (STitle) 73**] in 2 weeks Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**11-15**] weeks ([**Telephone/Fax (1) 608**]) Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (ENT) as an outpatient to evaluate mass on left vocal cord please call for appointments Completed by:[**2165-12-9**] ICD9 Codes: 5185, 5180, 2761, 4019, 2724
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Medical Text: Admission Date: [**2158-9-11**] Discharge Date: [**2158-9-15**] Service: [**Last Name (un) **] Allergies: Coumadin / Sulfa (Sulfonamides) / Penicillins Attending:[**First Name3 (LF) 5880**] Chief Complaint: fall Major Surgical or Invasive Procedure: 1. Casting of Left forearm for Colles fracture 2. Hinge casting of bilateral lower extremities for spiral fracture of the right distal femoral diaphysis extending to the supracondylar region and oblique fracture of the distal left femur metaphysis 3. Placement of percutaneous left nephrostomy tube 4. Transfusion of 2U PRBC History of Present Illness: 82 y.o. female nursing home resident who fell during transfer from bed to wheelchair on [**2158-9-9**]. The patient landed on her knees bilaterally and struck her nose on the bed. After this event, she complained of bilaterally leg pain. On [**2158-9-10**] X-rays were taken at the nursing home, showing bilateral femur fractures. She was then transferred to [**Hospital1 18**] for treatment. Past Medical History: A fib HTN Depression Non-insulin dependent DM Chronic venous stasis w/ hx of foot ulcers Bilateral hip fractures s/p bilateral hip replacement Osteoporosis Arthritis Degenerative joint disease Chronic UTI Social History: lives at [**Location 58139**] [**First Name9 (NamePattern2) 58140**] [**Doctor First Name 533**] center for extended care has two goddaughters who both have POA: [**Name (NI) 58141**] [**Name (NI) 58142**] and [**Last Name (un) **] [**Name (NI) 58143**] Family History: non-contributory Physical Exam: on arrival to the ED vitals: Temp 101.6 rectal HR 138 BP 153/52 RR 23 Sats 100% on NRB FSBG 280 GEN: awake, alert, able to answer yes and no to questions, follows commands NAD HEENT: PERRL, EOMI, right perorbital ecchymosis, midface stable, no oral pharyngeal trauma NECK: c-collar in place, trachea midline CHEST: equal BS bilaterally CV: irregularly irregular, no M/R/G ABD: SNTND PELVIS: stable to AP and lateral compression RECTAL: normal tone, no gross blood, heme neg BACK: no palpable step-offs, no visible abrasions EXT: left wrist swelling and ecchymosis, Right leg in flexion, no grossly apparent deformities of bilateral LE Skin: warm, dry, intact NEURO: CN II-XII intact, able to move all 4 ext, no apparent motor or sensory deficits Pertinent Results: [**2158-9-10**] 10:11 PM CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST IMPRESSION: 1) No evidence of acute traumatic intraabdominal injury. 2) 9 mm obstructing stone in the proximal left ureter with moderate hydronephrosis. CT evidence of bilateral pyelonephritis [**2158-9-10**] 10:11 PM CT C-SPINE W/O CONTRAST; CT RECONSTRUCTIONIMPRESSION: Severe degenerative changes and demineralization. No definite acute fracture seen. [**2158-9-10**] 10:10 PM CT HEAD W/O CONTRAST IMPRESSION: Likely remote right MCA distribution infarct. Subacute to chronic right PCA distribution infarct, but exact timing is indeterminate without a prior study. MRI could be performed for further evaluation, if the patient is a candidate for MRI [**2158-9-10**] 9:36 PM ELBOW (AP, LAT & OBLIQUE) LEFT; WRIST(3 + VIEWS) LEFTIMPRESSION: 1. Suspicion for fracture of the radial head. 2. Colles' fracture. [**2158-9-11**] 3:57 PM L-SPINE (AP & LAT); T-SPINE IMPRESSION: 1. Loss of height in multiple midthoracic vertebral bodies and in the L1 vertebral body. These are of uncertain chronicity. 2. Grade I anterolisthesis of L4 on L5. 3. Diffuse demineralization. No acute fracture can be identified, noting that evaluation is limited in the presence of diffuse demineralization. [**2158-9-11**] 12:52 AM FEMUR (AP & LAT) BILAT There is a spiral fracture of the right distal femoral diaphysis extending to the supracondylar region. There is an oblique fracture of the distal left femur metaphysis. Neither of these fractures appear to extend intraarticularly. There is posterior displacement of the distal fracture fragments bilaterally. There is diffuse demineralization. Degenerative changes are seen in both knees. There is a dynamic compression screw in the proximal right femur with extensive foreshortening of the femoral neck region and associated heterotopic bone formation. A bipolar left hip prosthesis is present without evidence of fracture. [**2158-9-10**] 09:10PM BLOOD WBC-21.3* RBC-3.16* Hgb-9.9* Hct-29.0* MCV-92 MCH-31.5 MCHC-34.3 RDW-13.9 Plt Ct-360 [**2158-9-11**] 08:50AM BLOOD WBC-17.6* RBC-2.44* Hgb-7.7* Hct-23.4* MCV-96 MCH-31.7 MCHC-33.1 RDW-13.7 Plt Ct-329 [**2158-9-11**] 10:35PM BLOOD Hct-27.6* [**2158-9-12**] 01:59AM BLOOD WBC-15.6* RBC-3.24*# Hgb-10.2*# Hct-29.4* MCV-91 MCH-31.4 MCHC-34.5 RDW-15.3 Plt Ct-270 [**2158-9-12**] 03:47PM BLOOD WBC-14.0* RBC-3.22* Hgb-10.3* Hct-28.5* MCV-89 MCH-32.1* MCHC-36.3* RDW-15.6* Plt Ct-250 [**2158-9-13**] 05:27AM BLOOD WBC-11.7* RBC-3.21* Hgb-10.3* Hct-28.9* MCV-90 MCH-32.0 MCHC-35.5* RDW-15.2 Plt Ct-267 Brief Hospital Course: [**2158-9-10**]: X-ray studies revealed bilateral femur fx and left Colles' fx. CT of Abd/Pelvis also revealed obstructing 9mm ureteral stone on left with bilateral hydronephrosis. The pt was empirically started on Levofloxacin for treatment of presumed pyelonephritis. The pt was initially admitted to the TSICU because she was requiring Diltiazem IV for management of her rapid a fib. Vascular and Ortho services were also consulted for evaluation of the pt's injuries. Based on clinical exam, the pt's fractures did not compromise blood flow to the lower extremities. A confirmatory angiogram was deferred secondary to the risks of the procedures and the [**Hospital **] medical comorbidities. Close neurovascular surveillence of the pt's LE was continued throughout her hospital course and no changes were noted. Orthopedics performed a closed reduction of the pt's left Colles' fracture with good success. Her left forearm was then placed in a hard cast. Urology was also consulted for the pt's obstructing ureteral stone. Their decision to place a diverting percutaneous nephrostomy tube would be determined based on the pt's urine culture. [**2158-9-11**] to [**2158-9-15**]: The pt's C-spine was cleared after flex-ex films were obtained. T/L spine films revealed old compression fx. The pt's HCT dropped to 23 and she was transfused 2U PRBC. After clearance of the pt's C-spine, she was switched to PO meds and transferred to the hospital floor. Options for treatment of the pt's bilateral femur fx were discussed and the POA's decided on non-surgical management with casting under fluoroscopy. This was performed by orthopedics and the pt tolerated the procedure well. The pt's initial urine ctx came back with diffuse contamination. Urology decided to place a percutaneous nephrostomy tube due to the high likelihood of infxn. This was performed by interventional radiology on [**2158-9-14**]. After the procedure, the pt's foley remained in place and will be removed at the nursing care facility at the request of the pt's health care POA. She had no difficulty urinating and clear urine was draining from the tube. She was tolerating PO without difficulty and placed back on all of her home meds. The bilateral hinged casts on her LE fit well with no evidence of pain, swelling, or erythema of the skin or her toes. Physical therapy worked with the pt in house to facilitate her rehab. On [**2158-9-15**] the pt was discharged home to her previous rehab facility. She will be continued on PO antibiotics for five days after discharge. Medications on Admission: 1. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO QD (once a day). Disp:*60 Tablet(s)* Refills:*2* 2. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*120 Tablet(s)* Refills:*2* 3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO at bedtime. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Effexor 37.5 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 7. Isordil Titradose 40 mg Tablet Sig: 1.5 Tablets PO once a day. Disp:*45 Tablet(s)* Refills:*2* 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* Discharge Medications: 1. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO QD (once a day). Disp:*60 Tablet(s)* Refills:*2* 2. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*120 Tablet(s)* Refills:*2* 3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO at bedtime. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Effexor 37.5 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 7. Isordil Titradose 40 mg Tablet Sig: 1.5 Tablets PO once a day. Disp:*45 Tablet(s)* Refills:*2* 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 9. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: One (1) injection Subcutaneous QD (once a day) for 6 weeks. Disp:*30 injection* Refills:*2* 10. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Disp:*5 Tablet(s)* Refills:*0* 11. Acetaminophen-Codeine 300-30 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*90 Tablet(s)* Refills:*0* 12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**First Name4 (NamePattern1) 533**] [**Last Name (NamePattern1) **] for Extended Care - [**Location 1268**] Discharge Diagnosis: 1. Pyelonephritis 2. A fib 3. GERD 4. Degenerative joint disease 5. Bilateral hip replacement 6. Left Colles' fracture requiring reduction and casting 7. Spiral fracture of the right distal femoral diaphysis requiring reduction and casting 8. Oblique fracture of the distal left femur metaphysis requiring reduction and casting 9. HTN 10. Depression 11. Non-insulin dependent DM 12. Chronic venous stasis w/ hx of foot ulcers 13. Osteoporosis 14. Blood loss anemia requiring transfusion 2U PRBC 15. Obstructive nephrolithiasis requiring placement of percutaneous nephrostomy tube in the left ureter Discharge Condition: Stable Discharge Instructions: You may resume your regular diet. Continue physical therapy as tolerated to help improve your movement with the leg casts. Your weight bearing status is: non-weight bearing on bilateral lower extremities and non-weight bearing on left upper extremity. You will be on the Lovenox injections for anticoagulation for a total of six weeks. Please leave the foley catheter in place until arrival at the health care facility, then it may be removed. Followup Instructions: You should follow up with Dr. [**Last Name (STitle) **] in the [**Hospital **] clinic located in the [**Hospital Ward Name 23**] building on the [**Location (un) 1773**]. An appointment has been scheduled for you on [**10-20**] @ 9:10 AM. Please call ([**Telephone/Fax (1) 58144**] if you have any questions or need to change the appointment. Prior to this appointment, please obtain AP and Lateral x-rays of bilateral femurs and an x-ray of the pt's left wrist. Please have these transported with the pt on the day of the clinic appointment so Dr. [**Last Name (STitle) **] may see the films. Follow up with Dr. [**Last Name (STitle) 770**] of Urology in 4 weeks. Call ([**Telephone/Fax (1) 58145**] to schedule an appt. The clinic is located in the [**Hospital Ward Name 23**] building. If possible, you may want to schedule the appt for the same day as your orthopedic visit. ICD9 Codes: 2851
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Medical Text: Admission Date: [**2159-6-27**] Discharge Date: [**2159-7-24**] Date of Birth: [**2134-1-29**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5880**] Chief Complaint: s/p Motorcycle crash Major Surgical or Invasive Procedure: Exploratory Laparotomy [**2159-6-27**] Bialteral chest tubes Bronchoscopy [**2159-6-29**] [**2159-7-11**] Percutaneous tracheostomy [**2159-7-11**] History of Present Illness: 24 yo male helmeted driver, s/p motorcycle crash; ? LOC. Transported to [**Hospital1 18**] for continued trauma care. Past Medical History: Seizure Disorder Family History: Noncontributory Physical Exam: VS upon admission to trauma bay: HR 150's BP 60's RR 30 GCS 14 Gen: color ashened HEENT: EOMI, PERRL 3->2; TM's clear Neck: c-collar Chest: CTA bilat Cor: reg tachy Abd: soft, NT, ND FAST positive for fluid around liver Rectum: nl tone Back: no stepoffs Pertinent Results: [**2159-6-27**] 10:49PM TYPE-ART PO2-98 PCO2-75* PH-7.07* TOTAL CO2-23 BASE XS--10 [**2159-6-27**] 10:49PM GLUCOSE--251* LACTATE-7.8* NA+-138 K+-5.3 CL--103 [**2159-6-27**] 10:49PM HGB-13.2* calcHCT-40 O2 SAT-95 CARBOXYHB-1 MET HGB-1 [**2159-6-27**] 10:00PM PT-19.1* PTT-57.6* INR(PT)-1.8* CHEST (PORTABLE AP) [**2159-7-16**] 10:31 AM CHEST (PORTABLE AP) Reason: eval: R CT placement [**Hospital 93**] MEDICAL CONDITION: 25 year old man s/p R CT placement REASON FOR THIS EXAMINATION: eval: R CT placement EXAMINATION: AP CHEST 10:45 A.M., [**7-16**]. HISTORY: Chest tube placement. IMPRESSION: AP chest compared to [**7-10**] and 7: New right apical pleural tube. No pneumothorax. Decrease moderate size right pleural effusion. Left lung clear aside from mild vascular congestion. Heart is normal size. Widening of the upper mediastinum due to fat deposition and vascular engorgement. Nasogastric tube ends in the stomach. CT ABDOMEN W/CONTRAST [**2159-7-15**] 11:29 AM CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST Reason: eval for abcess, loculated fluid collection Field of view: 48 Contrast: OPTIRAY [**Hospital 93**] MEDICAL CONDITION: 25 year old man with s/p motorcycle accident, h/o chest tubes, s/p ex lap for liver lac, now with fevers REASON FOR THIS EXAMINATION: eval for abcess, loculated fluid collection CONTRAINDICATIONS for IV CONTRAST: None. 25-year-old male status post motorcycle accident with multiple fractures and hepatic lacerations, now with fever and concern for intra-abdominal abscess. COMPARISON: [**2159-7-3**]. TECHNIQUE: MDCT continuously acquired axial images of the chest, abdomen and pelvis were obtained after 130 mL Optiray IV as well as oral contrast. CT OF THE CHEST WITH IV CONTRAST: The tracheostomy remains in appropriate position. There has been interval removal of a right chest tube. A nasogastric tube terminates in the stomach. The heart and pericardium as well as aorta are unremarkable. There is no pathologic mediastinal, hilar or axillary lymphadenopathy. There has been interval worsening in a now very large right pleural effusion with associated total atelectasis of the right middle and lower lobes. There has been improvement in left basilar consolidation with residual patchy nodular opacities more peripherally, possibly representing areas of contusion. CT OF THE ABDOMEN WITH IV CONTRAST: Again demonstrated is extensive laceration of the right hepatic lobe, primarily segments V, VI and VII. This is not significantly changed. The gallbladder, pancreas, spleen, adrenal glands, kidneys, stomach, duodenum, and intra-abdominal loops of large and small bowel are unremarkable. The kidneys enhance and excrete contrast symmetrically, and the ureters are of normal caliber. There has been interval resolution of the small bowel obstruction, and there is free passage of oral contrast through to the ascending colon. There is a small amount of fluid along the inferior edge of the liver. There has been resolution of ascites seen previously to track into the pelvis. No intra-abdominal fluid collection or abscess is identified. CT OF THE PELVIS WITH IV CONTRAST: There is a Foley catheter within the decompressed urinary bladder. The rectum, prostate gland, seminal vesicles and intrapelvic loops of bowel are unremarkable. There is no significant free pelvic fluid or lymphadenopathy. BONE WINDOWS: Again demonstrated are multiple bilateral posterior rib fractures as well as fractures of the posterior spinous processes from T2 through T5 as well as the right scapula. IMPRESSION: 1. Interval worsening in now large right pleural effusion with associated total atelectasis of the right middle and lower lobes. 2. Improvement in left basilar consolidation with residual patchy nodular peripheral left lung opacities, probably representing contusion. 3. No significant change in right hepatic laceration. 4. Multiple fractures as previously described. 5. Near resolution of intra-abdominal free fluid with only a small amount of residual fluid along the inferior edge of the liver. PATIENT/TEST INFORMATION: Indication: Left ventricular function. Height: (in) 68 Weight (lb): 228 BSA (m2): 2.16 m2 BP (mm Hg): 106/67 HR (bpm): 116 Status: Inpatient Date/Time: [**2159-6-28**] at 15:36 Test: Portable TTE (Complete) Doppler: Full Doppler and color Doppler Contrast: None Tape Number: 2006W014-1:08 Test Location: West SICU/CTIC/VICU Technical Quality: Suboptimal REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] MEASUREMENTS: Left Atrium - Long Axis Dimension: 2.6 cm (nl <= 4.0 cm) Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm) Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 4.6 cm (nl <= 5.6 cm) Left Ventricle - Ejection Fraction: >= 55% (nl >=55%) Aorta - Valve Level: 3.3 cm (nl <= 3.6 cm) Aorta - Ascending: 3.2 cm (nl <= 3.4 cm) Aortic Valve - Peak Velocity: 1.0 m/sec (nl <= 2.0 m/sec) Mitral Valve - E Wave: 0.5 m/sec Mitral Valve - A Wave: 0.5 m/sec Mitral Valve - E/A Ratio: 1.00 Mitral Valve - E Wave Deceleration Time: 160 msec TR Gradient (+ RA = PASP): 25 mm Hg (nl <= 25 mm Hg) INTERPRETATION: Findings: LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size. Suboptimal technical quality, a focal LV wall motion abnormality cannot be fully excluded. Overall normal LVEF (>55%). No resting LVOT gradient. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic root diameter. Normal ascending aorta diameter. AORTIC VALVE: Aortic valve not well seen. No AS. No AR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. Normal tricuspid valve supporting structures. Normal PA systolic pressure. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Suboptimal image quality - poor echo windows. Suboptimal image quality - poor parasternal views. Suboptimal image quality - poor apical views. Suboptimal image quality - poor subcostal views. Suboptimal image quality - bandages, defibrillator pads or electrodes. Suboptimal image quality as the patient was difficult to position. Suboptimal image quality - ventilator. Conclusions: The left atrium is normal in size. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function appears grossly normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve is not well seen. There is no aortic valve stenosis. No aortic regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. CT T-SPINE W/O CONTRAST [**2159-6-28**] 5:02 PM CT T-SPINE W/O CONTRAST Reason: trauma [**Hospital 93**] MEDICAL CONDITION: 25 year old man with REASON FOR THIS EXAMINATION: trauma CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: 25-year-old man with trauma. TECHNIQUE: T-spine CT without contrast. No comparison. FINDINGS: There is no evidence of subluxation. The prevertebral soft tissue is unremarkable. Note is made of minimally displaced fracture of the spinous processes from T2-T5. Note is made of rib fractures bilaterally at T1, on the righta t T3-8, and possibly on the left at T8. Note is made of opacities in the lungs, which was described in detail in torso CT report. IMPRESSION: No subluxation. Minimally displaced fractures of the spinous processes of T2-T5. Multiple rib fractures. Please also refer to the official report of the CT torso study. Brief Hospital Course: Patient admitted to the trauma service. FAST exam positive in the emergency department; he was intubated and immediately taken to the operating room for exploratory lap, repair of liver laceration and placement of bilateral chest tubes for pulmonary contusions. His chest tubes were eventually removed; follow up chest xray after removal of right chest tube reveals tiny apical pneumothorax. Neurosurgery was consulted for ICP bolt placement given his mechanism of injury and decreased mental status; initial pressures were 28. The bolt was eventually removed several days later. Orthopedic spine surgery was consulted because of minimally displaced fractures of spinous processes T2-T5. he was treated non operatively for these injuries and was fitted for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 36323**] brace to be worn while out of bed. Infectious disease was consulted for persistent fevers; he was cultured; central line tip cultured as well; blood cultures grew out staph caog negative; catheter tip grew Acinetobacter and Klebsiella; sputum grew Klebsiella. He was treated with Vancomycin, which completed on [**7-23**]; Meropenem and Gentamicin, which will continue through [**7-31**] & Bactrim po, which will also continue through [**7-31**]. Speech and Swallow was consulted to evaluate swallowing and Passy Muir valve. He was eventually able to tolerate the PMV; his diet was upgraded to regular solids with thin liquids. His tracheostomy was downsized on HD #28 with the plan to follow up in Trauma Clinic in 1 week to decannulated. Physical and Occupational therapy have worked with patient throughout his hospital course; at time of discharge he is independent with ambulation and ADL's; will require some assistance for donning his [**Location (un) 36323**] brace. Medications on Admission: "Antiseizure" meds Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 2. Gentamicin 40 mg/mL Solution Sig: One (1) Injection Q 12 for 7 days: 250 mg. Disp:*24 * Refills:*0* 3. Meropenem 500 mg Recon Soln Sig: One (1) Recon Soln Intravenous Q6H (every 6 hours) for 7 days. Disp:*28 Recon Soln(s)* Refills:*0* 4. Bactrim 400-80 mg Tablet Sig: 1.5 Tablets PO three times a day for 7 days. Disp:*30 Tablet(s)* Refills:*0* 5. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: Two (2) Tablet PO every 6-8 hours as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 8. PICC PICC line care per protocol 9. Carbamazepine 100 mg Tablet, Chewable Sig: 1.5 Tablet, Chewables PO four times a day. Disp:*180 Tablet, Chewable(s)* Refills:*2* 10. Dulcolax 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO once a day as needed for constipation. Discharge Disposition: Home With Service Facility: Critical Care Systems Discharge Diagnosis: s/p Motorcycle crash Liver laceration Lung contusions Respiratory failure Right scapula fracture Spinous process fractures T2-T5 Bacteremia Multiple rib fractures Discharge Condition: Good Discharge Instructions: Return to the emergency department if you develop fevers, chills, headache, dizziness, increased shortness of breath, nausea, vomiting, diarrhea and/or any other symptoms that are concerning to you. You must continue to wear your brace when out of bed. Your antibiotics will continue until [**7-31**]. Followup Instructions: Follow up in Trauma Clinic in 2 weeks. Call [**Telephone/Fax (1) 6439**] for an appointment. Follow up with Dr. [**Last Name (STitle) 363**], Orthopedic Spine Surgery in 4 weeks, call [**Telephone/Fax (1) 3573**] for an appointment. Inform the office that you may need a repeat MRI scan for this appointment. Follow up with Dr. [**Last Name (STitle) **], Neurosurgery in 3 months, call [**Telephone/Fax (1) 1669**] for an appointment. Completed by:[**2159-7-31**] ICD9 Codes: 5185, 2851, 7907, 486
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Medical Text: Admission Date: [**2146-8-24**] Discharge Date: [**2146-8-30**] Service: [**Hospital 878**] HOSPITAL COURSE: This is an 88-year-old right-handed woman with past medical history of myocardial infarction, hypertension, atrial fibrillation, and poor medicine compliance, who was admitted on [**8-24**] after falling off her chair when trying to get up. She notes she had weakness on She was brought to the Emergency Room and was noted to have slurred speech with language intact. She had a right gaze preference, but no gaze paresis. She did not respond to visual threat on the left and had a flattened left nasolabial fold. She was inattentive to said stimuli. Upper and lower extremity strength was normal on the right and was 3+ to 4- and had an upgoing toe also on the left. Diffusion-weighted imaging at the time showed increased signal intensity in the left cerebellum and right hemisphere at MCH distribution, involving the basal ganglia, insula, and parotid lobe. She was treated with intra-arterial TPA by Dr. [**Last Name (STitle) 17302**], and Interventional Radiology team, and there was successful partial revascularization of the distal right MCA branch (M-II). She did well postoperatively, and began to regain strength on the left side. On the evening of [**8-25**], she developed a large groin hematoma that extended to her abdominal wall. Her hematocrit remained stable at 28.0 to 28.4, and CT scan of the abdomen and pelvis showed no retroperitoneal bleed. She was then transferred out of the Intensive Care Unit and onto the Neurology Service. Since transfer, she continued to recover function neurologically. She had been progressing well with physical therapy. She initially complained of bilateral leg pain that has since resolved. On Tele monitoring, she has been noted to have episodes of intermittent rapid atrial fibrillation. She is currently on metoprolol 25 mg [**Hospital1 **] for this. In regard there is anticoagulation for atrial fibrillation, Vascular Surgery recommended to wait one week prior to starting Coumadin. Her hematocrit was stable at 30.1 on the day of discharge. She will follow up with Dr. [**First Name (STitle) 1001**] in the Stroke/[**Hospital 878**] Clinic at [**Hospital1 69**] on [**9-13**] at 4 pm. Phone number [**Telephone/Fax (1) 17303**] at the [**Hospital Ward Name 23**] Clinical Center. MEDICATIONS: Protonix 40 mg po q day, aspirin 325 mg po q day, metoprolol 25 mg po bid, Tylenol 650 mg q4-6 hours prn for pain, Heparin 5,000 units subQ q12, Lasix 20 mg po q day, and Colace 100 mg po bid. DISCHARGE DIAGNOSES: 1. Right middle cerebral artery stroke. 2. Atrial fibrillation. 3. Right groin hematoma. 4. Hypertension. DISPOSITION: Rehab. Diet is cardiac. Condition is stable. Rehabilitation potential excellent. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 17304**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2146-10-12**] 11:27 T: [**2146-10-15**] 07:36 JOB#: [**Job Number 17305**] ICD9 Codes: 4280, 4019
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Medical Text: Admission Date: [**2176-2-27**] Discharge Date: [**2176-5-15**] Date of Birth: [**2115-11-10**] Sex: F Service: MEDICINE Allergies: Sulfa (Sulfonamides) / Penicillins / Latex / Red Dye / Darvon / Percodan / Aspirin / Aspartame / Fentanyl Attending:[**First Name3 (LF) 2565**] Chief Complaint: 10% blasts on routine differential Major Surgical or Invasive Procedure: Ommaya Placement with Intrathecal Chemotherapy Cycle 1 of hyperCVAD Right femeral a-line Right central line History of Present Illness: 60-year-old woman with a history of ALL status post allogeneic transplant with subsequent disease recurrence status post DLI with subsequent achievement of a complete remission p/w several non-spicific pain-related complaints and dizziness and 10% blasts on peripheral smear. Patient endorses dizziness, generalized pain with sharp, stabbing pain in her right mid-back and neck. Also endorses shortness of breath. She is unsure if it is exertional. . ROS: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Past Medical History: ONCOLOGIC HISTORY: The patient was diagnosed with acute lymphoblastic leukemia in [**2166**] after bone marrow biopsy was performed secondary to iron deficiency anemia workup. She was treated with standard dose chemotherapy and had a good response. She completed induction and consolidation chemotherapy and achieved a complete remission. Her course was complicated by severe bilateral avascular necroses of the hips due to steroid use. She also had multiple dental issues requiring extractions. [**Known firstname **] remained in remission for several months but ultimately showed signs of disease recurrence in her marrow. She underwent reinduction and achieved once again a complete remission. She did well until the summer of [**2168**] when she developed evidence of relapse. She received induction chemotherapy once again and achieved remission. This course was complicated by neutropenic fever, development of a coagulative negative staph bacteremia, left upper extremity DVT, aseptic necrosis of the bilateral hips, and septic emboli of the liver. [**Known firstname **] then underwent a nonmyeloablative allogeneic stem cell transplant from matched unrelated donor with Campath conditioning in [**2169-11-29**]. She did well and subsequently achieved remission. Her posttransplant course was complicated by the development of a sore throat and question of low level EBV infection. There was some concern at that time by involvement with a lymphoproliferative disease. Her EBV titer disappeared upon withdrawal of her cyclosporine. She was followed by quantitative EBV levels, which remained undetectable, and she had fully recovered from this. She had no definite evidence for GVHD. She remained in remission until her relapse in 10/[**2170**]. . Since her relapse in [**8-/2171**], [**Known firstname **] received treatment with hyper-CVAD in [**9-/2171**] and a donor lymphocyte infusion on [**2171-11-5**]. She was again noted for relapse of her ALL in [**12/2171**] and was admitted to the hospital from [**2172-1-7**] to [**2172-2-26**]. She had persistent pain in the perirectal area with incontinence and was found to have CNS involvement of the cauda equina and received radiation therapy to her lower spine in 02/[**2171**]. She then received another cycle of hyper-CVAD in [**1-/2172**] following the completion of her radiation therapy. Her day 14 bone marrow showed no residual leukemia and she received another DLI on [**2172-2-18**]. She also received two doses of intrathecal methotrexate on [**2172-2-25**] and [**2172-3-19**]. Unfortunately, by the end of [**2-/2172**], she was noted for decreasing counts and was admitted with concern for relapsed disease, which was confirmed on bone marrow aspirate and biopsy. Because of her debilitated state, [**Known firstname **] was not given any further treatment and she was sent home with increased support and to follow up with her local oncologist with a concern that her disease would relapse or progress further. However, since her discharge from the hospital in [**3-/2172**], [**Known firstname **] improved with normalization of her counts and no further evidence for disease recurrence. She has required no further treatment, but has had many chronic complications. She developed increasing problems with [**Name2 (NI) 7809**] with constipation and intermittent diarrhea, as well as increasing pain in the rectal area, as well as increasing pelvic and hip pain. There have been no changes with MRI of the lower spine. The feeling was that she developed issues with anal stricture after her cauda equina syndrome and radiation therapy along with a neurogenic rectum that did not empty fully. After approximately two years of significant stress with her bowel regimen and attempts at anal dilatation, she underwent a diverting sigmoid colostomy in [**11/2173**] under the direction of Dr. [**Last Name (STitle) 1120**] at [**Hospital1 18**]. She also has had issues of chronic hip pain due to osteonecrosis of the hip and she is status post left hip replacement. In [**Month (only) 958**]/[**2175-2-28**], [**Known firstname **] was noted for increasing shortness of breath. She underwent an echocardiogram, which was noted for a drop in her ejection fraction to 35-40%. She has been started on captopril. She underwent an adenosine stress test, which did not show any evidence for coronary artery disease. It was felt that this may have been related to a viral illness. She did undergo a repeat echocardiogram on [**2175-6-12**], which showed improvement to about 40%. [**Known firstname **] has been followed with continued normal counts until more recently when labs from an outside hospital have shown increased lymphocytes with atypical lymphocytes and decreasing neutrophils with ANC of 700. There were no immature cells noted and white count, hematocrit and platelet count were normal. She had been recovering from two upper respiratory infections. Given the persistent change in her counts, [**Known firstname **] was seen today for further evaluation and was noted for 10% circulating blasts. She underwent bone marrow aspirate and biopsy and is being admitted for further evaluation and probable treatment. . PAST MEDICAL HISTORY: ALL, juvenile rheumatoid arthritis, h/o paroxysmal supraventricular tachucardia and paroxysmal atrial tachycardia, h/o of laryngeal spasm, irritable bowel syndrome w colostomy placed for chronic constipation,avascular necrosis of the hips in the left shoulder and s/p left hip replacement, left upper extremity clot, Sjogren's, Shingles (Spring [**2174**]), systolic CHF (EF in the 30s per patient) Social History: Mrs. [**Known lastname 11513**] lives alone in her own home. She has a personal home care assistant that helps with her cooking, cleaning, and personal hygiene. She also is followed closely by the Visiting Nurses Association and Physical Therapy. She denies alcohol or tobacco use. She reportedly has a remote history of marijuana use. She has three children. Family History: [**Name (NI) 1094**] mother died [**2172-3-7**] of lung cancer with brain mets at 80y/o. Also had gallstones and hypothyroidism. The patient's father had prostate cancer, hypertension, and diabetes. At least one of her paternal aunts had breast cancer, and another had multiple myeloma. One of the patient's paternal cousins has leukemia. The patient's aunt has scleroderma. Physical Exam: Vital Signs: T: 98.4 BP: 124/78 HR: 86 RR: 16 O2 sat: 95% RA Weight: 137.9 lbs Height: 60.5 in General: Alert, oriented, no acute distress, chronically ill appearing HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, 1cm nontender, mobile L maxillary LN Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CN 2-12 grossly intact. Unsteady gait. Pertinent Results: [**2176-2-27**] 12:10PM RET AUT-0.2* PLT SMR-NORMAL PLT COUNT-224 [**2176-2-27**] 12:10PM HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-1+ MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL HOW-JOL-1+ NEUTS-25* BANDS-0 LYMPHS-58* MONOS-4 EOS-0 BASOS-0 ATYPS-3* METAS-0 MYELOS-0 OTHER-10* WBC-3.7*# RBC-4.17* HGB-13.4 HCT-39.3 MCV-94 MCH-32.1* MCHC-34.1 RDW-15.8* [**2176-2-27**] 12:10PM T4-9.4 TSH-11* [**2176-2-27**] 12:10PM ALT(SGPT)-44* AST(SGOT)-42* LD(LDH)-209 ALK PHOS-109 TOT BILI-0.2 DIR BILI-0.1 INDIR BIL-0.1 ALBUMIN-4.3 CALCIUM-9.3 PHOSPHATE-4.4 MAGNESIUM-2.0 UREA N-22* CREAT-0.8 SODIUM-137 POTASSIUM-5.1 CHLORIDE-100 TOTAL CO2-32 ANION GAP-10 GLUCOSE-86 [**2176-2-27**] 03:12PM BONE MARROW IPT-D CD34-D CD3-D CD4-D CD8-D CD33-D CD41-D CD56-D CD64-D CD71-D CD117-D CD45-D HLA-DR[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 31151**] A-D KAPPA-D CD2-D CD7-D CD10-D CD11C-D CD13-D CD14-D CD15-D CD19-D CD20-D LAMBDA-D CD5-D IMAGING AND DIAGNOSTICS: Bone Marrow [**2-27**]: ACUTE LEUKEMIA, RECURRENT. By immunostaining most immature (blasts) cells appear immunoreactive for CD34 and c-kit. A subset is in addition positive for nuclear TDT. Myeloperoxidase stains only approximately 20% of the cells. Immunophenotypic findings consistent with relapsed acute leukemia. KARYOTYPE: 46,XX[17]//46,XY[3] INTERPRETATION: A chimerism result was obtained from this unstimulated specimen. Three cells were 46,XY and represent the male bone marrow donor. The remaining 17 cells were 46,XX and represent the female patient. nuc ish(DXZ1x2)[89]//(DXZ1,DYZ3)x1[111] FISH was performed on interphase nuclei with probes ([**Doctor Last Name 7594**] Molecular) for DXZ1 (chromosome X alpha satellite DNA) at Xp11.1-q11.1 and DYZ3 (chromosome Y alpha satellite DNA) at Yp11.1-q11.1 probes. A chimeric XX/XY hybridization pattern was observed, in which 89 cells were XX and 111 cells were XY. These XY cells represent that of the male donor and not the female recipient. MR [**Name13 (STitle) 430**] [**2-28**]: 1. No masses, edema or infarct. 2. Nonspecific heterogeneous marrow which may represent hyperplasia or infiltration. CSF [**2-29**]: Immunophenotypic findings consistent with involvement by acute leukemia. CSF [**3-7**]: There is a minor population of CD34+ cells, which in conjunction with the morphology on the cytospin, are consistent with the patient's known leukemia. CSF [**3-9**]: ATYPICAL. CSF [**3-12**]: Cell marker analysis was performed, but was non-diagnostic in this case due to insufficient numbers of cells/insufficient amount of tissue for analysis and due to poor viability; however, morphologic assessment of the cytospin showed numerous blasts consistent with patient's known leukemia. TTE [**3-1**]: The left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. There is mild global left ventricular hypokinesis (LVEF = 50%). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] Right ventricular chamber size and free wall motion are normal. The number of aortic valve leaflets cannot be determined. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. IMPRESSION: Mild global left ventricular systolic dysfunction. Moderate mitral regurgitation. Compared with the report of the prior study (images unavailable for review) of [**2172-4-1**], left ventricular systolic function is probably similar. Mitral regurgitation may have slightly increased. MR C/T/L spine [**3-1**]: 1. Diffuse leptomeningeal and cauda equina root enhancement, in this setting strongly suspicious for leptomeningeal involvement by the patient's known ALL. 2. No discrete enhancing epidural or other paraspinal soft tissue mass. 3. Diffusely abnormal bone marrow signal, consistent with extensive replacement by known recurrent ALL. 4. No spinal canal stenosis. MICRO: CMV Viral Load (Final [**2176-2-28**]): CMV DNA not detected. CSF GRAM STAIN (Final [**2176-3-8**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2176-3-11**]): SPECIMEN NO GROWTH ON REPLANT. CLOSTRIDIUM PERFRINGENS. Isolated from broth media only, INDICATING VERY LOW NUMBERS OF ORGANISMS. STAPHYLOCOCCUS, COAGULASE NEGATIVE. Isolated from broth media only, INDICATING VERY LOW NUMBERS OF ORGANISMS. *****This was thought to be a contaminated specimen.