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{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6700 }
Medical Text: Admission Date: [**2160-1-6**] Discharge Date: [**2160-1-17**] Date of Birth: [**2107-7-20**] Sex: F Service: NEUROLOGY Allergies: Penicillins / Sulfa (Sulfonamide Antibiotics) / Mercaptopurine Analogues (Thiopurines) Attending:[**First Name3 (LF) 5378**] Chief Complaint: Baclofen Overdose. Major Surgical or Invasive Procedure: 1. Nasogastric tube 2. PICC line History of Present Illness: This is a 52 year-old female who is a pathologist at [**Hospital1 2025**] with a history of worsening MS [**First Name (Titles) **] [**Last Name (Titles) **] who presents to the ED with Baclofen overdose. The history was obtained from the patient's husband. The patient has relapsing progressive multiple sclerosis that has been worsening over the last two years and has been wheelchair bound. The husband states that she has had [**Last Name (Titles) **] for years, but seemed more depressed over the last week. He could not identify a particular trigger, but thought that the holidays had made things worse. The patient was at home alone when the husband got a call from his wife who was tearful and said she had taken "20 tabs" of baclofen, but the husband thought she had taken more. Per ED they had estimated ~80-170 pills equaling 3400mg) He called EMS and on arrival they cound her "sleepy" and tachycardic to the 120-140's. . In the ED she was 97.6 98 158/78 14 100% RA. She became more somnolent then unresponsive and was intubated for airway protection. She was started on a propofol gtt in the ED. Initial vent settings were Tv: 500, PEEP: 5, RR: 12 and FiO2: 50%. CXR showed right main-stem intubation and tube was withdrawn 3 cm. Her ABG was 7.32/45/132/24. She was given 25g of charcoal. Her labs were significant for a tox screen positive for opiates and amphetamines. She had a mildly positve UA and was give cipro. She was seen by Tox in the ED who recommended supportive care, tachyarrhythmias per ACLS and bradydysrhythmias with atropine. . On arrive to the ICU the patient was intubated and sedated. . ROS: unable to obtain Past Medical History: Relapsing progressive multiple sclerosis [**Last Name (Titles) **] Sleep apnea - mixed picture: CPAP dependent Sarcoidosis (in lung, diagnosed when moved to US for residency) Social History: She was practicing at [**Hospital1 2025**] as a liver pathologist until 5 months ago. Husband is a pulmonologist. She was born in [**Country 18084**], brought up in [**Country 4754**]. Family History: Her brother has MS, but currently less severe. Physical Exam: On Admission: GEN: intubated and sedated HEENT: pupils reactive to light, sclera anicteric, no epistaxis or rhinorrhea, MMM, OG in place NECK: No JVD, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB anteriorly, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses/ supra-pubic catheter EXT: No C/C/E, no palpable cords NEURO: CN II ?????? XII grossly intact. grimace to pain. Patellar DTR +1. Plantar reflex downgoing. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. . At discharge: General: awake, alert, and oriented Neuro exam: She has normal pupillary reactions and EOMs. No dysarthria. Strength in UEs reveals right>left and distal>proximal weakness mostly in an UMN pattern although right biceps also are quite weak. FEs are particularly weak at 2-3/5, and FFs slightly weak (5-/5). Elsewhere mostly [**4-8**]. Tone relatively normal in UEs but prominent spasticity bilaterally in LEs with only trace IP movement, [**4-8**] quads, 2-3/5 foot DFs. Toes easily upgoing. Pertinent Results: Labs on admission: [**2160-1-6**] 05:08PM WBC-9.8# RBC-4.77 HGB-13.5 HCT-41.1 MCV-86 MCH-28.4 MCHC-32.9 RDW-13.9 [**2160-1-6**] 05:08PM PLT COUNT-394 [**2160-1-6**] 05:08PM NEUTS-84.4* LYMPHS-8.9* MONOS-4.1 EOS-0.9 BASOS-1.8 [**2160-1-6**] 01:37PM GLUCOSE-140* UREA N-12 CREAT-0.4 SODIUM-135 POTASSIUM-3.6 CHLORIDE-100 TOTAL CO2-24 ANION GAP-15 [**2160-1-6**] 01:37PM PT-11.9 PTT-23.0 INR(PT)-1.0 [**2160-1-6**] 01:37PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2160-1-6**] 01:43PM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS cocaine-NEG amphetmn-POS mthdone-NEG [**2160-1-6**] 01:43PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.024 [**2160-1-6**] 01:43PM URINE BLOOD-MOD NITRITE-POS PROTEIN-75 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2160-1-6**] 01:43PM URINE RBC-[**3-8**]* WBC-[**6-13**]* BACTERIA-FEW YEAST-NONE EPI-0-2 [**2160-1-6**] 01:43PM URINE CA OXAL-RARE [**2160-1-6**] 09:36PM TYPE-ART RATES-14/ TIDAL VOL-500 O2-50 PO2-31* PCO2-42 PH-7.39 TOTAL CO2-26 BASE XS--1 INTUBATED-INTUBATED VENT-CONTROLLED [**2160-1-6**] 03:35PM TYPE-ART PO2-132* PCO2-45 PH-7.32* TOTAL CO2-24 BASE XS--3 . Micro: [**2160-1-8**] STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B: negative [**2160-1-8**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE: no growth [**2160-1-8**] URINE Legionella Urinary Antigen: negative [**2160-1-7**] BLOOD CULTURE Blood Culture: pending [**2160-1-6**] MRSA SCREEN MRSA SCREEN-negative [**2160-1-6**] BLOOD CULTURE Blood Culture: pending [**2160-1-6**] URINE CULTURE: pansensitive ESCHERICHIA COLI . Imaging: [**2160-1-11**] CXR: OGT in stomach. RUE PICC stable. Lungs remain clear without effusion or pneumothorax. [**2160-1-8**] EEG: IMPRESSION: This tracing gives evidence for a severe diffuse encephalopathy with periods of runs of what looks like relatively sustained epileptiform activity over both central regions and also occasional multifocal independent interictal epileptiform spike wave discharges seen on the spike detection algorithm only. It is also noted that the frequency of the sustained epileptiform activity seemed to decrease during the course of the study. [**2160-1-7**] CXR: The ET tube tip continues to be relatively low, 2 cm above the carina. There is progression of the left lower lobe opacities, still most likely represent atelectasis, but should be further followed to exclude the possibility of developing infection. Otherwise, no significant change has been demonstrated. [**2160-1-6**] CXR: The patient is intubated with the tip of the ET tube in the proximal aspect of the right main stem bronchus. If the tube is withdrawn approximately 3 cm, it would be appropriately positioned. There is left retrocardiac atelectasis. No pneumothorax or pleural effusion is present. There is an OG tube within the stomach. Cardiomediastinal silhouette and hilar contours are normal. IMPRESSION: Right mainstem bronchial intubation. Mild retrocardiac atelectasis. Brief Hospital Course: 52 year-old female pathologist with history of worsening MS [**First Name (Titles) **] [**Last Name (Titles) 34499**] admitted with Baclofen overdose. Hospital course complicated by seizures and delirium. . #Baclofen overdose: Husband reports that she took 70 Baclofen pills. Tox screen was negative for coexisting substances. She was intubated for airway protection given sedation in the ED. She was seen by toxicology in the ED who recommended supportive care. On the first hospital day, she had brady and tachyarrhythmias. In addition, she had two seizures that day- the first of which was self limited and the second which did not respond to IV Ativan. She was started on a midazolam drip for seizure prevention. She was subsequently loaded with Dilantin and then midazolam was weaned once Dilantin was therapeutic. She was also hooked up to cEEG. The seizures were beleived to be due to Baclofen withdrawal. Her Baclofen was restarted at half dose 36 hours after intoxication taking the half life of Baclofen into consideration. It was subsequently increased to home dose. Her EEG improved after she was restarted on her home dose of Baclofen. Her Dilantin was then stopped as she does not have an underlying seizure disorder but rather had seizures as she was withdrawing from thr Baclofen. . #Respiratory Distress: She was intubated for airway protection in the setting of sedating overdose with Baclofen. Initial CXR showed right main stem intubation with subsequent LLL atelectasis. The ETT was pulled