************ Brief Hospital Course: 60 YO F with recurrent ALL status-post non-myeloablative allogeneic matched transplant from an unrelated donor in [**11/2169**] with relapse treated w chemo and DLI in [**8-/2171**] and 03/[**2171**]. #. ALL: The patient was found to have recurrent bone marrow as well as CNS disease after presenting with dizziness. After C/T/L spine imaging, the patient's CSF was sampled and she was given IT MTX through an Ommaya biweekly for 2 weeks after her CSF cleared on [**2176-4-1**]. The was then treated on a weekly basis starting on XXXX. The patient was unable to tolerate AraC due to severe nausea and vomiting. After one treatment with Ara-C, the patient instead recevied intra-thecal methotrexate approximately twice per week. Her CSF remained positive for blasts until tap on [**2176-4-1**]. She also received a cycle of HyperCVAD. She received part A as well as dexamethasone on D11-14 but vincristine was not given on D11 due to poor ostomy output and concern for further ileus. Peripheral blood smears showed resolution of peripheral blasts after 1-2 days of systemic chemotherapy. Her course was complicated by mucositis, poorly healing aphthous ulcers and poor po intake secondary to pain, which complicated healing and cause electrolyte abnormalities requiring significant repletion. She was changed from oral pain medication to a low dose morphine PCA with good effect. She was also started on TPN for nutrition and her electrolytes abnormalities resolved. #. History of anthracycline-induced cardiomyopathy: Repeat TTE showed improvement in EF from 35% in the past to 50% on [**3-1**]. The patient became quite hypervolemic during hyperCVAD part A and required aggressive diuresis. Her home captopril was switched to lisinopril. She was started on low dose maintenance lasix. An attempt was made to start the patient on a low dose beta-blocker as well but she developed an episode of fluid-responsive hypotension most likely due to the addition of multiple anti-hypertensive medications so beta-blockade could not be initiated. She was intermittently able to tolerate low dose lisinopril and lasix 20mg PO with maintenance of euvolemia, they were occasionally held in setting of low blood pressures. She was intermittently hypotensive in the setting of poor po intake as above. Repeat echo on [**2176-3-27**] showed ER 40-45%, essentially unchanged from prior. #. Hypothyroidism. Patient was maintained on home dose levothyroxine which she intermittently agreed to take. TSH was elevated upon admission although free T4 was within normal limits. The patient was encouraged to continue to take her medications in order to prevent symptomatic hypothyroidism. ================================== #. MICU course #1 ([**Date range (1) 31152**]): Overnight [**4-13**], Ms. [**Known lastname 11513**] became increasingly tachypneic and tachycardic and was transferred to the [**Hospital Unit Name 153**]. Her Omaya port was tapped and she was found to have infection in her CSF which later speciated as VRE. Her antibiotics were changed to linezolid and vancomycin for improved CSF penetration. #. Code blue event: On [**4-14**], Ms. [**Known lastname 11513**] developed a supraventricular tachycardia at ~170-180 bpm, with tenuous blood pressures. ECG was performed, and no obvious p-waves were noted. She was noted to have a history of SVT/atrial tachycardia in the past. 5mg IV metoprolol were given without change in rate; the metoprolol was repeated x 1, again with no change in rate. Given her tenuous clinical status, respiratory alkalosis, and tachypnea, 15mg diltiazem was given x 1 with resulting improvement in her rate to the 70's. Her blood pressure at that time was in the 70's systolic, and normal saline was hung wide open. There was difficulty obtaining [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1131**] on the non-invasive blood pressure [**Last Name (LF) **], [**First Name3 (LF) **] phenylephrine was initiated to bring up the blood pressure. . Given the difficulty in obtaining an accurate blood pressure, several ([**6-5**]) attempts were made to place a radial arterial line to obtain arterial blood pressure. During these attempts, her blood pressure ranged from 70-170 systolic (depending on the rate of phenylephrine infusion). She continued to be tachypneic, breathing at a rate of 40-50 breaths per minute. At 0121, her heart rate was noted to decline, and asystole was subsequently noted. A code was called. Within approximately 15 seconds, chest compressions were initiated. 1mg atropine was given, followed by 1mg epinephrine. After one cycle of CPR, she remained pulseless. She was successfully intubated by anesthesia. ABG during code was 6.82/37/315/7. CPR was continued. She received another 1mg epinephrine, followed by 1mg atropine. She was subsequently given 1 amp of CaCl2, 20 units of vasopressin, and another amp of CaCl2, with return of spontaneous circulation. Please see code sheet for further details. The theory behind her cardiac arrest is calcium channel blocker poisoning from diltiazem given in the setting of hypocalcemia and alkalemia; thus she regained her pulse after admininstering calcium chloride. She was given 2 amps of calcium chloride after return of circulation and 4 grams of calcium gluconate. She was given 5mg glucagon for possible beta blocker toxicity and to increase cyclic AMP in the setting of calcium channel toxicity. She had no further episodes of bradycardia. Several physicians attempted to place an arterial line after the code without success. A repeat ABG was 7.09/27/87/9 on FiO2 100%, PEEP 10, rate ~30, Tv 560. Further MICU #1 ([**Date range (1) 31152**]) course: # VRE in CNS: Blood cx negative since [**4-11**], but now enterococcus in CSF, presumably the same bacteria. Omaya port which was seeded has now been removed. Daptomycin was switched to linezolid for better CSF penetration, although linezolid will cause BM suppression. Gentamicin for synergy initially, later stopped. TTE was negative for vegetation [**4-15**], but given new finding of likely VRE in CSF, suspicion is high for endocarditis. Would need 8 weeks of abx if vegetation present vs 4 week if only CNS infection s/p source removal. Meropenem was discontinued given low suspicion for gram negative process. TEE would not affect immediate mgt and was thus not pursued in [**Hospital Unit Name 153**] as she had just been extubated. ID consult is following. . # HYPOTENSION: Patient had an episode of SBP 80s, did not respond to 750 cc bolus so far. Lactate also elevated, likely secondary to poor perfusion. Differential includes sepsis, and her new leukocytosis would go along with this (although she is not neutropenic, on very broad abx coverage, and blood cx repeatedly negative). Also on the differential are cardiogenic shock (EF recently 20% in the post-arrest period), volume depletion, adrenal insufficiency, CNS etiology, PE (but not hypoxic nor impressively more tachycardic). She required levophed for 1 day. [**Last Name (un) **] stim did not show evidence of adrenal insufficiency and infectious work-up was negative. BP improved. # ALTERED MENTAL STATUS: Mental status changes likely multifactorial including recent SDH, prolonged asystolic arrest, CNS infection, possible recurrent CNS lymphoma. Improved over 4 days from not alert at all despite no sedation to alert and interactive. She was extubated when neuro status had improved. . # ALL: Neupogen was continued initially and thought o be responsible for her bump in WBC. s/p hyper-CVAD. She is also s/p intrathecal MTX and DLI this admission. Per BMT, will need further treatment for CNS lymphoma in the future. . # RESPIRATORY FAILURE: Intubated in the setting of cardiac arrest, with ongoing primary metabolic alkalosis. Cause is most likely intracranial process (ongoing infection, recent surgery). PE was on the differential but LENIs negative; unable to do CTA [**1-1**] contrast allergy. There is some concern for the risk of seizure with alkalemia, but we are not able to give opiates to depress her respiratory drive because of hypotension. Respiratory alkalosis improved. Her neurologic status also improved such that she was extubated without difficulty 4 days after the arrest event. # LEUKOCYTOSIS: Most likely secondary to counts recovering after chemo (many immature forms), however very sharp bump today is also concerning for an infectious etiology. She has been afebrile since her evacuation procedure and is on very broad coverage as above. Will work-up for infectious cause as above. . # RASH: Concerning for a drug allergy. After discussion with ID, meropenem is a likely culprit. Although it has been on for a month, it is possible to develop a new rash after this time. Would also be concerned that linezolid could be contributing, since this was recently started, although this drug is much less likely to cause rash. Rash improved after stopping meropenem. . # ELEVATED LIVER ENZYMES: consistent with shock liver. Now downtrending. INR climbing, which may be secondary to synthetic dysfunction after hepatic injury. . # S/P ASYSTOLIC ARREST: likely was secondary to CCB in the setting of a heart compromised by prior cardiotoxic chemotherapy. Recent echo showed significant interval worsening of EF (40%-->20%) over the past 2 weeks without any focal wall motion abnormalities. Nodal agents were avoided and electrolytes repleted with particular attention to calcium. She will need a repeat echo in [**3-4**] weeks. . # Isolated elevation in PTT: Repeating, this is likely a spurious value, but if it remains high, would pursue mixing studies to eval for acquired coagulopathy. . # MICU Course #2 ([**Date range (1) 31153**]): . # RESPIRATORY DISTRESS: Unclear etiology - ? [**1-1**] flash pulmonary edema from cardiogenic shock given elevated troponins. On [**4-25**], her BMT intern found her to be in respiratory distress, tachypneic and hypoxic. She was able to maintain adequate O2 saturation on a non-rebreather but was working hard and looked to likely be tiring. She was transferred to the [**Hospital Unit Name 153**] and intubated. She required dobutamine and norepinephrine support for possible cardiogenic shock. Pt diuresed and eventually weaned off mechanical ventilation. On transfer to the floor, pt is comfortable at 100% on 3L by NC. Speech and swallow evaluation recommended dysphagic diet, 1:1 observation. . # HYPONATREMIA: Until [**4-23**] the patient had serum sodiums in the range of 135-137. Her sodium declined to 125-127 until [**4-27**] when it began to further deline now to a nadir of 115. Urine osms suggested SIADH, thought to be secondary to her recent known intracranial empyema vs pulmonary processes. A medication effect from rarely (<1%) micafungin or atovaquone (7-10%) is also possible. She also likely has a component of heart failure and lasix-associated exacerbation which are also contributing. She received hypertonic saline w correction of Na to 125. On transfer to the floor pt is started on salt tabs. . # VRE infection w CNS involvement, s/p Omaya removal: ID continued to follow her, linezolid was continued. There were no further positive cultures. Micafungin stopped on transfer to floor per ID. . # ANEMIA: received 2pRBCs w lasix in between to transfuse to Hct > 25. Transferred temporarily to MICU on [**5-4**] after episode of vtach likely in the setting of baseline heart disease and low K, Mg. Vtach resulted in decreased peripheral perfusion w elevated lactate and demand ischemia. Temporarily on amiodarone drip, but became bradycardic, so stopped. Treated temporarily w abx for possible septic infxn, but discontinued as no evidence of active infection. Did continue linezolid for prior VRE bacteremia. Pt improved to baseline by morning and transferred back to BMT. . FLOOR: Since arriving back on the floor, pt has required 500 cc bolus of IVFs for hypotension and then this afternoon found to be more tachypneic. Initial ABG 7.26/12/86/6 and written for ativan prn for anxiety. However, upon reeval, pt still tachypneic and appeared to be tiring. Respiratory code called, pt intubated by anesthesia and transferred to [**Hospital Unit Name 153**]. Pt transferred for acute respiratory failure (s/p intubation on [**5-6**]), thought to be [**1-1**] shock - cardiogenic vs septic vs combination. Cardiogenic shock [**1-1**] acute on chronic CHF from chemo (repeat TTE showed LVEF 25%). Sepsis [**1-1**] prior VRE infection (L femoral TLC still in on transfer, as pt has difficult access) vs Klebsiella PNA (based on sputum cx). L femoral TLC d/c'd on [**5-7**], new L femoral aline and R femoral venous TLC placed. Elevated lactate to 14 on transfer [**1-1**] hypoperfusion from shock, though ddx included linezolid side effect vs nutritional (thiamine deficiency), so linezolid switched to daptomycin and thiamine administered. Continued broad antimicrobial coverage: meropenem x 7 days ([**5-6**] - [**2176-5-12**]), daptomycin x 7days ([**5-7**] -[**2176-5-13**]), ciprofloxacin (5 days total), atovaqone, acyclovir. Monitored CO, CI and hemodynamics w vigileo system. Patient extubated on [**5-10**]. Diuresed as tolerated by blood pressure with lasix 40mg IV x 1 daily (required one dose albumin for support). Blood, urine and sputum culture negative. She was transitioned to tube feeds. Video swallow study was deferred as patient was too weak and sleepy to cooperate. Transferred to floor on [**5-15**] in AM. Patient had been called out to the floor earlier in the AM, but respiratory status declined over a period of hours within arriving to the floor. Code blue was called for increased work of breathing. Patient intubated and immediately required initiation of pressors. Upon arrival to the [**Hospital Unit Name 153**], SBPs in 60-70s in spite of being maxed out on 1 pressor and she was noted to be very cold in her extremities. Stat labs notable for worsening anion gap metabolic acidosis. Patient given stress dose steroids, broad spectrum antibiotics, started and quickly maxed out on 3 pressors, bedside TTE revealed no significant pericardial effusion, and pt given several amps of HCO3. During this time, the pt's pulse was maintained and chest compressions were not required. Stat aline was placed in sterile conditions in R femoral and ABG obtained revealed 7.05/33/34/10 with lactate 8.5. Given profound hypoxemia, SBPs in 60s in spite of being maxed out on 3 pressors, pt's son was called who agreed with withdrawing care. Pressors were turned off and pt's BPs decreased to 30/10s; however, she did not expire until ETT was removed several hours later. Son declined autopsy. Medications on Admission: ativan 1mg q6 PO prn captopril 6.25 po BID synthroid 100mcg daily oxycodone 5-10mg QID prn benadryl topical ointment for pruritis artificial tears Discharge Medications: n/a Discharge Disposition: Expired Discharge Diagnosis: Expired Primary: Recurrent Acute Lymphoblastic Leukemia with CNS involvement Cardiopulmonary Arrest Secondary: Acute on Chronic Systolic Anthracycline-Induced Congestive Heart Failure Hypertension Discharge Condition: Expired. Discharge Instructions: n/a Followup Instructions: n/a Completed by:[**2176-5-18**] ICD9 Codes: 2761, 4275, 4280, 2449, 4019
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Medical Text: Admission Date: [**2121-3-28**] Discharge Date: [**2121-3-30**] Date of Birth: [**2069-1-17**] Sex: F Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 14802**] Chief Complaint: new onset seizure Major Surgical or Invasive Procedure: L craniotomy for resection of meningioma History of Present Illness: She is a 52-year-old right-handed woman with multiple medical problems who last week suffered her first ever seizures. Both of these lasted relatively short periods of time. The first of these episodes sounds as if it was psychomotor in nature but during the second episode, the patient states she was fully awake but unable to speak. The patient was brought to an outside hospital where her Lamictal was increased. She has been previously taking Lamictal (to stabilize her mood), the patient was sent for imaging which reveals a left-sided meningoma along the convexity in the region of the primary motor cortex. The patient presents today to be evaluated for this lesion. Aside from these two seizures, the patient denies new weakness, nausea or vomiting. The patient has a history of chronic headache but she does not feel her headaches have changed in any way. She has had no further seizures since the two episodes that occurred last week. Past Medical History: headache, bipolar disease, hypothyroism, LBP Social History: The patient received an associate's degree. She is married and has two children. She does not smoke and she drinks alcohol rarely. Family History: NC Physical Exam: On ADmission: The patient is a normally developed woman who appears her stated age. She is alert and oriented toall spheres. Her expressive and receptive language functions arenormal. Pupils are equal and reactive to light. Her extraocular movements are full. Her face is symmetric. Her tongue and palate are midline. Her motor tone and bulk are normal. Her strength is [**4-19**] throughout. There is no upper extremity drift. The patient ambulates on a narrow base. She can turn on a dime. Romberg is negative. Sensory exam is grossly intact. Coordination is normal and toes are downgoing. The patient has perhaps brisk knee reflexes on the right compared to the left. On discharge: Pertinent Results: Review of the patient's MRI does indeed reveal a contrast enhancing mass along the convexity in the region of the primary motor cortex. This lesion is consistent with a meningoma. There is underlying cerebral edema associated with this lesion. There is some modest local mass affect but no shift of midline. Lesion comes close to but does not seem to invade the superior sagittal sinus Brief Hospital Course: 52 y/o F with new onset of seizures presents with L frontal meningioma. She was taken to the OR on [**3-28**] for elective L craniotomy for resection of meningioma. OR course was uncomplicated and she was transferred to the ICU for monitoring. She remained neurologically and hemodynamically stable. She had post-op MRI which showed no residual tumor. Activity and diet were advanced. She transferred to the floor. On POD #2 she was tolerating a regular diet, ambulating without difficulty. Her dressing was removed and her incision was clean and dry. She has requested to be discharged home, she will follow up in the brain tumor clinic to have sutures removed. Medications on Admission: aspirin, lithium, Caltrate, meloxicam, Synthroid, Topamax, Lamictal, Percocet and OxyContin Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): Use while on Oxycodone. Disp:*40 Capsule(s)* Refills:*0* 2. lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. lamotrigine 100 mg Tablet Sig: One (1) Tablet PO QPM (once a day (in the evening)). 4. levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. lithium carbonate 150 mg Capsule Sig: Four (4) Capsule PO QAM (once a day (in the morning)). 6. lithium carbonate 150 mg Capsule Sig: Three (3) Capsule PO QPM (once a day (in the evening)). 7. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 8. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): Use while on decadron. Disp:*8 Tablet(s)* Refills:*0* 9. topiramate 100 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 10. oxycodone 20 mg Tablet Extended Release 12 hr Sig: Two (2) Tablet Extended Release 12 hr PO Q8H (every 8 hours). 11. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for breakthrough pain. Disp:*40 Tablet(s)* Refills:*0* 12. dexamethasone 1 mg Tablet Sig: 2mg tid X 24 hour; 1mg tid X 24 hours; 1mg [**Hospital1 **] X24 hours; then 1mg PO X1 then stop Tablets PO per wean for 4 days. Disp:*9 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: L frontal meningioma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: ?????? Have a friend/family member check your incision daily for signs of infection. ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? You may wash your hair only after sutures and/or staples have been removed. ?????? You may shower before this time using a shower cap to cover your head. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. ?????? ?????? Clearance to drive and return to work will be addressed at your post-operative office visit. ?????? Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? Fever greater than or equal to 101?????? F. Followup Instructions: Follow-Up Appointment Instructions ??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**2121-4-7**] @ 10:30AM . The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 516**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone number is [**Telephone/Fax (1) 1844**]. Please call if you need to change your appointment, or require additional directions. Completed by:[**2121-3-30**] ICD9 Codes: 2449
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Medical Text: Admission Date: [**2151-4-14**] Discharge Date: [**2151-4-18**] Service: SICU CHIEF COMPLAINT: Transferred from outside hospital for a bronchoscopy by family wishes. HISTORY OF THE PRESENT ILLNESS: The patient is an 81-year-old man with a past medical history significant for hypertension, COPD, status post multiple hospitalizations for this in the recent few months, new onset atrial fibrillation, alcohol abuse, moderate aortic stenosis, who presented to [**Hospital3 **] on [**2151-3-23**] with a COPD flare after being discharged two weeks prior with a COPD flare. At that time, the patient's symptoms were cough, productive yellow sputum, fever, chills, and difficulty breathing. In the Emergency Room, at the outside hospital, chest x-ray showed acute infiltrate superimposed on chronic right middle lobe infiltrate. One month prior to admission, a right pleural based mass was seen. He had a repeat CAT scan on admission at [**Hospital3 **] with an increase in size of mass. The patient was initially treated with Levaquin for community-acquired pneumonia as well as steroids for a COPD exacerbation; however, he grew MRSA in his sputum culture on [**2151-4-12**]. He was started on vancomycin at that time. In addition, he had new onset atrial fibrillation with rapid ventricular response that was treated with Diltiazem and then loaded with Amiodarone. This led to a likely rate-induced ischemia with peak troponin I to 0.54. The patient was given Lovenox to a Coumadin bridge. Of note, he had Guaiac positive diarrhea two days after admission prior to starting anticoagulation. He was treated with 2 units of packed red blood cells on [**2151-4-10**] for a hematocrit of 26.6 down from 36 on [**2151-4-6**]. There were no further Guaiac stools at that time. On [**2151-4-12**], he had an episode of hypoxia with P02 66.8, PC02 58, saturating 92% on a nonrebreather mask. He was then transferred to the [**Hospital1 18**] for further evaluation of his hypoxia and questionable lung mass. PAST MEDICAL HISTORY: 1. Hypertension. 2. COPD, status post multiple hospitalizations and flares. 3. Alcohol abuse. 4. Moderate aortic stenosis with a reported valve area of 0.9. 5. New onset atrial fibrillation. 6. MRSA pneumonia, as described in HPI. 7. Questionable right lower lobe mass versus round atelectasis. 8. Questionable IBD. ALLERGIES: The patient has no known drug allergies. MEDICATIONS ON TRANSFER: 1. Coumadin 5 mg q.h.s. 2. Amiodarone 200 mg p.o. b.i.d. 3. Zantac 150 mg p.o. b.i.d. 4. Multivitamin. 5. Rifampin 600 mg q.d. 6. Vancomycin 1 gram IV q.d., day number one is approximately [**2151-4-12**]. 7. Zovirax 400 mg p.o. t.i.d. 8. Lovenox 60 mg subcutaneously b.i.d. SOCIAL HISTORY: The patient smoked for 45 years, two packs per day. He also has a history of asbestos exposure. FAMILY HISTORY: Noncontributory. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Temperature 100.3, pulse 73, blood pressure 180/60, respirations 21, 93% on a 50% face mask. General: The patient was in no acute distress, speaking in full sentences. HEENT: Significant for a lesion in the middle of his upper lip that had irregular borders, nontender. Cardiovascular: Regular rate and rhythm with a III/VI holosystolic murmur at the left sternal border heard throughout the precordium. Pulmonary: Poor inspiratory effort, wheezes bilaterally, crackles one-third of the way up bilaterally. Abdomen: Soft, nontender with active bowel sounds, right lower quadrant scar from appendectomy. Extremities: No cyanosis or clubbing, [**2-23**]+ edema to the mid thigh bilaterally, small weeping ulcer on left lower extremity. Neurologic: Intact. LABORATORY/RADIOLOGIC DATA: On admission, white blood cell count 8.1, hematocrit 33.8, platelets 224,000, MCV 87. Chemistries within normal limits. INR 1.6. Chest x-ray showed a right middle lobe and right lower lobe opacity. HOSPITAL COURSE: 1. HYPOXIA: The patient's hypoxia was felt to be multifactorial given the patient's history of congestive heart failure, COPD, recent rapid atrial fibrillation, and multilobar MRSA pneumonia. For the patient's COPD, he was continued on nebulizer treatments. He had completed a full course of steroids at [**Hospital3 **] prior to transfer and thus the patient was not started on IV steroid therapy. It was felt that he was not in acute flare during his ICU course. For the patient's congestive heart failure, he was gently diuresed in the setting of his aortic stenosis. An echocardiogram was obtained which showed an ejection fraction of greater than 55%, pulmonary artery pressure of 20 mmHg, mild symmetric left ventricular hypertrophy, mild 1+ aortic regurgitation, and moderate aortic stenosis with mild dilation of the ascending aorta. The patient's oxygen requirement decreased with continued diuresis. The patient was very responsive to small doses of IV Lasix and was negative daily. The patient was also continued on treatment of his multilobar pneumonia with IV vancomycin at 1 gram q. 12. The patient also had a CAT scan to follow-up on history of lung mass and asbestos exposure. CAT scan showed no pleural mass but loculated fluid in the minor fissure that is somewhat mass-like in appearance. There were emphysematous changes. There was also bilateral air space opacities in the mid lower lungs, right greater than left with some nodular appearance. There were multiple sites of mediastinal lymphadenopathy and bilateral calcified plaques consistent with asbestos exposure. A follow-up CAT scan in three months is recommended. An abdominal aortic aneurysm was also noted infrarenally at 3.7 cm. The patient's hypoxia continued to improve and on the day of transfer to the floor, he was on [**4-27**] liters of nasal cannula with saturations greater than 93%. 2. METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS PNEUMONIA: The patient began vancomycin therapy at approximately [**2151-4-12**], however, it is difficult to decipher in the transfer summary from [**Hospital3 **]. It was decided that the patient would have a 14 day course of IV antibiotics and thus a request for a PICC line was placed prior to transfer to the floor. The patient remained afebrile during this admission and his white count was within normal limits as well. His sputum cultures were repeatedly contaminated and his blood cultures are no growth to date. 3. QUESTIONABLE RIGHT LOWER LOBE MASS: There was no mass seen on chest CT here, however, there was lymphadenopathy that could be consistent with infectious reaction. However, it was felt that lymphadenopathy should be followed-up in three months with a CAT scan. 4. PAROXYSMAL ATRIAL FIBRILLATION: The patient's weight was well controlled during his admission until [**2151-4-17**] when he went into atrial fibrillation with rapid ventricular response to the 120s. His hypoxia slightly worsened at this time and thus a Diltiazem drip was started. The patient had a good response to this and was transitioned quickly to p.o. Diltiazem with slow titration upwards. At the time of floor transfer, he is currently on Diltiazem 60 mg p.o. q.i.d. It was thought that a calcium channel blocker would be a better choice in this patient with COPD as opposed to metoprolol. The patient was Coumadin loaded at [**Hospital3 **]. However, this was stopped upon admission to the [**Hospital1 18**] in case procedures were necessary. The patient was started on a heparin drip and Coumadin was held during his ICU course with exception of one dose on the evening prior to transfer. The patient was loaded with Amiodarone at the outside hospital and his dose was decreased in the Intensive Care Unit to 200 mg q.d. The patient's rhythm oscillated between normal sinus as well as rate-controlled atrial fibrillation on day prior to floor transfer. It is uncertain at this time whether Amiodarone will still be indicated in this patient. These issues will be addressed in the patient's floor course. The patient's echocardiogram showed an ejection fraction of greater than 55% with no marked left atrial dilation. Please see above for more details on echocardiogram report. 5. QUESTIONABLE HYPOTHYROIDISM: The patient's TSH was elevated during his Intensive Care Unit course; however, his free T4 was normal. It was thought that this would be hard to interpret in the acutely ill ICU setting and should be followed up as an outpatient. No therapy was started. 6. SKIN LESION: The patient's skin lesion superior to his lip looked worrisome for malignancy and thus a dermatology consult was obtained. Dermatology felt quite certain that the patient's lesion was a squamous cell carcinoma. However, they were unable to biopsy this lesion in-house as microsurgery is indicated and cannot be done in the inpatient setting. They recommended biopsy within ten days at the [**Hospital 2652**] Clinic and the Dermatology Service should be contact[**Name (NI) **] for close follow-up upon discharge. 7. METABOLIC ALKALOSIS: The patient suffered a metabolic alkalosis during his ICU course. It was felt that this was likely due to diuresis. He received three days of acetazolamide and [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] repletion. His respiratory status continued to improve. However, he did have a mild respiratory acidosis as well. This is likely chronic given the patient's history of COPD. His bicarbonate upon admission was also 37. 8. HYPERTENSION: The patient's blood pressure was well controlled during this admission. He was titrated up on Captopril. Diltiazem was also started in the setting of his rapid atrial fibrillation. There were no acute issues. 9. ANEMIA: During the inpatient hospital course at [**Hospital1 **] it was noted that he had Guaiac positive stools with the need of 2 units of packed red blood cells. The patient's hematocrit was stable during his ICU course requiring no transfusions. He was Guaiac positive here. Iron studies showed an anemia of chronic disease picture, however, it is hard to interpret in the setting of recent transfusions. The patient will likely need outpatient follow-up with colonoscopy as he has never been evaluated for this. 10. PROPHYLAXIS: The patient was continued on pantoprazole as well as heparin drip, as above. Communication was with the patient's daughter. Of note, the patient is a DNR/DNI according to multiple discussions with the patient and his daughter. The patient will be transferred to the floor on [**2151-4-18**] to continue his evaluation and treatment. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-986 Dictated By:[**Last Name (NamePattern1) 9244**] MEDQUIST36 D: [**2151-4-18**] 06:44 T: [**2151-4-18**] 18:55 JOB#: [**Job Number 54934**] ICD9 Codes: 4280, 4241
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Medical Text: Admission Date: [**2173-4-9**] Discharge Date: [**2173-5-5**] Date of Birth: [**2104-4-12**] Sex: F Service: [**Last Name (un) 7081**] HISTORY OF PRESENT ILLNESS: This is a 68-year-old Cambodian female who has no significant past medical history. She was found unresponsive at home on [**2173-4-6**]. She was found to be hypertensive and intubated at the scene and resuscitated with IV fluid boluses. Prior to this, the patient had neck swelling for 2 days which occurred in conjunction with administration of Actos for newly diagnosed diabetes. Laryngoscopy was performed revealing airway edema. A CT scan of the chest and neck revealed a goiter with airway compression. TSH was elevated at 7.13. Neurology workup including EEG and CT was negative. She was transferred here for a planned sternotomy with mass resection. HOSPITAL COURSE: On admission, the patient was stable and intubated. Endocrine was consulted given the patient's diabetes and hypothyroid state. It was recommended that total thyroidectomy be performed as well as thyroid hormone replacement initiated. She was preopped for surgery on [**2173-4-12**]. On [**2173-4-12**], the patient underwent bronchoscopy and partial sternotomy with right total and left subtotal thyroidectomy. See operative report for details. The patient tolerated the procedure well from a hemodynamic standpoint. However, attempts to re-intubate her at the end with assistance of tube changer were unsuccessful using 8.0, 7.5, 7.0 and even a 6.5 endotracheal tube and it was presumed that the patient had an extrinsic mass or perhaps extrinsic pathology to the trachea. She was returned to the OR on [**2173-4-14**] for rigid bronchoscopy and tumor debridement as well as dilation of tracheal stenosis. At this time, it was noted that she had diffusely abnormal mucosa of her subglottic space and significantly narrow tracheal lumen down to the distal trachea. Biopsies and therapeutic aspiration were performed. At this time, a 6.5 ET tube was placed without difficulty. She was transferred back to the ICU for further management. The pathology showed the patient to have papillary carcinoma of the thyroid with extrathyroidal invasion and nodal involvement. At this time, the patient was found to have nosocomial pneumonia with sputum cultures positive for Acinetobacter, pan-resistant, as well as Enterobacter cloacae, pansensitive. ID was consulted and the patient was started on imipenem and tobramycin at this time. The patient remained stable and on [**2173-4-16**], returned to the OR for bronchoscopy with tracheal dilation (balloon and rigid) with tracheostomy. Postoperatively, chest x-ray showed that the patient had developed a right pneumothorax, displacing the right hemidiaphragm and the mediastinum, collapsing the right lung secondary to barotrauma versus the tracheal dilation procedure. A right chest tube was placed as well as her central line was changed over wire and post chest tube chest x-ray showed marked improvement of the large right pneumothorax. At this time, it was also noted that the patient had gram negative rods, specifically Acinetobacter in her blood cultures, and she was also placed on amikacin. On [**4-17**], chest x-ray showed near resolution of her right pneumothorax. Unfortunately, the patient went into atrial flutter which responded to IV Lopressor. Given her high grade of bacteremia, a CT sinus was recommended by Infectious Disease. This showed mucosal thickening of both maxillary sinuses and opacification of the ethmoid and sphenoid air cells. No fluid levels were noted. Additionally, there is opacification of the mastoid air cells bilaterally. At this time, given her stable, resolved pneumothorax, the chest tube was placed to water seal. On [**2173-4-18**], her vent was weaned to CPAP and pressure support which the patient tolerated well. Her A line sites were changed as well. Over the following day, the patient was diuresed and tolerated tracheostomy mask trials for 2-3 hour periods per day. Endocrine was following and corrected the patient's hypocalcemia with Calcitriol as well as calcium carbonate. Her blood sugars were stable and the patient was off the insulin drip at this point. She was started on NPH and sliding scale insulin. On [**2173-4-20**], a chest CT was performed to evaluate for consolidation. Multifocal opacities in the left lower lobe, right lower lobe and right upper lobe were concerning for pneumonia. A small right-sided pneumothorax persisted with the right chest tube in place. On [**2173-4-22**], the patient remained stable. Her chest tube was removed and post pull chest x-ray showed no evidence of pneumothorax. At this point, the patient had been receiving tube feeds at goal via NG tube. On [**2173-4-23**], a PICC line was placed and the central line was removed. She was tolerating tracheostomy mask for 6 hours. Over the next few days, the [**Hospital 228**] hospital course was uneventful save for a fever spike in which blood cultures were negative, sputum cultures showed persistent Acinetobacter infection and urine cultures showed yeast. The Foley was changed. On [**2173-4-27**], a bedside swallow was performed to evaluate for the patient's ability to tolerate p.o. intake. Unfortunately, she aspirated at this time and failed the swallow exam. ENT was consulted for evaluation of possible vocal cord paralysis. On fiberoptic exam, it was noted that the patient had significant edema and pooling of secretions above her vocal cords. ENT felt that her ET tube was too big/long to phonate and cognitive issues were also preventing her from fully cooperating with the exam. They recommended downsizing her tracheostomy. Discussions with interventional pulmonology were initiated regarding having a custom-made T tube made. On [**2173-4-28**], a Dobhoff tube was placed and plans were made for a PEG to be placed the following week given the patient's failure to pass the swallow exam. Over the next few days, the patient was stable and remained afebrile on Unasyn and amikacin. She completed her antibiotic course on [**2173-5-1**]. She continued to tolerate her Dobhoff tube feeds. On [**2173-5-3**], the patient returned to the OR for a flexible bronchoscopy for tracheal measurements as well as flexible EGD with insertion of a percutaneous endoscopic gastrostomy tube. The patient tolerated the procedure well and returned to the recovery room in stable condition. On [**5-4**], her tube feeds were resumed and increased to a goal of 50 cc per hour with fiber at full strength. She tolerated her tube feeds well. On [**2173-5-5**], a rehab facility accepted the patient and she was discharged to rehab in stable condition. Of note, I had no interaction with this patient's care. This hospital course was dictated from the patient's records only. CONDITION ON DISCHARGE: Stable. DISCHARGE DIAGNOSES: Papillary cancer with positive nodes status post sternotomy and partial right and total left thyroidectomy on [**2173-4-12**], status post rigid bronchoscopy and tumor debridement on [**2173-4-14**], status post open tracheostomy on [**2173-4-16**], status post bronchoscopy and percutaneous endoscopic gastrostomy tube placement on [**2173-5-3**]. DISCHARGE MEDICATIONS: Heparin subcutaneously 5,000 units/ml, 1 injection b.i.d., albuterol sulfate 0.083% solution, 1 puff q.6h. as needed, ipratropium bromide 0.02% solution, 1 puff q.6h. as needed, Percocet 5/325 mg per 5 ml solution, [**6-16**] ml p.o. q.4-6h. p.r.n., metoprolol 37.5 mg p.o. t.i.d., lansoprazole 30 mg suspension, delayed release, 1 p.o. daily, liothyronine 25 mcg 0.5 tablets p.o. b.i.d., calcium carbonate 500 mg per 5 ml suspension, 5 ml p.o. t.i.d., Heparin Lock Flush 100 units per ml, 2 ml IV daily as needed, followed by 10 cc of normal saline, insulin NPH human recombinant 100 units per ml suspension, 20 units subcutaneously 3 times a day, adjust to achieve euglycemia. FOLLOW-UP PLANS: Interventional Pulmonology has ordered a custom T tube for the patient. Later, she will be contact[**Name (NI) **] to arrange for overnight admission for placement. She has an appointment with Dr. [**Last Name (STitle) 10759**] from Endocrine, [**Telephone/Fax (1) 62877**] on [**2173-6-1**] at 2:30 p.m. in the [**Hospital Ward Name 23**] Clinical Center, [**Location (un) **]. [**Name6 (MD) 4667**] [**Name8 (MD) **], M.D. [**MD Number(2) 39921**] Dictated By:[**Name8 (MD) 37607**] MEDQUIST36 D: [**2173-5-5**] 11:27:34 T: [**2173-5-5**] 12:59:02 Job#: [**Job Number 65843**] cc:[**Name8 (MD) 65844**] ICD9 Codes: 496, 7907, 4019