back and confirmed with CXR. On the third day of hospitalization ([**1-8**]), she had a new leukocytosis, a fever to 100.7, and thick secretions with some concern for a RLL infiltrate. Vancomycin and Cefepime were started for HCAP treatment for a planned 8 day course. A PICC line was placed for these antibiotics. She was extubated without issue after 5 days of invasive ventilation. After transfer to the Neurology service from the ICU, she had no evidence of any infection and her CXR was clear, so it was decided that her antibiotics would be stopped (on [**1-13**]). During her stay on the floor, she has had no respiratory issues. . #Psych: Given her impulsive suicide attempt, she was followed by the psych department while she was an inpatient. They determined that discharge to [**Hospital1 **] reheab, where she would be followed by the psych department there, would be a safe discharge for her. Her Effexor ER was initially held, but was subsequently restaretd at a dose of 37.5 mg as per psych. Can Consider adding Adderall when at rehab as per psych. . #UTI: She had a mildly positive urinalysis and a urine culture revealing pansensitive E.coli. She was initially treated with ciprofloxacin on [**1-7**]. However, this was discontinued once Vancomycin/Cefepime was started on [**1-8**]. . #MS: She has secondary progressive MS. [**Name13 (STitle) **] her outpatient psychiatrist and neurologist, venlafaxine and mycophenalate were held during her acute illness. Mycophenalate was restarted on [**1-12**]. Venlafaxine was also subsequently restarted at a dose of 37.5 mg daily as per psych. . #FEN: She was fed with TPN during her intubation. She failed speech and swallow on the day of extubation. A nasogastric tube was placed for both tube feeds and medication administration. A repeat speech and swallow evaluation showed that she had no difficulty with swallowing and she was started on a regular diet. Medications on Admission: Tylenol #3 2 tabs [**Hospital1 **]:prn Adderall 10mg [**Hospital1 **] Baclofen 20mg QID Cellcept 1000mg [**Hospital1 **] Pramipexole 0.125mg 1-2 tabs prn Vesicare 10mg daily:prn venlafaxine 150mg SR daily Bisacodyl 10mg recally twice a week vitamin d3 1000U daily cyanocobalamin 1000mcg sl daily 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. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 3. pramipexole 0.125 mg Tablet Sig: 1-2 Tablets PO daily prn. 4. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily) as needed for constipation. 5. baclofen 10 mg Tablet Sig: Two (2) Tablet PO QID (4 times a day). 6. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 8. venlafaxine 37.5 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO DAILY (Daily). 9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for hold for loose stool. 10. acetaminophen-codeine 300-30 mg Tablet Sig: 1-2 Tablets PO q6h prn as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Baclofen Overdose Secondary Progressive MS 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: You were admitted to the hospital with a Baclofen overdose, which you say was an impulsive and not a planned act. Upon arrival to the [**Hospital1 18**] ED, you were intubated for airway protection. You were seen by toxicology, who reccommended supportive care. During your first day in the hospital, you had 2 seizures for which you were started on Dilantin and placed on cEEG. The seizures and the subsequent delusions you experienced were likely due to withdrawal from Baclofen. You have since been restarted on your home dose Baclofen. The Dilantin has also been stopped as you do not have an underlying seizure disorder. After you were extubated, you were transferred to the Neurology service. While on the neurology service, you passed a speech and swallow eval and was started on a regular diet. You were also seen by PT, who reccomended that you would benefit from rehab given that you were bedbound for 1 week. You were seen by psychiatry, who restarted you on your home Effexor and also helped formualte the plan for a safe discharge to [**Hospital1 **], where you will be followed by the psychiatry service there. With regards to your MS, you were continued on your home dose of Cellcept. Followup Instructions: Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1045**], [**Name12 (NameIs) 1046**] Phone:[**Telephone/Fax (1) 1690**] Date/Time:[**2160-1-22**] 1:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6855**], M.D. Phone:[**Telephone/Fax (1) 6856**] Date/Time:[**2160-1-22**] 2:00 Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 1690**] Date/Time:[**2160-1-29**] 1:30 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5379**] MD, [**MD Number(3) 5380**] Completed by:[**2160-1-17**] ICD9 Codes: 486, 5990, 5180
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6701 }
Medical Text: Admission Date: [**2194-9-24**] Discharge Date: [**2194-9-24**] Date of Birth: [**2143-1-30**] Sex: F Service: SURGERY Allergies: Penicillins / Darvon / Gabapentin / Mucinex / Robitussin / Lyrica / Lipitor / Oxycontin / Codeine Attending:[**First Name3 (LF) 5569**] Chief Complaint: Colonic ischemia Major Surgical or Invasive Procedure: Exploratory laparotomy [**2194-9-24**] History of Present Illness: 51F s/p CRT on [**2194-6-5**] with h/o persistent abdominal pain and associated nausea, diarrhea and ongoing c.diff w/ multiple recent admissions now presented to [**Hospital3 417**] Hospital from [**Hospital **] Rehab late evening [**2194-9-23**] w/ acute abdominal pain and h/o recent coffee-ground emesis w/ leukocytosis peak at 25.2 w/ 60% bands and lactate of 13.7 initially and then 9.3, also hypotensive on high-dose levophed on transfer to [**Hospital1 18**]. CT abd/pelv reviewed here demonstrated colonic distension/dilation w/ pneumatosis. Pt arrived intubated and sedated w/ abd TTP, still requiring vasopressor support. She was taken to OR emergently for ex-lap and possible total abdominal colectomy. Past Medical History: PMH: ESRD d/t chronic glomerulonephritis now s/p cadaveric renal transplant [**2194-6-5**], hypercholesterolemia, HTN, GERD, restless leg syndrome, persistent C. diff infection PSH: failed living related kidney transplant [**2187-1-30**], cadaveric renal transplant [**2194-6-5**], RUE AV fistula with multiple revisions for aneurysm s/p removal and wound revision, PD catheter placement Social History: Lived at home with husband and children prior to recent surgery and has been in/out of rehab since. Has smoked [**12-7**] PPD for the last 30 years but despite plans to quit after her transplant she has not. Denies past or current alcohol or illicit/recreational drug use. Family History: Mother had DM Type 2 Brother had brain aneurysm Physical Exam: PHYSICAL EXAM ON ADMISSION: Levoph 0.25, Fent 200, Versed 4 O: T: 100.1 HR: 119 BP: 103/49 RR: 33 O2Sats: 100% CMV 100%/450x18/5 Gen: Intubated, sedated. Neck: Supple. Lungs: coarse bilaterally. Cardiac: RRR. Abd: no BS, mildly firm, +diffuse TTP, mild distension. Extrem: no edema. Pertinent Results: [**2194-9-24**] 12:47PM BLOOD WBC-5.4# RBC-3.00* Hgb-9.7* Hct-29.0* MCV-97 MCH-32.4* MCHC-33.6 RDW-21.3* Plt Ct-179 [**2194-9-24**] 12:47PM BLOOD PT-19.7* PTT-37.0* INR(PT)-1.8* [**2194-9-24**] 12:47PM BLOOD Fibrino-415* [**2194-9-24**] 12:47PM BLOOD Glucose-69* UreaN-44* Creat-1.5* Na-138 K-3.3 Cl-104 HCO3-17* AnGap-20 [**2194-9-24**] 01:48PM BLOOD Glucose-70 Lactate-5.0* Na-138 K-3.3* Cl-110 [**2194-9-24**] 01:13PM BLOOD Lactate-5.3* [**2194-9-24**] 12:47PM BLOOD ALT-43* AST-133* LD(LDH)-471* AlkPhos-120* TotBili-0.9 [**2194-9-24**] 12:47PM BLOOD Albumin-2.5* Calcium-7.8* Phos-6.2*# Mg-2.5 [**2194-9-24**] 01:48PM BLOOD Type-ART pO2-283* pCO2-35 pH-7.29* calTCO2-18* Base XS--8 Intubat-INTUBATED Vent-CONTROLLED CT abd/pel (OSH, no official report - reviewed here w/ Dr. [**Last Name (STitle) **] - demonstrated diffusely distended colon w/ bowel wall thickening and ?pneumatosis but no obvious free fluid/air Brief Hospital Course: Patient arrived in SICU on cardiopulmonary support (levophed, vent, sedated). Outside chart reviewed including CT abd/pel w/ Dr. [**Last Name (STitle) **]. Patient