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Medical Text: Admission Date: [**2159-8-5**] Discharge Date: [**2159-8-9**] Date of Birth: [**2112-11-11**] Sex: F Service: Dictating for: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D. CHIEF COMPLAINT: Chest pressure. HISTORY OF PRESENT ILLNESS: The patient is a 46-year-old female with cardiac risk factors of a positive family history and tobacco use who was in her usual state of health until 7 a.m. on the day prior to admission when she noted the sudden onset of chest pain which was intermittent throughout the day and radiated to her left arm. This chest pain was associated with nausea, shortness of breath, and diaphoresis. She presented to the [**Hospital1 69**] Emergency Department and was found to have inferior ST elevations. While in the Emergency Department she was started on aspirin, heparin, and Integrilin. She was hypotensive upon arrival and was then started on dopamine. While in the Emergency Department she had an episode of ventricular fibrillation arrest requiring shock therapy times one at 200 joules. She was then taken to the Catheterization Laboratory emergently and found to have a 100% mid right coronary artery lesion which was treated by stent placement. While in the Catheterization Laboratory she required a temporary wire placement for complete heart block as well as shock therapy times two, and an amiodarone intravenously drip was started for current ventricular fibrillation. She had an intra-aortic balloon pump placed and was sent to the Coronary Care Unit in stable condition. Of note, her hemodynamic revealed a mean arterial pressure of 37 and a mean pulmonary capillary wedge pressure of 31. Her echocardiogram showed no tamponade or effusions. PAST MEDICAL HISTORY: None. MEDICATIONS ON ADMISSION: No medications at home. ALLERGIES: No known drug allergies. SOCIAL HISTORY: Positive tobacco smoking history for approximately 20 years or so. FAMILY HISTORY: Family history of coronary artery disease in her mother. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination revealed vital signs with a weight of 59 kilograms, heart rate was 71, her blood pressure was 99/64, and her oxygen saturation was 100%. The patient was ventilated on assist control with a tidal volume of 300, respiratory rate of 24, FIO2 of 100%, positive end-expiratory pressure of 5, and she was saturating 100%. In general, a middle-aged female, intubated and sedated. Head, eyes, ears, nose, and throat examination revealed pupils were 5 mm and reactive. Normocephalic and atraumatic. The neck was supple. No lymphadenopathy, and no bruits appreciated. Chest examination revealed the lungs were clear to auscultation anteriorly. No wheezes. Cardiovascular examination revealed heart was regular, intra-aortic balloon pump sounds, no rubs or gallops. The abdomen was soft, nontender, and nondistended. Positive bowel sounds. Extremity examination revealed no edema. Dopplerable pulses. Extremities were cool to touch. Neurologic examination revealed the patient was sedated. PERTINENT LABORATORY VALUES ON PRESENTATION: Laboratories revealed her white blood cell count was 22.9 and her hematocrit was 35.7. Her blood sugar/glucose was 375. Creatinine was 0.8. INR was 1. Initial creatine kinase was 57. Troponin was less than 0.01. Next creatine kinase was 1109. Troponin was 0.56. Lactate was 6.5. PERTINENT RADIOLOGY/IMAGING: Electrocardiogram revealed complete heart block with ST elevations in leads II, III, and aVF, and V3. Early R wave progression. ST depressions in leads I and aVL. A chest x-ray revealed no pneumonia and appropriate placement of intra-aortic balloon pump. An echocardiogram revealed no effusions. Poor echo windows. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: 1. CARDIOVASCULAR ISSUES: (a) Ischemia: The patient was maintained on aspirin, Plavix, a heparin drip, and an Integrilin drip times 18 hours status post catheterization. The patient's beta blocker was initially held due to a decrease in blood pressure and intra-aortic balloon pump. The patient was maintained on dopamine in house which was subsequently weaned off. The patient's ACE inhibitor initially held. A statin was started with a goal low-density lipoprotein of less than 100. The patient was counseled significantly on smoking cessation. On hospital day two, the patient's intra-aortic balloon pump was removed without any complications. Her creatine kinase had peaked to a level of [**2181**]. She was extubated without complications. Initially tolerated 4 liters, down to 2 liters. On the day of discharge, she was saturating 94% on room air. The patient's dopamine was subsequently weaned off with an elevation in her blood pressure, and the patient was started on Lopressor and captopril titrated doses to a discharge dose for Toprol-XL of 100 mg and captopril changed to lisinopril 20 mg by mouth once per day. The patient initially had a heparin drip, but this was discontinued after the removal of the intra-aortic balloon pump. (b) Pump: The patient had initially presented in cardiogenic shock and received 4 liters of intravenous fluids in the Emergency Department. The patient was maintained and volume resuscitated during her course in the Coronary Care Unit. The patient was initially started on dopamine which was eventually weaned off; we continued to keep her mean arterial pressures of greater than 16 and was subsequently eventually weaned off. The intra-aortic balloon pump was also weaned off after extubation of the patient on hospital day two. An echocardiogram was done on hospital day three which showed an ejection fraction of greater than 55%, mild regional left ventricular systolic function, with hypokinesis in the basal inferoseptal and basal inferior regions, 1+ mitral regurgitation, and 1+ tricuspid regurgitation. No further anticoagulation was given. (c) Rhythm: The patient is currently in sinus rhythm, but had recurrent ventricular fibrillation arrest both during catheterization. The patient was maintained initially on an amiodarone drip and temporary pacing wires in place which were discontinued on hospital day two. The amiodarone drip was also stopped. She had no further episodes of ventricular tachycardia or any abnormal rhythms during the remainder of her hospitalization. The patient did not require any further workup, and she was maintained on telemetry until the day of discharge. On hospital day three, the patient had two episodes of recurrent chest pain which showed no electrocardiogram changes and responded to one sublingual nitroglycerin tablet with full relief. The patient was subsequently started Isordil while in house and was to be discharged with Imdur for continued angina. This was unlikely to be acute coronary syndrome given the fact that she had received catheterization prior. 2. PULMONARY ISSUES: The patient initially presented with severe shortness of breath, and she was ventilated initially on assist control which was done. The patient was subsequently weaned off on hospital day two and extubated without complications. 3. GASTROINTESTINAL ISSUES: The patient has a history of coffee-grounds emesis upon arrival to the Coronary Care Unit, but this subsequently resolved. She was maintained on intravenous Protonix twice per day. Serial examinations showed no further episodes, and her hematocrit remained stable. The patient was to be discharged on a proton pump inhibitor. 4. HEMATOLOGIC ISSUES: The patient's hematocrit remained stable throughout her hospitalization. On the day prior to discharge, she had a slight drop in her hematocrit which was likely due to the fact that she initiated a full diet and started to take lots of oral intake. [**Month (only) 116**] have been dilutional. The patient was transfused with a hematocrit of 32 on the day of discharge. 5. INFECTIOUS DISEASE ISSUES: On hospital day three, the patient had a temperature spike of 102.1 degrees Fahrenheit. Blood cultures and urine cultures which were no growth to date up to the day of discharge. A STAT chest x-ray was obtained which showed some consolidations in the right lower lobe and possibly involving the left lower lobe. The patient was initially started on Zithromax, but upon repeat examination of the chest x-ray showed worsening consolidation. The patient was changed to levofloxacin on the day of discharge which was to be continued for 10 days for ventilator-associated pneumonia. The patient had been afebrile for 72 hours on the day of discharge, and no growth on the blood cultures. The patient was maintained on Robitussin with codeine and Tessalon Perles and Cepacol lozenges for her cough. 6. PROPHYLAXIS ISSUES: The patient was maintained on a Protonix for gastrointestinal prophylaxis and subcutaneous heparin for deep venous thrombosis prophylaxis. 7. CODE STATUS: The patient was a full code. 8. ENDOCRINE ISSUES: The patient initially presented with elevations in her blood sugars; likely due to stress given her significance illness from the ventricular fibrillation arrest. The patient initially had fingersticks four times per day and was initially placed on an insulin drip with improvement of her blood sugars. The insulin drip was discontinued on hospital day two. The patient had no further episodes of hyperglycemia during this hospitalization. DISCHARGE DISPOSITION: The patient had a stable blood pressure in the 110s, heart rate goal to 60s, return of her hematocrit after a blood transfusion, with no further abnormal heart rhythms, her cough was improving, and she had been afebrile for 72 hours on the day of discharge, and was covered broadly with antibiotics for ventilator-associated pneumonia. It would be reasonable to obtain a chest x-ray to follow up the pneumonia in a few weeks to see resolution of her symptoms. DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The patient was instructed to follow up with her primary care physician (Dr. [**First Name4 (NamePattern1) 1790**] [**Last Name (NamePattern1) 1789**]) at [**Hospital 92821**] Health Care, [**Street Address(2) 92822**], [**Location (un) 538**] on [**2159-8-22**] at 10 a.m. (telephone number [**Telephone/Fax (1) 1792**]). 2. The patient was instructed to follow up with Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] (cardiologist) at [**Hospital1 188**], on [**2159-9-5**] at 11 a.m. (telephone number [**Telephone/Fax (1) 25135**]). MEDICATIONS ON DISCHARGE: 1. Enteric-coated aspirin 325 mg by mouth every day. 2. Clopidogrel 75 mg by mouth once per day. 3. Atorvastatin 10 mg by mouth once per day. 4. Percocet 5/325 one to two tablets by mouth q.4-6h. as needed (for pain); dispensed eight tablets. 5. Pantoprazole 20 mg by mouth once per day. 6. Nicotine patch 21 mg one patch transdermally once per day. 7. Bupropion sustained release 150 mg by mouth twice per day (for 60 days; until [**2159-8-11**]). 8. Robitussin with codeine. 9. Lisinopril 20 mg by mouth once per day. 10. Toprol-XL 100 mg by mouth once per day. 11. Imdur 30 mg by mouth once per day. 12. Levofloxacin 500 mg by mouth once per day (times 10 days; first dose on [**2159-8-9**]). CONDITION AT DISCHARGE: Condition on discharge was stable. DR.[**First Name (STitle) **],[**First Name3 (LF) **] 12-953 Dictated By:[**Last Name (NamePattern1) 92823**] MEDQUIST36 D: [**2159-8-9**] 11:42 T: [**2159-8-9**] 11:58 JOB#: [**Job Number 92824**] ICD9 Codes: 4275, 486, 4280
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Medical Text: Admission Date: [**2194-10-23**] Discharge Date: [**2194-10-31**] Date of Birth: [**2118-10-15**] Sex: F Service: NSU HISTORY OF PRESENT ILLNESS: The patient is a 76-year-old female transferred from [**Hospital6 33**] with suspected subarachnoid hemorrhage. The patient reports that the night before admission, while watching a Sox game, he had a sudden onset of whole headache. The headache, the patient states, radiated down the posterior aspect of the neck bilaterally into the shoulders and arms, but further states left-sided, and some numbness in the hands. The patient was unable to move the entire left side x 45 minutes. The patient was transferred to [**Hospital6 33**] where a head CT was negative. She had an LP, which showed stable amount of blood in all 4 tubes. The patient further states that now she just has posterior neck discomfort bilaterally. Denies current nausea, visual changes, shortness of breath, fever, headache or stiff neck. PAST MEDICAL HISTORY: Giant cell arteritis. Polymyalgia rheumatica. Breast cancer with right lumpectomy. Hypothyroidism. Left cochlear implant. ALLERGIES: 1. MORPHINE. 2. SULFA. 3. AMOXICILLIN. 4. CODEINE. PHYSICAL EXAMINATION: She is awake, alert and oriented x 3. Vital signs are stable. Visual fields are intact bilaterally. Cardiovascular: Regular rate and rhythm. No murmurs, rubs or gallops. Lungs are clear to auscultation. Neck: Nontender to palpation. Abdomen: Soft, nontender, nondistended. Positive bowel sounds. Neurologic: Moving all extremities with good strength 5/5. Sensation is intact to light touch. Proprioception is intact. She has no drift. Naming is intact. Repetition intact. Cranial nerves II through XII grossly intact. Her face is symmetric. Lips are full bilateral. Tongue midline. Deep tendon reflexes are full and symmetric. Toes are downgoing. Again, head CT was negative. LP showed 630 white cells and [**Pager number **],000 red cells. HOSPITAL COURSE: The patient was admitted to the ICU for close neurologic observation. She underwent an angiogram, which showed a 1.5-mm right PCOmm infundibulum, which required no intervention and most likely is not the source of her subarachnoid hemorrhage. She remained neurologically stable, was transferred to the regular floor, had a CT myelogram to rule out spinal AVM, which was ruled out. Was seen by Physical Therapy and Occupational Therapy and was felt to be safe for discharge to home with follow-up with Dr. [**Last Name (STitle) 1132**] in 2 weeks. The patient's condition was stable at the time of discharge. MEDICATIONS ON DISCHARGE: 1. Levothyroxine 88 mcg p.o. q.d. 2. Divalproex sodium 250 mg 1 p.o. q.8h. 3. Hydrochlorothiazide 50 q.d. 4. Valsartan 100 mg p.o. q.d. 5. Alendronate sodium 70 p.o. q.Sunday. 6. Prednisone 15 mg p.o. q.d. CONDITION ON DISCHARGE: Stable. FOLLOW UP: She will follow up with Dr. [**Last Name (STitle) 1132**] in 2 weeks. [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**] Dictated By:[**Last Name (NamePattern1) 6583**] MEDQUIST36 D: [**2194-10-31**] 12:26:26 T: [**2194-11-1**] 02:29:08 Job#: [**Job Number 111000**] ICD9 Codes: 4019, 2449, 2859
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Medical Text: Admission Date: [**2126-5-19**] Discharge Date: [**2126-5-22**] Date of Birth: [**2069-5-13**] Sex: F Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 2901**] Chief Complaint: NSTEMI Major Surgical or Invasive Procedure: Cardiac catheterization, 2 stents to LAD and LCX History of Present Illness: Ms [**Name13 (STitle) 85175**] is a 57 year old woman with HLD, GERD, ? HTN who presented via EMS status post cardiac arrest to [**Location (un) 620**] and transferred to [**Hospital1 18**] for cardiac catheterization. . Per ED records, patient called EMS for substernal chest pain and shortness of breath. On EMS arrival, patient was conscious but then she passed out. She arrested infront of EMS and received 2 shocks by AED. She regained consciousness with reported normal mental status. Enroute, she arrested again and was shocked again. She got 300mg of amio by EMS. Rhythm strips reportedly showed torsades. At [**Location (un) 620**], she was again, awake, but intubated for airway protection. She received aspirin 325mg, plavix 600mg, heparin gtt, amiodarone gtt and integrillin. An ECG showed heart rate 63, STD in v1-3 with concern for posterior STEMI. . She was transferred to [**Hospital1 18**] for cath lab. In cath lab, her she had proximal 95% LAD and mid 95% LCx oclusion that were stented. She was also noted to have markedly elevated filling pressures and received lasix. . Past Medical History: 1. CARDIAC RISK FACTORS: Diabetes, + Dyslipidemia, ? Hypertension 2. CARDIAC HISTORY: -CABG: -PERCUTANEOUS CORONARY INTERVENTIONS: -PACING/ICD: 3. OTHER PAST MEDICAL HISTORY: HLD HTN GERD Social History: + smoking history Family History: family history of CAD Physical Exam: ADMISSION PHYSICAL EXAM GENERAL: Intubated, sedated. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP elevated to mandible. CARDIAC: Distant heart sounds, regular rate, no murmurs/rubs/gallops appreciated. LUNGS: Anterior breath sounds clear. ABDOMEN: Obese. Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Pertinent Results: Admission labs: [**2126-5-19**] 02:08AM BLOOD WBC-14.4* RBC-3.86* Hgb-11.6* Hct-36.1 MCV-94 MCH-30.0 MCHC-32.1 RDW-13.0 Plt Ct-391 [**2126-5-19**] 02:08AM BLOOD Neuts-89.3* Lymphs-7.7* Monos-2.7 Eos-0.2 Baso-0.1 [**2126-5-19**] 02:08AM BLOOD PT-13.1 PTT-65.7* INR(PT)-1.1 [**2126-5-19**] 02:08AM BLOOD Glucose-194* UreaN-10 Creat-0.7 Na-141 K-4.1 Cl-108 HCO3-23 AnGap-14 [**2126-5-19**] 02:08AM BLOOD ALT-38 AST-46* LD(LDH)-272* AlkPhos-76 TotBili-0.4 [**2126-5-19**] 02:08AM BLOOD Albumin-3.8 Calcium-7.9* Phos-2.9 Mg-2.2 Cholest-159 [**2126-5-19**] 02:08AM BLOOD %HbA1c-6.0* eAG-126* [**2126-5-19**] 02:08AM BLOOD Triglyc-110 HDL-32 CHOL/HD-5.0 LDLcalc-105 LDLmeas-112 [**2126-5-19**] 02:08AM BLOOD TSH-1.4 . Cardiac enzymes: [**2126-5-19**] 02:08AM BLOOD CK-MB-16* MB Indx-7.8* cTropnT-0.23* [**2126-5-19**] 02:08AM BLOOD ALT-38 AST-46* LD(LDH)-272* CK(CPK)-204* AlkPhos-76 TotBili-0.4 [**2126-5-19**] 05:28AM BLOOD CK-MB-29* MB Indx-9.5* [**2126-5-19**] 05:28AM BLOOD CK(CPK)-305* [**2126-5-19**] 05:26PM BLOOD CK-MB-20* MB Indx-5.5 cTropnT-0.40* [**2126-5-19**] 05:26PM BLOOD CK(CPK)-364* [**2126-5-20**] 05:04AM BLOOD CK-MB-6 [**2126-5-20**] 05:04AM BLOOD CK(CPK)-204* . Discharge labs [**2126-5-22**] 07:20AM BLOOD WBC-7.0 RBC-3.97* Hgb-11.6* Hct-36.1 MCV-91 MCH-29.3 MCHC-32.2 RDW-12.7 Plt Ct-541* [**2126-5-22**] 07:20AM BLOOD Glucose-89 UreaN-12 Creat-0.7 Na-141 K-4.4 Cl-103 HCO3-33* AnGap-9 [**2126-5-22**] 07:20AM BLOOD Calcium-9.1 Phos-3.7 Mg-2.0 CATH REPORT [**2126-5-19**] COMMENTS: 1. Coronary angiography in this right-dominant system demonstrated two-vessel disease. The LMCA had no angiographically apparent disease. The LAd had a proximal 95% stenosis. The LCx had a 99% hazy stenosis just prior to the second obtuse marginal branch. The RCA had mild disease. 2. Resting hemodynamics revealed elevated right- and left-sided filling pressures, with an RVEDP of 22 mm Hg and a PCWP of 25 mm Hg. There was mild pulmonary arterial systolic hypertension with a PASP of 41 mm Hg. The cardiac index was high at 8.9 L/min/m2. 3. Successful PTCA and stenting of the mid LCx with a 2.5 x 18mm Promus drug eluting stent which was postdilated to 3.0mm. Final angiography revealed no residual stenosis, no dissection, and TIMI 3 flow. (see PTCA comments for details) 4. Successful POBA of the jailed OM with a 1.5mm Apex Flex balloon. 5. Successful PTCA and stenting of the proximal LAD with a 2.5 x 15mm Promus drug eluting stent which was postdilated to 3.0 mm. Final angiography revealed no residual stenosis, no dissection, and TIMI 3 flow. (see PTCA comments for details) FINAL DIAGNOSIS: 1. Two vessel coronary artery disease. 2. Elevated right- and left-sided filling pressures. 3. Successful PTCA and stenting of the mid LCx. 4. Successful POBA of the jailed OM. 5. Successful PTCA and stenting of the proximal LAD. ECHO - TTE [**2126-5-20**] The left atrium is normal in size. The estimated right atrial pressure is 10-15mmHg. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). The estimated cardiac index is normal (>=2.5L/min/m2). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. Brief Hospital Course: 57 year old woman with HLD and family history of CAD transferred to [**Hospital1 18**] for cardiac catheterization. She was shocked x3 by EMS for reported torsades. . # Coronary Artery Disease: Patient is status post cardiac catheterization on [**2126-5-19**] with two stents placed to proximal LAD and mid LCx. She is status post cardiac arrest, shocked three times by EMS, likely ischemic in etiology. She received integrillin and discharged on aspirin 325 mg PO daily, plavix 150 mg PO daily x 2 weeks and 75 mg PO daily thereafter, simvastatin 40 mg PO QHS, and Toprol XL 50 mg PO QD. The plavix dose was increased for the first two weeks given her thrombocytosis in house. Pharmacy called and stated atorvastatin was not covered by pt's insurance, and so she was D/C'ed on simvastatin. An echo prior to discharge showed normal global left ventricular systolic function with an EF of >55%. Patient was discharged with follow up to see cardiology at [**Location (un) **] to be arranged by PCP. . # Rhythm: Currently, patient is in sinus. Per report she had event of torsades, status post shock by EMS in the field. Event was thought to be ischemic in nature. Patient's electrolytes and tele were closely monitored. No further intervention was done, and patient was started on metoprolol. . # Respiratory distress: Intubated at OSH for airway protection. Successfully extubated at [**Hospital1 18**] without any compications. . # GERD: Switched PPI to H2 blocker. . # Smoking cessation: Discussed with patient importance of smoking cessation and risk of MI with continued tobacco use. Patient aware, will follow up with PCP regarding this. Medications on Admission: simvastatin prilosec Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. Clopidogrel 75 mg Tablet Sig: 1-2 Tablets PO DAILY (Daily): Take two pills at once for the next two weeks (150 mg through [**2126-6-5**]). Then take one pill a day after this. Disp:*45 Tablet(s)* Refills:*0* 3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 5. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). Disp:*1 Disk with Device(s)* Refills:*0* 6. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* NOTE: Pharmacy called a couple hours after pt's discharge. Fluticasone-Salmeterol and atorvastatin were unavailable on formulary, so she was changed to Flovent and simvastatin. Discharge Disposition: Home Discharge Diagnosis: Primary: ST elevation Myocardial Infarction Discharge Condition: A&OX3 Self ambulatory Discharge Instructions: You were transferred to [**Hospital1 18**] because you had a heart attack and cardiac arrest. Your cardiac arrest was because of your heart attack. At [**Hospital1 18**] you underwent cardiac catheterization and had two stents placed to two coronary arteries. We started you on several new medications. We have started you on aspirin and plavix. IT IS VERY IMPORTANT THAT YOU TAKE ASPIRIN AND PLAVIX DAILY. Do not skip these medications. They are blood thinners and will prevent clot formation in your stents. IT IS VERY IMPORTANT THAT YOU STOP SMOKING. Cigarettes can accelerate atherosclerosis and increases your risk of a heart attack. You should talk to your doctor about quitting smoking. We have made the following changes to your medications: 1. Start Plavix. You should take plavix every day. DO NOT MISS THIS [**Hospital1 **]. You should take this [**Hospital1 4085**] for at least 1 year. Your cardiologist will tell you how long to take this for. For the next two weeks only through [**2126-6-5**], take two plavix at once. This will be a total of 150 mg once a day. Then, after two weeks beginning on [**2126-6-5**], take only one pill a day. This will be 75 mg daily. 2. Start Aspirin. You should take aspirin every day. DO NOT MISS [**First Name (Titles) **] [**Last Name (Titles) **]. 3. Start Metoprolol. 4. Switched Simvastatin to Lipitor. 5. Switched Omeprazole to Ranitidine. 6. Start Fluticasone/Salmeterol inhaler Followup Instructions: Please follow up with: 1. PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 70012**] on Thursday, [**2126-5-23**] at 11:00 am. His telephone number is [**0-0-**]. He will schedule an appointment for you to see Cardiology at [**Location (un) 912**] cardiology. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**] Completed by:[**2126-5-22**] ICD9 Codes: 3051, 4019, 2724
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Medical Text: Admission Date: [**2134-5-17**] Discharge Date: [**2134-5-30**] Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1283**] Chief Complaint: Shortness of breath with known Aneurysm Major Surgical or Invasive Procedure: [**2134-5-17**] Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to PDA), Asc. Aorta Replacement (26mm gelweave graft), Mitral Valve Replacement (31mm CE mosaic tissue valve) [**2134-5-21**] Flexible bronchoscopy [**2134-5-28**] PICC line placement History of Present Illness: 86 y/o male with known asc. aortic aneurysm x 3yrs. He has developed increased shortness of breath and fatigue. Aneurysm has slightly increased in size. Recent cardiac cath revealed coronary artery disease along with moderate mitral regurgitation. He is being admitted for elective surgery. Past Medical History: Coronary Artery Disease, Ascending Aortic Aneurysm, Mitral Regurgitation, Diabetes Mellitus, Hypertension, Benign Prostatic Hypertrophy, Obesity, Hiatal hernia, s/p pacemaker in [**2129**], s/p left knee surgery Social History: Denies tobacco use. Admits to rare ETOH use. Family History: Non-contributory Physical Exam: On admission: VS: 60 14 112/60 5'8" 210# Gen: WD/WN male in NAD Skin: W/D -lesions HEENT: NC/AT EOMI, PERRL, OP benign Neck: Supple, FROM, -JVD, -carotid bruits Chest: CTAB -w/r/r Heart: CTAB -w/r/r Abd: Soft, NT/ND, +BS Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses throughout Neuro: A&O x 3, MAE, non-focal Pertinent Results: Echo [**2134-5-17**]: PRE-BYPASS: The probe could not be advanced beyond the mid-esophagus. Even at that level, windows and views were very limited. Therefore it was not possible to assess ventricular fxn or the tricuspid valve. No atrial septal defect is seen by 2D or color Doppler. The aortic root is mildly dilated at the sinus level. The ascending aorta is markedly dilated The aortic arch is mildly dilated. The descending thoracic aorta is mildly dilated. There are three aortic valve leaflets. The aortic valve leaflets are mildly thickened. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. There is mild mitral valve prolapse. There is severe mitral annular calcification. There is mild mitral stenosis (area 1.5-2.0cm2). The mitral regurgitation jet is eccentric. There is no pericardial effusion. POST-BYPASS: Limited views of the prosthetic mitral valve were seen. From what was visible, the valve seemed well-seated without perivalvular leak or MR. Could not assess LV or RV fxn. Aortic valve appeared unchanged. Dr. [**First Name (STitle) 6507**] assisted on exam. We recommended esophagoscopy and transthoracic echo on this patient. Echo [**5-24**]: 1. No atrial septal defect is seen by 2D or color Doppler. 2. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is mildly depressed. 3. Right ventricular chamber size is normal. Right ventricular systolic function is borderline normal. 4. There are three aortic valve leaflets. The aortic valve leaflets are mildly thickened. There is no aortic valve stenosis. Trace aortic regurgitation is seen. 5. A bioprosthetic mitral valve prosthesis is present. The motion of the mitral valve prosthetic leaflets appears normal. The transmitral gradient is normal for this prosthesis. A small perivalvular mitral prosthesis leak is seen in the anteromedial aspect of the valve. 6. There is no pericardial effusion. UE U/S [**5-26**]:Ultrasound evaluation of the left upper extremity deep venous system using grayscale, color, pulse wave Doppler reveals the left internal jugular, subclavian, axillary, brachial, basilic veins to be fully compressible with normal Doppler waveforms, augmentation, and respiratory variation in flow. The left cephalic vein is not compressible with hyperechogenic within the lumen consistent with thrombosis. CXR [**5-27**]: The right internal jugular catheter was withdrawn in meantime interval. The pacemaker leads terminate in right atrium and right ventricle, unchanged. The heart size is markedly enlarged but stable. There is worsening of the left lower lobe and right lower lobe atelectasis. Right pleural effusion is small to moderate. Left pleural effusion cannot be assessed due to the fact that the left costophrenic angle was not included in the field of view. There is slight worsening of the perihilar haziness and upper zone pulmonary vasculature redistribution suggesting mild pulmonary edema. The distended azygos vein contributes to the diagnosis suggesting for overload. [**2134-5-17**] 02:40PM BLOOD WBC-12.0*# RBC-3.26*# Hgb-10.4*# Hct-29.2*# MCV-90 MCH-31.8 MCHC-35.5* RDW-15.0 Plt Ct-69*# [**2134-5-21**] 03:01PM BLOOD WBC-8.6 RBC-3.17* Hgb-9.9* Hct-29.4* MCV-93 MCH-31.2 MCHC-33.7 RDW-15.5 Plt Ct-103* [**2134-5-28**] 06:35AM BLOOD WBC-8.1 RBC-3.97* Hgb-12.1* Hct-36.8* MCV-93 MCH-30.4 MCHC-32.8 RDW-15.1 Plt Ct-310 [**2134-5-17**] 02:40PM BLOOD PT-19.2* PTT-65.9* INR(PT)-1.8* [**2134-5-25**] 03:34AM BLOOD PT-14.3* PTT-30.6 INR(PT)-1.3* [**2134-5-17**] 04:33PM BLOOD UreaN-14 Creat-0.8 Cl-120* HCO3-22 [**2134-5-28**] 06:35AM BLOOD Glucose-147* UreaN-25* Creat-1.4* Na-137 K-4.1 Cl-99 HCO3-32 AnGap-10 [**2134-5-27**] 06:00AM BLOOD Calcium-8.5 Mg-2.5 [**2134-5-28**] 06:35AM BLOOD Mg-2.6 Brief Hospital Course: Mr. [**Known lastname 14410**] was a same day admit after undergoing all pre-operative work-up as an outpatient. On day of admission he was brought to the operating room where he underwent Coronary Artery Bypass Graft x 2, Asc. Aorta Replacement, and Mitral Valve Replacement. Please see operative report for details. Following surgery he was transferred to the CSRU for invasive monitoring in stable condition. Over the next two days he remained intubated secondary to hemodynamic instability requiring multiple Inotropes. on post-op day two he was weaned from sedation, awoke neurologically intact and extubated. He required aggressive pulmonary toilet via multiple inhalers and diuresis. He was gently diuresed towards his pre-op weight. On post-op day four he underwent a bronchoscopy for left lung atelectasis and a mucous plug was removed. Gram stain from bronchoscopy revealed gram negative rods and antibiotics were started. On post-op day five he was transfused one unit pRBC. Chest tubes and epicardial pacing wires were removed per protocol. Despite aggressive pulmonary toilet, diuresis for CHF and antibiotics for pneumonia, patient was having worsening shortness of breath on post-op day six and eventually had respiratory decompensation that required re-intubation. He was eventually weaned from sedation on post-op day eight and extubated without incident. On post-op day nine he underwent an upper ext. U/S which revealed a thrombosis of the left cephalic vein. He began ambulating well with PT and on post-op day ten he was transferred to the telemetry floor for further care. Over the next two days there were no further complications. On post-op day eleven he required a PICC line placement d/t poor venous access. He continued to work with physical therapy for strength and mobility. He appeared stable on post-op day twelve, but still required additional physical therapy. He was therefore discharged to rehab facility with the appropriate follow-up appointments and medications.Prior to d/c a UA was sent after UOP cloudy. Results were negative for UTI. Medications on Admission: Zocor 40mg qd, Felodipine 10mg qd, Terazosin 5mg qd, Atenolol 50mg qd, Aspirin 325mg qd, Proscar 5mg qd, Novolog 70/30 5qAM, 8qPM Discharge Medications: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Terazosin 5 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 2 weeks. 9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for 2 weeks. 10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 11. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours). 12. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Tablet(s) 13. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 5 days. 14. Insulin NPH-Regular Human Rec 100 unit/mL (70-30) Suspension Sig: Five (5) units Subcutaneous qAM: Please also have Insulin Sliding Scale (see attached). 15. Insulin NPH-Regular Human Rec 100 unit/mL (70-30) Suspension Sig: 8 (eight) units Subcutaneous qPM: Please also have Insulin Sliding Scale (see attached). Discharge Disposition: Extended Care Facility: [**Doctor Last Name **] Nursing & Rehabilitation Center - [**Location (un) **] Discharge Diagnosis: Coronary Artery Disease/Ascending Aortic Aneurysm/Mitral Regurgitation s/p Coronary Artery Bypass Graft x 2, Asc. Aorta Replacement, Mitral Valve Replacement Pneumonia Congestive Heart Failure Deep Vein Thrombosis PMH: Diabetes Mellitus, Hypertension, Benign Prostatic Hypertrophy, Obesity, Hiatal hernia, s/p pacemaker in [**2129**], s/p left knee surgery Discharge Condition: Good Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. In the event that you have drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 1504**]. 2) Report any fever greater then 100.5. 3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) No lotions, creams or powders to incision until it has healed. You may shower and wash incision. Please shower daily. No bathing or swimming for 1 month. Use sunscreen on incision if exposed to sun. 5) No lifting greater then 10 pounds for 10 weeks. 6) No driving for 1 month. 7) Call with any questions or concerns. [**Last Name (NamePattern4) 2138**]p Instructions: Dr. [**Last Name (Prefixes) **] in 4 weeks Dr. [**Last Name (STitle) **] in [**2-6**] weeks Dr. [**Last Name (STitle) 2204**] in [**1-5**] weeks Completed by:[**2134-5-30**] ICD9 Codes: 486, 5180, 4280, 4240, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6179 }
Medical Text: Admission Date: [**2182-12-3**] Discharge Date: [**2182-12-8**] Date of Birth: [**2115-4-23**] Sex: F Service: CARDIOTHORACIC Allergies: Ace Inhibitors Attending:[**First Name3 (LF) 1505**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2182-12-3**] Aortic Valve Replacement (21mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue) History of Present Illness: This is a 67 year old female with known history of aortic stenosis that is followed by serial echocardiograms. She complains of progressively worsening dyspnea on exertion. Cardiac cath revealed no coronary artery disease. She is now scheduled for aortic valve replacement this month. Overall she feels well and has no major change in symptoms from [**2182-8-1**]. Past Medical History: Past Medical History: Aotic Stenosis Hypercholesterolemia Hypertension Hyperthyroidism with thyroid nodule Nonspecific Thrombocytopenia ( mild) Obesity Depression Meralgia paresthetica Asthma GERD Dysglycemia Thoracic back pain/sciatica SVT ( episode during stress test) remote esopagitis Past Surgical History: s/p Tonsillectomy Social History: Race:Caucasian Dental: clearance letter obtained Lives with: Daughter Contact: [**Name (NI) **] [**Name (NI) 88836**], [**First Name3 (LF) **] Phone #[**Telephone/Fax (1) 88837**] [**Name2 (NI) 27057**]tion: Runs coat checking business (has summer off) Cigarettes: Smoked no [] yes [X] last cigarette [**2147**] Hx: 1.5 ppd Other Tobacco use: no ETOH: < 1 drink/week [] [**1-7**] drinks/week [X] >8 drinks/week [] Illicit drug use: Denies Family History: Family History: Denies premature coronary artery disease Physical Exam: VS: B/P Right: 118/66 Left: 116/60 Height: 5'7 [**12-2**]" Weight: 190 lbs General: WDWN female in NAD Skin: Dry []x intact [x] HEENT: PERRLA [x] EOMI [x]anicteric sclera;OP unremarkable Neck: Supple [x] Full ROM []no JVD Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur [x] grade ___3/6 systolic radiates throughout chest to carotids___ Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x] no HSM Extremities: Warm [x], well-perfused [x] Edema none Varicosities: R lat thigh Neuro: Grossly intact [x];nonfocal exam;MAE [**4-5**] strengths Pulses: Femoral Right: 2+ Left:2+ DP Right: 1+ Left:1+ PT [**Name (NI) 167**]:NP Left:NP Radial Right:2+ Left:2+ Carotid Bruit -murmur radiates to carotids Pertinent Results: Admission labs: [**2182-12-3**] 10:31AM WBC-8.5# RBC-2.67*# HGB-7.8*# HCT-23.7*# MCV-89 MCH-29.0 MCHC-32.7 RDW-13.7 [**2182-12-3**] 12:15PM PT-11.6 PTT-30.5 INR(PT)-1.1 [**2182-12-3**] 12:15PM WBC-7.0 RBC-3.02* HGB-9.0* HCT-27.0* MCV-90 MCH-29.9 MCHC-33.3 RDW-13.8 [**2182-12-3**] 12:15PM UREA N-12 CREAT-0.6 SODIUM-143 POTASSIUM-4.0 CHLORIDE-114* TOTAL CO2-24 ANION GAP-9 Discharge labs: [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Ejection Fraction: 60% to 65% >= 55% Aorta - Ascending: 3.4 cm <= 3.4 cm Aortic Valve - Peak Velocity: *4.2 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *81 mm Hg < 20 mm Hg Aortic Valve - LVOT diam: 2.0 cm Aortic Valve - Valve Area: *0.9 cm2 >= 3.0 cm2 Findings LEFT ATRIUM: Mild LA enlargement. No spontaneous echo contrast or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA ejection velocity. No thrombus in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or color Doppler. LEFT VENTRICLE: Severe symmetric LVH. Normal LV cavity size. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV free wall thickness. Normal RV chamber size. Normal RV systolic function. AORTA: Normal aortic diameter at the sinus level. Normal ascending aorta diameter. Normal aortic arch diameter. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Severely thickened/deformed aortic valve leaflets. No masses or vegetations on aortic valve. Severe AS (area 0.8-1.0cm2). Moderate (2+) AR. MITRAL VALVE: Moderate mitral annular calcification. No MS. Moderate (2+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: Trivial/physiologic pericardial effusion. GENERAL COMMENTS: The patient was under general anesthesia throughout the procedure. The patient received antibiotic prophylaxis. The TEE probe was passed with assistance from the anesthesioology staff using a laryngoscope. No TEE related complications. Results were personally reviewed with the MD caring for the patient. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions Pre-CPB: 1.The left atrium is mildly dilated. No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. No mass/thrombus is seen in the left atrium or left atrial appendage. No thrombus is seen in the left atrial appendage. 2. No atrial septal defect is seen by 2D or color Doppler. 3. There is severe symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). 4. The right ventricular free wall thickness is normal. Right ventricular chamber size is normal. with normal free wall contractility. 5. There are simple atheroma in the descending thoracic aorta. 6. There are three aortic valve leaflets. There was minimal movement of the NCC and RCC. The aortic valve leaflets are severely thickened/deformed. No masses or vegetations are seen on the aortic valve. There is severe aortic valve stenosis (valve area 0.8-1.0cm2). Moderate (2+) aortic regurgitation is seen. 7. Moderate (2+) mitral regurgitation is seen. 8. There is a trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results. Post-CPB: On infusion of phenylephrine, AV-pacing for slow CHB (initially). Well-seated bioprosthetic valve in aortic position with trivial valvular AI, transvalvular gradient measured at 15mmHg. Preserved biventricular systolic function, 1+ MR, aortic contour normal post-decannulation. Brief Hospital Course: Ms [**Known lastname 88836**] was a same day admission to the operating room for a scheduled aortic valve replacement. Please see the operative report for details,in summary she had: Aortic valve replacement with a 21mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue valve. Her cardiopulmonary bypass time was 57 minutes with a crossclamp time of 42 minutes. She tolerated the operation well and was transferred from the operating room to the cardiac surgery ICU in stable condition with minimal vasopressor support. She remained hemodynamically stable in the immediate post-op period, her anesthesia was reversed, she woke neurologically intact and was extubated. On POD1 she was transferred from the cardiac surgery ICU too the stepdown floor for continued post-op care. All tubes lines and drains were removed per cardiac surgery protocol. She was transfused one unit PRBC for post-op anemia. She reports postoperative intermittent visual changes, lasting only seconds. No focal defecit appreciated. As discussed with Dr.[**Last Name (STitle) **], Ms.[**Known lastname 88836**] will alert the cardiac surgery service if these symptoms persist. Dr[**Last Name (STitle) **] office will also follow up in 1 week after discharge to ascertain whether Ms.[**Known lastname 88836**] will require an outpatient eval by Neuro and/or Opthamologist. The remainder of her hospital course was uneventful. She worked with nursing and physical therapy to increase her strength and endurance. By POD# 5 she was ready for discharge home with visiting nurses. She is to follow up with Dr [**Last Name (STitle) **] in 1week at wound clinic and at 1 month in cardiac surgery clinic. Medications on Admission: METHIMAZOLE - 15 mg once a day METOPROLOL SUCCINATE -50 mg Extended Release once a day ROSUVASTATIN 5 mg once a day CALCIUM CARBONATE - 500 mg calcium (1,250 mg) - 1 Tablet once a day CHOLECALCIFEROL 1,000 unit once a day LYSINE -500 mg once a day Discharge Medications: 1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 2. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO Q12H (every 12 hours) for 5 days. Disp:*20 Tablet Extended Release(s)* Refills:*0* 3. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 5 days. Disp:*10 Tablet(s)* Refills:*0* 4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*45 Tablet(s)* Refills:*0* 8. methimazole 10 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). Disp:*90 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) **] Discharge Diagnosis: Aortic Stenosis s/p AVR PMH: Hypercholesterolemia Hypertension Hyperthyroidism with thyroid nodule Nonspecific Thrombocytopenia ( mild) Obesity Depression Meralgia paresthetica Asthma GERD Dysglycemia Thoracic back pain/sciatica SVT ( episode during stress test) remote esopagitis PSH: Tonsillectomy Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - healing well, no erythema or drainage Leg Edema: Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments: Wound Check on [**12-12**] at 11:00am [**Hospital **] Medical Office Building [**Hospital Unit Name **] [**Telephone/Fax (1) 1504**] Surgeon: Dr [**First Name (STitle) **] [**Name (STitle) **] on [**1-8**] at 1:15pm [**Hospital **] Medical Office Building [**Hospital Unit Name **] [**Telephone/Fax (1) 1504**] Cardiologist:Dr [**First Name8 (NamePattern2) 88838**] [**Last Name (NamePattern1) 1923**] on [**12-31**] at 2:30pm Please call to schedule appointment with: Primary Care: Dr [**Last Name (STitle) **],[**First Name3 (LF) **] L. [**Telephone/Fax (1) 88839**] in [**3-6**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2182-12-8**] ICD9 Codes: 4241, 5119, 2724, 4019, 2859, 311