w/ clinical and radiographic signs of colonic ischemia. Decision was made to take patient emergently to OR for exploratory laparotomy w/ likely total abdominal colectomy. [**Name (NI) 1094**] mother [**First Name8 (NamePattern2) **] [**Name (NI) 2716**]) who is one of her healthcare proxies (husband is primary but has hearing disorder) was contact[**Name (NI) **] via cell phone for operative consent which was obtained. Intraoperative findings were consistent with pan-necrosis of small and large bowel - a non-survivable injury and thus, patient's abdomen was closed and she was returned to the SICU where after discussions w/ the family and surgical staff, she was made CMO. She was removed from all medications except morphine for comfort. She eventually expired at 10:28pm. Her case was declined by the medical examiner but the family requested and consented for an autopsy. Medications on Admission: fentanyl patch 25mcg per hour, D5NS w/ bicarb, sterile water 250cc PO q6h, vancomycin 250mg PO q6hr, flagyl 500mg IV q6h, Jevity 1.5 cal TF, zofran PRN, tramadol 50mg q6h prn, ergocalciferol 50,000units PO weekly, methylphenidate 5mg PO BID, azathioprine 50mg PO daily, valcyte 450mg daily, protonix 40mg daily, citalopram 10mg daily, dapsone 100mg daily, levothyroxine 50mcg dialy, metoclopramide 10mg before meals and bedtime, tacrolimus 2mg q12h, clonazepam 0.5mg nightly, mirtazapine 15mg daily, acetaminophen 650mg q6h prn, albuterol sulfate 2 puffs INH q4h prn, simethicone 80mg q8h prn, ipratropium 2 puffs INH q6h prn Discharge Medications: Expired Discharge Disposition: Expired Discharge Diagnosis: Pan-necrosis of small and large bowel ESRD d/t chronic glomerulonephritis s/p cadaveric renal transplant [**2194-6-5**] hypercholesterolemia HTN GERD restless leg syndrome persistent C. diff infection Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired ICD9 Codes: 4019, 2720
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6702 }
Medical Text: Admission Date: [**2163-4-8**] Discharge Date: [**2163-5-6**] Date of Birth: [**2087-12-30**] Sex: M Service: CCU CHIEF COMPLAINT: Dyspnea. HISTORY OF PRESENT ILLNESS: The patient is a 75-year-old male with a history of coronary artery disease, status post multiple myocardial infarctions in the past, status post right nephroureterectomy on [**2163-3-7**] for a transitional cell carcinoma, who presented on the day of admission to [**Hospital3 **] with worsening lower extremity edema and exertional dyspnea since discharge. The patient awoke on the morning of admission with acute dyspnea and presented to [**Hospital3 **] where his electrocardiogram revealed new lateral ST depressions of 2 mm in V5 through V6 which was initially read as left ventricular hypertrophy with strain, and he had an initial creatine kinase of 40 with a negative troponin, but an oxygen saturation of 85% on room air. The patient was given Lasix 120 mg intravenously, nitroglycerin, morphine sulfate, given 100% nonrebreather, and his oxygen saturation improved to 100%. He was diuresed and sent to the [**Hospital1 346**]. On review of the patient's history, he admits to having frequent bologna sandwiches and can soups and was unaware of their sodium content. At [**Hospital1 69**], the patient had a blood pressure of 130/54, pulse of 72, respiratory rate of 26, and an oxygen saturation of 100% on 50% Venturi mask with electrocardiograms that revealed 1-mm ST depressions in V5 through V6. The patient was admitted to the C-MED Service, and several hours later suffered acute worsening dyspnea with 5/10 chest pain, and diaphoresis, and an electrocardiogram that showed ST depressions in II and F as well as V4 through V5, with a rate of 120, and a blood pressure of 150/90. The patient was given intravenous nitroglycerin, morphine, Lasix, and heparin. He was taken to the catheterization laboratory where he had a pulmonary artery pressure of 62/30 and wedge of 35. He was found to have a left main coronary artery with a 40% distal lesion, left anterior descending artery with a 50% proximal lesion, left circumflex with a 50% middle lesion, second obtuse marginal and third obtuse marginal were totally occluded, right coronary artery with a 70% proximal lesion. An echocardiogram revealed global hypokinesis, left ventricular ejection fraction of 20%, and mild-to-moderate mitral regurgitation. The patient was transferred to the Coronary Care Unit for observation, diuresis, and afterload reduction in the setting of 3-vessel disease and left ventricular dysfunction. PAST MEDICAL HISTORY: 1. Coronary artery disease; status post myocardial infarction in [**2149**], as well as a non-Q-wave myocardial infarction in [**2159**]. 2. First-degree anterior vesicular block. 3. Congestive heart failure with an ejection fraction that was markedly depressed by not quantified on a recent outside hospital echocardiogram. 4. History of prostate cancer. 5. History of colon cancer, status post right hemicolectomy. 6. Type 2 diabetes mellitus. 7. Chronic obstructive pulmonary disease without a history of intubation or hospitalizations. 8. Hypertension. 9. Peripheral vascular disease, status post left femoral-popliteal in [**2155**] with known carotid artery disease with a right internal carotid artery of 80%. 10. Transitional cell bladder cancer, status post right nephroureterectomy on [**2163-3-7**]. 11. Postoperative confusion. 12. Chronic renal insufficiency (with a bowel sounds creatinine of 2 to 2.5). 13. Anemia of chronic disease. ALLERGIES: IODINE which causes anaphylaxis. MEDICATIONS ON ADMISSION: Lopressor 50 mg p.o. b.i.d., NPH 15 units subcutaneous q.12h., clonidine 0.15 mg p.o. q.o.d. alternating with 0.3 mg p.o. q.o.d., allopurinol 100 mg p.o. q.d., Lipitor 20 mg p.o. q.d., enteric-coated aspirin 325 mg p.o. q.d., Lasix 120 mg p.o. q.d., multivitamin, trazodone 25 mg p.o. q.d., Protonix 40 mg p.o. q.d. SOCIAL HISTORY: The patient has a 100-pack-year smoking history. He quit smoking 14 years ago. The patient is married. His wife is his primary caretaker. His health care proxy is his daughter, [**Name (NI) 1494**]. [**Name2 (NI) **] has four daughters and one son. PHYSICAL EXAMINATION ON PRESENTATION: The patient's temperature was 97.4, pulse of 94, blood pressure of 140/69, respiratory rate of 21, 100% on 100% nonrebreather. On general examination, the patient was a pleasant elderly man in mild respiratory distress. Head, eyes, ears, nose, and throat examination revealed pupils were equally round and reactive to light and an oropharynx was that clear and moist. Neck examination revealed elevated jugular venous pressure to 10 cm of water. Chest examination revealed crackles up to one-third of the lung fields bilaterally. The patient had fair movement. Cardiovascular examination revealed distant heart sounds, a regular rate and rhythm. No third heart sound or fourth heart sound appreciated, and a soft 3/6 systolic blowing murmur heard at the left lower sternal border radiating to the apex. Abdominal examination revealed no hepatosplenomegaly, normal bowel sounds, with a nontender and nondistended abdomen. Extremity examination revealed 2+ edema. PERTINENT LABORATORY DATA ON PRESENTATION: The patient had a white blood cell count of 10.5, hematocrit of 25.3, platelets of 195. The patient's creatinine was 2.5. The patient's creatine kinase was 39 with a troponin of 0.6. RADIOLOGY/IMAGING: An echocardiogram status post catheterization revealed the patient had an ejection fraction of 15% to 20%, severe global left ventricular hypokinesis, and a normal right ventricle. There was 2+ mitral regurgitation. HOSPITAL COURSE: The patient is a 75-year-old male with a history of diabetes, coronary artery disease, congestive heart failure, and chronic renal insufficiency who presented with a congestive heart failure exacerbation. 