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6180 }
Medical Text: Admission Date: [**2172-4-30**] Discharge Date: [**2172-5-12**] Date of Birth: [**2117-1-11**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 443**] Chief Complaint: abdominal pain, dyspnea Major Surgical or Invasive Procedure: intra-aortic balloon bump central line PA catheter arterial line intubation History of Present Illness: This is a 55 YOM with PMHX significant for CAD, HTN, smoking, hyperlipidemia who presents in shock. He was well until 5 days PTA. Per his family he had onset of abdominal pain/indigestion (similar to 1st ACS presentation). They are unaware of the nature of the pain or if he had any other symptoms including fevers, chest pain, dyspnea, nausea, vomiting, or dysuria. He was taken by his girldriend to [**Hospital1 **] [**Location (un) 620**] ED for evaluation [**2172-4-29**]. At their ED his intial vitals were, T 98.7 HR 110 BP 116/83 RR 18 and 99% on RA. PEr their ED records he complained of orthopnea, denied N/V, chest pain, palps, fevers. The abdominal pain was characterized as gradual onset, constent, [**4-30**], and diffuse in location. Their exam noted mild tenderness in LLQ and normal cardipulmonary exam aside from tachycardia.He was found to have an elevated WBC count and treated with levo/flagyl empirically for presumed diverticulitis. EKG revealed afib with rate of 171. nl axis. TWI in V5 V6. He was given a total of 25 mg IV diltiazem, 30 mg po, atenolol 50 mg po. His pulse then dropped to 70 and SBP to 40. He was then intubated and started on dopamine. Dopamine titrated up to 20 mcg with SBP still in the 50s. He then also started on levophed and given a total of 8L of NS. Pressures then to 113 systolic. . Upon arrival to the [**Hospital1 18**] ED, his vitals were HR 116, BP 113/96. He was not making urine. A right IJ triple lumen was placed. He was given 1g of vancomycin. Dopamine switched to dobutamine with out significant improvement in urine output. He was also given 1 amp of bicarb for pH of 7.11. . REVIEW OF SYSTEMS: Unobtainable Past Medical History: hypertension coronary artery disease hyperlipidemia ethanol abuse smoking Social History: significant for current tobacco use. There is history of daily alcohol use. Family History: Brother and father with CAD in 50s Physical Exam: VS: T 97.8 BP111/78 HR103 RR 23 O2 100% VENT" AC Vt 600 RR 20 FiO2 60% Peep 10 Gen: Intubated/sedated HEENT: NCAT. Sclera anicteric. PERRL, . Conjunctiva were pink with periorbital edema.No pallor or cyanosis of the oral mucosa. No xanthalesma. Neck: R IJ cordis in place CV: irregular, normal S1, S2. Distant heart sounds No m/r/g. No thrills, lifts. No S3 or S4. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB (anterior, no crackles, wheezes or rhonchi. Abd: Soft, NT, distended. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: No c/c/e. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pertinent Results: Percutaneous coronary intervention, in [**2-23**] anatomy as follows: 1. Selective coronary angiography revealed a right-dominant system with single-vessel coronary disease. The LMCA had no angiographically apparent disease. The LAD had no angiographically apparent disease. The LCx had a proximal 30% ulcerated plaque and the large first OM was occluded proximally. The RCA had minor diffuse plaquing and the posterolateral branch had a distal 60% stenosis. 2. Limited resting hemodynamics revealed a moderately elevated left-sided filling pressure of 28 mmHg. There was no gradient across the aortic valve on pullback of the catheter from the left ventricle. 3. Left ventriculography revealed no significant mitral regurgitation, normal wall motion, and a calculated ejection fraction of 60%. 4. Successful PTCA and stenting of the totally occluded OM1 with a 2.5x 8 mm Cypher DES. Final angiography revealed no residual stenosis, no apparent dissection, and normal flow in the vessel . . EKG demonstrated afib,rate 79 bpm. nl axis. narrow qrs. ST depressions in v5 v6 . TELEMETRY demonstrated: afib . 2D-ECHOCARDIOGRAM performed in ED demonstrated: Global hypokinesis . HEMODYNAMICS: CVP 20 RV 47-53/17 PA 50/38 PCWP 23 CO 3.6 SVR 1467 . CXR: There is a new right central venous catheter terminating in the superior vena cava. The nasogastric tube projects only immediately beyond the hemidiaphragms and a side hole is within the distal esophagus. Advancing the tube is recommended into the stomach. Patient remains intubated. There is distention of the azygos vein and vascular pedicle, as well as marked cardiomegaly and a small effusion. . CT OF THE ABDOMEN WITHOUT IV CONTRAST: There are bibasilar atelectases and effusions. There is fatty infiltration of the liver. There is dense material throughout the gallbladder, which is nondistended, which may represent sludge, and less intravenous contrast was administered recently, which could suggest vicarious excretion. The spleen is normal in size. The pancreas is somewhat atrophic. The kidneys show a small 2-mm calcification on the right, which may be vascular or tiny nonobstructing stone. The adrenal glands are within normal limits. The bowel is not dilated, and there is a full thickening of the small bowel, as well as stranding in the retroperitoneum and ascites, all of this could be explained by fluid overload. There is fatty infiltration of the wall of the ascending colon, which is suggestive of chronic inflammation. There is stranding focussed in the central mesentery. Although nondistended jejunal folds appear thickened, and more distally the bowel is collapsed. There is marked diverticulosis, but no evidence of diverticulitis. . CT OF THE PELVIS WITHOUT IV CONTRAST: There is a Foley catheter in the bladder. Rectum appears normal. Severe diverticulosis is noted. There is fairly extensive fatty hypertrophy of the perirectal fat. . RUQ U/S WET READ No gallstones or gallbladder distension. Wall edema may be due to anasarca. Fatty liver. . [**2172-4-30**] Echo: Conclusions: 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. The left atrial appendage emptying velocity is depressed (<0.2m/s). No spontaneous echo contrast is seen in the body of the right atrium or right atrial appendage. No atrial septal defect is seen by 2D or color Doppler. There is severe global left ventricular hypokinesis. Overall left ventricular systolic function is severely depressed. Right ventricular systolic function appears depressed. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Mild to moderate ([**12-24**]+) mitral regurgitation is seen. There is no pericardial effusion. Impression: No [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA thrombus. Severely depressed LV function. Mild to moderate mitral regurgitation. [**2172-5-7**] CT head: No acute intracranial hemorrhage, shift of normally midline structures, or major vascular territorial infarct. [**Doctor Last Name **]-white matter differentiation is preserved. There is no hydrocephalus. Osseous structures and soft tissues are unremarkable. IMPRESSION: no hemorrhage or major vascular territorial infarct. . TTE [**2172-5-7**]: EF 30%. The left atrium is mildly dilated. The right atrium is moderately dilated. The estimated right atrial pressure is 11-15mmHg. Left ventricular wall thicknesses and cavity size are normal. There is moderate to severe global left ventricular hypokinesis (ejection fraction 30 percent). Right ventricular chamber size is normal. Right ventricular systolic function appears depressed. The ascending aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. Mild to moderate ([**12-24**]+) mitral regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. . [**2172-4-30**] 12:28AM WBC-12.5* RBC-3.80* HGB-13.2* HCT-40.1 MCV-106* MCH-34.8* MCHC-33.0 RDW-14.4 [**2172-4-30**] 12:28AM cTropnT-0.09* [**2172-4-30**] 12:28AM CK-MB-8 [**2172-4-30**] 12:28AM ALT(SGPT)-491* AST(SGOT)-705* LD(LDH)-692* CK(CPK)-118 ALK PHOS-56 AMYLASE-45 TOT BILI-2.9* DIR BILI-2.1* INDIR BIL-0.8 [**2172-4-30**] 12:28AM GLUCOSE-183* UREA N-38* CREAT-1.8* SODIUM-136 POTASSIUM-4.9 CHLORIDE-105 TOTAL CO2-13* ANION GAP-23* Brief Hospital Course: Hospital course: This is a 55 year old male who presented from an OSH intubated in atrial fibrillation with RVR and cardiogenic shock. He initially required multiple pressors to support his blood pressure. His hemodynamics were monitored with a PA catheter and he required an intra-aortic balloon pump to be placed. Soon after the IABP was placed his cardiac indices improved and he was weaned off of pressor support and the IABP was removed. He was aggressively diuresed and extubated. . 1) Shock: The differential of the etiology of shock in this patient was cardiogenic vs septic. He had initially presented with complaints of abdominal pain to the OSH. Per the OSH ED record, the patient had a leukocytosis and some LLQ tenderness to palpation concerning for a possible abdominal infection. However, there were no conclusive findings on abd. CT or U/S. Seen on CT was some stranding and thickening of the small bowel (could be explained by fluid overload). On admission, he was started empirically on vanc/levo/flagyl for presumed sepsis. More likely was cardiogenic shock in the setting of atrial fibrillation with RVR and many nodal blocking agents given at OSH. Given his significant alcohol history it was felt that he may have had an underlying cardiomyopathy that in setting of his arrhythmia and drugs tipped him over into cardiogenic shock requiring intubation. TTE here showed global hypokinesis consistent with this. A right-heart catheter was placed. Hemodynamics were also consistent with cardiogenic shock (elevated filling pressures, elevated SVR, low CO and CI). He required pressors to maintain MAPs >65. He was placed on levophed and dobutamine drips transiently. Elevated lactate was consistent with decreased tissue perfusion. An IABP was placed due to worsening cardiac status. He eventually improved on the IABP which allowed weaning off the pressors. His IABP was removed again and the patient remained hemodynamically stable off pressors and mechanical support and could be extubated. His Afib was managed as described below. His CHF and BP were also medically managed and optimized towards the end of his hospital stay. He was discharged on ASA 81, BB, Lasix, Spironolactone and Dig (also for Afib, see below). He has an outpatient appointment with his PCP, [**Name10 (NameIs) 2085**] and electrophysiologist. He was off oxygen requirement, hemodynamically stable and with minimal LE edema upon discharge. He should weigh himself daily and follow a sodium restricted diet. . 2) ID: As above, there was concern for initial sepsis with possible abdominal source. He was started on vanco/levo/flagyl empirically. Cultures were negative. He completed a 7 day course of antibiotics. His leukocytosis trended down and he remained afebrile. . 3) Respiratory failure: Hypoxic secondry to pulmonary edema in the setting of afib and RVR. In addition, the patient had been given 8 liters of fluid at the OSH. Patient was intubated at OSH and remained intubated in the CCU. Once his hemodynamics improved and he was maintaining his BP without pharmacologic support he was given boluses of IV lasix for diuresis. His respiratory status improved with diuresis and he was successfully extubated. He was off any oxygen requirement upon discharge. . 4) CAD: Stent to OM in [**2168**]. No CP. No significant cardiac enzyme elevations. . 5) Rhythm: AFib with RVR. DC cardiovesion was attempted several times without success in addition to medical management including frequent IV metoprolol doses. Medical conversion was also attempted with Amiodarone. However, the patient remained in Afib although he was rate controlled later during his hospital stay. He was eventually stabilized on a regimen of Amiodarone, metoprolol, and Digoxin. Anticoagulation was initiated transiently with a heparin drip and with coumadin 5mg qHS towards his discharge. His INR prior to discharge was 1.8. An appointment with his PCP was scheduled two days after discharge in order to check another INR with a goal of [**1-25**]. . 6) Pump: Global hypokinesis. Unclear cause. Myocarditis vs depression in setting of sepsis vs other. Likely underlying alcohol-induced cardiomyopathy given his history of ethanol abuse until recently. See above with regards to his CHF/cardiogenic shock management. . 7) Acidosis: metabolic with inadequate respiratory response initially. High lactate. No osmolar gap. Gap eventually closed after having stabilized his cardiogenic shock. Lactate trended down. Acidosis resolved. . 8) Renal failure: In setting of likely poor PO intake. Pre-renal vs ATN from cardiogenic shock. No hydro seen. Renal function improved slowly throughout the course of his hospital stay. His renal function returned to [**Location 213**] prior to discharge. . 9) Acute Liver failure: History of daily alcohol use. Fatty liver on U/S. No stones or ductal dilation. Transaminases elevated and direct hyperbilirubinemia. Likely shock liver due to cardiogenic shock. Hepatitis serologies were negative LFTs were slowly trending down throughout his hospital stay. . 10) Coagulopathy: [**1-24**] liver failure. Improved with improving liver function. Towards the end of his hospital stay, coumadin was started for anticoagulation for Afib. . 11) Alcohol use: H/o [**12-24**] bottle of whiskey until recently. No history of DTs. MCV was high. Patient received B12/thiamine/folate. . 12) Hyperlipidemia: Normal cholesterol and TGs. Chol/HDL was 2.0. . 13) DM: No history. Sugars transiently elevated. Covered with SSI. HbA1c was 5.7. . 14) FEN: cardiac, heart healthy diet after extubation. . 15) PPX: Pneumoboots, PPI, later coumadin. . 16) Access: A-line, R IJ, initially femoral line . 17) Code: Full . Medications on Admission: Atenolol Lipitor Lisinopril Discharge Medications: 1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 7. Furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 9. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO every twelve (12) hours for 3 days: twice daily for 3days, then daily after that until you see your cardiologist. Disp:*12 Tablet(s)* Refills:*0* 11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day: Start daily doses after 3 days of twice daily doses after discharge. . Disp:*60 Tablet(s)* Refills:*2* 12. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: Three (3) Tablet Sustained Release 24 hr PO once a day: Start on [**2172-5-13**]. Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2* 13. Outpatient Lab Work INR check on [**2172-5-14**] Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: 1. Cardiomyopathy with cardiogenic shock and CHF (EF initially 15%, then up to 30%), status post intubation and inotropic pressure support and intraaortic balloon pump 2. Systolic and diastolic CHF, EF 15% (now 30%) 3. Hypertension 4. Hyperlipidemia 5. Atrial fibrillation with rapid ventricular response requiring DC cardioversion, on coumadin 6. Questionable sepsis, completed 7 day course of vanc/levo/flagyl empirically 7. CAD s/p stent in [**2168**] 8. Acute renal failure secondary to poor forward flow from CHF 9. Acute liver failure in setting of cardiogenic shock 10. Fatty liver, h/o Etoh abuse . Secondary Diagnosis: 1. H/o Ethanol abuse 2. Obesity Discharge Condition: Stable. Afebrile. Tolerating PO. Ambulating without difficulty. Discharge Instructions: You have been treated for a heart condition called cardiomyopathy with congestive heart failure. You have been intubated and sedated and received intravenous medications to keep your blood pressure and circulation stable. You have partially recovered from this condition. You have been started on several new oral medications: Amiodarone, Digoxin and Coumadin (a blood thinner) for anticoagulation and rate control for a heart rhythm condition called atrial fibrillation; blood pressure and heart failure medications (lisinopril, spironolactone, toprol XL, lasix). Please take all medications as prescribed and discontinue your previous oral medications. . You should weigh yourself daily and call your PCP if you gain more weight than 3 pounds. You should follow a low sodium diet and restrict your fluid intake to 1.5 liters per day. . Please call your primary doctor or return to the ED with fever, chills, chest pain, shortness of breath, leg swelling, nausea/vomiting, spontaneous bleeding or any other concerning symptoms. . Please take all your medications as directed. . Please keep you follow up appointments as below. Followup Instructions: You should have a lung function test (called PFTs) as an outpatient because you have been started on a drug called amiodarone to control your heart rate and rhythm. This medication can sometimes compromise lung function and therefore you should have a baseline test to be scheduled by your PCP. . You should follow up with an electrophysiologist regarding your atrial fibrillation and arrythmias. You have an appointment scheduled with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for [**5-25**] at 9:20am in the [**Hospital Ward Name 23**] Clinical Center, [**Location (un) 436**]. Call ([**Telephone/Fax (1) 5862**] with any questions. . Please also follow up with your cardiologist at [**Hospital1 18**] [**Location (un) 620**] (Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **], phone: ([**Telephone/Fax (1) 8937**]. An appointment has been scheduled for [**6-29**], Monday, at 3pm. The office will contact you if an earlier appointment is going to be available as you should follow up earlier than that with him, if possible. . You have an appointment with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) 1022**], on [**2172-5-20**] at 3:30pm. [**Last Name (LF) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 15818**] . You should go to your Dr.[**Name (NI) 2989**] office on [**2172-5-14**] for lab work. The so called INR should be checked which is a lab test to determine if your anticoagulation (blood thinning) on coumadin is accurate. Your last INR on discharge was 1.8. ICD9 Codes: 4254, 4280, 5849, 0389, 2762, 2761, 4019, 2930, 2724, 3051, 412
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6181 }
Medical Text: Admission Date: [**2103-5-17**] Discharge Date: [**2103-5-23**] Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Shortness of Breath Major Surgical or Invasive Procedure: Coronary Artery Byapss Graft x 1 (LIMA to LAD) and Aortic Valve Replacement (21mm CE pericardial tissue valve) [**2103-5-17**] History of Present Illness: 82 y/o female with worsening shortness or breath. Referred for cardiac cath which revealed coronary artery disease and aortic stenosis. Past Medical History: Hypertension, Hypercholesterolemia, Seizure disorder, Hypothyroidism, Myeloproliferative disorder with mild anemia, h/o Atrial Fibrillation h/o cellulitis, s/p Hysterectomy Social History: Retired waitress. Denies tobacco use. Denies ETOH use, but admits to alcoholism and quit in [**2087**]. Family History: Father died of MI at age 47. Physical Exam: VS: 60 15 168/70 5' 68.5kg General: WD/WN elderly female in NAD HEENT: EOMI, PERRLA, OP benign Neck: Supple, FROM, -JVD, -carotid bruits Chest: CTAB -w/r/r Heart: Irreg-regular with 3.6 murmur Abd: Soft, NT/ND, +BS Ext: Warm, well-perfused, trace edema, -varicosities Neuro: A&O x 3, non-focal, MAE Pertinent Results: Echo [**5-17**]: Pre-cpb: The left atrium is moderately dilated. The left atrial appendage emptying velocity is depressed (<0.2m/s). There is mild symmetric left ventricular hypertrophy with normal cavity size. There is moderate symmetric left ventricular hypertrophy. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular systolic function is normal. There are simple atheroma in the aortic root. There are simple atheroma in the ascending aorta. There are simple atheroma in the aortic arch. There are focal calcifications in the aortic arch. There are complex (>4mm) atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are severely thickened/deformed. There is severe aortic valve stenosis. Mild (1+ aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Moderate (2+) mitral regurgitation is seen. POST-CPB-Well seated bioprosthetic valve in the aortic posotion. No AI Peak gradient 23, mean 12 mm Hg. Preserved [**Hospital1 **]-ventricular systolic fxn, MR 2+, unchanged from pre-bypass. CXR [**5-22**]: Small bilateral pleural effusions and left lower lobe atelectasis unchanged. Stable postoperative appearance of the heart and mediastinum. [**2103-5-17**] 11:27AM BLOOD WBC-21.4*# RBC-1.99*# Hgb-6.8*# Hct-20.3*# MCV-102* MCH-34.2* MCHC-33.5 RDW-21.6* Plt Ct-197 [**2103-5-17**] 06:02PM BLOOD Hct-28.8*# [**2103-5-23**] 07:05AM BLOOD Hct-30.2* [**2103-5-22**] 06:40AM BLOOD WBC-11.2* RBC-2.98* Hgb-9.5* Hct-28.2* MCV-95 MCH-31.8 MCHC-33.6 RDW-20.3* Plt Ct-129* [**2103-5-17**] 12:19PM BLOOD PT-17.5* PTT-36.3* INR(PT)-1.6* [**2103-5-20**] 03:00PM BLOOD PT-67.3* PTT-36.1* INR(PT)-8.5* [**2103-5-21**] 08:50AM BLOOD PT-28.2* INR(PT)-2.9* [**2103-5-23**] 07:05AM BLOOD PT-13.3* INR(PT)-1.2* [**2103-5-17**] 12:19PM BLOOD Glucose-164* UreaN-18 Creat-0.5 Na-141 K-3.3 Cl-111* HCO3-23 AnGap-10 [**2103-5-22**] 06:40AM BLOOD Glucose-99 UreaN-29* Creat-1.0 Na-137 K-3.4 Cl-98 HCO3-29 AnGap-13 [**2103-5-23**] 07:05AM BLOOD K-4.4 [**2103-5-21**] 02:30AM BLOOD Calcium-8.8 Phos-2.1* Mg-2.1 Brief Hospital Course: As mentioned in the HPI, Ms. [**Known lastname 487**] was found to have severe AS and coronary artery disease. She had all pre-operative work-up done as an outpatient and was electively admitted on [**2103-5-17**] for surgery. She was brought to the operating room on this day where she underwent an aortic valve replacement and coronary artery bypass graft. Please see operative report for surgical details. Amiodarone was started in the OR for AFIB. She tolerated the procedure well and was transferred to the CSRU for invasive monitoring in stable condition. Later on op day she was weaned from sedation, awoke neurologically intact and extubated. On post-op day one her chest tubes were removed and she was started on beta blockers and diuretics. She was gently diuresed during post-op course towards her pre-op weight. Coumadin was started for her Atrial Fibrillation. Over the next several days she remained stable in the CSRU. Her INR increased dramatically to over 8 within a couple of days. Coumadin was held and INR decreased significantly. At time of discharge her INR was 1.2. Her therapeutic goal is 2-2.5. On post-op day four she was transferred to the telemetry floor. Epicardial pacing wires were removed on post-op day five. Physical therapy followed patient during entire post-op course for strength and mobility. She appeared to be doing well with stable labs and vital signs, but still needed PT. She was discharged to rehab facility with the appropriate follow-up appointments on post-op day 6. Medications on Admission: Dilantin 130mg qd, Lopressor 25mg qd, Clonazepam 0.5mg prn, Synthroid 137mcg qd, Lasix qd, Procrit Discharge Medications: 1. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO QAM (once a day (in the morning)). 3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 2 weeks. 7. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO BID (2 times a day) for 2 weeks. 8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): 400mg [**Hospital1 **] for 2 days. Then 400mg qd for 7 days. Then 200mg qd until stopped by cardiologist. 9. Warfarin 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Titrate for INR goal of [**1-4**].5. 10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital 941**] - [**Location 942**] Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Byapss Graft x 1 Aortic Stenosis s/p Aortic Valve Replacement Post-operative Atrial Fibrillation PMH: Hypertension, Hypercholesterolemia, Seizure disorder, Hypothyroidism, Myeloproliferative disorder with mild anemia, h/o Atrial Fibrillation h/o cellulitis, s/p Hysterectomy Discharge Condition: Good Discharge Instructions: [**Month (only) 116**] take shower. Do not take bath. Do no apply lotions, creams, ointments or powders to incision. Do not drive for 1 month. Do not lift greater than 10 pounds for 2 months. If you develop a fever or notice redness or drainage from incision, please contact office immediately. Followup Instructions: Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 170**] Follow-up appointment should be in 1 month Provider: [**Name10 (NameIs) **],[**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 29977**] Follow-up appointment should be in 2 weeks Dr. [**Last Name (STitle) 8098**] in [**1-5**] weeks Completed by:[**2103-5-23**] ICD9 Codes: 4241, 2859, 2449
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Medical Text: Admission Date: [**2149-1-26**] Discharge Date: [**2149-2-5**] Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1854**] Chief Complaint: Right subdural hematoma Major Surgical or Invasive Procedure: s/p burr holes foe evacuation of subdural hematoma History of Present Illness: 84M who was admitted here early [**Month (only) 404**] falling fall while on coumadin for afib. At that admisssion had small R acute convexity SDH. Repeat scans were stable and he was discharged to home. He has been off coumadin since that time. Was discharged on dilantin but level was 1 at OSH today He returns today with increasing confusion. Head CT at OSH shows 2cm R chronic SDH with shift and effacement of ventricle. Past Medical History: Afib Htn MI Social History: lives with wife who has dementia. Very supportive family, children Family History: Unknown Physical Exam: Gen: WD/WN HEENT: Pupils:PERRLA EOMs unable to participate Neck: Supple. Extrem: Warm and well-perfused. Neuro: Mental status: Lethargic, confused, unable to cooperate with exam. Orientation: Oriented to person only Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, 4to3 mm bilaterally. III, IV, VI: Extraocular movements unable to assess V, VII: Facial strength appears intact. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength antigravity all 4. Pertinent Results: Head CT [**1-26**] Significant increase in size of large right subdural collection with associated leftward subfalcine herniation, dilation of the left lateral ventricle, and likely some rightward uncal herniation. CXR [**1-26**] Low position of the endotracheal tube terminating at the carina. This was discussed with Dr. [**First Name (STitle) **] at 12 noon on [**2149-1-26**]. Nasogastric tube terminates in the stomach, however side port is near the GE junction. This was relayed to the emergency board dashboard at 12 noon and flagged for urgent attention. EKG [**1-26**] Atrial fibrillation with a rapid ventricular response and ventricular premature beat. Diffuse non-specific ST-T wave abnormalities. Compared to the previous tracing of [**2149-1-10**] ventricular rate is faster. Head CT [**1-27**] Large improvement in the size of the right subdural collection. Improved leftward subfalcine herniation with mild residua remaining. The uncal herniation has resolved. CXR [**1-28**] Lung volumes are preserved following removal of the endotracheal tube. Although there is minimal atelectasis at the left lung base medially, the lungs are otherwise clear. Heart size remains top normal. There is no pleural effusion or pneumothorax. Transvenous right ventricular pacer lead in standard placement Head CT [**1-29**] Study is compared with the most recent NECT dated [**1-27**], as well as a series of previous studies dating to [**2149-1-10**]. The overall appearance is not significantly changed since the most recent study. As before, the patient is status post placement of two right frontal burr holes with residual post-operative pneumocephalus, smaller. The mixed-attenuation subdural collection layering over the right cerebral convexity is unchanged and normal in overall size and appearance, and continues to measure roughly 11 mm in maximal thickness, at the vertex, with small layering dependent hemorrhage. Additional small hypoattenuating foci may represent vessels, fibrovascular strands or additional foci of more acute hemorrhage. There is persistent mass effect on subjacent gyri and approximately 7 mm leftward shift of the septum pellucidum, effacement of the ipsilateral and trapping of the contralateral lateral ventricles, improved. No new extra- and no intra-axial hemorrhage is identified. Again demonstrated are some lacunes in the left basal ganglia. IMPRESSION: No significant change in the moderately large subdural collection layering over the right convexity with similar degree of mass effect and shift of the midline structures, no new hemorrhage Brief Hospital Course: Patient was transferred from outside hospital to [**Hospital1 **] with 2cm right chronic SDH with shift and effacement of the ventricle. He went to the operating room to have a burr hole procedure to evacuate the blood. He spend the night in the PACU intubated and the patient went in and out of atrial fibrilation requiring IV diltiazem for control. After restarting his normal home medications, the situation improved and he defervesced to the floor. We had the EP team come and evaluate the pacemaker as the patient fell on the side of his pacemaker before his admission. The EP team found nothing wrong with the pacemaker. On POD 2, the patient did very well. PT saw and worked with him. Later that day, he had a temperature and became tachycardic. Labs were drawn and fluids were given aggressively. The rest of his exam at this time was normal. On POD1, we drew labs to establish a better baseline of where he started at. There were no bacteria in his urine. On POD2, we d/c'd his IVF and foley. On [**2149-1-30**] the patient had continued tachycardia with heart rate up to the 150s which only briefly reponded to fluid boluses. As a result, a medicine consult was obtained. After a 5mg dose of lopressor his heart rate came down to 115. His quinapril and atenolol were discontinued and metoprolol was added per medicine's recommendations. He continued to have periods of tachycardia during his hospitalization an EP consult was also obtained he diltazem and lopressor were increased to 360 daily and Lopressor 125mg. He was ruled out for an MI on [**2-3**]. The cardiology and medicine teams felt he was safe for discharged without telemetry. Neurologically he intact without any deficits and his sutures were removed on discharge. He was found to have a Digoxin level of 3.1 on discharge, we recommend hold his digoxin dose for 2 days then rechecking a level on [**2-7**]. Medications on Admission: Digoxin, Pravastatin, Allopurinol, Quinapril Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 2. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily): HOLD UNTIL [**2-7**] FOLLOW UP DIG LEVEL. 3. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 9. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 10. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO DAILY (Daily). 11. Metoprolol Tartrate 50 mg Tablet Sig: 2.5 Tablets PO TID (3 times a day). Discharge Disposition: Extended Care Facility: [**Hospital 12414**] Healthcare Center - [**Location (un) 12415**] Discharge Diagnosis: Right acute subdural hematoma Discharge Condition: good Discharge Instructions: PLease call the office or come to the emergency room for any changes in mental status, weakness, seizure, worsening headache or for any questions/concerns you may have. Please call the office or come to the emergency room for excessive redness at incision site, drainage from incision or fever>101.5 Hold Digoxin for next two days then check level if within normal limits than may resume. Followup Instructions: Follow up with your cardiologist in 1 week You will also need to make an appointment for follow up with Dr. [**Last Name (STitle) **] 4 weeks from the time of discharge. Call the same number to make that appointment. You will need to have a Head CT at that time. Please follow dilantin levels;dig levels weekly. Dilantin goal [**10-25**] Completed by:[**2149-2-5**] ICD9 Codes: 5180, 4019, 412
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6183 }
Medical Text: Admission Date: [**2104-7-1**] Discharge Date: [**2104-7-15**] Date of Birth: [**2045-5-4**] Sex: F Service: SURGERY Allergies: Codeine / Penicillins Attending:[**Doctor Last Name 19844**] Chief Complaint: s/p MVC Major Surgical or Invasive Procedure: none History of Present Illness: 59F who is s/p motor vehicle crash. She was in the front seat when the car ran into a crowd of people and then into a pole. There was reportedly no LOC. Her c-spine was cleared at the OSH. Her EtOH level was 122. She had bilateral rib fractures and a 24Fr R chest tube was placed into the subcutaneous tissue of the R chest wall at the OSH. She was transferred from an OSH via med flight. Past Medical History: PMH: COPD, bipolar depression, NIIDM, EtOH abuse, ?old R humeral fx? PSH: bilateral knee replacement, CCY, VHR Social History: H/o EtOH abuse, has had multiple trauma in the past Family History: NC Physical Exam: Discharge day exam: 99.1 97.7 105 95/61 18 93% trach mask Gen: NAD, alert, appropriately responsive to yes/no questions CV: RRR Pulm: coarse breath sounds, breathing comfortably on trach mask, most of subcutaneous emphysema resolved, chest tube sites appear clean Abd: soft, nontender, nondistended Ext: WWP Pertinent Results: [**2104-7-1**] 05:50PM BLOOD WBC-11.7* RBC-2.96* Hgb-9.8* Hct-30.1* MCV-102* MCH-33.0* MCHC-32.4 RDW-14.7 Plt Ct-147* [**2104-7-1**] 07:46PM BLOOD WBC-11.7* RBC-3.41* Hgb-11.1* Hct-34.3* MCV-101* MCH-32.7* MCHC-32.5 RDW-15.4 Plt Ct-155 [**2104-7-15**] 03:20AM BLOOD WBC-12.7* RBC-3.30* Hgb-10.3* Hct-31.8* MCV-96 MCH-31.2 MCHC-32.4 RDW-14.8 Plt Ct-336 [**2104-7-1**] 07:46PM BLOOD Glucose-150* UreaN-16 Creat-1.1 Na-139 K-5.1 Cl-111* HCO3-17* AnGap-16 [**2104-7-15**] 03:20AM BLOOD Glucose-151* UreaN-20 Creat-0.9 Na-138 K-4.9 Cl-93* HCO3-37* AnGap-13 [**2104-7-1**] 05:50PM BLOOD ASA-NEG Ethanol-48* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-POS [**2104-7-1**] CT Abd/Pelv: IMPRESSION: 1. Extensive subcutaneous emphysema. 2. Right chest tube within the subcutaneous air and not within the pleural space. 3. Small right pleural pneumothorax. 4. Trace bilateral hemothoraces. 5. Trace pneumomediastinum. 6. Trace complex perihepatic fluid without evidence of injury to the solid organs. 7. Right third through tenth and left fourth through eighth rib fractures. Sternal fracture. 8. Small subcutaneous hematoma overlying the right upper abdomen. 9. Loss of height of the L4 vertebral body, likely chronic. 10. Complex splenic cyst. 11. Apparent soft tissue lesion with dense calcifications in the region of the right anterior mediastinum, not clearly evaluated on this exam. After the acute findings have resolved, recommend followup with dedicated chest CT for further evaluation. 12. Findings suggestive of chronic pancreatitis with possible obstructing calculus in the distal pancreatic duct within the pancreatic head. An MRCP can be obtained for further evaluation. CT Head: IMPRESSION: No acute intracranial abnormality. [**2104-7-4**] Echo: Left ventricular wall thickness, cavity size, and overall systolic function are normal (LVEF 65%). Right ventricular chamber size and free wall motion are normal. However, in very suboptimal imaging, the basal segment of the posterior wall may be hypokineticThere is no aortic valve stenosis. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is a very small pericardial effusion. There is an anterior space which most likely represents a prominent fat pad. There are no echocardiographic signs of tamponade. Brief Hospital Course: 59F s/p MVC partially restrained passenger, front seat, car vs crowd and then a pole, -[**Hospital 63213**] transferred from OSH via med flight, neck cleared at OSH. Pt was hypotensive in the CT scan, triggered was called, pt received 1 U PRBC. CT was found to be placed in chest wall subcutaneous tissue. She was stable until arrival in the TICU when she began to have respiratory distress and was intubated, sedated and is paralyzed. CT scan shows to have numerous rib fractures, sternal fx, Sub-Q emphysema, pneumomediastinum, and R PTX. R anterior chest pigtail was placed initially but it was not resolved her PTX. Bilateral CT were then placed in the TSICU. On [**7-5**]+ gram negative diplococci was detected on SCx.Cultures grew w/ Moraxella. Vanco/Cipro/Cefepime started. Bedside trach was placed on [**7-7**]. On [**7-9**], pt was doing well, +OOB to chair, b/l CT to waterseal. On [**7-10**]: Left sided chest tube D/c'd. Mental status starts to improve. [**7-11**]: dobhoff placed. R Chest tube dc'd. On [**7-13**], Pt was weaned to trach mask and she passed bedside swallow evaluation. Pt was advanced to regular diet with supplements. The rest of her hospital course per systems are detailed below: Neurologic: Oxycodone/IV dilaudid, zyprexa/seroquel/paxil. TLSO brace when OOB for T12 Fx h/o EtOH on thiamine, folate supplementation Cardiovascular: Stable, Echo: normal EF, very small effusion, no tamponade. Cont to monitor for S&S of blunt cardiac injuries Pulmonary: On Trach mask, cont to wean as tolerates Cont pulmonary toilet, breathing treatment (Ipratropium, Albuterol) Gastrointestinal: Regular diet Hematology: Stable, cont to monitor Endocrine: - DM Cont GlipiZIDE, Metformin - Hypothyroidism continue synthroid Infectious Disease: Cont abx for VAP Prophylaxis: SQ heparin Medications on Admission: detrol LA 4 XR', vesicare 10', lorazepam 0.5'', MVI', glipizide 5'', pantoprazole 40', levothyroxine 75', doxepin 100', zyprexa 10', paroxetine 40', folate 1', metformin 500'', spiriva 18', klor-con 20', albuterol 90 q4h, hydroxyzine 50''' prn, ranitidine 150'', albuterol nebs prn Discharge Medications: 1. Bisacodyl 10 mg PR HS:PRN constipation 2. CeftriaXONE 1 gm IV Q24H Duration: 6 Days 3. Docusate Sodium (Liquid) 100 mg PO BID 4. Albuterol 0.083% Neb Soln 1 NEB IH Q4H 5. Doxepin HCl 100 mg PO HS home med 6. GlipiZIDE 5 mg PO BID home med 7. Heparin 5000 UNIT SC TID 8. HydrOXYzine 50 mg PO Q8H:PRN home med- anxiety 9. Levothyroxine Sodium 100 mcg PO DAILY 10. MetFORMIN (Glucophage) 500 mg PO BID home med 11. Paroxetine 40 mg PO DAILY 12. Senna 1 TAB PO BID 13. FoLIC Acid 1 mg PO DAILY 14. Ipratropium Bromide Neb 1 NEB IH Q4H 15. Multivitamins 1 TAB PO DAILY 16. OLANZapine 15 mg PO DAILY 17. Quetiapine Fumarate 25 mg PO BID 18. Furosemide 20 mg PO DAILY:PRN for volume overload 19. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain Discharge Disposition: Extended Care Facility: [**Hospital **] Hospital for Continuing Medical Care - [**Location (un) 1121**] ([**Hospital3 1122**] Center) Discharge Diagnosis: bilateral rib fractures, sternal fracture, small pneumomediastinum, small right pneumothorax Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted to the ACS service after your trauma. Please follow these directions: You should resume walking and exercising as you can tolerate. You have rib fractures and a sternal fracture. If you have pain, you can take tylenol or motrin. You can also take narcotic medication if your pain is severe. You can resume a regular diet. Followup Instructions: Please call [**Hospital 2536**] clinic to schedule a follow-up appointment [**12-31**] weeks after your discharge. The clinic # is [**Telephone/Fax (1) 600**] ICD9 Codes: 4589, 2851, 496, 4019, 2449
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Medical Text: Admission Date: [**2140-1-27**] Discharge Date: [**2140-2-9**] Date of Birth: [**2068-10-26**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1481**] Chief Complaint: Presents for surgery Major Surgical or Invasive Procedure: [**1-27**] Laparoscopic esophagogastrectomy with placement of feeding tube History of Present Illness: Mr. [**Known lastname 104432**] is a 71 year old male who presented to [**Hospital1 18**] on [**1-27**] for scheduled surgical resection of a biopsied confirmed carcinoma of the esophagus, T2 lesion without evidence of positive lymph nodes. Past Medical History: Past Medical History: GERD/ Barrett's esophagus Asthma Left knee arthritis Past Surgical History: Tonsillectomy Submandibular gland excision Social History: Married, works as a dentist; seven drinks per week, non-smoker Family History: Father and 2 half sisters with CAD Pertinent Results: Operative report [**1-27**]: Carcinoma of the esophagus. . PROCEDURES: Minimally invasive total esophagectomy with laparoscopic feeding jejunostomy. Chest x-ray [**1-28**]: There is no pneumothorax or sizable pleural effusions. Right chest tubes in position. NG tube tip in unchanged position. Left lower lobe retrocardiac atelectasis is peristent. Improved right lower lobe and left mid zone atelectasis. There has been no change in the cardiomediastinal contour in the postoperative period. Barrium esophageal swallow [**2-1**]: IMPRESSION: No evidence of anastomotic leak on barium esophagram. Chest x-ray [**2-1**]: IMPRESSION: 1. Worsening asymmetrical alveolar and interstitial opacities in the right lung, which may be due to asymmetrical pulmonary edema, but superimposed aspiration in the perihilar region is also possible given the clinical suspicion. 2. Interval placement of nasogastric tube with decreased distention of pull-up. Abdominal x-ray [**2-4**]: FINDINGS: Supine and upright films of the abdomen were obtained. There is persistent left retrocardiac opacity and a left-sided effusion. A right-sided chest tube is present as well as partially visualized right lower lung opacities. There has been progression of contrast through the colon which is now seen extending to the rectum. Gas distended loops of predominantly large bowel may be slightly decreased compared to prior study. There is no evidence for free intraperitoneal air. A linear area of contrast noted in the right lower quadrant, which likely represents a normally filled appendix. The osseous structures are unchanged. Chest x-ray [**2-5**]: Heterogeneous opacification in the right lung, particularly the axillary subsegments is improving, suggesting resolution of aspiration. The neoesophagus remains severely distended with fluid. Left lung is clear and the heart is normal size. No pneumothorax noted. Small right pleural effusion is new since [**2-3**], small left pleural effusion unchanged ENT evaluation [**2-6**]: IMPRESSION/PLAN: 71yM s/p lap esophagogastrectomy now with mild hoarseness and aspiration. His laryngoscopy is essentially normal with normal vocal cord function and no evidence that he is unable to tolerate his secretions. Recommend [**Hospital1 **] PPI therapy and humidification if possible. I would expect improvement in his voice an, depending on what his video swallow shows, eventual improvement in his swallow coordination. We will follow up on his video swallow and are available for any additional questions or concerns. Speech and swallow therapy [**2-8**]: RECOMMENDATIONS: 1. PO diet texture of pureed solids and nectar thick liquids. Po medications can be given crushed in puree or via J-tube. 2. Aspiration precautions, as follows: a. Take small bites/sip. b. Swallow 3 times for each bite & sip. c. Alternate each bite with a sip. 3. Outside of meals, the pt may be allowed small amounts of thin liquids (without any other solids) using a chin tuck maneuver. 4. Repeat video swallow study in the next 10-14 days to monitor for any further resolution of unilateral pharyngeal paresis in hopes that the pt's po diet may be upgraded. Video swallow [**2-8**]: IMPRESSION: Mild-to-moderate pharyngeal residue due to decreased laryngeal valve/airway closure and bolus propulsion. This leads to mild-to-moderate aspiration with thin liquids. Discharge labs: COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2140-2-5**] 07:55AM 8.0 3.33* 10.3* 30.9* 93 31.0 33.3 12.6 395 Plt Ct INR(PT) [**2140-2-5**] 07:55AM 395 RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2140-2-7**] 10:33AM 137* 12 0.8 134 4.6 100 25 14 Calcium Phos Mg UricAcd Iron [**2140-2-7**] 10:33AM 8.9 4.0 2.3 Brief Hospital Course: Mr. [**Known lastname 104432**] had no intra-operative complications, post-operatively he was NPO with intravenous hydration, Dilaudid PCA, and intravenous beta-blockade for optimal heart rate and blood pressure; he had a neck [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] drain, right chest tube, [**Doctor Last Name **] drain, j-tube, nasogastric tube, and foley catheter; he was transferred to the SICU for close monitoring. POD 1: Chest tube removed, Toradol added for optimal pain control. POD 2: Tube feeds started, nasogastric tube removed, aggressive pulmonary toileting, transferred to in-patient nursing unit POD 4: Desaturation with emesis, improved with oxygen therapy, transferred back to SICU for aspiration, nasogastric tube replaced, broad spectrum antibiotics started, temperature with leukocytosis of 12k. POD 6: Oxygenating well with nasal cannula, productive cough, afebrile, antibiotics discontinued, barium esophageal swallow negative for an anastomotic leak, chest x-ray with opacities in right lung, transferred back to in-patient nursing unit, all medications given through jejunostomy tube including oral beta-blockade and proton pump inhibitor, tube feeds continued, pain well controlled with Oxycodone elixir and Morphine as needed; aggressive physical and chest therapy for ambulation, coughing, and deep breathing continued, ambulating with assistance. POD 7: Nasogastric tube and foley catheter removed; foley replaced secondary to urinary retention, diet advanced, oxygenating well on room air. POD 8: Abdominal distention with +flatus, tube feeds held, abdominal x-ray demonstrated ileus, NPO with intravenous hydration resumed, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and [**Doctor Last Name **] drain removed. POD 9: Speech and swallow therapy evaluation with aspiration of thin liquids and hoarse voice, abdomen soft, +flatus and bowel movement. POD 11: ENT consult with laryngoscopy revealed normal vocal cords function. Foley catheter removed with patient voiding without difficulty, tolerating tube feeds. POD 12: Video swallow confirmed right side unilateral pharyngeal weakness; diet advanced to regular pureed solids and nectar thick liquids. He tolerated minimal amount of diet, all medications either crushed in puree or given through J tube. Tolerating tube feeds of replete with fiber 2/3 strength to reach goal of 120mL. Pain well controlled with Roxicet, oxygenating well on room air, ambulating with assistance, and chest physical therapy continued with good mobilization of secretions. Discharged to [**Hospital3 2558**] rehabilitation center in stable condition on [**2-9**]. He was to have a repeat video swallow in [**9-4**] days, and was to follow-up with Dr. [**Last Name (STitle) **] in [**11-24**] weeks. Medications on Admission: Aspirin Flovent Prilosec Voltaren Discharge Medications: 1. Fluticasone 110 mcg/Actuation Aerosol [**Month/Day (2) **]: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 2. Metoprolol Tartrate 50 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times a day): Hold for HR < 60 or SBP < 100 Crush and give with applesauce/pudding or put through J tube. 3. Miconazole Nitrate 2 % Powder [**Hospital1 **]: One (1) Appl Topical PRN (as needed). 4. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution [**Hospital1 **]: 5-10 MLs PO Q4-6H (every 4 to 6 hours) as needed for pain: Can give oral or through J tube . 5. Albuterol Sulfate 0.083 % Solution [**Hospital1 **]: One (1) Inhalation Q6H (every 6 hours). 6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr [**Hospital1 **]: One (1) Capsule, Sust. Release 24 hr PO DAILY (Daily): Give with applesauce/pudding or through J tube. 7. Bisacodyl 10 mg Suppository [**Hospital1 **]: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 8. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) Inhalation Q6H (every 6 hours). 9. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: Ten (10) mL PO BID (2 times a day): Hold for loose stool. 10. Magnesium Hydroxide 400 mg/5 mL Suspension [**Hospital1 **]: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 11. Diphenhydramine HCl 12.5 mg/5 mL Elixir [**Hospital1 **]: Five (5) mL PO HS (at bedtime) as needed: Crush with applesauce or put through J tube. 12. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: 0.5 Tablet,Rapid Dissolve, DR PO BID (2 times a day): Give through J tube or oral with applesauce/pudding. Discharge Disposition: Extended Care Facility: [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] Discharge Diagnosis: Esophageal cancer Post-operative apsiration Post-operative urinary retention Right sided unilateral pharyngeal weakness Discharge Condition: Stable Discharge Instructions: Notify MD or return to the emergency department if you experience: *Increased or persistent pain *Fever > 101.5 *Nausea, vomiting, diarrhea, or abdominal distention *Inability to pass gas, stool, or urine *If incisional sites or feeding tube exit site develop redness or drainage *If feeding tube falls out *Shortness of breath or chest pain *Any other symptoms concerning to you You may shower, feeding tube exit site must be covered with an occlusive dressing Feeding tube exit site should always have a dry dressing over exit site and be changed daily No swimming or tub baths with feeding tube Followup Instructions: Follow-up with Dr. [**Last Name (STitle) **] in [**11-24**] weeks, call [**Telephone/Fax (1) 2981**] for an appointment Completed by:[**2140-2-9**] ICD9 Codes: 5180
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Medical Text: Admission Date: [**2124-5-3**] Discharge Date: [**2124-5-16**] Date of Birth: [**2052-1-1**] Sex: F Service: NEUROLOGY Allergies: Penicillins Attending:[**First Name3 (LF) 5018**] Chief Complaint: ICH Major Surgical or Invasive Procedure: Bronchoscopy x2 Tracheostomy PEG tube placement History of Present Illness: The pt is a 72 year-old right-handed woman with a history of hypertension who presented as a transfer from an OSH with an ICH. . The pt was unable to offer a history at the time of my encounter. Therefore, the following history is per the medical record and the pt's husband. . The pt had been otherwise in her usual state of health and was without complaint until approximately 7:30pm on the evening prior to transfer. At that time, she finished her dinner and told her husband that her left leg felt "numb." He noticed that she had some difficulty walking, but was able to do so and went to rest on the couch in their living room. When her husband went back to check on her at around 9pm, he noticed that she had a left facial droop and was slurring her words. He intended to bring her to a local ED, but the pt was initially reluctant. He subsequently called 911 and she was taken to an OSH. . At the OSH, she was noted to have a flaccid hemiparesis on the left. She underwent a CT scan which showed a right putaminal hemorrhage. Reportedly, she became progressively somnolent and was intubated for airway protection (received etomidate, succinylcholine, lidocaine for intubation at 2330). She was subsequently given 4mg of ativan (at 2327 and 2348) and 1g of IV dilantin (at 2330)- no convulsive activity documented. She was also given 15mg of IV labetalol at the OSH for BP of 168/108 on arrival. No subsequent vital signs documented. Per the ED resident, the pt was given an indeterminate amount of IV ativan en route from the OSH (no EMS report could be found). . The pt was unable to offer a review of systems. Past Medical History: -hypertension -hyperlipidemia Social History: Retired but worked in business, mostly for non-profit organizations. No history of tobacco or illicit drug use. Occasional alcohol use. Family History: Notable for mother with CAD. Physical Exam: Vitals: T: 98F P: 50 R: 16 BP: 88/48 SaO2: 100% on CMV with FiO2 100% General: intubated, lying in bed with eyes closed. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: No nuchal rigidity Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: bradycardic, RR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses bilaterally. Skin: no rashes or lesions noted. . Neurologic (at 0100): -mental status: Does not respond to verbal command or noxious stimuli. No verbal output. . -cranial nerves: PERRL 1.5mm and sluggishly reactive bilaterally. Funduscopic exam technically limited due to pupil size. Right exotropia (old per husband). EOM absent to oculocephalic maneuver. Corneal reflex weak bilaterally. No overt facial asymmetry although ET tube in place. Gag and cough reflex intact. . -motor: Normal bulk throughout. Tone flaccid throughout. Does not withdraw to noxious stimuli in any of the four extremities. No adventitious movements noted. . -sensory: No response to noxious stimuli in all four extremities. . -DTRs: [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach L 1 1 1 1 0 R 2 2 2 1 0 . Plantar response was extensor bilaterally. Pertinent Results: [**2124-5-3**] 07:30PM TYPE-ART PO2-146* PCO2-34* PH-7.39 TOTAL CO2-21 BASE XS--3 [**2124-5-3**] 07:30PM LACTATE-1.8 [**2124-5-3**] 07:30PM freeCa-1.06* [**2124-5-3**] 04:54AM TYPE-ART PO2-127* PCO2-44 PH-7.35 TOTAL CO2-25 BASE XS--1 [**2124-5-3**] 04:54AM LACTATE-1.9 [**2124-5-3**] 04:54AM freeCa-1.07* [**2124-5-3**] 04:54AM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015 [**2124-5-3**] 04:54AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2124-5-3**] 04:45AM GLUCOSE-328* UREA N-19 CREAT-0.7 SODIUM-140 POTASSIUM-3.7 CHLORIDE-108 TOTAL CO2-22 ANION GAP-14 [**2124-5-3**] 04:45AM ALT(SGPT)-28 AST(SGOT)-23 LD(LDH)-205 CK(CPK)-143* ALK PHOS-67 AMYLASE-51 TOT BILI-0.6 [**2124-5-3**] 04:45AM LIPASE-35 [**2124-5-3**] 04:45AM CK-MB-4 cTropnT-<0.01 [**2124-5-3**] 04:45AM ALBUMIN-3.5 CALCIUM-7.6* PHOSPHATE-3.3 MAGNESIUM-1.8 CHOLEST-139 [**2124-5-3**] 04:45AM VIT B12-421 FOLATE-15.0 [**2124-5-3**] 04:45AM TRIGLYCER-101 HDL CHOL-61 CHOL/HDL-2.3 LDL(CALC)-58 [**2124-5-3**] 04:45AM TSH-3.5 [**2124-5-3**] 04:45AM PHENYTOIN-10.9 [**2124-5-3**] 04:45AM WBC-13.7*# RBC-3.52* HGB-11.1* HCT-32.4* MCV-92 MCH-31.6 MCHC-34.3 RDW-13.2 [**2124-5-3**] 04:45AM PLT COUNT-198 [**2124-5-3**] 04:45AM PT-11.2 PTT-25.6 INR(PT)-0.9 [**2124-5-3**] 01:04AM TYPE-ART TEMP-35.6 RATES-20/ TIDAL VOL-450 PO2-271* PCO2-38 PH-7.42 TOTAL CO2-25 BASE XS-0 -ASSIST/CON INTUBATED-INTUBATED [**2124-5-3**] 12:55AM GLUCOSE-212* UREA N-18 CREAT-0.6 SODIUM-141 POTASSIUM-3.9 CHLORIDE-110* TOTAL CO2-19* ANION GAP-16 [**2124-5-3**] 12:55AM WBC-9.0 RBC-3.26* HGB-10.6* HCT-30.0* MCV-92 MCH-32.5* MCHC-35.3* RDW-13.3 [**2124-5-3**] 12:55AM NEUTS-80.0* BANDS-0 LYMPHS-16.0* MONOS-2.3 EOS-1.3 BASOS-0.4 [**2124-5-3**] 12:55AM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL [**2124-5-3**] 12:55AM PLT SMR-NORMAL PLT COUNT-193 [**2124-5-3**] 12:55AM PT-13.4* PTT-23.5 INR(PT)-1.2* . . Radiologic Data MR CONTRAST GADOLIN [**2124-5-3**] 1:27 PM IMPRESSION: 1. Right putaminal hemorrhage without underlying mass, with imaging features strongly favoring a hypertensive etiology. 2. Patent circle of [**Location (un) 431**] and major tributaries. . CT HEAD W/O CONTRAST [**2124-5-3**] 12:54 AM FINDINGS: There is a 4.3 x 4.0 x 2.1 cm parenchymal hemorrhage involving the right putamen and subinsular white matter. Noted is a dependent blood-fluid level, dorsally. There is no significant associated shift of normally midline structures. The ventricles appear normal in size and are symmetric. No hemorrhage is identified within the basal cisterns or ventricles. There is no evidence of hydrocephalus. Osseous and soft tissue structures are unremarkable. There is fluid within the right maxillary sinus. The orbits are unremarkable. IMPRESSION: 4.3 x 4.0 x 2.1 cm parenchymal hemorrhage involving the right putamen and subinsular white mater. This is a typical location for hypertensive bleed. . CHEST (SINGLE VIEW) [**2124-5-3**] 12:52 AM IMPRESSION: Endotracheal and nasogastric tubes in appropriate position. Retrocardiac opacity concerning for pneumonia. . EEG [**2124-5-3**] IMPRESSION: Abnormal EEG, due to a markedly reduced voltage record with some rare alpha activity biposteriorly in most delayed portions of the record. The precentral beta represents an Ativan effect related to medication administered earlier to the patient. The record overall suggests a mild to moderate encephalopathy with excessive drowsiness and slowed and poorly sustained posterior background rhythm's. . CT HEAD W/O CONTRAST [**2124-5-4**] 3:41 PM CONCLUSION: No change in the appearance of the brain since [**2124-5-3**]. Right putaminal hemorrhage with surrounding edema. No evidence of new hemorrhage. . CXR [**5-14**]:Left subclavian vein catheter and tracheostomy tube appear unchanged in position. There is a left retrocardiac opacity, which appears stable and may represent atelectasis and/or consolidation. There are atelectatic changes at the right lung base. There probably is a small pleural effusion on the left. . CXR [**5-5**]: The endotracheal tube and NG tube remain in satisfactory position. There are relatively low lung volumes. There is persistent left lower lobe opacity, which could reflect aspiration or pneumonia. There is also persistent left-sided effusion. No other significant changes are identified. Brief Hospital Course: Patient was admitted to the neuro ICU, sedated, intubated, and with a diagnosis of R putaminal hemorrhage. Differential diagnosis included hypertensive or amyloid hemorrhage, AVM rupture or intratumoral bleed. She underwent a head MRI which showed a stable hemorrhage and no underlying mass, strongly favoring a hypertensive etiology for the hemorrhage due to its typical location. An EEG suggested mild to moderate encephalopathy with excessive drowsiness and slowed and poorly sustained posterior background rhythm's but no epileptiform activity. Her treatment was focused on strict BP control (<140) and seizure prophylaxis. On hospitalization day (HD) 2, patient was still stuporous, likely due to medication effect; a repeat head CT confirmed the hemorrhage was stable. Plan was to wean her from the respirator towards extubation, despite a retrocardiac opacification concerning for pneumonia as seen on CXR and treated with Levofloxacin (sputum cx [**5-3**]: strep. pneumoniae; bld cs: neg.) On HD 3, patient was extubated, but failed to breathe on her own successfully. She continued her levofloxacin for a 7 day course. She had a bronchoscopy performed and there was a concern for possible airway collapse due to tracheomalacia. The interventional pulmonary service saw the patient and repeated a bronchoscopy. They determined that tracheomalacia was not playing a role in her difficulty being extubated. She had 2 more attempts at extubation and failed each time. At this point, the decision was made to place a tracheostomy tube and PEG tube. This went well without complication. She was quickly weaned from the vent to a trach mask, but contineud to require frequent suctioning. She then developed a fever and WBC ct elevation again. She had another sputum culture which grew GPCs, so she was started on vancomycin due to concerns that this may be MRSA. She defervesed and her WBC count began to trend down. Repeat CXRs showed stable left retrocardiac opacity. She will continue on vancomycin at rehab for 1 week. She was initially loaded with dilantin but developed no evidence of seizure. She was therefore stopped after 10 days of this medication. The patient's mental status had improved significantly after 4-5 days in the hospital. By the time of her tracheostomy, she was wide awake, off sedation, following commands and answering questions/writing well. Imaging throughout of her head showed a stable hemorrhage. Her exam remained unchanged as well, with good use of her right side, but no use of left side(other than minimal use of her toes and ankle). Her arm is not moving at all. She is able to look to the left with left eye, but right eye has old exotropia and does not cross easily to left. On discharge, the patient's lasix dose was halved due to dehydration. This may need to be increased at [**Hospital1 **] if she has trouble with fluid overload. Medications on Admission: -triamterene-HCTZ -lipitor 10mg po daily Discharge Medications: 1. Artificial Tear with Lanolin 0.1-0.1 % Ointment Sig: One (1) Appl Ophthalmic PRN (as needed) as needed for dry eyes. 2. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) mL Injection TID (3 times a day). 3. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty (30) mg PO DAILY (Daily). 4. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day): HOLD for SBP<100, HR<55 . 5. Acetaminophen 160 mg/5 mL Solution Sig: 320-640 mg PO Q4-6H (every 4 to 6 hours) as needed. 6. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 7. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 8. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day) as needed. 9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO BID (2 times a day) as needed. 10. Bismuth Subg-Balsam-ZnOx-Resor Suppository Sig: One (1) Suppository Rectal PRN (as needed). 11. Pramoxine-Mineral Oil-Zinc 1-12.5 % Ointment Sig: One (1) Appl Rectal PRN (as needed). 12. Medication Insulin Sliding Scale as per nurse's spread sheet; 13. Insulin NPH-Regular Human Rec 100 unit/mL (70-30) Suspension Sig: Twenty Eight (28) U Subcutaneous twice a day: Before breakfast and before dinner!. 14. Vancomycin 1,000 mg Recon Soln Sig: One (1) Intravenous twice a day for 7 days. 15. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. 16. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every [**3-16**] hours as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: ICH Discharge Condition: Stable. Pt not moving left arm or leg(except for toes). She is not speaking due to tracheostomy. She is otherwise answering questions and following commands. Discharge Instructions: Please tell the staff at [**Hospital1 **] if you have any new fever, headache, new weakness, numbness, or tingling, falls, dizziness, or lightheadedness. Followup Instructions: Please follow-up as the doctors [**First Name (Titles) **] [**Last Name (Titles) **] arrange for you with your PCP. ----- You can follow-up in the neurology clinic with Dr [**Last Name (STitle) 4638**] and Dr [**Last Name (STitle) **] as the staff at rehab arrange. They should call [**Telephone/Fax (1) 2574**] for an appointment for 1 month after your discharge. [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**] ICD9 Codes: 431, 5180, 4019, 2724
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Medical Text: Admission Date: [**2141-6-12**] Discharge Date: [**2141-6-16**] Date of Birth: [**2070-7-11**] Sex: F Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 6075**] Chief Complaint: left frontal operculum stroke Major Surgical or Invasive Procedure: none History of Present Illness: This is a 70 yo woman with hx CAD, high chol, HTN, who presents at 6:30PM to [**Hospital1 18**] after presenting at 1PM to [**Hospital **] Hospital with global aphasia since last known well time of NOON, s/p IV TPA and transferred to [**Hospital1 18**] for further post-TPA care. Hx provided by son in law, at bedside: pt had been feeling "slightly unwell" over wknd, had c/o leg cramps bilaterally. Was last seen by husband to be well at noon - husband left house to take a walk, and returned between 12:20 and 12:30 PM to find wife staring straight ahead and not talking, not interacting well. He feels that she seemed to understand what he was saying to her; he asked her to get in the car, and she had no trouble walking to car, and even locked door on the way out. No obvious weakness anywhere, or gait problems. [**Name (NI) 4906**] brought pt by car to [**Hospital **] Hospital, where initial NIHSS score documented as 7 (2 for LOC questions, 3 for mute/aphasic, and 2 for dysarthria "speech so slurred or pt mute" - Dr. [**First Name (STitle) **]/neurology [**Name (NI) 653**], and after head CT negative for ICH (or early signs of stroke), IV TPA given at 14:48 (6mg bolus for wt 150 lbs, followed by infusion of 55mg over 1 hr, ended at 15:35). BG at time was 121, but unknown coags. Per family's request (upon arrival of son in law and daughter), pt was transferred to [**Hospital1 18**] for post-TPA care. Of note, following TPA administration, nursing note reads "Pt seems to say 'yes' to all questions." Initially in [**Hospital1 18**] ER, BP was 178/117 but was rechecked as 160/80 after no intervention. There is no difference in her exam, though her son in law feels that she appears very fatigued. Past Medical History: PMH: CAD s/p MI 5 yrs ago s/p stent (unknown details, osh) High chol HTN "occasional headaches" s/p basal cell ca resection 1 mo ago GERD Social History: Social History: Lives with husband, very physically active, takes care of 4 horses; no tob, etoh, drugs. Has one son [**Doctor First Name **], one daughter. Family History: Family History: No known early strokes in family. Physical Exam: Examination: Afebrile, hr 60, bp initiall 178/117 upon arrival-> 160s/80s with no intervention when rechecked, RR 17, 97% 2L General appearance: white female, appears younger than stated age 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 No TTP along spine. Mental Status: The patient is alert awake; could understand command to "close eyes" and "open eyes" but did not understand other verbal commands; could imitate with nonverbal cues, though not 100% of time; did not make facial expressions, stick out tongue, or close eyes "tighter." No verbal output (completely mute). Occasionally closed eyes when not being spoken to, but appeared alert, with somewhat poor eye contact when being addressed directly. Cranial Nerves: +blink to threat bilat. The optic discs are normal in appearance. Eye movements are normal, with no nystagmus. Pupils react equally to light, both directly and consensually. +Corneals bilat. Facial movements are diminished, with no volitional mvmt of facial mms, did not protrude tongue - no obvious asymmetry. Hearing is intact to voice/commands. Motor System: No obvious abnl bulk/tone, full strength at delt, [**Hospital1 **], tri, wrist ext, finger ext, finger flex, IPs, hams, quads, TAs, gastrocs, with no drift, no asterixis Reflexes: The tendon reflexes are 2+ at [**Hospital1 **], [**Last Name (un) **], tri, knees, ankles, with downgoing toes bilat Sensory: W/d slightly to tickling x 4 ext, no obvious asymmetry; no obvious unilateral neglect. Coordination: There is no ataxia, with nl RAMs, nl f->n bilat Gait: deferred for now Pertinent Results: [**2141-6-15**] 06:15AM BLOOD WBC-6.2 RBC-3.79* Hgb-12.3 Hct-34.6* MCV-91 MCH-32.5* MCHC-35.7* RDW-13.1 Plt Ct-222 [**2141-6-14**] 07:05AM BLOOD PT-12.1 PTT-22.1 INR(PT)-1.0 [**2141-6-15**] 06:15AM BLOOD Glucose-118* UreaN-12 Creat-0.7 Na-140 K-3.7 Cl-104 HCO3-27 AnGap-13 [**2141-6-12**] 08:10PM BLOOD ALT-22 AST-25 CK(CPK)-181* AlkPhos-92 Amylase-52 TotBili-0.5 [**2141-6-15**] 06:15AM BLOOD ALT-PND AST-PND CK(CPK)-58 Amylase-PND TotBili-PND [**2141-6-15**] 06:15AM BLOOD Calcium-9.0 Phos-3.2 Mg-2.2 [**2141-6-13**] 03:25AM BLOOD Triglyc-70 HDL-71 CHOL/HD-3.0 LDLcalc-125 [**2141-6-12**] 08:10PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG Studies: MRI brain/MRA brain: Acute infarct in the superior division of the left MCA territory.The posterior circulation is patent with no significant stenosis. In the superior division of the left MCA is an abrupt cut off of signal on time-of-flight images, suggesting stenosis from embolus to this vessel. The remaining branches of the anterior circulation are patent. No evidence of aneurysm.Loss of signal in the superior division of the left MCA, likely from embolus to this vessel. EEG: This is an abnormal EEG in the waking and drowsy states due to the persistent left posterior quadrant slowing and left temporal rhythmic slowing. This suggests left posterior quadrant subcortical dysfunction, while rhythmic left temporal slowing suggests a region of cortical irritability. No epileptiform features were noted. Surface echocardiogram: No PFO/ASD seen. Preserved global and regional biventricular systolic function. Mild rheumatic mitral stenosis with moderate mitral regurgitation. Mild aortic regurgitation. Mild pulmonary hypertension. Moderately dilated ascending aorta. carotid US: Less than 40% stenosis of the proximal internal carotid arteries bilaterally. This is a baseline examination at the [**Hospital1 18**]. Brief Hospital Course: Neurology: Patient admitted for known left frontal operculum stroke s/p IV TPA likely of cardioembolic etiology. She was in the ICU x 24 hours on admission for post-IV TPA care. The patient had an EEG because of first presentation of global aphasia to rule out seizure (as outside CT scan showed no evidence of stroke). Her EEg showed no epileptiform activity that would be concerning for seizure but showed some slowing over the area of the infarction site. The patient received a work-up for stroke. Her labs are as following: HgbA1c 6%, LDL 121, HDL 71. Her suface echocardiogram showed the mitral valve leaflets are mildly thickened, with characteristic rheumatic deformity. She had mild left atrial dialtion. No thrombus, vegetations or PFO noted. Family declined trans-esophageal echocardiogram to visualize aorta. Patient was kept on telemetry during her hospital stay with no arrhythmias noted. In terms of exam, it was clear patient had some dysfunction of facial muscles from stroke site which limited facial expression and ability to take oral foods. She initially failed her swallow study but on follow-up testing with bedside swallow study and video swallow study, she was cleared for regular diet and thin fluids. She improved in terms of her ability to produce speech but speaks with hypophonic voice, and has little spontaneous speech output. She will work with outpatient speech therapy. PT/OT cleared her for home discharge. Upon further discussions with family, it was thought the patient did take a baby aspirin at home so patient discharged on Aggrenox. She has history of muscle aches with statins. CK checked and was 58 and LFTS nml. She was started on Zetia 10 mg po qday which will be monitored by her primary care doctor. Medications on Admission: Atenolol 50 mg [**Hospital1 **] Zetia 10 mg qd Nexium 40 mg qd Wellchol - not taking, per daughter, as bottle full ASA 81 mg po qday Discharge Medications: 1. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12 hr Sig: One (1) Cap PO twice a day: you may start with one pill qday x 3 days. If no headache, you may take 1 tab po twice daily. Disp:*60 Cap(s)* Refills:*2* 2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 3. Outpatient Speech/Swallowing Therapy Speech therapy outpatient therapy Discharge Disposition: Home Discharge Diagnosis: stroke Discharge Condition: stable. MS: hypophonic voice, few spontaneous words. Does not read. Follows midline and appendicular commands. Has mild right facial droop. Mild right UMN pattern right arm weakness. Discharge Instructions: Please follow-up with appointments and take medications as instructed. Followup Instructions: [**Hospital 4038**] Clinic. Neurology. [**Hospital1 18**] [**Hospital Ward Name 23**] [**Location (un) **]. [**Name6 (MD) 3688**] [**Name8 (MD) 72617**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2141-7-18**] 9:30 AM. YOU MUST CALL TO CONFIRM THIS APPOINTMENT ICD9 Codes: 2720, 4019, 412
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Medical Text: Admission Date: [**2124-10-4**] Discharge Date: [**2124-10-9**] Date of Birth: [**2045-11-7**] Sex: F Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1835**] Chief Complaint: recurrent mass Major Surgical or Invasive Procedure: Craniotomy with resection mass History of Present Illness: The patient is a 78-year-old female who is well- known to neurosurgery service from previous hospitalizations as well as from surgery in [**2121**]. The patient had been diagnosed with an atypical meningioma. The patient was previously irradiated and underwent a gross total resection, [**Doctor Last Name 18741**] grade 2, in [**2123-3-20**]. The patient has been followed sequentially with MRI scans. The patient now re-presents with an enlarging recurrent tumor on the left side posterior to the resection bed and abutting the falx. The lesion causes significant mass effect as well as perifocal edema. The patient has shown progressive weakening on the right side. The patient was, therefore, extensively counseled. Since conservative means are rather exhausted in her case, the family agreed to proceed with a second resection. The patient was extensively counseled. The patient was consented. The patient was aware of the risks and benefits of the procedure. The patient was then taken electively to the operating room on [**2124-10-4**]. Past Medical History: Parasagittal meningioma HTN Glaucoma Right wrist fracture Recent dental tooth extraction Left rotator cuff repair with LUE weakness Pelvic prolapse repair Cataract extraction Soft diet . Past Surgical History: Pelvic prolapse repair Cyberknife [**9-22**] cataract resection s/p bifrontal craniotomy and resection of parasagittal meningioma [**2123-4-15**] Social History: Originally from [**Location (un) 3156**], lives w/husband (who recently had a mild stroke) in [**Location (un) **]; one son, no [**Name2 (NI) **]/etoh/drugs. Not working, no prior career. Family History: No illnesses per patient Physical Exam: Exam After Patient Medically clear for discharge. T:97.7 P:96.9 HR:64 BP:96/52 RR:18 SaO2:97%RA Awake alert oriented x3 Eyes open Follows commands. Articulate, intelligent, appropriate. No dysarthria. Strength is likely full but the exam is limited by poor effort. Weakness in the right lower extremity greater than the left but strength exam is limited by patient effort. Has at least [**12-24**] strength in the IP, Quad, and hamstring on the right. Strength is [**3-23**] in the IP and quad on the left. Senation intact to light touch. Reflexes symmetrical. Toes upgoing on the right, mute on the left. Pertinent Results: [**2124-10-4**] 03:05PM GLUCOSE-159* UREA N-14 CREAT-0.6 SODIUM-138 POTASSIUM-4.3 CHLORIDE-108 TOTAL CO2-21* ANION GAP-13 [**2124-10-4**] 11:41AM GLUCOSE-100 LACTATE-1.1 NA+-132* K+-3.7 CL--102 [**2124-10-4**] 10:17AM HGB-11.7* calcHCT-35 O2 SAT-99 [**2124-10-8**] 08:10AM BLOOD WBC-9.9 RBC-3.87* Hgb-11.5* Hct-34.0* MCV-88 MCH-29.7 MCHC-33.8 RDW-14.6 Plt Ct-265 [**2124-10-8**] 08:10AM BLOOD Glucose-96 UreaN-20 Creat-0.7 Na-140 K-4.3 Cl-103 HCO3-31 AnGap-10 [**2124-10-6**] 05:00AM BLOOD Calcium-8.3* Phos-2.5* Mg-1.8 CT-Head without contrast: [**2124-10-4**]: IMPRESSION: Status post left frontal craniotomy, with post-procedural changes seen at the vertex, likely a small amount of hemorrhage at the resection site. No shift of midline structures identified. Expected pneumocephalus seen, as noted above. CXR [**2124-10-4**]: IMPRESSION: Right subclavian line entering the internal jugular. ET tube at the carina. An NG tube in the distal esophagus. MR [**Name13 (STitle) 430**] With Contrast [**2124-10-4**]: IMPRESSION: Relatively unchanged (or very slightly larger) left parasagittal enhancing meningioma and postoperative sequela. MR [**Name13 (STitle) 430**] with and without contrast [**2124-10-5**]: IMPRESSION: Anticipated post-surgical changes. No definite abnormal enhancement to indicate residual tumor. Bilateral parietal T2 hyperintensities, secondary to vasogenic edema, are unchanged. Brief Hospital Course: 78 Russian woman with recurrent meningioma admitted for surgical resection. PRINCIPAL PROCEDURE PERFORMED on [**2124-10-4**]: 1. Bifrontal redo craniotomy for resection of predominantly left recurrent meningioma. 2. Intraoperative image guidance. 3. Microscopic dissections. 4. Duraplasty. 5. Central line placement. Patient was given Dexamethasone post operatively. Patient started on Cipro for urinary tract infection. Patient recovered very well after the operation. She complained of zofran responsive nausea on the day of discharge. Medications on Admission: This list was obtained from prior Neuro-oncology note. AFO --R afo qd while walking pt with r foot drop, please fit new r afo ARTHROTEC 50 50 mg-0.2 mg--one tablet(s) by mouth three times a day as needed for as needed for pain DARVOCET-N 50 50 mg-325 mg--one tablet(s) by mouth three times a day as needed for for pain KEPPRA 250 mg--1 tablet(s) by mouth twice a day increase as directed to 4 tabs [**Hospital1 **] MOBIC 7.5 mg--1 tablet(s) by mouth [**Hospital1 **] start at 1 tab [**Last Name (LF) **], [**First Name3 (LF) **] increase to 2 tabs after one week if not enough effect. PAMELOR 10 mg--1 capsule(s) by mouth at bedtime increase by 1 tab qweek to a max dose of 4 tabs qhs. hold increase if enough effect at a lower dose or excess sedation No medications DC'd on [**2124-9-8**]. Medications prescribed on [**2124-9-8**]: DEXAMETHASONE 2 mg--2 tablet(s) by mouth twice a day DILANTIN 100 mg--1 capsule(s) by mouth at bedtime Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Meningioma Discharge Condition: Neurologically stable Discharge Instructions: DISCHARGE INSTRUCTIONS FOR CRANIOTOMY ?????? Have a family member check your incision daily for signs of infection ?????? Take your pain medicine as prescribed ?????? Exercise should be limited to walking; no lifting, straining, excessive bending ?????? You may wash your hair only after sutures and/or staples have been removed ?????? You may shower before this time with assistance and use of a shower cap ?????? Increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, aspirin, Advil, Ibuprofen etc. ?????? You have been prescribed an anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing as ordered ?????? Clearance to drive and return to work will be addressed at your post-operative office visit CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: ?????? New onset of tremors or seizures ?????? Any confusion or change in mental status ?????? Any numbness, tingling, weakness in your extremities ?????? Pain or headache that is continually increasing or not relieved by pain medication ?????? Any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? Fever greater than or equal to 101?????? F Followup Instructions: PLEASE RETURN TO THE OFFICE IN ____________DAYS FOR REMOVAL OF YOUR STAPLES/SUTURES PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.[**Last Name (STitle) **] TO BE SEEN IN _______WEEKS. YOU WILL / WILL NOT NEED A CAT SCAN OF THE BRAIN WITH OR WITHOUT CONTRAST YOU WILL/WILL NOT NEED AN MRI OF THE BRAIN WITH OR WITHOUT GADOLIDIUM Completed by:[**2124-10-9**] ICD9 Codes: 5990, 4019