1. CARDIOVASCULAR: From a coronary artery disease standpoint, the patient had 3-vessel disease with 40% left main lesion, 50% left anterior descending artery lesion, a 40% first diagonal lesion, a circumflex lesion with a 60% to 70% midvessel stenosis, a 70% proximal right coronary artery lesion, and a totally occluded first obtuse marginal. No intervention was performed on the patient's first catheterization. Within 48 hours of the patient being in the Coronary Care Unit, the patient developed an episode of bradycardia, hypotension, and hypoxic arrest requiring intubation and the use of pressors. In this setting, the question arose of possible ischemic mitral regurgitation in addition to viable myocardial compromise by rate-related ischemia. The patient was taken to cardiac catheterization four days later, at which point he received stents to his right coronary artery and first obtuse marginal. He was maintained on aspirin and Plavix. From a myocardium standpoint, the patient had a right heart catheterization on presentation which showed elevated left-sided filling pressures with a mean pulmonary capillary wedge pressure of 37 mmHg. The patient initially required Levophed and dopamine which was able to be weaned off within the first 24 hours after intubation. The patient was then started on afterload reduction with hydralazine and then nitrates. From a rhythm standpoint, the patient presented in normal sinus rhythm but then developed intermittent Wenckebach until nine days into the admission when the patient developed atrial flutter without rapid ventricular response. The patient was anticoagulated and chemically cardioverted with ibutilide. The patient was eventually stabilized on a heart failure regimen that included hydralazine and Isordil. 2. PULMONARY: From a pulmonary standpoint, the patient was initially intubated for hypoxic respiratory failure secondary to flash pulmonary edema in the setting of known poor systolic function. The patient also had renal insufficiency in the setting of recent right nephroureterectomy. The patient was intubated for progressive hypoxia. He was started on continuous venovenous hemofiltration, and then the patient's clinical status improved. He was extubated two days later. Twenty four hours later, the patient became progressively lethargic, developing ventilatory failure as well as hypoxemia, and the patient was once again reintubated. The patient was able to be extubated within approximately three days of intubation. The patient was once again extubated, and within 48 hours was reintubated for hypoxic respiratory failure. At that point, Pulmonary was consulted and felt that the patient's multiple reintubations had to do with poor cardiac status limiting increase cardiac output and stress response to mild episodes of respiratory compromise including mucous plugging and aspiration. Multiple meetings were held with the family regarding goals of care, and at all times they wished to pursue reintubation and resuscitation with the exception if the patient were to require long-term ventilatory care. They were amenable to tracheostomy and percutaneous endoscopic gastrostomy tube placement if needed. The patient was successfully extubated and did well status post third extubation. 3. INFECTIOUS DISEASE: The patient had presented with a low-grade temperature and possible right lower lobe infiltrate. He was empirically started on Levaquin and Flagyl. Subsequent cultures grew only pan-sensitive enterococcus in his urine. The patient completed a 10-day course of levofloxacin and ampicillin for a urinary tract infection. When the patient experienced his decompensation status post initial extubation, he was started on vancomycin and ceftazidime for a possible line-related sepsis and ventilatory-associated pneumonia. This was continued for approximately seven days. After the patient's second extubation, he was found to have progression of a right lower lobe consolidation and was restarted on ceftazidime, vancomycin, and ciprofloxacin. This was to cover ventilatory-related pneumonia. The patient had a right femoral internal jugular tip which had grown out methicillin-resistant Staphylococcus epidermitis for which he received a single dose of gentamicin. The patient was continued on coverage for ventilatory-associated pneumonia for 10 days; after which his antibiotics were discontinued. He had a normal white blood cell count at that time and was afebrile. 4. RENAL: The patient developed progressive oliguria in the setting of known chronic renal insufficiency within the first 48 hours of presentation. His acute renal failure was felt to be secondary to acute tubular necrosis from hypotension. The patient subsequently underwent two cardiac catheterizations which also were felt to have contributed to dye-associated nephropathy. The patient was initially started on continuous venovenous hemofiltration with excellent results and excellent control of his volume status. The patient was then started on hemodialysis. Over the course of the admission, the patient did not have significant improvement in urinary output averaging about 600 cc per day. Although possible renal recovery was not excluded, it appeared to the Renal Service that the patient would remain on prolonged hemodialysis. The patient had a Perm-A-Cath placed for durable hemodialysis access. 5. HEMATOLOGY: The patient presented with a low hematocrit which was initially thought secondary to chronic anemia. The patient had been anticoagulated for several of his catheterizations and after stent placement. He exhibited significant bleeding around lines and had multiple clot suctions in his endotracheal tube. Anticoagulants were held. The patient was evaluated for DIC, which laboratories were found to be normal. His hematocrit eventually stabilized. He was transfused with blood products to maintain a hematocrit of greater than 30. 6. GASTROINTESTINAL: The patient presented with borderline nutritional compromise. He was provided tube feeds through nasogastric tube. When the patient was extubated, he was evaluated for his swallowing and was found to aspirate significantly at the bedside. The patient was re-evaluated after his third extubation with video swallowing and was also found to have marked aspiration. After discussion with the family, a PEG-J placement was elected. The patient underwent this procedure without difficulty. He will receive tube feeds until it is felt that his swallowing capacity may be re-evaluated. 7. EAR/NOSE/THROAT: The patient complained of difficulty hearing after his second extubation. This was thought to be possibly secondary to drug effect; although the only ototoxin he received was gentamicin, and he had only received one dose of this. The patient had marked cerumen impaction on examination, and upon removal of the cerumen the patient's hearing improved slightly. After the patient's third extubation it appeared that his hearing had improved. He will likely need formal audiologic testing and possible hearing aide. 8. PSYCHOSOCIAL: The patient remained full code throughout the admission. Multiple discussions were held with the daughters and with the patient. He felt strongly that his daughters should make the decision for him regarding his health care. His daughters felt that he would want aggressive respiratory and ventilatory efforts as long as he was not to remain on machines indefinitely. CONDITION AT DISCHARGE: Condition on discharge was good. DISCHARGE FOLLOWUP: The patient was discharged with followup with primary care physician's (Dr. [**First Name8 (NamePattern2) 12041**] [**Last Name (NamePattern1) 5361**]) office within one week of discharge. DISCHARGE STATUS: The patient was to be discharged to acute rehabilitation for ongoing conditioning and management of pulmonary hygiene. NOTE: The remainder of this dictation will be dictated as an Addendum as the patient approaches discharge. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 8227**] Dictated By:[**Last Name (NamePattern1) 5246**] MEDQUIST36 D: [**2163-5-5**] 14:27 T: [**2163-5-5**] 15:12 JOB#: [**Job Number 22146**] ICD9 Codes: 4280, 4240, 486, 5990, 5845, 496