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Medical Text: Admission Date: [**2193-3-3**] Discharge Date: [**2193-3-5**] Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2724**] Chief Complaint: Mental status changes Major Surgical or Invasive Procedure: None History of Present Illness: 85F h/o HTN, hypothyroidism fell at home yesterday and hit her head on the radiator. Her step-daughter went to her house today and noticed that she had mental status changes and brought her to [**Hospital **] Hospital. Her head CT revealed hemorrhage so she was loaded with phosphenytoin and was transferred to [**Hospital1 18**] for further evaluation. The patient reports that she takes a baby aspirin daily. She reports no headache, dizziness, or visual changes. She has no SOB or chest pain. Past Medical History: HTN, hypothyroidism, [**Last Name (un) 8061**], UTI Social History: Lives with husband who she cares for. Has several children and step-children. Family History: non-contributory Physical Exam: T:99.3 BP:115/43 HR:78 RR:14 O2Sats:100% 2L NC Gen: Sleeping when examiner entered the room but woke easily. HEENT: Pupils: PERRL EOMs-intact Neck: Supple. No tenderness. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. When asked again several minutes later, she could not recall the name of the hospital. Recall: Cannot recall any of the 3 objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, 2.5 to 2.0 mm bilaterally. Visual fields are full to confrontation. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: + left facial droop VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**4-3**] throughout. Slight left pronator drift. Sensation: Intact to light touch bilaterally. Toes upgoing on the left Pertinent Results: [**2193-3-5**] 04:25AM BLOOD WBC-9.5 RBC-3.76* Hgb-10.8* Hct-34.1* MCV-91 MCH-28.8 MCHC-31.8 RDW-13.4 Plt Ct-209 [**2193-3-3**] 03:00PM BLOOD Neuts-78.0* Lymphs-16.7* Monos-4.9 Eos-0.2 Baso-0.2 [**2193-3-5**] 04:25AM BLOOD Plt Ct-209 [**2193-3-5**] 04:25AM BLOOD Glucose-83 UreaN-29* Creat-1.2* Na-142 K-3.4 Cl-104 HCO3-26 AnGap-15 [**2193-3-3**] 03:00PM BLOOD CK(CPK)-494* [**2193-3-5**] 04:25AM BLOOD Albumin-3.7 Calcium-8.4 Phos-2.2* Mg-1.8 [**2193-3-5**] 04:25AM BLOOD Phenyto-16.5 Radiology CT Head: [**2193-3-3**] IMPRESSION: Multifocal intraparenchymal hemorrhages as described above with small amount of subarachnoid hemorrhage and hemorrhage within the ventricular system with hydrocephalus. Rightward shift of normally midline structures toward the right by 2 mm. These findings are stable when compared to prior exam. This configuration of hemorrhagic findings is unusual given multifocality and MRI is recommended for further evaluation for underlying mass lesion or cause. CT Head [**2193-3-4**] Impression: Essentially unchanged CT examination of the head compared to one day prior. There is multifocal intraparenchymal hemorrhage, with intraventricular extension, and likely a small focus of subarachnoid hemorrhage. Associated edema and mass effect is unchanged. Ventricular size is also stable, with prominent ventricles, possibly reflecting hydrocephalus, though a component of underlying atrophy is not excluded. Continued imaging followup is recommended. Brief Hospital Course: Ms [**Known lastname **] was admitted to the neurosurgery service and monitored in the ICU for the first 24 hours of her hospital stay. A repeat CT showed no interval increase in left IPH (basal ganglia) and stable contusion. She was transferred to the surgical floor for further monitoring and left on telemetry. She was stable and tolerated a regular diet without problem. [**Name (NI) **] exam showed improved strength in all her extremities, but continued short attention span and she could not follow complex commands. She was evaluated by PT and OT and deemed to be a good candidate for short term rehab where she will continue her work with PT and regain her strength. She will be seen in follow up with neurology and neurosurgy in 4 weeks. Medications on Admission: levoxyl (dose unknown) atenolol (dose unknown) aspirin 81 mg Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain/fever. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 5. Magnesium Sulfate 2 gm IV ONCE Duration: 1 Doses 6. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush Peripheral line: Flush with 3 mL Normal Saline every 8 hours and PRN. 7. HydrALAzine 10 mg IV Q6H:PRN SBP > 160 8. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush Peripheral line: Flush with 3 mL Normal Saline every 8 hours and PRN. 9. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 10. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Intraparenycmal Hemorrhage Basal Ganglia Bleed Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. ?????? You have been prescribed Dilantin (Phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. This can be drawn at your PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**]. You should continue taking this medication and it will be addressed at your follow up appointment with neurology. Followup Instructions: Follow up with Neurology Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2193-4-12**] 10:00 You should call ([**Telephone/Fax (1) 7394**] to arrange an MRI around that time. Neurosurgery: ??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**Last Name (STitle) 548**] to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. ICD9 Codes: 4019, 2449
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Medical Text: Admission Date: [**2140-1-30**] Discharge Date: [**2140-2-5**] Service: MEDICINE Allergies: Penicillins / Shellfish Attending:[**First Name3 (LF) 2145**] Chief Complaint: Fever, mental status changes Major Surgical or Invasive Procedure: None History of Present Illness: Pt is an 89 yo woman, NH dependent, w/ h/o HTN, diet controlled DM who presented initially to [**Hospital **] hospital from NH w/ altered mental status, fevers to 103, hypoxia. Per family, pt noted to have cough x past 5 days, have worse MS x 1 day, fevers and hypoxia started today. On presentation to OSH, pt noted to be hypoxic to 80's on RA, increased to 100% on NRB, 91% on 3L NC, febrile to 100.8, rectal temp 102.9, BP stable, HR 125 (sinus tachy). Per report, CXR showed RLL pna, pt was given moxifloxacin, 500cc IVF and transferred to [**Hospital1 18**]. On presentation to [**Hospital1 18**], T99.2, HR 130, BP 97/45, RR 18, O2 98% NRB. Pt given 1 (?2) liters NS, w/ decrease HR to 100-110, increase BP to 105. She was given vanc, aztreonam, cipro for nosocomial pna coverage given CXR report from OSH. Labs notable for ARF (Cr 1.4 from baseline < 1), nl lactate, elevated trop (in setting of ARF), leukocytosis (WBC 18.2). Given trop, pt given ASA x 1. U/A markedly positive. Rpt CXR here w/ no pna per report. Family w/ pt, and pt is DNR/DNI. Would like to avoid central line if possible, so pt w/ 2 x PIV. Currently pt awake, not able to answer questions. Of note, pt w/ recent hospital admission [**Date range (3) 13940**] for UTI and pneumonia, sputum cxs growing staph and klebsiella, on discharge she was on Vanc, Levofloxacin, and flagyl. Past Medical History: 1. breast cancer, status post lumpectomy, radiation therapy, and Tamoxifen about 10y ago. 2. Depression - also hears voices, s/p ECT years ago. 3. Hypothyroidism. 4. Diet controlled diabetes mellitus. 5. Hypertension. 6. Gout. 7. Cataracts 8. vascular dementia 9. Li toxicity 10. diverticulitis s/p partial colectomy at which time colon adenoma was found and removed. 11. s/p TAH/BSO 12. s/p full tooth extraction with dentures 13. HOH with hearing aids in both ears 14. GERD 15. ?Aspiration events 16. ?Myasthenia [**Last Name (un) **] Social History: Lives at [**Hospital6 13941**] home for years. Used walker until about 4 m ago when declined to needing wheelchair at all times. Son [**Name (NI) **] is HCP, daughter [**Name (NI) **] is intimately involved as well. No Etoh or tobacco. Previously was very active in charity work with [**Hospital1 **] Family Services, sang in a choir and danced. In other discussions she has stated that she has lived a full life and is ready to die without an invasive fight, desiring to be DNR and opposed to a G-tube. Family History: noncontributory Physical Exam: Vitals - T 98.6, HR 125, BP 109/42, RR 30, O2 98% NRB Gen - awake, appears to be following conversation, able to mumble but otherwise non-verbal, tachypnic, no use of accessory muscles HEENT - dry MM CVS - tachycardia, no noted m/r/g Lungs - ?mild rhonci anteriorly R middle chest. Could not fully assess posterior lung fields as pt was moaning Abd - soft, nt/nd Ext - 2+ LE edema b/l At discharge, the patient was afebrile. She is conversant and able to answer questions clearly. She appears to be comfortable on one liter nasal cannula. The remainder of her exam was unchanged with the exception of her resolving tachycardia with heart rate in the nineties. In addition she was noted to have a small white head on her labia. Please continue to monitor skin. Pertinent Results: CXR ([**2140-2-1**]): There has been interval worsening with increase in now moderate bilateral pleural effusions, greater on the right side with associated adjacent atelectasis. Lower lung volumes accentuate the cardiac silhouette which is top normal. There is engorgement of the mediastinal vasculature. No overt pulmonary edema. EKG: Probable multifocal atrial tachycardia, rate 132. Cannot exclude sinus tachycardia with frequent atrial premature beats. Borderline low voltage. Delayed precordial R wave progression. Possibly normal variant. The overall pattern could be seen in chronic obstructive pulmonary disease with pneumonia. [**2140-1-30**] 07:30PM URINE COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.017 [**2140-1-30**] 07:30PM URINE BLOOD-MOD NITRITE-POS PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2140-1-30**] 07:30PM URINE RBC-21-50* WBC->50 BACTERIA-MANY YEAST-NONE EPI-[**2-17**] RENAL EPI-0-2 [**2140-1-30**] 06:59PM LACTATE-1.6 [**2140-1-30**] 06:45PM GLUCOSE-180* UREA N-26* CREAT-1.4* SODIUM-146* POTASSIUM-5.0 CHLORIDE-109* TOTAL CO2-25 ANION GAP-17 Urine culture grew out E. Coli which was sensitive to Aztreonam. Brief Hospital Course: Pt is an 89 yo NH resident w/ PMH DM, HTN p/w sepsis and respiratory distress who was transferred from an outside hospital. She was admitted to the intensive care unit for agressive care with antibiotics, non-rebreather and IVF support. Per the family, the patient did not receive a central line, nor other invasive procedures. . The patient was admitted with fever, altered MS, ARF, borderline hypotension, leukocytosis and tachycardia. The etiology of the infection was likely secondary to a UTI given results of her u/a and urine cx. She was admitted to the intensive care unit for management of her sepsis. While in the unit, her blood pressure and tachycardia were stabilized with IVF but did not require pressors. She was treated with IV antibiotics, including aztreonam and clindamycin (to cover a question of aspiration pneumonitis vs PNA, although review of her admitting CXR showed no evidence of PNA). The clindamycin was discontinued once the patient was called out to the floor. The patient completed a seven day course of aztreonam to treat the E. Coli infection in her urine. Urine cultures were sensitive to the medication. Her mental status improved with treatment of her infections. Given her recent antibiotic use, if the patient starts having diarrhea, consider checking for a C. difficle infection and consider starting Flagyl. Please check a CBC in several days to monitor her white count. She has been afebrile with stable blood pressure since leaving the intensive care unit. She was weaned from a non-rebreather to 4L nasal cannula and maintained her O2 saturation levels between 96-99% on two liters. She is currently on one liter nasal cannula and is maintaining her saturation at 94%. She can continued to be weaned of the oxygen as tolerated. Her home dose of Lasix was held in the hospital given her hypotension and acute renal failure. It should be restarted to help decrease the edema in her legs. Please weigh the patient daily and assess whether she seems volume overloaded. If she appears dry or is not taking good PO intake, consider holding her dose of Lasix. Please check her electrolytes within two to three days of returning, and if her BUN/cr are elevated or her Na level begins to rise, also consider holding her Lasix regimen. The patient appears to have a chronic anemia. Her hematocrit has been stable throughout this admission. The patient had mild hypernatremia on admission to the hospital. Her sodium was 146 on admission, increasing to 147 s/p IVF hydration. Her free water deficit was calculated at 1.4L. She was treated with D5W repletion which improved her sodium. Please check her electrolytes to monitor her sodium in two to three days. Please encourage oral intake. For her history of depression/dementia the patient was continued on her home regimen of risperidone and Effexor. Given her history of hypothyroidism, the patient's TSH was checked during this admission which was normal. She was continued on her home regimen of levothyroxine. The family reported the patient has a newly dx Myasthenia [**Last Name (un) 2902**]. Please discuss follow up with Neurology at [**Hospital1 2025**] with the patient's family. Per report, she saw Neurolgy at [**Hospital1 2025**] on prior to her admission at [**Hospital1 18**]. The patient takes a pureed diet (as aspiration risk). In addition, the patient was noted to have a small whitehead on her labia. It was treated with topical bacitracin as needed. Please monitor her skin integrity and treat accordingly. COMM: [**Name (NI) **] [**Name (NI) **] is HCP (h) [**Telephone/Fax (1) 13942**]. (c)[**Telephone/Fax (1) 13943**] DO NOT CALL CELL ON WEEKENDS OR MON EXCEPT FOR ABSOLUTE EMERGENCY (he works weekends for MA Pike and will have real trouble if phone rings at work). Daughter [**Name (NI) **] intimately involved (h) [**Telephone/Fax (1) 13944**], (w) [**Telephone/Fax (1) 13945**]. Can call her at all times. CODE: DNR/DNI confirmed with son and daughter, also has DNR ppwk from [**Name (NI) **]. Medications on Admission: Docusate Sodium 100 mg PO BID Risperidone 1 mg PO BID Senna 8.6 mg 1-2 Tablets PO BID as needed. Pentoxifylline 400 mg PO BID Polyvinyl Alcohol 1.4 % 1-2 Drops Ophthalmic TID as needed. Levothyroxine 50 mcg PO DAILY Hexavitamin PO DAILY Colchicine 0.6 mg PO DAILY Lansoprazole 30 mg PO DAILY Ipratropium Inhalation Q6H as needed. Venlafaxine 37.5 mg PO QAM, 112.5mg PO QPM Lasix 40 mg PO daily Discharge Medications: 1. Docusate Sodium 50 mg/5 mL Liquid [**Name (NI) **]: One (1) PO BID (2 times a day). 2. Risperidone 1 mg Tablet, Rapid Dissolve [**Name (NI) **]: One (1) Tablet, Rapid Dissolve PO BID (2 times a day). 3. Sodium Chloride 0.65 % Aerosol, Spray [**Name (NI) **]: [**12-16**] Sprays Nasal QID (4 times a day) as needed. 4. Colchicine 0.6 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO DAILY (Daily). 5. Ipratropium Bromide 0.02 % Solution [**Month/Day (2) **]: One (1) Inhalation Q6H (every 6 hours) as needed. 6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 7. Lasix 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day. 8. Venlafaxine 37.5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO QAM (once a day (in the morning)). 9. Venlafaxine 37.5 mg Tablet [**Last Name (STitle) **]: Three (3) Tablet PO HS (at bedtime). 10. Levothyroxine 50 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 11. Bacitracin Zinc 500 unit/g Ointment [**Last Name (STitle) **]: One (1) Appl Topical QID (4 times a day). 12. Hexavitamin Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day. 13. Pentoxifylline 400 mg Tablet Sustained Release [**Last Name (STitle) **]: One (1) Tablet Sustained Release PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital **] - [**Location (un) **] Discharge Diagnosis: Primary: #Urosepsis from E.Coli UTI #Severe Hypoxemia due to Aspiration Pneumonitis #Mental Status changes now resolved . Secondary: #Hypothyroidism #Diet controlled diabetes #GERD #HTN #Gout #Vascular dementia #?Aspiration #?Myasthenia [**Last Name (un) 2902**] Discharge Condition: Stable, with decreased oxygen requirement and improved mental status. Discharge Instructions: You were admitted to the hospital with a urinary infection, fevers and difficulty breathing. While you were in the hospital you were treated with antibiotics for the infection in your urine and briefly treated for a possible aspiration event in your chest. . We completed your course of antibiotics while you were in the hospital. We did not change any of your other medications. Please continue to take your other medications as prescribed. Followup Instructions: Please follow up with your primary care doctor in the next seven to ten days. . Please follow up with your Neurologist at [**Hospital1 2025**] for further work-up of your diagnosis of myasthenia [**Last Name (un) 2902**]. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**] ICD9 Codes: 5070, 5119, 5849, 2762, 5990, 2761, 2859, 311, 2449
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6190 }
Medical Text: Admission Date: [**2128-2-4**] Discharge Date: [**2128-2-7**] Date of Birth: [**2080-5-8**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2745**] Chief Complaint: Hypoxia, dyspnea, and tachycardia Major Surgical or Invasive Procedure: None History of Present Illness: 47M with DM1, CKD, recent admission for MRSA PNA requiring intubation and DKA in late [**Month (only) 1096**] (discharged to rehab [**1-29**]), was at rehab this morning when he was awoken for routine vitals and was diaphoretic, dyspneic, and hypoxic to 70% on RA as well as tachycardic to 130s. O2 up to NRB, given lasix 40mg with diuresis of 1L and lopressor and transferred to our ED. In the ED, sat was 68-74% on RA on arrival, able to speak in full sentences. CXR shows similar multifocal opacities to last admission, but also new RLL infiltrate as well as some worsening effusions/congestion. Added zosyn; last dose of vanc was [**2-3**]. Unable to wean down from [**Last Name (LF) 34474**], [**First Name3 (LF) **] admitting to ICU. VS on transfer: 88, 119/62, 95% on 50% [**First Name3 (LF) 34474**], RR 12. Past Medical History: - IDDM c/b peripheral neuropathy - Medullary sponge kidney - Nephrolithiasis - chronic low back pain - gastritis - gastroparesis - depression/anxiety - HTN Social History: Divorced though still in contact with ex-wife. Lived with his father in [**Name (NI) **], MA, prior to hospitalization in [**Month (only) 1096**]. Smoked [**1-23**] ppd x 20 yrs but no longer smokes. Patient denies abusing any recreational drugs and denies ETOH abuse, though recent OMR notes indicate that his ex-wife reported hx of substance abuse. Family History: Mother: Leukemia, currently undergoing chemotherapy Father: CAD, HTN Physical Exam: VS: 98.7 126/63 78 20 97% 50% facemask GEN: pale middle aged white man, appears older than stated age HEENT: PERRL 3-2mm, anicteric sclera RESP: poor airmovement throughout, esp decreased at R base, no wheezing, no crackles CV: Reg Nml S1, S2, no M/R/G ABD: Soft, Distended, NT, + BS EXT: Mild (2+) peripheral edema, warm, 1+ DP pulses NEURO: alert and oriented, interactive. moving all four extremities. SKIN: scabs over recent R IJ site Pertinent Results: [**2128-2-4**] 11:30AM GLUCOSE-214* UREA N-26* CREAT-2.2* SODIUM-136 POTASSIUM-4.6 CHLORIDE-99 TOTAL CO2-29 ANION GAP-13 [**2128-2-4**] 11:30AM CK(CPK)-15* [**2128-2-4**] 11:30AM cTropnT-0.06* [**2128-2-4**] 11:30AM CK-MB-NotDone proBNP-[**Numeric Identifier 34475**]* [**2128-2-4**] 11:30AM WBC-10.2 RBC-2.74* HGB-8.2* HCT-24.9* MCV-91 MCH-29.9 MCHC-32.9 RDW-17.0* [**2128-2-4**] 11:30AM NEUTS-74.8* LYMPHS-18.8 MONOS-5.6 EOS-0.2 BASOS-0.7 [**2128-2-4**] 11:30AM PLT COUNT-671*# [**2128-2-4**] 11:30AM PT-14.6* PTT-31.0 INR(PT)-1.3* [**2128-2-4**] 11:47AM LACTATE-1.3 IMAGING: CXR: Acute infective change in the right lower lobe with right basal effusion superimposed on multifocal pulmonary opacities consistent with areas of infection. EKG: SR 94 nml axis, rSr' in V1, 1mm J point elevation in V2. No significant change compared to [**1-17**]. ECHO ([**7-/2126**]): Global, diffuse HK; EF 35% TTE [**2128-2-5**]: The left atrium is normal in size. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with mild basal inferior wall hypokinesis. The remaining segments contract normally (LVEF = 50%). 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. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Mild regional left ventricular systolic dysfunction, c/w CAD. Mild mitral regurgitation. Mild pulmonary hypertension. Compared with the prior study (images reviewed) of [**2126-8-6**], overall biventricular systolic function has substantially improved, but regionality of LV dysfunction is now appreciated. The other findings are similar. 2 view CXR [**2128-2-6**]: PA AND LATERAL CHEST, [**2-6**] HISTORY: Multifocal pneumonia. Hypoxemia. IMPRESSION: AP chest compared to [**1-25**] through [**2-4**]. Moderate interstitial pulmonary edema is stable since [**2-4**]. Moderate right and small left pleural effusion have increased. Right middle lobe consolidation most likely pneumonia. Moderate cardiomegaly stable. Tip of the left PIC catheter projects over the superior cavoatrial junction. Interval improvement in left suprahilar consolidation suggests that this second region of pneumonia is improving. Brief Hospital Course: AP: 47 yo M with IDDM, recent multifocal, MRSA pneumonia, now with hypoxia at rehab #. Hypoxia: The patient had a recent/resolving multifocal, MRSA pneumonia, and his symptoms (cough, sputum production) have been resolving, although there does appear to be a new RLL infiltrate and he has completed > 14 days now of vanc and zosyn. He had no crackles on exam, but there was mild bilateral ankle edema, grossly elevated BNP, and pt has history of systolic dysfunction which could point to heart failure as a cause of his hypoxia. Also in favor of heart failure is the improvement he had with diuresis at rehab prior to transfer. Finally, diabetic gastroparesis may predispose to aspiration as well as his impaired oropharyngeal swallow seen on recent S & S, which, with his new RLL infiltrate and acuity of event, seems most likely explanation. Patient underwent IV lasix diuresis and was discharged on his normal lasix 20 mg po qd regimen. The patient may require further diuresis to optimize his pulmonary status per discretion of the physicians at [**Hospital1 **]. He was treated with cefepime (day 1 [**2-4**]), renally dosed for an 8-day course days given his likely aspiration; He was continued on vanc(8 more days)& flagyl. #. CAD risks: Given the patient's acute hypoxia and cardiac risk factors such as DM and a low EF. Serial enzymes were checked to rule out ischemia. He was continued on ASA and a B-blocker. A TTE showed EF 50%, mild regional left ventricular systolic dysfunction, c/w CAD, mild mitral regurgitation, mild pulmonary hypertension. #. IDDM: He was continued on glargine 12 units at bedtime and HISS with meals. #. C diff: The patient was diagnosed recently with C.diff and was continued to be treated with flagyl x14 past end of other antibiotics. #. Thrombocytosis: likely due to his recent, serious infection. #. Depression: The patient was continued on his outpatient medication regmien. #. HTN: Patinet's metoprolol was continued. #. CKD, Stage 3: current Cr of 2.2 is below recent values of [**3-25**]. #. Chronic pain syndrome: The patient continued to experience low back pain. He was continued on fentanyl patches, lidocaine, neurontin per his outpatient regimen and given break through pain control with morphine 5mg oral liquid. #. Anemia: The patient has anemia likely secondary to CKD. He was continued on epo (formulary exchange for darbepoetin). #. FEN: The patient's most recent S & S recs were pills whole or with purees, thin liquids and pureed diet and he was continued on this regimen. #. CODE: FULL Medications on Admission: MEDS at Rehab amlodipine 5mg [**Hospital1 **] aspirin 325mg daily escitalopram 20mg daily darbepoetin alfa 100mcg qFriday colace fentanyl 150mcg patch q72hrs--last on [**2-4**] lidocaine patch topical (lumbar region) lasix 20mg daily metoprolol 25mg QID neurontin 300mg tid heparin 5000 units [**Hospital1 **] insulin glargine 12 units qhs and lispro sliding scale omeprazole 20mg [**Hospital1 **] sucralfate 1gm QID vancomycin Q48hrs flagyl 500mg tid klonopin 0.5mg tid prn morphine 3mg po q2h prn compazine 10mg IV q6h prn Discharge Medications: 1. Escitalopram 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 3. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) injection Injection TID (3 times a day). 5. Morphine 10 mg/mL Solution Sig: Two (2) mg Intravenous every four (4) hours as needed for pain. 6. Fentanyl 75 mcg/hr Patch 72 hr Sig: Two (2) Patch 72 hr Transdermal Q72H (every 72 hours). 7. Lantus 100 unit/mL Solution Sig: Twelve (12) units Subcutaneous at bedtime. 8. Humalog 100 unit/mL Solution Sig: One (1) unit Subcutaneous QACHS: Administer per sliding scale. 9. Neurontin 300 mg Capsule Sig: One (1) Capsule PO three times a day. 10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 12. Citalopram 20 mg Tablet Sig: One (1) Tablet PO once a day. 13. Darbepoetin Alfa In Polysorbat 100 mcg/0.5 mL Pen Injector Sig: One Hundred (100) mcg Subcutaneous every Friday. 14. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO four times a day as needed for heartburn. 15. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO twice a day. 16. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day. 17. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for low back pain: on for 12 hours, remove for 12 hours. 18. Vancomycin 1,000 mg Recon Soln Sig: One (1) mg Intravenous every twenty-four(24) hours for 4 days. 19. Cefepime 2 gram Recon Soln Sig: Two (2) gm Intravenous every twenty-four(24) hours for 4 days. 20. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a day for 18 days: Continue for 14 days beyond the end of vanc and cefepime. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: MRSA Multifocal Pneumonia Systolic Heart Failure, Acute Hypoxemia ARF on CKD stage 4 Discharge Condition: Vital Signs Stable Discharge Instructions: Return to the ED if you having high fevers, difficulty breathing, hypotension, confusion, uncontrollable blood sugars not responding to medical management, severe abdominal pain. Followup Instructions: Patient to schedule f/u with his PCP [**Name9 (PRE) 28955**] [**Name9 (PRE) **],[**Name9 (PRE) **] [**Telephone/Fax (1) **] in [**1-23**] weeks. ICD9 Codes: 5070, 5849, 4280, 3572
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Medical Text: Admission Date: [**2183-11-3**] Discharge Date: [**2183-11-20**] Date of Birth: [**2106-2-24**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1572**] Chief Complaint: Presented for elective catheterization Major Surgical or Invasive Procedure: Coronary catheterization with stenting of the OM2 and LCx EGD with epinephrine injection and cautery of distal esophagus EGD with biopsy History of Present Illness: This is a 77 year old male with a h/o coronary artery disease, congestive heart failure (last EF 15%), aflutter s/p ablation, paroxysmal atrial fibrillation (on coumadin), chronic renal insufficiency, and schatki's ring dilated in past admitted to CMI on [**2183-11-3**] for elective cardiac catheterization. Pt had exercise MIBI (walked 8.5 minutes with resultant drop in BP from 112/60 to 88/60). Imaging showed fixed moderate defect in apex and distal anterior wall and moderate reversible defect in septum. . Then admitted electively to CMI for cath, which showed R heart: RA 14, RV 61/8, PA 60/23, PCPW 33 L heart: LMCA norm; LAD 100% prox; LCX 80% mid, 70% prox OM2, 50% distal OM2, distal vessel fills via left to left collaterals; RCA not visualized; [**Date Range **]-D1-OM1 patent, [**Date Range **]-LAD patent. Prox OM2 lesion rotablated and stented with minivision stent (unable to deploy drug-eluting stent); mid LCX stented with cypher. . Pt was started on [**Date Range **], plavix, and also given bivalirudin during the catheterization. Pt vomitted x 3 with clotted blood in one episode. Sheath pulled and BP decreased to 88/40 with HR 40's. Pt received atropine 0.6mg IV x1 and 200 cc NS bolus with BP in 100's/50's and HR 70's. Hct dropped 10 points and pt was tx'd to [**Hospital Unit Name 196**] from CMI. NGT x3 was attempted unsuccesfully. . Of note, pt had abd pain and postprandial abd pain as outpt leading to 30 lb wt loss. Outpt work up has included an MRA abdomen to rule out bowel ischemia [**9-15**]. It was a poor study and results were equivocal. Of note, EGD [**12/2178**] showed schlatki's ring at GE junction. Also of note, in [**2166**] had CABG using gastroepiploic artery for bypass. Furthermore, pt is on coumadin. . Past Medical History: 1. Atrial flutter, s/p ablation in [**4-12**]. on coumadin 2. CABG [**2167**] - 5 vessel arterial bypass (using [**Last Name (LF) **], [**First Name3 (LF) **], gastroepiploic artery) 3. Hypercholesterolemia. 4. Gout 5. Prostate cancer followed by [**Doctor Last Name **] - watchful waiting, last PSA 2.5, and no signs of progression 6. s/p right hip surgery. 7. CVA, s/p B CEA 8. h/o Deep Venous Thrombosis 9. HTN 10. Left femoral-popliteal bypass. 11. Rectus sheath hematoma. Social History: Remote tobacco - smoked at least 1ppd but quit in [**2167**] after CABG. No EtOH x 5 years, past "excessive" alcohol intake. Professor [**Known lastname **] lives at home with wife. [**Name (NI) **] remains very active with his children and grandchildren and at baseline (until a few months ago) can walk up many flights of stairs. They have no VNA or other services but they do have a housekeeper. He is a retired engineering professor [**First Name (Titles) **] [**Last Name (Titles) **]. He also consulted for an energy firm until last spring, when he decided to retire after the CEO of the firm passed away. He holds over 40 patents. He has 3 children, 5 grandchildren, most of whom he sees often. He enjoys seeing his grandchildren and spending time in his summer home. Family History: non contributory Physical Exam: VSS gen: nad, interactive, appropriate heent: NCAT, no LAD, PERRL, EOMI neck: jvd 2cm sup to clavicle at 30 degrees, cea scars, no bruits, supple cv: rrr; 2/6 sem without radiation lungs: lungs clear abd: soft, nt, nd, +bs ext: right groin c/d/i, no oozing, no bruits; good distal pulses in feet b/l neuro: aox3; moves all 4 ext, cn grossly intact . Pertinent Results: Labs on Admission [**2183-11-3**] 10:10PM BLOOD Hct-25.2*# Plt Ct-209 [**2183-11-4**] 06:45AM BLOOD Hct-29.7* Plt Ct-193 [**2183-11-4**] 10:25AM BLOOD WBC-11.6* RBC-3.13* Hgb-9.8* Hct-28.8* MCV-92 MCH-31.4 MCHC-34.1 RDW-15.6* Plt Ct-205 [**2183-11-3**] 08:35AM BLOOD INR(PT)-1.6 [**2183-11-3**] 05:15PM BLOOD Plt Ct-225 [**2183-11-4**] 03:17AM BLOOD PT-18.0* PTT-31.7 INR(PT)-2.3 [**2183-11-3**] 10:10PM BLOOD K-3.9 [**2183-11-3**] 10:10PM BLOOD CK(CPK)-58 [**2183-11-4**] 06:45AM BLOOD LD(LDH)-164 CK(CPK)-128 [**2183-11-4**] 06:45AM BLOOD CK-MB-12* MB Indx-9.4* [**2183-11-4**] 06:45AM BLOOD Mg-1.8 [**2183-11-4**] 10:25AM BLOOD Calcium-8.8 Phos-2.8 Mg-1.8 Labs on Discharge [**2183-11-19**] 6:30A wbc 8.3 rbc 3.27* hgb 9.9* hct 30.0* mcv 92 [**2183-11-19**] 6:30A gluc 158* urea 50* creatinine 1.6* Na 138 K 4.6 Cl 101 HCO3 23 ENZYMES & BILIRUBIN [**2183-11-11**] 07:50PM ALT 2197 AST 1842 LDH 1506 ALK phos 293 Amylase 264 t-bili 2.5 . [**2183-11-17**] 06:20AM ALT527* AST103* LDH305* ALK phos190* Amlyase 110* t-bili 1.9* . EKG [**2183-11-3**]: Sinus rhythm. Prolonged A-V conduction delay. Left bundle-branch block. Left axis deviation. Rare ventricular premature beat. Compared to the previous tracing of [**2183-8-8**] atrial ectopy is no longer present. Left axis deviation has become more pronounced. . Coronary Cath: 1. Selective coronary angiography was performed on the LMCA and [**Date Range **]. The [**Date Range **] was non-selectively injected and the RCA was not injected as it is known to be totally occluded proximally. The LMCA had no angiographic evidence of CAD. The LAD was proximally 100% occluded, it was filled by a patent [**Date Range **]. The [**Date Range **] to D1 with jump to the OM2 was widely patent with only mild diffuse disease in the proximal left subclavian artery. The LCx had a heavily calcified mid-vessel 80% stenosis just prior to a large OM2. The OM2 had a 70% proximal stenosis and a distal 50% stenosis. The distal LCx was occluded and the distal vessel including the LPDA filled via left to left collaterals. The RCA was non-dominant and was not injected. 2. Hemodynamics revealed severely elevated left and right heart filling pressures. There was moderate-severe pulmonary hypertension. The cardiac output/index was moderately depressed. There were large V waves on the wedge tracing consistent with significant mitral regurgitation. 3. Left ventriculography was not performed. 4. It proved very difficult to access the left femoral artery and vein due to the presence of significant scarring and calcification. The artery was progressively dilated with 4, 5 and 6 French dilators before the sheath could be introduced. The left femoral artery was imaged showing moderate calcification and diffuse disease in the iliac system. 5. Successful rotational atherectomy, PTCA, and stenting of the LCX and OM with a 2.5 x 13 mm Cypher DES, post-dilated with a 3.0 mm balloon (LCX) and a 2.0 x 12 mm Minivision (OM). FINAL DIAGNOSIS: 1. Three vessel coronary artery disease. 2. Moderate mitral regurgitation. 3. Severe diastolic ventricular dysfunction. 4. Moderate systolic ventricular dysfunction. 5. Calcification and scarring of the left femoral artery. 6. Successful PCI of the LCX and OM. . EKG post Cath: No significant change compared to pre-cath. . Imaging Liver/Gallbladder U/S [**2183-11-10**] The gallbladder is markedly distended, contains sludge and has significant wall thickening. Of note the patient is not locally tender here. A very limited MRI was performed [**2183-10-27**]. In this study, although a trace amount of pericholecystic fluid is seen, the gallbladder was not distended on that occasion. While appearances may represent third spacing with secondary gallbladder wall thickening, acalculous cholecystitis cannot be excluded. Correlation with clinical symptoms plus minus HIDA scan recommended. . [**2183-11-12**] Liver or Gallbladder Ultrasound The liver parenchyma appears unremarkable. Again, there is evidence of enlargement of the IVC and the intrahepatic and hepatic veins consistent with congestion, and on Doppler examination, retrograde flow from reflux can be identified within these hepatic veins. The main portal vein, anterior and posterior branches of the right portal vein are all seen and appear within normal limits. The main hepatic artery is patent. The patient's gallbladder again is noted to be abnormal, although it is not as distended as on previous examination and the degree of edema has lessened when compared to examination from [**2183-11-10**]. Extensive biliary sludge is again identified. CONCLUSION: The findings are suggestive of right-sided heart dysfunction and raise possibility of a congestive cause of abnormal LFTs. Pathology [**2183-11-28**] Diagnosis Stomach ulcer, biopsy: 1. Poorly differentiated adenocarcinoma, signet ring cell type. There is extension of tumor into the adjacent squamous epithelium and focal ulcer. 2. Special stains (mucicarmine and PAS-diastase) of the tumor show rare cells positive for mucin, with satisfactory controls. Note: The tumor cells have more cytoplasm, compared to the previous endoscopic biopsy; see addendum to S05-[**Numeric Identifier 92326**]. Dr. [**Last Name (STitle) **]. [**Doctor Last Name **] was provided with a preliminary diagnosis on [**2183-11-20**]. Brief Hospital Course: The [**Hospital 228**] hospital course was as follows: . 1. CAD - The patient was admitted to the CMI service for an elective catheterization after an abnormal stress test. The catheterization was uncomplicated. The OM2 and LCx were both found to have critical lesions and were stented with good flow post stent. The patient received [**Last Name (LF) **], [**First Name3 (LF) **], plavix after cath. He developed hematemesis x 2 and melenotic stools. [**First Name3 (LF) 37318**] was stopped but the patient was continued on plavix, [**First Name3 (LF) **] (just stented); lipitor. Beta-blocker was held. . Two days after transfer out of the CCU the patient was started on lopressor 12.5 because he was having premature atrial contractions. . For the remainder of his course the patient was maintained on aspirin, statin, plavix and beta-blocker. . 2. CHF - The patient has an EF of 15%. He received significant amount of blood transfusions throughout his hospital course and was in positive fluid balance. For a majority of this hospital course, the patient complained of SOB and was maintained on O2. Due to his rising creatinine, he initially received one time doses of Lasix and was re-assessed. To optimize cardiac function by reducing afterload, imdur and hydralazine were later added to the regimen. He was later placed on his home dose of Lasix. The patient was later weaned off the oxygen and his dependent edema later improved. . 3. Rhythm - The patient has a history of paroxysmal atrial fibrillation but was observed to be in sinus with LBBB on EKG throughout his hospital course. The patient's Coumadin was held in the CCU and throughout the rest of his course becuse of his gastrointestinal bleed. . 4. Anemia - Post cath, the patient developed hemetemesis and melena. He was found to have a large HCT drop and was transferred to the [**Hospital Unit Name 196**] service. He was transfused with 2 units PRBC and one unit of FFP. His HCT did not show appropriate response and the patient was transferred to the CCU with presumed upper GI bleed. Vitals remained stable and the patient appeared clinically stable. He was started on a PPI IV drip and HCT was monitored q4. He was seen by the GI service for upper scope. The scope showed an esophogeal ulcer with associated friable mucosa with exudate and surrounding erythema. Stomach cardia showed mass vs blood clot.At that time, GI decided that given the patient's clinical status and friability of the lesions, they would biopsy the lesion once the patient was clinically stable. Pt received another 2 units PRBC in the CCU with suboptimal HCT response. He received another unit PRBC and his HCT bumped to over 30 and remained stable. The patient was transferred to the [**Hospital Unit Name 196**] service with the plan to cont with blood tx as needed and monitor HCT. At this point, the patient had had only one melenotic stool over 12 hours and had not had repeat hemetemesis. . Once transferred to the floors, the patient received 1 PRBCs. For a total of 6 six his admission. His hematocrit hovered in the low 30s. His melena tapered off. . 5. UGIB bleed- The patient was seen by GI and had an EGD in the unit. The EGD showed a small mass ? malignancy and an ulcerating lesion. Epi and cauterization were used, however a biopsy was not taken at this time. The patient had a repeat EGD once he was clinically stable. Per GI Reccs: the patient was kept on a PPI, Coumadin was held, his diet was advanced and his HCT was kept above 30. . 6. Coagulopathy/Shock Liver- In preparation for the repeat endoscopy by GI, the patient's coags were monitored. Despite not being on Coumadin or heparin and receiving Vitamin K multiple times, patient's INR remained elevated. Transaminases were found to be elevated (AST [**2178**], ALT 1800s). Acetaminophen was held and a level was checked and was negative. Patient's coagulopathy was attributed to his shock liver. His shock liver was attributed to hepatic congestion secondary to congestive heart failure. On U/S there was enlargement of the IVC, intrahepatic and hepatic veins consistent with congestion. The train of thought at this point was that right sided heart failure had contributed to the congestive changes seen in the liver. A HIDA scan was done which showed delay kinetics suggestive of cholecystitis. With continued management of the patient's congestive heart failure his transaminases improved and coagulopathy resolved. . There was also concern that the patient's use of Acetaminophen extra strength for several months prior to admission and use of Acetaminophen during his hospital course to control his GI pain may have also contributed to his shock liver. But the primary etiology was thought to be his congestive heart failure. . 7. Acute on chronic renal insufficiency - Due to patient's elevating creatinine, renal was consulted. They attributed his acute renal insufficiency to prerenal physiology due to low EF and lasix. Per their reccs, Imdur and Hydralazine were added to reduced afterload and improve forward flow. In the setting of renal insufficiency, phosphate was also elevated. Renagel was therefore also given. At the time of discharge, the patient's creatine was near baseline. . 8. Adenocarcinoma- Biopsy of the stomach ulcer was consistent with adenocarcinoma. The patient was seen by Heme/Onc and followup for further management was scheduled as an outpatient. . 9. Hypernatremia - While in the CCU, the patient developed mild hypernatremia for which he was encouraged to take PO medications. . 10. Dispo- At the time of discharge the [**Hospital 228**] medical issues were stable. He had close followup scheduled with his PCP, [**Name10 (NameIs) 2085**] and with Heme/Onc. The patient was discharged with the instructions to continue taking his medications as prescribed, not to take Acetaminophen (he was given a bottle of and precription for Maalox/ Diphenhydramine/Lidocaine)to return to the hospital if any worrisome symptoms should arise and to followup with his physicians. Medications on Admission: 1. lasix 60 mg PO Qday 2. Losartan 25 mg Qday 3. [**Name10 (NameIs) **] 325 Qday 4. lipitor 10 mg Qday 5. carvedilol 3.125 mg Qday 6. Plavix 75 mg Qday 7. finesteride 5 mg Qday Discharge Medications: 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual Q5MIN () as needed for chest pain. Disp:*30 Tablet, Sublingual(s)* Refills:*0* 2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 6. Coreg 3.125 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 7. Cozaar 25 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 8. Proscar 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 9. Colace 50 mg Capsule Sig: One (1) Capsule PO once a day. Disp:*30 Capsule(s)* Refills:*2* 10. Ferrous Gluconate 325 mg Tablet Sig: One (1) Tablet PO twice a day: This medication may darken your stools. Disp:*60 Tablet(s)* Refills:*2* Of note the patient was also given a prescription for maalox/diphenhydramine/lidocaine mix. He was also given a bottle to take home. Discharge Disposition: Home Discharge Diagnosis: S/P stent placement and Upper GI bleeding Discharge Condition: Good VS T96.8 (oral, HR 63-82, BP 100-106/55-70, R20, 02sat 95-985RA Discharge Instructions: You are to return to the hospital immediately if you should experience any chest pain, shortness of breath or any other worrisome symptom. . Please take your medications as prescribed. Please note that you were previously taking lipitor but this medication has been held due to your elevated liver enzymes. . You are being discharged on the following medications: nitroglycerin, aspirin, clopidogrel, folic acid, lasix, coreg, cozaar, proscar, colace (stool softener), and ferrous gluconate. Followup Instructions: Your PET scan is scheduled for [**12-10**] at 10:30AM. Please see your instruction book for preparation prior to testing. . Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] MULTI-SPECIALTY THORACIC UNIT-CC9 Date/Time:[**2183-12-11**] 10:30. . Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 5566**] [**Name Initial (NameIs) **]. HEMATOLOGY/ONCOLOGY-CC9 Date/Time:[**2183-12-11**] 10:30 . Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] MULTISPECIALTY MULTI-SPECIALTY THORACIC UNIT-CC9 Date/Time:[**2183-12-11**] 11:30 Completed by:[**2183-12-21**] ICD9 Codes: 4240, 5849
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Medical Text: Admission Date: [**2138-3-29**] Discharge Date: [**2138-4-11**] Date of Birth: [**2111-9-19**] Sex: M Service: MEDICINE Allergies: Cefepime Attending:[**First Name3 (LF) 3963**] Chief Complaint: Fever Major Surgical or Invasive Procedure: Sinus polyp biopsy, sinus wash and culture History of Present Illness: History of Present Illness: . 26 yo man D +278 after single cord transplant for hypoplastic MDS with h/o persistent pancytopenia thought to be [**3-20**] myelosuppression from CMV + antivirals who is now admitted for sepsis. . Patient was first diagnosed with with MDS in Fall [**2136**] when he presented with pancytopenia. Initial MDS course was complicated by mucor infection of the tongue with prolonged ICU course for upper airway obsturuction, followed by pericoronitis as well as perirectal abcess. Was subsequently managed with a single cord transplant on [**2137-6-24**] with reduced intensity Flu/MEL/ATG conditioning. Post transplant course c/b VRE + Coag neg staph bacteremia [**6-/2137**] (treated with dapsone); CMV viremia [**7-/2137**], c.diff infection [**10/2137**] (treated with 14 days oral vanc), admission on [**10/2137**] for low grade temperature attributed to +CMV viremia with prolonged IV ganciclovir --> oral Valgancyclovir course; last admission 10/4-6 for neutropenic fever, CT chest showed non specific minimal peribronchial ground-glass opacity in the left lower lobe, treated with course of levofloxacine; Saw ID [**12-12**] Valgancyclovir was stopped as CMV viral loads remained negative since [**10-22**], was started on valacyclovir for HSV/VZV PPx. He also continues oral Posiconazole for mucor and monthly pentamidine nebs for PCP [**Name Initial (PRE) **] (most recent [**12-28**]). . Patient had > 97% donor on chimerism on peripheral blood from [**2137-10-17**]. He has been intermitently leukopenic and neutropenic throughout his illness with especially low white counts generally ranging around 1000-3000 during the past 2 months. This has been attributed to possible BM supression by CMV and/or antiviral meds. Thrombocytopenia has been continous throughout his illness and latley stable at ~ 25,000. Hct generally in the high teens to low twenties. He also had had a stable transaminitis for months which is attributed to drug effect +/- hemochromatosis. Finally he is thought to be at low risk for GVH and thus stopped immunosupressive meds in [**2137-9-16**] (was on tacrolimus prior). Last neupogen was given on [**2138-3-27**]. . Over the past several months, he has had recurrent PNAs and has been followed in pulmonary clinic. In [**Month (only) 404**] he was found to have fever and neutropenia and worsening tree-in-[**Male First Name (un) 239**] opacities, particularly in the left side. He was treated with meropenem, azithromycin and oseltamivir. Repeat CT chest on [**3-4**] showed some resolution and he was most recently seen in pulm clinic on [**2138-3-20**]. During this visit he was in the midst of being treated for another pulm infection with moxifloxacin. . Today pt called clinic because he reported feelings of malaise and nausea and noted that he had a low grade fever. He went to clinic and was found to have a fever of 103, Bp in 80's systolic, HR of 140. He was started on meropenem and vancomycin and started on maintenance fluids at 150cc/hr. WBC were 4.1 with 80%N. Past Medical History: -Hypoplastic MDS (deletion 7q and 13) - single cord transplant on [**2137-6-24**] with reduced intensity Flu/MEL/ATG. -Last chemo: Tacrolimus [**2138-10-5**], which was stopped after clinical suspicion of GVH decreased - Oral Mucor infection [**2136**]: infiltration into base of the tongue with bleeding requiring intubation and IR guided ablation of bleeding lingual artery. s/p excision by ENT. Complicated hospital course involving multiple ICU stays for post-operative laryngeal edema following intubation. - C. difficile infection [**10/2136**] - pericoronitis s/p extraction 4 teeth [**2137-1-24**] - peri-rectal abscess s/p drainage [**2137-2-27**] - Hemochromatosis - Transaminitis (felt most likely multifactorial; contributions by medications and hemochromatosis) Social History: -Moved from [**Country **] in [**2136**]. -lives with sister, brother-in-law, and their 2 children. -He has no pet exposures. -previously worked in warehouse packing boxes, has not worked since [**35**]/[**2136**]. He has a history of working for an oil company in [**Country **], though per reports worked mainly in office and had only occasional exposure to factory environment. -No significant tobacco history. -Occasional alcohol use -No illicit drug. Family History: Father died at age 73, per reports had "illness" and progressive weakness. Mother died of stroke at age 60. No known family history of cancer or bleeding disorders. Has 6 siblings who are healthy. Physical Exam: Vitals: T:100.6 BP:95/60 P:104 R:20 O2: 98% General: Alert, oriented, no acute distress, flat affect HEENT: Sclera anicteric, PERRLA, MMM, OP clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, some basilar crackles which clear with cough, no wheezes or ronchi CV: tachycardic, regular rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: no focal deficits, motor [**6-21**] throughout, CNII-XII normal. Pertinent Results: [**2138-3-29**] 03:35PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.007 [**2138-3-29**] 03:35PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG [**2138-3-29**] 03:35PM URINE RBC-1 WBC-2 BACTERIA-NONE YEAST-NONE EPI-<1 [**2138-3-29**] 10:15AM GLUCOSE-116* UREA N-14 CREAT-1.0 SODIUM-133 POTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-22 ANION GAP-14 [**2138-3-29**] 10:15AM estGFR-Using this [**2138-3-29**] 10:15AM ALT(SGPT)-39 AST(SGOT)-62* LD(LDH)-319* ALK PHOS-147* TOT BILI-0.6 [**2138-3-29**] 10:15AM ALBUMIN-4.1 CALCIUM-8.5 PHOSPHATE-3.1 MAGNESIUM-2.1 [**2138-3-29**] 10:15AM WBC-4.5# RBC-2.14* HGB-7.7* HCT-22.4* MCV-104* MCH-35.9* MCHC-34.4 RDW-19.1* [**2138-3-29**] 10:15AM NEUTS-80* BANDS-1 LYMPHS-14* MONOS-4 EOS-0 BASOS-0 ATYPS-1* METAS-0 MYELOS-0 NUC RBCS-3* [**2138-3-29**] 10:15AM HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-1+ MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-OCCASIONAL SCHISTOCY-OCCASIONAL TEARDROP-OCCASIONAL [**2138-3-29**] 10:15AM PLT SMR-VERY LOW PLT COUNT-21* [**2138-4-3**] 04:08AM BLOOD WBC-2.8* RBC-2.14* Hgb-7.7* Hct-21.1* MCV-99* MCH-36.2* MCHC-36.7* RDW-20.5* Plt Ct-43*# [**2138-4-5**] 11:00AM BLOOD WBC-1.2*# RBC-1.98* Hgb-6.6* Hct-19.6* MCV-99* MCH-33.2* MCHC-33.6 RDW-20.0* Plt Ct-26* [**2138-4-8**] 11:00AM BLOOD WBC-6.0# RBC-2.76*# Hgb-9.4*# Hct-26.9*# MCV-97 MCH-33.9* MCHC-34.8 RDW-18.9* Plt Ct-12*# [**2138-4-11**] 05:32AM BLOOD WBC-2.0*# RBC-2.58* Hgb-8.8* Hct-25.4* MCV-98 MCH-34.0* MCHC-34.6 RDW-19.1* Plt Ct-17* [**2138-4-11**] 05:32AM BLOOD Neuts-42* Bands-0 Lymphs-25 Monos-30* Eos-0 Baso-0 Atyps-2* Metas-0 Myelos-1* [**2138-3-30**] 09:20AM BLOOD Gran Ct-1206* [**2138-3-31**] 03:44PM BLOOD Gran Ct-1533* [**2138-4-1**] 09:45AM BLOOD Gran Ct-2378 [**2138-4-2**] 04:08PM BLOOD Gran Ct-[**2101**]* [**2138-4-5**] 11:00AM BLOOD Gran Ct-492* [**2138-4-8**] 11:00AM BLOOD Gran Ct-4800 [**2138-4-11**] 05:32AM BLOOD Gran Ct-860* [**2138-4-11**] 05:32AM BLOOD Glucose-92 UreaN-14 Creat-0.8 Na-134 K-4.1 Cl-101 HCO3-23 AnGap-14 [**2138-4-3**] 04:08AM BLOOD ALT-36 AST-61* LD(LDH)-294* AlkPhos-136* TotBili-0.5 [**2138-4-5**] 11:00AM BLOOD ALT-42* AST-76* LD(LDH)-262* AlkPhos-151* TotBili-0.5 [**2138-4-8**] 11:00AM BLOOD ALT-48* AST-89* LD(LDH)-365* AlkPhos-162* TotBili-0.6 [**2138-4-11**] 05:32AM BLOOD ALT-43* AST-79* LD(LDH)-296* AlkPhos-149* TotBili-0.6 [**2138-4-11**] 05:32AM BLOOD Calcium-8.7 Phos-3.0 Mg-2.0 [**2138-4-8**] 11:00AM BLOOD POSACONAZOLE-PND [**2138-4-2**] 04:08PM BLOOD ADENOVIRUS PCR-Test Name . . . Blood cx [**2138-3-29**] - [**2138-4-3**]: No Growth Sinus Aspirate x4 [**2138-4-2**]: no growth on bacteria/fungal cx Resp Viral Swab: neg Stool C.Diff negative x 2 Urine Cx: negative CMV viral load: not detected . MRI Head/Sinus IMPRESSION: 1. No evidence of intracranial, orbital, or dural extension. 2. Extensive opacification of all the sinuses with mucosal thickening, air-fluid levels, loculated air within the fluid collections, and chronic inflammatory changes. No bony destruction is visualized. . . CT SINUS IMPRESSION: Extensive paranasal sinus disease with active secretions, suggestive of acute infection. The above findings appear significantly progressed from [**2138-2-20**] exam. . DIAGNOSIS: . R Middle Inferior Turbinate Polypoid lesion, right inferior middle turbinate, biopsy: - Polypoid fragments of sinonasal respiratory mucosa with focal acute (neutrophilic) and chronic inflammation and surface erosion. - No definitive fungal organisms seen; see note. Note: Special stains (PAS, PAS with Diastase, and GMS stains) are negative for fungal organisms. Dr. [**Last Name (STitle) **]. Sepehr reviewed frozen, permanent section, and special stain slides and concurs. Drs. [**First Name (STitle) **] and [**Name5 (PTitle) **] were notified via emails on [**2138-4-3**] at 5pm. Clinical: History of oral mucormycosis, now with sinusitis, polypoid tissue at inferior right middle turbinate. Gross: The specimen is received fresh labeled with the patient's name, "[**Known lastname **], [**Known firstname 87416**]" and the medical record number. It consists of fragments of tan pink soft tissue, measuring 0.9 x 0.8 x 0.2 cm in aggregate. The specimen is submitted entirely for frozen section evaluation. The frozen section diagnosis by Dr. [**Last Name (STitle) **]. Sepher is "Angioinvasive fungal elements, highly suspicious for mucormycosis." The frozen section remnant is entirely submitted in cassette A. . DISCHARGE [**2138-4-11**] 05:32AM BLOOD WBC-2.0*# RBC-2.58* Hgb-8.8* Hct-25.4* MCV-98 MCH-34.0* MCHC-34.6 RDW-19.1* Plt Ct-17* [**2138-4-11**] 05:32AM BLOOD Neuts-42* Bands-0 Lymphs-25 Monos-30* Eos-0 Baso-0 Atyps-2* Metas-0 Myelos-1* [**2138-4-11**] 05:32AM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-1+ Macrocy-1+ Microcy-1+ Polychr-1+ Stipple-OCCASIONAL Tear Dr[**Last Name (STitle) **]1+ Ellipto-1+ [**2138-4-11**] 05:32AM BLOOD Plt Smr-RARE Plt Ct-17* [**2138-4-11**] 05:32AM BLOOD Gran Ct-860* [**2138-4-11**] 05:32AM BLOOD Glucose-92 UreaN-14 Creat-0.8 Na-134 K-4.1 Cl-101 HCO3-23 AnGap-14 [**2138-4-11**] 05:32AM BLOOD ALT-43* AST-79* LD(LDH)-296* AlkPhos-149* TotBili-0.6 [**2138-4-11**] 05:32AM BLOOD Calcium-8.7 Phos-3.0 Mg-2.0 Brief Hospital Course: 26 yo man s/p single cord transplant ([**6-/2137**]) for hypoplastic MDS c/b mucormycosis, CMV infection, c.diff and VRE bacteremia, with persistent pancytopenia likely [**3-20**] myelosuppression from CMV + antivirals, recently with recurrent PNA now admitted from clinic with sepsis. . # Sinusitis/Sepsis: On admission, per SIRS criteria (fever of 103 and HR in 140s in clinic) pt met SIRS criteria. He was hypotensive initially in clinic, but has been responsive to fluids with BP stable in 110s systolic at time of admission. All culture data (including sinus aspirates, blood, urine, NP swab) was negative. The only obvious source of infection was sinuses. CT and MR sinuses showed diffuse acute sinusitis. To gather microbiological source, nasal swab was attained by our colleagues in ENT, which was negative. Due to pt's history of invasive mucormycotic infection without negative margins and pt being on suppressive doses of posaconazole, more invasive culture/biopsy data was pursued. Due to pt's request for sedation, repeat ENT was done under conscious sedation in the [**Hospital Unit Name 153**]. Four sinus aspirates and biopsy of polypoid lesion were collected during ENT exam. The polypoid lesion was sent for frozen path, and preliminary read came back positive for invasive fungal infection. Before pt could be brought to OR for debridement of this area, the final path report came back revealing that the invasive fungal read was actually artifact from frozen section. All fungal markers and stains were negative, and final path was negative for fungal infection. Pt was continued on IV broad spectrum antibiotics (dapto and [**Last Name (un) 2830**]) and posaconazole and ultimately transitioned to flagyl and levaquin. He will continue these medications for a total of 3 weeks from day after ENT biopsy. . #Epistaxis: on day after ENT procedure, pt removed packing from nose despite numerous warnings by staff not to take it out. He was given afrin and started on amicar drip. ENT re-evaluated pt, but he would not allow them to repack nose. Over the course of the day, the bx site clotted and bleeding resolved. Amicar was stopped. . # MDS, s/p BMT. Pt's valcyte dose was decreased to ppx dosing at 900mg daily given negative CMV viral load. He was transfused with platelets and PRBCs on numerous occasions during hospitalization. . # transaminitis: stable. thought to be [**3-20**] to med effect or hemochromatosis. . TRANSITIONAL: - follow up in [**Hospital 3242**] clinic and in BMT [**Hospital **] clinic in 4 weeks - continue levofloxacin and flagyl for three weeks from [**2138-4-3**] Medications on Admission: FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth once a day PENTAMIDINE [NEBUPENT] - (Prescribed by Other Provider) - 300 mg Recon Soln - 300 mg inh once per month diluted in 6mg sterile water; please give albuterol inhaler, 2 puffs, pre inhalation POSACONAZOLE [NOXAFIL] - 200 mg/5 mL (40 mg/mL) Suspension - 10 ml Suspension(s) by mouth twice daily for 400 mg twice daily URSODIOL - (Prescribed by Other Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **] nam; Dose adjustment - no new Rx) - 300 mg Capsule - 1 Capsule(s) by mouth twice a day VALACYCLOVIR - 1,000 mg Tablet - 1 Tablet(s) by mouth daily Medications - OTC MULTIVITAMIN [DAILY MULTIPLE] - Tablet - 1 Tablet(s) by mouth once a day Discharge Medications: 1. ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). 3. posaconazole 200 mg/5 mL (40 mg/mL) Suspension Sig: Ten (10) mL PO Q12H (every 12 hours). 4. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 14 days: until [**2138-4-24**]. Disp:*14 Tablet(s)* Refills:*0* 5. metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) for 14 days: last day [**2138-4-24**]. Disp:*42 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Sinusitis hypoplastic MDS Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to hospital for sinusitis. We were concerned that you might have an invasive fungal infection and had ENT surgery take a biopsy from your sinus. There was no evidence of fungal infection on your biopsy. We treated you with IV antibiotics and transitioned you to oral antibiotic therapy. We believe that you are now safe to home. . The following changes to your medications have been made: 1. Start Flagyl (metronidazole) 500mg by mouth every 8 hours until [**2138-4-24**] 2. Start Levaquin 500mg by mouth every 24 hours until [**2138-4-24**] 3. change valgancyclovir to 900mg once daily . Please continue the rest of your home medications Followup Instructions: Department: BMT/ONCOLOGY UNIT When: TUESDAY [**2138-4-15**] at 1 PM [**Telephone/Fax (1) 447**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: Main Garage Department: HEMATOLOGY/BMT When: TUESDAY [**2138-4-15**] at 1:30 PM With: [**First Name11 (Name Pattern1) 3750**] [**Last Name (NamePattern4) 3885**], NP [**Telephone/Fax (1) 3886**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: HEMATOLOGY/ONCOLOGY When: TUESDAY [**2138-4-15**] at 1:30 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3884**], MD [**Telephone/Fax (1) 3237**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage . Department: HEMATOLOGY/ONCOLOGY Infectious disease clinic When: [**2138-4-30**] 01:30p With: Dr. [**Last Name (STitle) 724**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage ICD9 Codes: 0389, 2930
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Medical Text: Admission Date: [**2116-12-27**] Discharge Date: [**2117-2-8**] Date of Birth: [**2049-3-12**] Sex: F Service: HISTORY OF PRESENT ILLNESS: The patient is a 67-year-old woman who has a past history of uncontrolled hypertension who was babys[**Name (NI) 12854**] her grandchildren on the day of admission when she started having a headache around 10 PM. At that time she spoke with her son-in-law and told him that she felt sick. A family friend was [**Name (NI) 653**] who went over to check on her, at that point she was found unresponsive. She was brought to an outside hospital still unresponsive, she was intubated and was hypertensive with a systolic blood pressure of 225/102, was given 20 mg of Labetalol and transferred to [**Hospital1 69**] via [**Location (un) **]. PAST MEDICAL HISTORY: Uncontrolled hypertension. MEDICATIONS ON ADMISSION: None. ALLERGIES: No known drug allergies. SOCIAL HISTORY: The patient speaks French Creole. She was on a visit from [**Country 2045**] visiting her daughter who lives here. Her daughter has been her sole source of support for the last several years. The patient has not worked in over two years. The patient does not smoke tobacco, use alcohol or use intravenous drugs. FAMILY HISTORY: Unknown. PHYSICAL EXAMINATION: At the time of admission the patient was intubated with a blood pressure of 166/80, with a heart rate of 100. Head, eyes, ears, nose and throat exam is normocephalic, atraumatic. Cardiac exam was regular rate and rhythm with a systolic ejection murmur. Lungs were clear to auscultation bilaterally. Abdomen was soft, nontender, nondistended. Extremities without edema. Neurologically she was intubated and sedated. Grimacing only to pain. Cranial nerves: Pupils were 1.5 mm bilateral and reactive. Corneal reflexes were depressed. She had a left facial droop. On motor exam she had no spontaneous movement, she withdrew to pain on the right. Had a flaccid left upper extremity. Reflexes were decreased on the left and 2+ on the right. She had bilateral extensor plantar responses. HISTORY OF HOSPITAL COURSE: The patient is a 67-year-old Hatian wound with a history of uncontrolled hypertension who presented after having a headache and was found unresponsive, sent to [**Hospital1 69**] after intubation. She had a head CT which showed a large right thalamic bleed with intraventricular blood and right lateral ventricle enlargement. Her INR on admission was 1.1. The patient was on no medications. She initially went to the Neurological Intensive Care Unit where she stayed for approximately one month. Her hospital course there was complicated by uncontrolled blood pressures which could not be adequately controlled by medication. She also continued to have low grade fevers. She developed hydrocephalus and had a ventricular drain placed which was left in place for approximately three weeks and then removed. She was on multiple different antibiotics during that time including Oxacillin and Zosyn for pseudomonas pneumonia and Oxacillin because of her ventricular drain. She had multiple blood cultures which showed no evidence of growth. She did not have any blood cultures drawn prior to the initiation of antibiotics. She continued to have unexplained fevers and on exam continued to have a large systolic ejection murmur. She developed punctate hemorrhages in her nailbeds and had an echocardiogram which showed evidence of a vegetation on the mitral valve. She was started on Vancomycin and Ceftriaxone for endocarditis. She had Infectious Disease consult and cardiology consult which also felt that her exam and presentation were consistent with endocarditis. She was continued on a course of Ceftriaxone and Vancomycin for six weeks. The patient remained with decreased mental status however, after extubation she would open her eyes spontaneously. She had a right gaze preference and her left upper extremity remained flaccid. She did move her left lower extremity spontaneously. The patient was able to speak a few words in French Creole her native language. After she was transferred to the floor she had a percutaneous endoscopic gastrostomy tube placed. Several days later she developed some abdominal tenderness. She had a CT of the torso which showed no evidence of intraabdominal abscess. Her tube feeds were restarted and she eventually became afebrile. The patient remained with waxing and [**Doctor Last Name 688**] mental status. An EEG was performed which just showed diffuse slowing consistent with encephalopathy. However, later she was observed to have some small focal motor seizures of her left face. She was started on Keppra. Her Keppra was gradually increased and her mental status improved. She was also started on Provigil to keep her more alert and able to participate with Occupational Therapy and Physical therapy. The patient's exam stabilized over the next month. She continued to be more alert. Able to deny having pain. Able to show two fingers and interact slightly with the examiner however, her left lower extremity remained flaccid. As of [**2-8**] she remained in this condition. She remained in the hospital due to her lack of insurance and lack of citizenship and she will be continued on intravenous antibiotics for her endocarditis until [**2-18**] at which time they can be discontinued. This is a summary of her hospital course to date and a dictation summary addendum will be added at the time of her eventual discharge. DR.[**Last Name (STitle) 726**],[**First Name3 (LF) 725**] 13-268 Dictated By:[**Dictator Info **] MEDQUIST36 D: [**2117-2-8**] 16:17 T: [**2117-2-8**] 16:21 JOB#: [**Job Number 14792**] ICD9 Codes: 431, 5070, 4019
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Medical Text: Admission Date: [**2183-7-16**] Discharge Date: [**2183-7-19**] Date of Birth: [**2123-10-19**] Sex: M Service: MICU/[**Hospital1 212**] HISTORY OF THE PRESENT ILLNESS: The patient is a 59-year-old male with a history of diabetes mellitus type 2, end-stage renal disease, status post failed renal transplant now on hemodialysis and hypertension admitted to the MICU for hypotension and mental status changes. The patient was scheduled for hemodialysis on the day of admission and he reportedly was too weak to go to his car and had unclear speech. He was brought to the Emergency Room by EMS. In the field, the patient's blood pressure was 102/42, heart rate 100 with a blood sugar in the 190s. On arrival to the [**Hospital3 **], the patient's blood pressure was 58/24, heart rate 90. The patient was afebrile. He was noted to be agitated. The patient, of note, reports having liquid stools and bouts of diarrhea increased over the past two weeks with one episode of vomiting. Initially, the patient had been given 4 liters normal saline and started on dopamine as well as 100 mg of hydrocortisone. Upon arrival to the MICU, the patient's mental status had improved and he had been able to give a good history and had reported these episodes of increased diarrhea, denied any blood in his stools, although he has had several weeks of increased diarrhea. PAST MEDICAL HISTORY: 1. End-stage renal disease, status post renal transplant in [**2176**], currently on hemodialysis. He had the kidney removed from the renal transplant in [**2183-4-12**]. 2. Diabetes mellitus type 2. 3. Hypertension. 4. Anemia of chronic disease. 5. History of multiple GI bleeds secondary to gastritis, AVMs, and [**Doctor First Name **]-[**Doctor Last Name **] tear in [**2172**]. 6. History of blindness. 7. Gastroparesis. 8. Neuropathy. ALLERGIES: The patient has no known drug allergies. ADMISSION MEDICATIONS: 1. Protonix 40 mg p.o. q.d. 2. Metoprolol. 3. Insulin 20 units of 70/30 in the morning. 4. Procrit. 5. Nephrocaps. 6. Tums t.i.d. with meals. 7. Prednisone 5 mg p.o. q.d. SOCIAL HISTORY: No tobacco or alcohol. He is a retired nurse 16 years ago. He lives with his wife. FAMILY HISTORY: Notable for diabetes. PHYSICAL EXAMINATION UPON ARRIVAL TO THE MICU: General: The patient was alert, lethargic appearing. Vital signs: Temperature 97.6, heart rate 109, blood pressure 139/58, saturating 100%. HEENT: Normocephalic, atraumatic. The mucous membranes were slightly dry. The sclerae were anicteric. Neck: Supple. Lungs: Clear to auscultation bilaterally. Heart: Regular rate and rhythm, tachycardiac with a III/VI systolic murmur. Abdomen: With good bowel sounds, soft, nontender. Surgical site was healed. Extremities: No edema, no calf tenderness. No open wounds. Left forearm fistula was with a thrill. No asterixis. Neurologic: Cranial nerves II through XII were intact. Strength: [**6-16**] in all extremities except for the left hand and the patient reports having prior surgery there and this is an old weakness. The patient was alert to [**Hospital1 18**], [**2183-7-13**], and date, able to spell world backwards. LABORATORY/RADIOLOGIC DATA: The patient's white count was 17.9, hematocrit 39.8, platelets 235,000. PT 1.1. Chemistries on admission: Sodium 143, potassium 3.7, chloride 107, BUN 31, creatinine 7.5, glucose 164. Amylase 90, lipase 26. HOSPITAL COURSE: The patient is a 59-year-old male with a history of diabetes mellitus, end-stage renal disease, on hemodialysis, and a history of multiple GI bleeds presenting after feeling dizzy and weak, noted to have hypotension. 1. HYPOTENSION: The [**Hospital 228**] hospital course on admission in the field had been noted for systolic blood pressures in the 50s to 60s. Upon arrival here, the patient had received pressors for treatment as well as multiple liters of fluid. The etiology of the patient's hypotension/shock is most likely secondary to sepsis versus hypovolemia. With regards to a sepsis workup, the patient was initially started on vancomycin and Flagyl. His blood cultures had been negative upon the time of discharge times 72 hours. During the hospital course, he had been afebrile. Other etiologies regarding the patient's hypotension and shock may have been secondary to hypovolemic shock as the patient had significant improvement with fluids. The patient had been initially weaned from pressors after approximately one day during the hospital MICU stay. Other etiologies of the patient's shock may have included a history of adrenal insufficiency. The patient has had a renal transplant in the past and had been on steroids for suppression. After the transplant had been removed, he had been tried on a prednisone taper, although per report had been told to continue with 5 mg of prednisone for the time being. He initially had been started on hydrocortisone and Florinef during the MICU course. The patient's infectious workup had been negative since the patient had been treated and had been having multiple days of diarrhea, he had recent stool cultures. The stool cultures were negative to date. Of note, the C. dif was also negative. Other workup for the patient's hypotension included abdominal CT and chest CT. This showed that there was no evidence of aortic dissection or pulmonary embolus. No pneumonia. No intra-abdominal abscess. No evidence of ischemic bowel. 3. NEUROLOGY: The patient initially presented with confusion per report upon admission. However, upon arrival to the MICU, the patient had been alert and oriented times three and had been able to give a good history. He had a head CT which had been negative for hemorrhage. 4. RENAL: The patient was continued on hemodialysis throughout this hospital course. Otherwise with regards to the patient's symptoms, he was initially started on hydrocortisone in the Emergency Room. He will be sent home on the steroid taper as the patient is on baseline 5 mg of prednisone per day. Also of note, during his hospital course, he reported that he wanted to leave, although we had recommended keeping the patient in-house for an extra day or to and the patient signed out against medical advise. He was recommended to call or return if he has any symptoms of lightheadedness or dizziness, increased nausea, vomiting, or diarrhea. He also was sent home on an empiric course of Flagyl as well as a steroid taper. The empiric course of Flagyl was possible C. dif. DISCHARGE DIAGNOSIS: 1. Hypovolemic shock. 2. Chronic renal failure. 3. Diabetes mellitus type 2. 4. History of anemia. DISCHARGE MEDICATIONS: 1. Protonix 40 mg p.o. q.d. 2. Nephrocaps one p.o. q.d. 3. Calcium carbonate 500 mg p.o. t.i.d. with meals. 4. Metoprolol q.d. 5. Flagyl 500 mg p.o. t.i.d. times 14 days. 6. Prednisone taper starting at 30 mg as directed to be tapered down to a home dose of 5 mg. FOLLOW-UP: The patient is to continue to follow-up with Dialysis on q. Monday, Wednesday, and Friday and he was also advised if needed to follow-up if his diarrhea persisted, follow-up with Gastroenterology. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 15234**] Dictated By:[**Last Name (NamePattern1) 25348**] MEDQUIST36 D: [**2183-7-21**] 02:42 T: [**2183-7-24**] 21:56 JOB#: [**Job Number 26610**] ICD9 Codes: 2765, 3572