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Medical Text: Admission Date: [**2138-9-29**] Discharge Date: [**2138-10-4**] Date of Birth: [**2138-9-29**] Sex: M Service: NB [**Known lastname **] [**Known lastname 61773**] [**Known lastname 60891**] was born at 36-4/7 weeks gestation by spontaneous vaginal delivery after induction for pregnancy induced hypertension. This mother is a 36-year-old gravida 2, para 1, now 2 woman. Her prenatal screens are blood type O+, antibody negative, rubella immune, RPR nonreactive, hepatitis surface antigen negative and Group B strep unknown. Rupture of membranes occurred six hours prior to delivery. The mother did receive intrapartum antibiotics for GBS prophylaxis. The infant emerged with decreased respiratory effort requiring bag and mask ventilation, his Apgar's were 6 at one minute and 8 at five minutes. Of note is that the infant also had a true knot in his umbilical cord. The birth weight was 3395 grams, the birth length 19-1/2 cm. And the head circumference was 34.5 cm. PHYSICAL EXAMINATION: On admission revealed a full term non- dysmorphic infant anterior fontanel open and flat, bruised faced due to rapid second phase of labor. Positive bilateral red reflex, intact palate, mild subcostal retractions, positive grunting, breath sounds were equal. Heart was regular rate and rhythm. No murmur. Abdomen soft, nontender, nondistended. Extremities well perfused, stable hips, spine intact, bilateral descended testes and age appropriate tone and reflexes. NICU COURSE BY SYSTEMS: He continued to have respiratory distress after admission to the NICU requiring nasopharyngeal continuous positive airway pressure. He weaned from that to nasal cannula oxygen on day of life #2 and then to room air also later on day of life #2 where he has remained. He continues to breath comfortably. Lung sounds are clear and equal. He has had no apnea or bradycardia. Cardiovascular status: He has remained normotensive throughout his NICU stay. His heart has regular rate and rhythm and no murmur. Fluid, electrolyte and nutrition status: At the time of discharge his weight is 3,175 grams. Enteral feeds were begun on day of life #2 and advanced without difficulty to full volume feeding by day of life #4. At the time of discharge he is breast feeding or taking 20 calorie per ounce formula on an ad lib schedule. He has remained U-glycemic throughout his NICU stay. Gastrointestinal status: He was treated with phototherapy from day of life 3 until day of life 4. His peak bilirubin on day of life 3 was total 15.5, direct 0.4. A rebound Bili is pending. Hematology: The infant has never received any blood product transfusions during his NICU stay. His hematocrit at the time of admission was 50.3. The infant is blood type O+, direct Coombs' negative. Infectious Disease: Ampicillin and gentamicin was started at the time of admission for sepsis risk factors. The antibiotics were discontinued after 48 hours and the blood cultures were negative and the infant was clinically well. Sensory Audiology: Hearing screening was performed with automated auditory brain stem responses and the infant passed in both ears. Psychosocial: The parents have been very involved in the infants care throughout his NICU stay. Genitourinary: A circumcision is planned prior to discharge. The infant is discharged in good condition. He is discharged home with his parents. His primary pediatric care provider will be Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7363**] of [**Location (un) 1439**], MA. RECOMMENDATIONS AFTER DISCHARGE: Feeding: Formula, breast feeding with appropriate support as needed. The infant is discharged on no medications. A State newborn screen was sent on [**2138-10-2**]. The infant has not yet received his first hepatitis B vaccine. Recommended immunizations: 1. Synagis RSV prophylaxis to be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following three criteria: Born at less then 32 weeks. Born between 32 and 35 weeks with two of the following: Day care during the RSV season, a smoker in the household, neuromuscular disease, airway abnormalities or school age siblings or with chronic lung disease. 2. Influenza immunization is recommended annually in the Fall for all infants once they reach 6 months of age. Before this and for the first 24 months of the childs life immunization against influenza is recommended for household contacts and out of home caregivers. FOLLOW UP: Includes follow-up with his primary pediatric care provider and lactation support as needed. DISCHARGE DIAGNOSIS: 1. Prematurity at 36-4/7 weeks. 2. Status post transitional respiratory distress. 3. Sepsis ruled out. 4. Status post hyperbilirubinemia of prematurity. [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern1) **], [**MD Number(1) 54604**] Dictated By:[**Last Name (NamePattern1) 56577**] MEDQUIST36 D: [**2138-10-4**] 06:26:40 T: [**2138-10-4**] 08:31:29 Job#: [**Job Number 62998**] ICD9 Codes: 769, 7742, V053, V290
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Medical Text: Admission Date: [**2105-10-15**] Discharge Date: [**2105-10-26**] Date of Birth: [**2021-10-31**] Sex: F Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 4691**] Chief Complaint: s/p MVA Major Surgical or Invasive Procedure: [**2105-10-16**] Thoracic epidural placement for pain control [**2105-10-20**] Placement of PICC line History of Present Illness: This is an 84-year-old female involved in a collision. She was the restrained driver involved in an accident. Extensive damage to the car including bending of the steering wheel. The patient was complaining of pain in her chest as well as in her right lower extremity. Hit her head on steering wheel. Patient does recall loss of consciousness. In the ED, CT pan-scan was performed, showing injuries as below. A pigtail catheter was placed for the left pneumothrorax. Past Medical History: PMH: A-fib, renal artery stenosis, s/p L renal a stent placement [**2097**], HTN, dyslipidemia, COPD (per [**2097**] d/c summary, pt denies), bowel obstructions s/p ex-lap (details unclear) c/b mesh infections, frequent falls. PSH: AAA repair and ABI [**2093**], b/l TKA, L3/L4 laminectomy, remote appendectomy, remote ovarian cystectomy, R THR [**2101**], mult bowel obstructions s/p ex-lap (details unclear) c/b mesh infections Social History: denies ETOH, denies tobacco Family History: Non-contributory Physical Exam: HR: 90 BP: 150/100 Resp: 20 O(2)Sat: 100% on 2 L Normal Constitutional: General appearance: The patient arrives boarded and collared and is in no acute distress. The GCS is 15. Head: The scalp is nontender and shows a laceration at the left forehead near the hairline. HEENT: The extraocular muscles are intact and the pupils both constrict to light, [**2-11**]. The midface is stable. Neck: There is no C-spine tenderness or step off. Upper extremities: The upper extremities a extensive abrasion over the left arm near the elbow. Thorax: The chest wall is tender on the left side. Lungs: The lungs are clear and symmetrical. Heart: The heart sounds are crisp. Abdomen: soft, scaphoid, and mildly tender in the right abdomen. Spine: There is no thoracic or lumbar spine tenderness. Hips and pelvis: The pelvis is stable and the hips are nontender. Lower extremities: no long bone signs; there is a large deep 12 cm laceration of the left leg below the knee. Neurovascular function distally is normal. There is an abrasion on the right knee. She has dopplerable pulses in both legs. Neurological: The patient moves all 4 extremities equally. Pertinent Results: [**2105-10-15**] CT CHEST W/CONTRAST: 1. Displaced fractures of the left anterolateral 3rd through 6th ribs with small left pneumothorax. 2. Nondisplaced sternal fracture without significant hematoma or vascular injury. 3. Trace left-sided pleural effusion measuring simple fluid density. 4. Significant subcutaneous emphysema over the left anterior chest wall. [**2105-10-15**] CT C-SPINE W/O CONTRAST: Possible nondisplaced fracture of the left transverse process of T1. No other fractures identified. Mild anterolisthesis of C6 on C7, age indeterminate, may be due to degenerative change. [**2105-10-16**] ANKLE (AP, MORTISE & LAT) BILAT PORT: Right distal fibular fracture. [**2105-10-16**] Echo: The left atrium is moderately dilated. The right atrium is moderately dilated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets are mildly thickened (?