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Medical Text: Admission Date: [**2160-5-18**] Discharge Date: [**2160-5-29**] Date of Birth: [**2088-6-15**] Sex: F Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: tibial plateau fracture, [**First Name3 (LF) 8813**] stenosis Major Surgical or Invasive Procedure: [**2160-5-23**] 1. [**Month/Day/Year **] valve replacement with a 23-mm Biocor Epic tissue valve. 2. Coronary artery bypass grafting x2: Left internal mammary artery graft to left anterior descending; reverse saphenous vein graft to diagonal branch. History of Present Illness: 71 year old woman with a medical history of A-fib on coumadin and sotalol and [**Month/Day/Year 8813**] stenosis. She was told by a doctor (presumably her cardiologist or cardiac surgeon) that she needed to have her [**Month/Day/Year 8813**] valve replaced. She was told this two months ago and because she is scared of the surgery has not scheduled a date for the surgery. She was walking and stepped on her left foot oddly, this caused her to stumble and fall on her left knee. Her daugher who lives with her was able to help her up and bring her to the ED at [**Hospital 39437**]. She is unable to walk across the room without getting short of breath. She does not get shortness of breath at rest, but consistently becomes short of breath with minimal exertion. She is now being referred to cardiac surgery for evaluation of an [**Hospital 8813**] vavle repelacment. Past Medical History: [**Hospital **] Stenosis Coronary Artery Disease PMH: A-fib Hypertension Hyperlipidemia [**Hospital **] Valve stenosis Mitral Valve problem Hypothyroidism Past Surgical History: s/p Left ankle fracture 10 years ago repaired with "10 screws and a bar" s/p Surgery for PUD causing gastric outlet obstruction s/p Tonsillectomy as child Social History: No Tob ever No EtOH No illicits Patient lives with daughter and granddaughter Family History: Obesity Heart problems, pt not sure what kind Half sister had [**Hospital 8813**] valve repalcement at the age of 43 No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory Physical Exam: Admission: VS: afebrile 87/62 145 96% RA GENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: difficult to assess due to body habitus. CARDIAC: RR, normal S1, soft S2, 3/6 systolic murmur crescendo-decrescendo heard throughout precordium, No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. crackles at bases bilaterally ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ Pertinent Results: [**2160-5-28**] 04:13AM BLOOD WBC-8.9 RBC-3.18* Hgb-10.0* Hct-28.9* MCV-91 MCH-31.4 MCHC-34.7 RDW-17.0* Plt Ct-220 [**2160-5-27**] 07:48AM BLOOD Hct-24.0* [**2160-5-27**] 04:43AM BLOOD WBC-9.7 RBC-2.57* Hgb-8.4* Hct-23.8* MCV-93 MCH-32.6* MCHC-35.2* RDW-16.4* Plt Ct-196 [**2160-5-29**] 06:08AM BLOOD PT-26.6* INR(PT)-2.5* [**2160-5-28**] 04:13AM BLOOD PT-17.9* INR(PT)-1.6* [**2160-5-27**] 04:43AM BLOOD PT-14.9* INR(PT)-1.3* [**2160-5-26**] 05:55AM BLOOD PT-14.0* INR(PT)-1.2* [**2160-5-25**] 12:59PM BLOOD PT-14.2* INR(PT)-1.2* [**2160-5-24**] 01:36AM BLOOD PT-14.6* PTT-27.1 INR(PT)-1.3* [**2160-5-23**] 04:00PM BLOOD PT-15.6* PTT-35.2* INR(PT)-1.4* [**2160-5-23**] 02:05PM BLOOD PT-15.9* PTT-32.7 INR(PT)-1.4* [**2160-5-23**] 07:05AM BLOOD PT-14.6* PTT-67.7* INR(PT)-1.3* [**2160-5-22**] 02:50AM BLOOD PT-13.5* PTT-50.5* INR(PT)-1.2* [**2160-5-21**] 07:30AM BLOOD PT-15.3* PTT-71.6* INR(PT)-1.3* [**2160-5-28**] 04:13AM BLOOD Glucose-109* UreaN-27* Creat-0.8 Na-133 K-4.2 Cl-95* HCO3-34* AnGap-8 [**2160-5-27**] 04:43AM BLOOD Glucose-124* UreaN-29* Creat-0.8 Na-131* K-4.4 Cl-94* HCO3-31 AnGap-10 CT L Lower ext [**2160-5-18**]: FINDINGS: There is a comminuted slightly depressed fracture of the left tibial plateau which involves the articular surface. The largest fracture fragment involves the medial tibial plateau with 4 mm lateral displacement of the distal tibia. A large anterior fracture fragment arising from the lateral tibial plateau also demonstrates slight displacement. Finally, there is a comminuted fracture of the lateral aspect of the proximal fibula. There is no evidence of femoral or patellar fracture. Bones are demineralized. There is a large lipohemarthrosis in the suprapatellar region and a small [**Hospital Ward Name 4675**] cyst. There is soft tissue edema. There is atrophy of the muscles, particularly the semimembranosis. The remainder of the soft tissues are normal. IMPRESSION: Comminuted tibial and fibular fractures as above. TTE [**2160-5-19**]: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>65%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The [**Month/Day/Year 8813**] valve leaflets (?#) are moderately thickened. There is severe [**Month/Day/Year 8813**] valve stenosis. Mild to moderate ([**2-17**]+) [**Month/Day (2) 8813**] regurgitation is seen. The mitral valve leaflets are mildly thickened. There is a minimally increased gradient consistent with trivial mitral stenosis. Moderate to severe (3+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is moderate to severe pulmonary artery systolic hypertension. There is an anterior space which most likely represents a prominent fat pad. IMPRESSION: Suboptimal image quality. Mild symmetric left ventricular hypertrophy with normal cavity size and normal regional excellent global systolic function. Severe [**Month/Day (2) 8813**] valve stenosis. At least moderate to severe mitral regurgitation. Pulmonary artery systolic hypertension. Dilated ascending aorta. Cardiac cath [**2160-5-20**]: 1. Selective coronary angiography of this left-dominant system demonstrated 1 vessel coronary artery disease. The LMCA had no angiographically apparent flow-limiting disease. The LAD had 80% mid-vessel stenosis and there was 70% stenosis at the origin of a large diagonal. The LCx had no significant disease. The RCA had 50% mid-vessel stenosis in a non-dominant vessel. 2. Limited resting hemodynamics revealed normal systemic arterial pressures. Intra-op TEE [**2160-5-23**] PRE-BYPASS: The left atrium is dilated. 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 is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the descending thoracic aorta. The [**Month/Day/Year 8813**] valve leaflets are severely thickened/deformed. There is critical [**Month/Day/Year 8813**] valve stenosis (valve area <0.8cm2). Moderate (2+) [**Month/Day/Year 8813**] regurgitation is seen. The mitral valve leaflets are moderately thickened. There is no mitral valve prolapse. There is moderate valvular mitral stenosis (area 1.0-1.5cm2). Moderate (2+) mitral regurgitation is seen. There is no pericardial effusion. There is severe mitral annular calcification. Calcium chunks were also seen on the atrial aspect of the P2 scallop of anterior mitral leaflelt probably leading to increased transmitral gradient and mod mitral stenosis. Dr. [**Last Name (STitle) **] was notified in person of the results on this patient before surgical incision. POST-BYPASS: Normal biventircular systolic function. LVEF 55%. Post bypass MVA still shows 1.2 cm2. Mild to Moderate MR. [**First Name (Titles) **] [**Last Name (Titles) 8813**] valve bioprosthesis is stable, functioning well, no leaks, transaortic mean gradient of 11 mm of Hg. Intact thoracic aorta. Minimal TR. Brief Hospital Course: Ms.[**Known lastname 1683**] was brought to the operating room on [**2160-5-23**] where the patient underwent [**Date Range **] valve replacement with a 23-mm Biocor Epic tissue valve/ Coronary artery bypass grafting x2(Left internal mammary artery graft to left anterior descending; reverse saphenous vein graft to diagonal branch) with Dr. [**Last Name (STitle) **]. Please refer to operative report for further surgical details. Overall the patient tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. POD 1 found the patient extubated, alert and oriented and breathing comfortably. She was neurologically intact and hemo- dynamically stable, weaned from inotropic and vasopressor support. Beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. Postoperatively, Orthopeadics followed up on her left tibial plateau fracture immobilization brace. Coumadin was resumed for atrial fibrillation. Subcutaneous heparin was administered for DVT prophylaxis. The patient was transferred to the telemetry floor for further recovery. Chest tubes and pacing wires were discontinued without complication. The patient was evaluated by the physical therapy service for assistance with strength and mobility. She remained non-weight bearing on the left lower extremity per ortho recommendations. By the time of discharge on POD#6 Ms.[**Known lastname 1683**] was cleared by Dr.[**Last Name (STitle) **] for discharge to [**Hospital1 756**] Manor Nursing and Rehabilitation for further increase in strength and mobility. All follow up appointments were advised. Medications on Admission: vitamin D 50,000 units once a week zestoretic daily levothyroxine 100 mcg daily lipitor 20 mg daily coumadin 5 mg daily sotalol AF 80 mg [**Hospital1 **] fish oil 1 gm [**Hospital1 **] Discharge Medications: 1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. insulin regular human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain/fever/HA. 4. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 5. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. omega-3 fatty acids Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 9. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 10. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 11. sotalol 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 13. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 14. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily) as needed for constipation . 15. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: One (1) Tablet, ER Particles/Crystals PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital1 756**] Manor Nursing & Rehab Center - [**Location (un) 5028**] Discharge Diagnosis: [**Location (un) **] Stenosis Coronary Artery Disease PMH: A-fib Hypertension Hyperlipidemia [**Location (un) **] Valve stenosis Mitral Valve problem Hypothyroidism Past Surgical History: s/p Left ankle fracture 10 years ago repaired with "10 screws and a bar" s/p Surgery for PUD causing gastric outlet obstruction s/p Tonsillectomy as child Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Trace LE edema Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge Left lower extremity: Non weight bearing Left lower extremity brace: [**Doctor Last Name 6587**] lockis 20 degree extension Followup Instructions: You are scheduled for the following appointments: Surgeon Dr. [**Last Name (STitle) **]: Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2160-6-19**] at 1:30 Cardiologist Dr. [**Last Name (STitle) 77919**], [**Last Name (un) 83355**] on [**7-11**] at 12:15pm Please call to schedule the following: Dr [**Last Name (STitle) 1005**] in 1 week [**Telephone/Fax (1) 9769**] Primary Care Dr. [**Last Name (STitle) **],[**Last Name (un) 75760**] A. [**Telephone/Fax (1) 75761**] in [**5-20**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Labs: PT/INR Coumadin for a-fib Goal INR 2-2.5 First draw day after discharge on [**2160-5-30**] Then please do daily INR checks with Coumadin dosing [**Name8 (MD) **] MD. Completed by:[**2160-5-29**] ICD9 Codes: 4241, 4019, 2724, 2449, 2859, 4280
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Medical Text: Admission Date: [**2197-4-10**] Discharge Date: [**2197-4-22**] Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 618**] Chief Complaint: ICU to [**Hospital **] transfer from [**Hospital6 204**] for bilateral thalamic and cerebellar infarcts. Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname 77747**] is an 83 year old Armenian speaking male with h/o hypertension, hyperlipidemia, type 2 DM who presents as an outside hospital transfer with acute bilateral thalamic and cerebellar infarcts. The pt was well until last Friday around noon he was at the grocery store and had the sudden onset of bitemporal headache. He appeared pale and sluggish to his son. [**Name (NI) **] was able to slowly walk to the car, but his speech appeared unusually slow. His son check his blood sugar upon returning home and it was 131. EMS was called and pt did not want to go to the hospital, he was taken to [**Hospital3 **] for evaluation. There his speech remained slow, but he seemed to improved, "he was 90% better" according to his family. Head CT reportedly without any acute changes. On Saturday the pt was still about 90% of himself. Able to write his name, sing a song, able to perform addition. Sunday afternoon the patient was scheduled for an MRI, as he was being lifted to the gurney he suddenly became pale, closed his eyes and became flaccid "passing out" per his son who was at the bedside. The pt has not improved since this time. The Sunday MRI was cancelled. Hospital records ? whether the patient may have transiently developed an AV block during this event. About 1-2 hours following this event on Sunday the patient had assymmetric shaking motions of his extremities. He was loaded on Dilantin and given Ativan. The movements persisted for about 2 hours despite the administration of AED's, but then later resolved. MRI was performed today [**4-10**] around 4pm at LGH, revealing bilateral thalamic infarcts, and bilateral cerebellar infarcts. The pt was transferred to [**Hospital1 18**] for further care. Prior to last friday family reports pt feeling well at home, independent of ADL's, still actively writing Armenian novels. Past Medical History: HTN Hyperlipidemia DM 2 Social History: Prior to last friday family reports pt feeling well at home, independent of ADL's, still actively writing Armenian novels. ROS- reported chronic right leg pain with ambulation. Family History: - Physical Exam: Vitals: T 98, HR 106, BP 136/66, R 21, Sat 100% 2L NC Gen- ill appearing, eyes closed, NAD HEENT- NCAT, Neck- no carotid or vertebral bruits, no nuchal rigidity CV- RRR, no MRG Pulm- transmitted upper airway sounds, expiratory rhonci at RML. Abd- soft, NT, ND, BS+ Extrem- no CCE, 2+ DP pulses Neurologic Exam- MS- no response to voice, eyes closed, does not follow commands, localizes noxious stimulation with left hand. CN- right pupil with corneal opacity 3mm fixed and unreactive to light, left pupil 3mm fixed and unreactive to light, + scatter of light with attempt of funduscopic exam, could not visualize L fundus, intact corneal reflexes bilaterally. Absent oculacephalic reflex, grimaces to nasal tickle, intact (weak) gag. Motor/Sensory- + grasp reflex bilaterally. winces to nailbed pressure in both arms, withdraws Left arm. No right arm withdrawal. Feet with triple flexion bilaterally. Reflexes- absent patellar and ankle jerks. 1+ biceps, triceps, brachioradialis bilatarally. Plantar response was triple flexion bilaterally. Pertinent Results: [**4-15**] CT/CT head and neck CT HEAD WITHOUT IV CONTRAST: There is no evidence of acute hemorrhage, mass, or shift of normally midline structures. Prominence of the ventricles and sulci is consistent with age-related involutional change. Regions of hypodensity in the periventricular white matter are consistent with small vessel ischemic disease. In addition, there are regions of hypodensity in the left greater than the right thalamus, left periventricular white matter, bilateral occipital lobes, and bilateral cerebellar hemispheres. These are consistent with age-indeterminate regions of ischemia/infarction. The paranasal sinuses and the mastoid air cells are clear except to note a small mucus retention cyst in the left side of the frontal sinus. The patient is status post replacement of the left ocular lens. A right NG tube is in place. Vascular calcifications are noted in the intracranial vertebral arteries and the cavernous carotid arteries. CTA HEAD AND NECK: There are calcified plaques along the aorta at the origin of the vertebral arteries and within the carotid system, particularly along the proximal ICA which is more notable on the left. There is a 7-mm segment of the left proximal ICA, which demonstrates 60-70% stenosis. There is a 55-60% stenosis of the right proximal internal carotid artery. The vertebral arteries are irregular, with short segments of narrowing, without occlusion of flow. Atherosclerotic calcifications are noted at the origins of the vertebral arteries, causing moderate stenosis, without flow limitation. The basilar artery is patent. No masses are seen in the lung apices. There is no evidence of supraclavicular adenopathy. Degenerative changes are noted at multiple levels in the cervical spine, with left foraminal narrowing at C3-4 level. However, these are not adequately assessed on the present study. IMPRESSION: 1. Hypodense lesions in bilateral thalami, in the left periventricular white matter, bilateral occipital lobes and bilateral cerebellar hemispheres, consistent with ischemia/infarction of indeterminate age. Correlation with MR performed at outside hospital is recommended for better assessment. 2. Atherosclerotic plaques, soft and calcified, in the proximal internal carotid arteries on both sides, more prominent on the left, with moderate stenosis of the proximal internal carotid arteries. No flow limitation. 3. Atherosclerotic calcifications, involving the vertebral arteries, with short segments of narrowing as well as at the origin. No flow limitation [**4-19**] HCHCT There is no evidence of an acute intracranial hemorrhage. There are well- defined hypodensities involving the cerebral hemispheres including the thalami, occipital lobes, and cerebellar hemispheres consistent with multifocal infarcts. The ventricular system is stable in size and configuration. There is no evidence to suggest hydrocephalus. The visualized mastoid air cells and sinuses are unremarkable. IMPRESSION: Overall stable appearance to the multifocal infarction without evidence of intracranial hemorrhage. Brief Hospital Course: Patient was admitted to the neurology service. MRI images were reviewed with the family - we indicated that he had a bad prognosis given (1) severe bilateral critical stenosis diffusely in the posterior circulation on multilple levels, most evidently in the bilateral vertebrals and (2) by that mechanism he had stroked bilateral occiput, cerebellum, thalamus - he was at high risk for recurrence or further strokes, including the brainstem. (3) Also, if he were to not have further strokes, bilateral thalamic infarcts can give a severe clinical picture resembling advanced dementia or an abulic state, with hypersomnolence as well. The patient had one brief moment of clinical improvement, with eyes opening to loud voice, acknowledging presence of his family, answering Y/N questions appropriately. After that, he became signficantly infected - and [**1-28**] continued negative cultures he was eventually treated empirically. The treatment was aimed on optimizing him physically to formerly assess his neurological status - but after more than a week of empyric therapy he continued to spike fever with increasing white count. Neurologically he had deteriorated more than what would be attributable to infection, he developed a new left hemiparesis and lost all horizontal eye-movements other than R eye abduction with head movements. A CT did not demonstrate a bleed, but clinically he had stroked out his pons now. Multiple conversations were held with the family, who were very understanding, and on the [**6-22**] care was withdrawn. He died shortly thereafter. Medications on Admission: metformin, glyburide, lasix, diltiazem, hydroxyzine, doxazocin, pentoxyfyline. Not taking any antiplatelet agents. Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: None (deceased) Discharge Condition: Deceased Discharge Instructions: None (deceased) Followup Instructions: None (deceased) [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**] Completed by:[**2197-4-25**] ICD9 Codes: 2760, 4019, 2724
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Medical Text: Admission Date: [**2134-12-6**] Discharge Date: [**2134-12-13**] Date of Birth: [**2134-12-6**] Sex: F Service: Neonatology HISTORY: Baby Girl [**Known lastname 52477**] is a 3170 gram female infant born at estimated gestational age of 35-3/7 weeks to a 34-year-old G3 P1-2-2 mother. PRENATAL LABS: Blood type B positive, antibody negative, hepatitis B surface antigen negative, RPR nonreactive, rubella immune, group B Strep unknown. The pregnancy was complicated by maternal diabetes. The mother presented in spontaneous labor. There was no prolonged rupture of membranes or maternal fever. Amniotic fluid was clear. Cesarean section was performed due to breech position. Apgars were 9 and 9. Infant developed respiratory distress at approximately two hours of life, with intermittent grunting and flaring noted. Respiratory distress persisted, and the baby was admitted to the NICU. PHYSICAL EXAM ON ADMISSION: Weight 3170 grams. General: Pink, alert and active, grunting, flaring, and retracting. HEENT: Anterior fontanel is soft. Palate intact. Cardiovascular: Normal S1, S2, regular rate and rhythm, no murmurs, normal pulses. Chest: Subcostal retractions, lungs clear with good air entry. Abdomen is soft, nontender, and nondistended, no hepatosplenomegaly. GU: Normal female external genitalia. Extremities are warm and well perfused with no deformities. Neurologic: Normal tone and reflexes. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: A. Respiratory: Initial chest x-ray was suggestive of transient tachypnea of a newborn. The infant was placed on a CPAP of 6 with 35% FIO2. By day of life three, she had no further respiratory distress, and has remained on room air since that time. She has had no apnea noted. B. Cardiovascular: Infant has been hemodynamically stable. She did not have a murmur. C. Fluids, electrolytes, and nutrition: The infant was initially NPO due to her respiratory distress, but was started on feeds on day of life three. She has been receiving either breast milk or Enfamil 20, and currently on full volume feedings of 140 cc/kg/day. She does require gavage feeds. Her oral intake has been improving. D. GI: The infant had a bilirubin checked at 24 hours of age, which was 6.2. Peak bilirubin on day of life five was 9.8. The infant is without clinical jaundice. E. Hematology: Initial CBC was notable for a white count of 10.8 with 82% polys, 0% bands, and 10% lymphocytes. Hematocrit was 58.6. Platelets were 297. F. Infectious disease: The infant was initially started on ampicillin and gentamicin, which was discontinued after 48 hours. She has had no further signs of bacterial infections. G. Neurology: There has been no active neurologic issues. H. Sensory: The infant passed her state mandate hearing screen on [**12-13**]. CONDITION ON DISCHARGE: Fair. DISCHARGE DISPOSITION: Discharged to [**Hospital3 **]. NAME OF PRIMARY PEDIATRICIAN: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11060**] in [**Hospital1 8**], [**State 350**]. CARE AND RECOMMENDATIONS: 1. Feeds at discharge: Breast milk or Enfamil 20 140 cc/kg/day p.o./p.g. 2. Medications: None. 3. Car seat position screening should be performed prior to discharge. 4. The state newborn screen was sent and is pending. 5. Immunizations received: Hepatitis B vaccine was received on [**2134-12-9**]. 6. Immunizations recommended: Synagis RSV prophylaxis should be considered from [**Month (only) 359**] through [**Month (only) 547**] for infants who meet any of the following three criteria: 1) Born at less than 32 weeks, 2) born between 32 and 35 weeks with two of three of the following: daycare during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities, or with school-age siblings, or 3) with chronic lung disease. Influenza immunization should be considered annually in the fall for preterm infants with chronic lung disease once they reach six months of age. Before this age, the family and other caregivers should be considered for immunization against influenza to protect the infant. DISCHARGE DIAGNOSES: 1. Prematurity at 35 weeks. 2. Respiratory distress. 3. Rule out sepsis. 4. Immature feeding. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 36142**], M.D. [**MD Number(1) 36143**] Dictated By:[**Last Name (NamePattern1) 50798**] MEDQUIST36 D: [**2134-12-13**] 11:08 T: [**2134-12-13**] 11:07 JOB#: [**Job Number 52478**] ICD9 Codes: 7742, V053, V290
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Medical Text: Admission Date: [**2146-10-5**] Discharge Date: Date of Birth: [**2146-9-14**] Sex: F Service: Neonatology INTERIM DISCHARGE SUMMARY: This summary covers the interim dates from [**2146-10-4**] to [**2146-10-31**]. Please see prior History of Present Illness for patient's course over the prior two months. SUMMARY OF HOSPITAL COURSE BY SYSTEM: Respiratory: Baby Girl [**Known lastname 58332**] was on nasal cannula at the beginning of this interim period for two days but was transitioned quickly to room air. She has been on room air throughout this month with mild apnea and bradycardia. She had apneic spells and was on caffeine until mid month when her caffeine was discontinued on the [**10-20**]. She has had no serious apneic spells since then but continues to have mild bradycardias usually associated with feeds. Her last bradycardia was overnight, the 27th, and was associated with feeding. Cardiovascular: Baby Girl [**Known lastname 58332**] has been cardiovascularly stable throughout this time period with normal blood pressures and perfusion. She had an echocardiogram that was performed when she was at [**Hospital3 1810**] in [**Location (un) 86**] from the [****] that was negative for any valvular vegetation. Fluids, Electrolytes and Nutrition: Baby Girl [**Known lastname 58332**] tolerated her feeding even throughout the beginning part of this month when her blood cultures were positive with staph aureus. Upon her return to [**Hospital1 188**] from [**Hospital3 1810**] on the [**10-5**] she quickly attained full volume enteral feedings by nasogastric tube. She was advanced to a maximum calorie density of 28 kilocals per ounce with ProMod. She had good weight gain and therefore on the 21st on this month was cut back to 26 calorie formula. She currently is on special care 26 calorie formula without ProMod at a total volume of 150 cc per kilo per day. Her discharge weight is 2160 grams. She is currently beginning to take feedings by [**Known lastname **] and is doing so very taking approximately half of her bottle volume when offered the bottle which is about twice per day. Her most recent set of electrolytes were on the [**10-14**], a sodium of 140, potassium of 5.8, chloride of 111, CO2 of 20, BUN of 7, creatinine .2. She also had nutrition laboratories sent on the [**10-27**] with an alkaline phosphatase of 235, a calcium of 9.2 and a phosphorus of 6.7. Gastrointestinal: She has tolerated feedings well with no history of significant aspirate or emesis. Hematology: Baby Girl [**Known lastname 58332**] most hematocrit is 25.4 from the [**10-26**]. Her last transfusion was on the [**10-6**] for a hematocrit of 27. She was transfused at this point secondary to having had multiple blood draws for blood cultures and drug levels given her prolonged antibiotic therapy course. Infectious Disease: Baby Girl [**Known lastname 58332**] was transferred over to [**Hospital3 1810**], [**Location (un) 86**] on the [**11-3**] for further work up of what turned out to be osteomyelitis associated with multiple positive blood cultures with staph aureus. Her last positive blood culture was from [**Hospital3 18242**], [**Location (un) 86**] on the [****]. She has had blood cultures negative from the [**10-6**], the [**10-7**], the 4th as well as the [**10-9**] upon her return here to the [**Hospital1 69**]. All of the positive blood cultures did show sensitivity to oxacillin as well as Gentamicin which she was on for the first week of her therapy for synergy. She has been Oxacillin throughout and currently on the day of transfer is on day 27 of 42 of Oxacillin therapy for right tibial osteomyelitis. She has a Broviac placed in her left chest which is in the superior vena cava-right atrial junction. This Broviac was placed on the [**10-12**]. The remainder of her work up surrounding her positive blood cultures at [**Hospital3 1810**] consisted of a normal renal ultrasound on the [****], [**First Name3 (LF) **] MRI of the rest of her extremities also on the [****] which showed an osteomyelitis of the right proximal tibia involving the growth plate with surrounding soft tissue swelling and myositis. Her hips on that MRI examination were normal as was her left leg. She had a head CT performed the [**10-5**] which showed an increased density in her left germinal matrix but no lesions and no abscesses. Baby Girl [**Known lastname 58332**] has had two 48 hour rule out events secondary to temperatures of 100.3 to 100.5. During this time a blood culture was sent both from her Broviac as well as peripherally and Vancomycin and Gentamicin were started in addition to the Oxacillin. The first of these episodes was on [**10-19**] and the second of these episodes started on [**10-26**]. She also had a C-reactive protein sent during these times which was less than 0.5. We used this value in conjunction with a negative blood culture to discontinue her Vancomycin and Gentamicin each time after 48 hours of blood negative cultures. Her C-reactive protein had been elevated above 1 during the initial phase of her positive blood cultures and osteomyelitis. Orthopedics: Her right proximal tibial osteomyelitis has improved, yet there is still a discrepancy in circumference around her proximal tibia of her right leg compared to the left. Currently it measures 9 1/2 cm, about 1 cm larger than her left. There is evidence of bony overgrowth in this area but there has not been swelling or erythema since the first week of this month. As stated above, she continues on Oxacillin and will continue a 42 day course for this. She has been followed by Dr. [**Last Name (STitle) 18647**], orthopedic fellow at [**Hospital3 1810**], [**Location (un) 86**] and will need close follow up when she is discharged from the nursery. Neurology: Baby Girl [**Known lastname 58332**] had a head ultrasound on the [**10-17**] that confirmed a left germinal matrix hemorrhage but no other abnormalities. Sensory: - Audiology: She has not had hearing screen performed. Ophthalmology: She had an eye examination on the [**10-18**] that showed her retinas to be immature. On the day of transfer, the [**10-31**], she had a repeat examination that showed her eyes to be immature zone 3. She will need follow up ophthalmology examination in three weeks per recommendation. CONDITION ON DISCHARGE: Good. DISCHARGE DISPOSITION: Level 3 Nursery [**Hospital 10908**]. MEDICATIONS: Include vitamin E and iron as well as Oxacillin. DISCHARGE DIAGNOSES: Prematurity. Presumed sepsis. Osteomyelitis. Hyperbilirubinemia. IMMUNIZATIONS: She received her hepatitis B immunization on the [**10-24**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Dictated By:[**Last Name (NamePattern1) 56887**] MEDQUIST36 D: [**2146-10-31**] 17:02:40 T: [**2146-10-31**] 18:02:28 Job#: [**Job Number 58333**] ICD9 Codes: 7742
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Medical Text: Admission Date: [**2196-3-4**] Discharge Date: [**2196-3-13**] Date of Birth: [**2129-5-16**] Sex: F The patient is not being discharged; this Summary will cover up until the date of [**2196-3-13**]. REASON FOR ADMISSION: The patient was admitted for a history. HISTORY OF PRESENT ILLNESS: This is a 66 year old female with a past medical history for diabetes mellitus type 2, peripheral vascular disease status post left below the knee amputation and right above the knee amputation in [**2173**], chronic renal insufficiency, coronary artery disease, status status post stent, and gout. The patient presented to [**Hospital6 **] with chest pain and shortness of breath. States that commonly has angina but yesterday had chest pain radiating to her neck and worsening anginal symptoms with low exertion. The patient's EKG showed ST changes with ST depression in I and AVL, a CK at the outside hospital of 1000, MB of 89 with troponin of 24.8. The patient was transferred for cardiac catheterization which showed a RA pressure of 9, PA pressure of 34/18, with a mean of 25 and a wedge pressure of 15. The patient had left main coronary artery mild disease, left anterior descending diffuse disease, totally occluded left circumflex, non-dominant with diffuse disease, right coronary artery dominant with mid-segment total occlusion. Catheterization was technically difficulty. No interventions were done. Cardiothoracic surgery was consulted. The catheterization was greatly unchanged from a cardiac catheterization in [**2190**] which showed left main disease with focal area of 80% in left anterior descending, left circumflex 80% occluded, right coronary artery with diffuse disease. Evidently, in [**2190**], the patient was evaluated for coronary artery bypass graft but it was not done because of being a poor surgical candidate with co-morbidities. REVIEW OF SYSTEMS: No history of cerebrovascular accident, no amaurosis fugax, no claudication in the arms. History of syncope several years ago but could not recall events surrounding this. The patient is having worsening of general symptoms. The patient used to be able to transfer from bed to wheelchair and would get chest pain after approximately ten feet. Now patient was getting chest pain strictly on transfer from bed to wheelchair. MEDICATIONS ON ADMISSION: 1. Lopressor 100 twice a day. 2. Imdur 60 mg q. day. 3. Insulin 70/30, 56 units twice a day. 4. Lasix 40 mg q. day. 5. Aspirin 81 mg q. day. 6. Allopurinol 100 mg q. day. 7. Pravachol 40 mg q. day. ALLERGIES: The patient has allergy to ACE inhibitor; she is intolerant with an increased creatinine. MEDICATIONS ON TRANSFER FROM CATHETERIZATION: 1. Integrilin drip. SOCIAL HISTORY: The patient lives in [**Location (un) 5503**] with her husband. She is independent. She had a 15 pack year history of smoking which she quit. No alcohol use. She was a former nurse. PHYSICAL EXAMINATION: The patient was afebrile on admission. Heart rate 95 to 100; right arm blood pressure 80, left arm blood pressure 120; 99% on two liters nasal cannula. Generally, comfortable, obese, lying in bed, slightly Cushingoid in appearance. HEENT: Showed sclerae are anicteric. Oropharynx clear. No jugular venous distention, no bruits. Pupils are equal, round, and reactive to light and accommodation. Mucous membranes were moist. Lungs clear to auscultation laterally and occasional expiratory rhonchi anteriorly. Heart: Regular rate and rhythm, positive S1, S2, with II/VI holosystolic murmur at apex. Point of maximal impulse difficult to palpate. Abdomen with positive bowel sounds, nontender, no ecchymosis. Groin: Right groin without hematoma. Venous groin sheath in place. Extremities with left below the knee amputation, right above the knee amputation. Scar along medial portion of left below the knee amputation. LABORATORY: On admission, white blood cell count 9.0. Hematocrit 26.7, platelets 166, INR 1.7, PT 15.7, PTT 37.2. Sodium 142, potassium 3.8, chloride 108, bicarbonate 22, BUN 42, creatinine 2.0, glucose 148, magnesium 1.5, calcium 7.8. CK 2187, MB fraction was 223, MB index 10.2. EKG on [**3-4**], showed sinus tachycardia, PR interval of 154 with QRS interval of 110 milliseconds, ST depressions in I and AVL, V5 through V6. RWP was normal. Q's in II and F. On [**3-4**], status post catheterization, sinus rhythm at 92 beats per minute, LAD, PR interval 166, QRS interval 106, ST depression in I, AVL and V5 through V6 with 1 millimeter Q's in III and F. No real change from previous pre-catheterization EKG. ASSESSMENT AND PLAN: 66 year old female with type 2 diabetes mellitus with vascular complications including coronary artery disease, chronic renal insufficiency and renal artery stenosis, status post catheterization with extensive coronary artery disease. 1. Coronary artery disease: Continue Integrilin, restart heparin without bolus. Cardiothoracic Surgery will be consulted. CT surgery is not an option. Interventional could consider stenting right coronary artery, consider functionality of this. Continue aspirin and beta blocker; oral nitrates, consider changing them to three times a day for titration. Pump: No signs of decompensation. Use Hydralazine with Nitroglycerin for symptomatic relief. No mortality benefit per V-Hef trial. Rhythm: Sinus; will monitor. 2. Type 2 diabetes mellitus: Continue NPH and sliding scale insulin. Check urine protein and creatinine. Continue blood sugar checks four times a day. 3. Chronic renal insufficiency: Hold on Lasix for now. Prerenal component. Watch creatinine closely post catheterization. 4. Hematology: Hematocrit decreased. Baseline creatinine 29.6, microcytic. Possible causes, chronic gastrointestinal loss or chronic renal insufficiency, guaiac stools. Will transfuse now. Check on her studies, reticulocyte count, goal hematocrit is greater than 30. 5. Pulmonary: Stable. 6. Fluids, Electrolytes and Nutrition: Continue with diabetic diet. Replete electrolytes as needed. 7. Code Status: To discuss with patient. Contact is her husband, [**Name (NI) **] [**Name (NI) **], [**Telephone/Fax (1) 42216**]. 8. Prophylaxis: The patient getting PPI and heparin. HOSPITAL COURSE: 1. Cardiovascular: The patient with congestive heart failure exacerbation status post myocardial infarction with no intervention. The patient was seen by Cardiothoracic Surgery and not deemed to be a surgical candidate. The decision was made that no catheterization intervention was needed as well and right coronary artery stent was not placed. The patient was continued on her current medications as well as the patient's Amiodarone was decreased from 400 twice a day to 400 q. day; Isordil was added. The patient put on Hydralazine titrated up to 40 four times a day. The patient had complication status post cardiac catheterization which turned out to be an extra-peritoneal bleed with a pseudo-aneurysm. The patient received blood transfusion for a hematocrit as low as 27.8. The patient then had thrombin injection/thrombin plug of pseudo-aneurysm, which was successful. The patient's Plavix, heparin were both held in light of the retroperitoneal bleed and have not been restarted. The patient's hematocrit has successfully stabilized status post thrombin injection of the pseudo-aneurysm. The patient is stable. While in Coronary Care Unit the patient also developed severe abdominal pain. CT scan of the abdomen and pelvis in [**3-8**], made no mention of gallbladder issues but did mention that gallbladder was distended with sludge but no edema or pericholecystic fluid around the gallbladder. Since that time, the patient did subsequently develop severe abdominal pain and was sent for an abdominal ultrasound which showed a grossly distended gallbladder with stones, edematous gallbladder wall and some pericholecystic free fluid with no biliary dilatation. The result was a percutaneous cholecystomy tube under ultrasound guidance; 400 cc. of bile fluid was removed and drained and the gallbladder was left in place to gravity bag. The bile fluid showed heavy growth of Gram negative rods. Subsequent cultures showed Klebsiella sensitive to Levofloxacin. The patient has been on Levofloxacin since the gallbladder drainage was placed. The patient has been afebrile with no real issues with her white blood cell count which is now slightly elevated. The patient did have blood cultures drawn for a temperature spike which, on [**2196-3-8**], was shown to have Staphylococcus coagulase negative in one bottle; subsequently no growth to date on other cultures. The patient was started on Vancomycin 750 mg q. 24 hours due to her renal clearance. This will be for a seven day course only. The patient was also put on Metronidazole (Flagyl), 500 mg three times a day, for further coverage. The patient's echocardiogram on [**3-6**], showed overall left ventricular systolic function severely depressed, global hypokinesis to akinesis in the inferior posterior wall, right ventricular systolic function was good, two plus mitral regurgitation. No definite pericardial effusion. Due to the patient's retroperitoneal bleed, the patient's Plavix and heparin has not been restarted. The patient does have a right subclavian line as well as a right PICC line for long-term antibiotic use. Since the patient has left the Coronary Care Unit she has been stable, but the right subclavian line is still in place on [**2196-3-13**], which will be pulled, and the PICC line will be left in place. The patient's INR is elevated at 1.9, therefore, Vitamin K 5 mg subcutaneously was given. INR will be rechecked before subclavian line is pulled. The patient will have gallbladder drainage left in place for approximately up to six weeks while the gallbladder has a chance to quiesce. Once the gallbladder inflammation has resolved, the drain will removed per Surgery. The patient now has restarted p.o./oral medications and eating. The patient is going well with regards to intake. The patient is now without abdominal pain, resting comfortably. Physical Therapy will see the patient to get the patient out of bed and back to functioning status of transferring to wheelchair. DISPOSITION: The patient will be discharged to a Rehabilitation Center for further intravenous antibiotics and rehabilitation status post non-Q wave myocardial infarction. DISCHARGE PLAN: The patient's plan will be to return to home, not yet with Hospice Care but with continued plan that she will be titrated up on her medicines for blood pressure and heart rate control as well as anginal control, and that she will at some point require Hospice Care for her failing condition that is not amenable to surgery. The patient's blood pressure medications will be titrated as tolerated. DISCHARGE INSTRUCTIONS: 1. The patient will follow-up with Surgery regarding drainage of gallbladder tube and removal of gallbladder tube. 2. The patient will need to be restarted on her anti-coagulation, heparin and Coumadin, once it is deemed safe status post her retroperitoneal bleed. 3. The patient will need her subclavian line pulled once INR is stable. 4. The patient will be continued on her Procrit and her creatinine has been trending down. 5. The patient will need continued Vancomycin until [**2196-3-16**]. 6. The patient will need Levaquin and Flagyl for a Klebsiella, Gram negative in her bile which is sensitive to Levaquin and will be continued to be deemed the course via Infectious Disease input. 7. The patient will be screened for rehabilitation and sent to rehabilitation as soon as she is clinically stable. CODE STATUS: The patient's code status is "DO NOT RESUSCITATE". MEDICATIONS AS OF [**2196-3-13**]: 1. Atrovent nebulizers for wheeze. 2. Hydralazine 40 mg p.o. four times a day. 3. Percocet one to two tablets p.o. q. six hours p.r.n. 4. Insulin sliding scale. 5. Lopressor 50 mg p.o. twice a day. 6. Amiodarone 400 mg p.o. q. day. 7. Robitussin AC 10 cc., four times a day p.r.n. 8. Aspirin 325 mg p.o. q. day. 9. Allopurinol 100 mg p.o. q. day. 10. Protonix 40 mg p.o., twice a day. 11. Procrit 3000 Units subcutaneously three times a week. 12. Iron 325 mg p.o. three times a day. 13. Colace 100 mg p.o. three times a day. 14. Isordil 30 mg p.o. three times a day. 15. Lipitor 40 mg p.o. q. day. 16. Levaquin 250 mg intravenously q. 24 hours. 17. Vancomycin 750 mg intravenously q. 24 hours to be discontinued on [**2196-3-16**]. 18. Metronidazole 500 mg intravenously three times a day. 19. NPH is at 40 Units in a.m. and 40 Units in p.m. The patient's blood sugars have been stable. CONDITION ON DISCHARGE: Stable and approved. DISCHARGE DIAGNOSES: 1. Coronary artery disease status post non-ST elevation myocardial infarction and status post cardiac catheterization with no intervention. 2. Diabetes mellitus type 2. 3. Hypertension. 4. Chronic renal insufficiency. [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D. Dictated By:[**Last Name (NamePattern1) 4724**] MEDQUIST36 D: [**2196-3-13**] 16:12 T: [**2196-3-13**] 18:07 JOB#: [**Job Number 42217**] ICD9 Codes: 4280, 5845