#). There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Normal global and regional biventricular systolic function. Mild mitral regurgitation. Moderate pulmonary hypertension. [**2105-10-15**] 04:10PM WBC-14.9* RBC-4.10* HGB-12.8 HCT-38.6 MCV-94 MCH-31.1 MCHC-33.1 RDW-14.1 [**2105-10-15**] 04:10PM PT-12.8 PTT-27.5 INR(PT)-1.1 [**2105-10-15**] 04:10PM PLT COUNT-432 [**2105-10-15**] 04:10PM FIBRINOGE-347 [**2105-10-15**] 04:10PM LIPASE-21 [**2105-10-15**] 04:10PM UREA N-26* CREAT-1.5* [**2105-10-15**] 04:20PM LACTATE-1.5 [**2105-10-15**] 04:20PM PO2-44* PCO2-54* PH-7.37 TOTAL CO2-32* BASE XS-3 COMMENTS-GREEN Brief Hospital Course: Ms. [**Known lastname 32734**] was admitted on [**2105-10-15**] under the acute care surgery service to the trauma ICU for further evaluation and management of her injuries. She remained hemodynamically stable on [**2105-10-18**] and was transferred to the surgical floor. She had a significant forehead laceration was sutured on admission. Sutures were removed prior to discharge and site remained clean and dry at the time of discharge. Neuro: A thoracic epidural was placed on [**2105-10-16**] for pain management given her rib fractures, which was removed on [**2105-10-19**]. She was transitioned from IV to PO analgesics. By the day of discharge on [**2105-10-26**], her pain was well-controlled with scheduled tylenol and prn tramadol and low dose oxycodone. On [**2105-10-21**], Ms. [**Known lastname 32734**] was triggered for a transient episode of altered mental status. Urine cultures were sent which were negative. A chest xray was obtained which stable showed bibasilar atelectasis and no evidence of infiltrate. She remained hemodynamically stable during this episode, which resolved quickly without intervention. She remained alert and oriented at her baseline mental status upon discharge. Cardiac: Her vital signs were monitored routinely throughout her hospitalization. On arrival to the ED, her ECG showed rapid atrial fibrillation with RVR (history of known atrial fibrillation). She was rate controlled initially with IV beta blockers in the ICU, and was then transitioned to her home cardiac medications. She remained in atrial fibrillation at her baseline throughout her floor course, with adequate rate control in the 60s and 70s. A bedside echo was performed to evaluate her cardiac function on [**2105-10-16**] (see pertinent results section). On [**10-24**], she became slighly hypotensive down to a systolic BP of 80 with diuresis. On [**10-25**] albumin was given and her systolic BP remained > 100 thereafter. Pulm: A pigtail CT was placed on admission given her left sided pneumothorax. It was removed on [**10-18**], with the post-pull chest xray showing no evidence of pneumothorax. Subsequent chest xrays showed bibasilar pleural effesions, and aggressive pulmonary toileting and incentive spirometry were encouraged. A chest xray on [**10-25**] revealed mild pulmonary edema, and gentle diuresis was continued with lasix. She was also started on nebulizers as needed. Her O2 therapy was weaned and her O2 sats remained in the high 90's on 3L of NC at the time of discharge. GI: On admission she was kept NPO and given IV fluids for hydration. On [**10-16**] she was placed on a regular diet. On [**10-18**], she began to develop nausea. She continued to have intermittent episodes of nausea/vomiting, and a KUB on [**10-19**] showed evidence of an ileus. She was given a 1X dose of methylnaltrexone as well as a dulcolax suppository, and she subsequently had multiple bowel movements. She subsequently had multiple episodes of diarrhea, and stool samples were sent for c. diff and she was empirically started on oral flagyl. She continued to be intermittently nauseated and a repeat KUB was obtained on [**10-23**] which showed continued evidence of an ileus with dilation of the stomach, small, and large bowel. On [**10-25**] she was c. diff negative x's 3 samples and flagyl was discontinued. On [**10-26**], she denied any further nausea and vomiting, and was tolerating a regular diet with no abdominal pain. GU: U/A on admission was suspicious for a UTI and she was placed on a 3 day course of oral ciprofloxacin. A repeat U/A [**10-18**] was normal. A foley catheter was placed for urine output monitoring on admission. It was removed on [**10-17**], however, she had an episode of urinary incontinence and retention on [**10-18**] and the catheter was replaced. Her I&O's were closely followed throughout her admission. Her baseline Creatinine was 1.5, which peaked at 1.9 and began to return to normal at 1.6 on [**2105-10-24**]. Her urine output remained borderline at 20-25 mL/hour, with the return toward baseline kidney function and adequate PO intake of fluids. She was discharged to rehab on [**10-16**] with the foley in place for continued urine output monitoring. Heme/ID: Her electrolyes were routinely monitored and repleted as needed. Continued hypocalcemia and hypophosphatemia were noted at the time of discharge and she was discharged on 3 days of neutra-phos as well as calcium supplements. Her initially leukocytosis of 14.9 resolved quickly, and her WBC count remained within normal limits throughout the remainder of her hospitalization. Antibiotic courses were notable for cipro and flagyl as discussed above. Her hgb and hct were routinely checked and remained stable. Musk: Orthopedics was consulted for her right distal fibula fracture. The injury was determined to be nonoperable and she remained weightbearing as tolerated in an aircast boot on her RLE. Physical therapy was consulted to evaluated her mobility, a discharge to an extended care facility when medically stable was recommended. The patient was encouraged to mobilize out of bed as tolerated. Follow up was scheduled in the orthopedic clinic after discharge. Prophyl: She was started SC heparin for DVT prophylaxis after removal of the thoracic epidural. Her home dose of protonix was continued during her hospitalization. On [**2105-10-26**], Ms. [**Known lastname 32734**] remained afebrile and hemodynamically stable. She expressed adequate pain control and was tolerating a regular diet. She was discharged to rehab with plan for coninued physical therapy, cardiopulmonary assessment, urine output monitoring, and pain management. Follow up was scheduled with orthopedics as well as the acute care service. Medications on Admission: advair diskus 250-50mcg'', amytriptyline 25'HS, amlodipine 5', cardizem cd 180' furosemide 60' labetolol 300'HS procrit solution [**Numeric Identifier 961**] unit/ml, 1ml subq/week pantoprozole 40' simvastatin 80' Spiriva' terazosin 5' vesicare 10' ezetimibe 10' Discharge Medications: 1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB. 3. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 4. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours). 5. amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 6. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. furosemide 40 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 8. labetalol 200 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 9. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 11. terazosin 5 mg Capsule Sig: One (1) Capsule PO Q 24H (Every 24 Hours). 12. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. diltiazem HCl 180 mg Capsule, Extended Release Sig: One (1) Capsule, Extended Release PO Q 24H (Every 24 Hours). 14. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 15. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed for constipation. 16. oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours) as needed for pain. 17. tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours) as needed for pain. 18. docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day) as needed for constipation. 19. ipratropium bromide 0.02 % Solution Sig: One (1) nib Inhalation Q6H (every 6 hours) as needed for wheezing. 20. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 21. potassium & sodium phosphates 280-160-250 mg Powder in Packet Sig: One (1) Powder in Packet PO TID (3 times a day) for 2 days. Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: left [**2-15**] rib fractures, right [**3-18**] rib fractures, sternal fracture, right distal fibular fracture, multiple lacerations, and a left pnuemothorax Secondary: renal artery stenosis Hypertension dyslipidemia COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Needs assistance to transfer Discharge Instructions: You were admitted to the hospital after you were in a motor vehicle accident. You sustained left [**2-15**] rib fractures, right [**3-18**] rib fractures, sternal fracture, right distal fibular fracture, multiple lacerations, and a collapse in your left lung. The orthopedic service saw you for your fibula fracture and recommended the aircast with weight bearing as tolerated until you follow up with them in clinic in 2 weeks. The acute pain service also was consulted to make sure you had adeuquate pain control and placed an epidural. You were then transitioned to pain medication by mouth after the epidural was removed. You were requiring some oxygen to maintain appropriate oxygen saturation levels. This was thought to be due to your rib fractures and some extra fluid that we gave you diuretics for. You were initially placed in the ICU for your rib fractures and were brought to a regular hospital floor 3 days later. At the time of discharge you had your forehead sutures removed, you were having bowel movements, and your pain was well controlled. Please follow up with the providers listed below. General Instructions for Rib fractures: You sustained rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. [**Name10 (NameIs) **] is a complication of rib fractures.?????? In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake.?????? This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs.?????? You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing.?????? Symptomatic relief with ice packs or heating pads for short periods may ease the pain.?????? Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible.??????Do not drive a vehicle or drink alcohol while taking narcotics. Do NOT smoke Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus). You may bear weight as tolerated on your right leg while wearing the air cast boot we have given you. Followup Instructions: Department: ORTHOPEDICS When: TUESDAY [**2105-11-10**] at 10:00 AM With: ORTHO XRAY (SCC 2) [**Telephone/Fax (1) 1228**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: ORTHOPEDICS When: TUESDAY [**2105-11-10**] at 10:20 AM With: [**First Name11 (Name Pattern1) 2191**] [**Last Name (NamePattern4) 2192**], NP [**Telephone/Fax (1) 1228**] Building: [**Hospital6 29**] [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: GENERAL SURGERY/[**Hospital Unit Name 2193**] When: THURSDAY [**2105-11-12**] at 2:30 PM With: ACUTE CARE CLINIC [**Telephone/Fax (1) 600**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Notes: You will need a chest x-ray prior to this appointment. Please go to [**Hospital1 7768**], [**Hospital Ward Name 517**] Clinical Center, [**Location (un) 3202**] Radiology 30 minutes prior to your appointment. Completed by:[**2105-10-26**] ICD9 Codes: 5119, 4168, 5990
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Medical Text: Admission Date: [**2190-4-5**] Discharge Date: [**2190-4-17**] Date of Birth: [**2156-11-23**] Sex: M Service: MEDICINE Allergies: morphine Attending:[**First Name3 (LF) 425**] Chief Complaint: Infected ICD lead Major Surgical or Invasive Procedure: ICD removal and reimplantation History of Present Illness: This is a 33 yo male with PMHx of congenital heart defect s/p ASD repair [**2159**], s/p MV repair [**2174**] and then mechanical MVR (model number #[**2184-1-18**]), complicated by complete heart block s/p pacemaker, developed pacemaker-induced cardiomyopathy, upgraded to biventricular ICD upgraded in [**2188**], who presents with an infected, eroded, exposed lead to OSH this AM. . He initially noted a small pustule around the [**Year (4 digits) **] pocket 2 weeks ago. At that time, he had no fevers, chills, and denied pain or drainage from the site. He visited his outpatient cardiologist, Dr. [**First Name (STitle) **], 3 days prior to admission, and was started on Keflex. He presented to OSH ED today after he noticed that exposed leads after the pustule spontaneously drained. He denied any recent fever (highest temp 99F on Friday), chills, sweats, or pain or redness at site. Further denies trauma in the area. . He was noted to be afebrile, HR 75 (paced), BP 129/81, satting 99% on RA. Prior to transfer, the patient was started on 1.25mg vancomycin q12 and Ancef 1g q8. INR at the OSH was noted to be 3.0, with goal INR 2.5 to 3.5. Labs showed glucose of 136, BUN of 13, creatinine of 0.69, sodium 139, potassium of 3.9, chloride of 106, bicarb of 26, WBC of 10.4, hemoglobin of 14.3, hematocrit of 41.5, platelets of 299,000. CXR showed no subcutaneous air and pacerleads looked intact. He was transferred to [**Hospital1 18**] on the same day for hardware removal and reimplantation. . On arrival to the floor, patient was afebrile and comfortable, VS were 98.2, 117/80, 86, 18, 100% RA. He denies chest pain and shortness of breath. . Past Medical History: 1. CARDIAC RISK FACTORS: (-)Diabetes, (-)Dyslipidemia, (-)Hypertension 2. CARDIAC HISTORY: *Premium ASD repair [**2159**] *MV repair [**2174**] *H/o Afib *MVR and Maze in [**1-/2184**] c/b CHB s/p PPM with pacemaker induced CM s/p *BiV ICD upgrade (EP-Hx: [**2184-2-18**] PPM placement for CHB post MVR; [**2184-10-29**] Upgrade to BiV ICD afer noted to have CM (EF 45--->17%); [**2188-4-8**], Generator change, RV PPM and Fidelis Lead extraction)complicated by a hematoma . 3. OTHER PAST MEDICAL HISTORY: None Social History: Lives with parents. Works at Shaws. Independent of ADLs. Family History: Two sisters, both in good health. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory Physical Exam: VS- 98.3 101/66 83 20 93% General- Well appearing, NAD. Cardio- RRR, nl s1s2, +2/6 systolic murmur Chest - Surgical dressings CDI, left arm in sling Resp- CTAB anteriorly, no w/ra/rh, respirations unlabored. Abd- S/NT/ND, NABS Ext- No cce, DP 2+ b/l. Pertinent Results: [**2190-4-5**] 08:30PM WBC-9.9 RBC-4.90 HGB-14.8 HCT-43.8 MCV-90 MCH-30.2 MCHC-33.8 RDW-13.3 [**2190-4-5**] 08:30PM GLUCOSE-124* UREA N-11 CREAT-0.8 SODIUM-139 POTASSIUM-3.7 CHLORIDE-103 TOTAL CO2-30 ANION GAP-10 [**2190-4-5**] 08:30PM CALCIUM-9.9 PHOSPHATE-3.4 MAGNESIUM-2.2 Chem Admission: [**2190-4-5**] 08:30PM BLOOD Glucose-124* UreaN-11 Creat-0.8 Na-139 K-3.7 Cl-103 HCO3-30 AnGap-10 Calcium-9.9 Phos-3.4 Mg-2.2 . Coag [**2190-4-5**] 08:30PM BLOOD PT-22.1* INR(PT)-2.1* [**2190-4-6**] 07:20AM BLOOD PT-18.2* INR(PT)-1.7* [**2190-4-7**] 06:45AM BLOOD PT-14.1* PTT-150* INR(PT)-1.3* . LFTs: [**2190-4-6**] 07:20AM BLOOD ALT-36 AST-39 AlkPhos-61 TotBili-0.5 . Vanc: [**2190-4-5**] 08:30PM BLOOD [**2190-4-5**] 08:30PM BLOOD Vanco-8.9* [**2190-4-6**] 05:20PM BLOOD Vanco-5.9* . Digoxin [**2190-4-6**] 07:20AM BLOOD Digoxin-0.6* . . Imaging: CXR ([**2190-4-5**]) COMPARISON: No comparison available at the time of dictation. FINDINGS: The lung volumes are normal. Moderate cardiomegaly, status post valvular replacement. Pacemaker in situ. No acute changes, notably no pulmonary edema, no pneumonia. No pleural effusions. The study and the report were reviewed by the staff radiologist. . TTE ([**2190-4-6**]): The left atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. There is an inferobasal left ventricular aneurysm. Overall left ventricular systolic function is moderately depressed (LVEF= 35 %) secondary to inferior and posterior akinesis. The basal inferior and posterior walls are aneurysmal. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. A bileaflet mitral valve prosthesis is present. At least moderate [2+] tricuspid regurgitation is seen. [Due to acoustic shadowing, the severity of tricuspid regurgitation may be significantly UNDERestimated.] There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. No valvular or wire-associated vegetation seen. . TEE ([**2190-4-8**]): No mass/thrombus is seen in the left atrium or left atrial appendage. No mass or thrombus is seen in the right atrium or right atrial appendage. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is moderate regional left ventricular systolic dysfunction with akinesis of the mid anteroseptal wall. There is moderate global left ventricular hypokinesis (LVEF = 30-35 %). Right ventricular cavity size is normal with mild global free wall hypokinesis. There are three aortic valve leaflets. There is no aortic valve stenosis. Trace aortic regurgitation is seen. A mechanical mitral valve prosthesis is present. The motion of the mitral valve prosthetic leaflets appears normal. Characteristic washing jets are seen. A mild paravalvular mitral prosthesis leak is probably present. Moderate to severe [3+] tricuspid regurgitation is seen. The tricuspid regurgitation jet is eccentric and may be underestimated. No masses or vegetations are seen on the tricuspid valve. No masses or vegetations are seen on the ICD/pacemaker leads in the right atrium and right ventricle. There is no pericardial effusion. . [**2190-4-16**] CXR Right ICD leads terminate in the right atrium and ventricle. Again seen is a tubular structure overlying the left hemithorax that is presumably external to the patient. Median sternotomy wires, and surgical clips are noted. The lungs are clear. There is mild cardiomegaly. Brief Hospital Course: Patient is a 33yo M w/ PMHx of congenital heart defect, s/p ASD repair at age 2, MVR, pacemaker induced cariomyopathy, s/p ICD placement who presents with an infected, eroded, exposed [**Month/Day/Year **] lead, s/p hardware removal and reimplantation. . ACTIVE PROBLEMS: # [**Name2 (NI) 19721**] lead infection: Upon presentation, the patient was afebrile with [**Name2 (NI) **] leads exposed in the left upper aspected of the chest with no surrounding erythema, palpable fluctuance, or purulence. The patient was started on IV cefepime and vancomycin under the guidance of infectious disease consult service. Blood cultures were drawn daily while the infected [**Name2 (NI) **] and generator were in place. TTE did not show evidence of valvular vegetations given the concern of wire-associated endocarditis. The patient was taken to the operating room [**2190-4-7**] for [**Year (4 digits) **] lead and generator extraction. Blood cultures remained negative. Cultures of the pocket grew PROPIONIBACTERIUM ACNES. His [**Year (4 digits) **] pocket was closed by plastic surgery on [**2190-4-13**] without complication. He then underwent a pacemaker replacement on his right anterior chest on [**2190-4-14**] with removal of the temporary pacing device. He is to continue antibiotic thearpy for 10 days following his new pacemaker placement, with linezolid and moxifloxacin. . # [**Date Range 19721**]-induced cardiomyopathy: ICD exchanged in [**2188**]. Patient with an EF of 35%. Followed by an outpatient cardiologist. His outpatient medications of lisinopril, metoprolol, and digoxin were initially held due to concern of hypotension. They were restarted at lower doses, including lisinopril 5mg daily and metoprolol tartrate 12.5mg [**Hospital1 **]. The patient's digoxin level was therapeutic when checked during admission. . # Status post mechanical MVR: Model number #[**Serial Number **]. Patient's goal INR 2.5-3.5. The patient was stopped on coumadin in the setting of intiating antibiotics (anticipate elevated INR) and started on a heparin drip. Coagulation studies were followed through the admission, and the heparin drip was adjusted accordingly. His INR was 2.2 on day of discharge and heparin was stopped. He was discharged on 7.5mg warfarin daily. . TRANSITIONAL ISSUES - He needs close monitoring of INR due to antibiotic use. He will have his INR checked at Dr.[**Name (NI) 220**] office on Monday. - He should followup with device clinic this week for interrogation and to have stitches removed. Medications on Admission: Coumadin 5-7.5mg qday (INR goal 2.5-3.5) Lisinopril 10mg [**Hospital1 **] Digoxin 250mcg [**Hospital1 **] Metoprolol succinate 100mg [**Hospital1 **] No longer takes ASA Discharge Medications: 1. linezolid 600 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 8 days. Disp:*16 Tablet(s)* Refills:*0* 2. digoxin 250 mcg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). 3. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4 PM. 5. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0* 6. moxifloxacin 400 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*8 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: 1. [**Hospital1 19721**]-pocket infection 2. s/p ASD repair 3. s/p MVR 4. [**Hospital1 19721**] induced cardiomyopathy 5. sCHF Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname 1968**], It was a pleasure to care for you at [**Doctor First Name **]-[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. You were transferred to us for a [**Last Name (NamePattern1) **]-pocket infection. You were treated with antibiotics. You device was replaced. You will be on the antibiotics for 10 days after implantation. Please note these medication changes to your medication: Linezolid 600mg twice daily for 8 more days for infection Moxifloxicin 400mg daily for 8 more days for infection Reduce lisinopril to 5mg daily (this can be further discussed with Dr. [**First Name (STitle) **] Reduce metoprolol succinate to 25mg daily (this can be further discussed with Dr. [**First Name (STitle) **] Followup Instructions: Name: DREW,[**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Location: [**State **]CARDIOLOGY CENTER Address: [**Location (un) **], [**Apartment Address(1) 77647**], [**Hospital1 **],[**Numeric Identifier 91109**] Phone: [**0-0-**] Appointment: Thursday [**2190-4-22**] 10:20am Department: CARDIAC SERVICES Please call to make an appointment on Thursday or Friday. With: DEVICE CLINIC [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Name: NP [**Location (un) 3230**] [**Location (un) 110215**] Address: 450 VETERANS [**Hospital1 **] PKWY [**Apartment Address(1) **], EAST [**Hospital1 **],[**Numeric Identifier 110216**] Phone: [**Telephone/Fax (1) 110217**] Appointment: Friday [**2190-4-23**] 1:00pm Department: INFECTIOUS DISEASE When: FRIDAY [**2190-4-30**] at 10:30 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13125**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 457**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Hospital 1422**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: SPINE CENTER When: FRIDAY [**2190-4-30**] at 2:45 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2477**], MD [**Telephone/Fax (1) 39347**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage ICD9 Codes: 4254, 4271, 4589, 2851, 4280
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6706 }
Medical Text: Admission Date: [**2173-4-14**] Discharge Date: [**2173-4-18**] Service: MEDICINE Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 30062**] Chief Complaint: Hypoxia & GI bleed Major Surgical or Invasive Procedure: none History of Present Illness: 85 y/o M with PMHx of Dementia, CAD s/p PCI, COPD and recent ARDS s/p appendectomy who was at [**Hospital **] rehab prior to recent admission for GI bleed. Pt was discharged on [**4-7**] and was found this morning to have black guaic positive stools and increased work of breathing. . In the ED, initial vs were: T 100.3 P 100 BP 102/48 R 30 O2 sat of 100% on NRB. Pt triggered on arrival with diaphoresis and tachypnea. He was noted to black guaic + stool and concentrated urine. He was weaned from NRB and had a Tmax of 102 in the ED. CXR showed worsening in bilateral infiltrates and he was given Zosyn, Levofloxacin, Protonix and 1L IVF for possible PNA. PIV was placed and blood was typed/crossed for GI bleed. . On arrival to the ICU, pt was oriented to person only and c/o feeling tired and thirsty. Pt has mild shortness of breath but denies cough, congestion or significant increased work of breathing. He denies abd pain, nausea, vomiting, diarrhea, bloody stools, changes in vision or sore throat but does report decreased appetite. Past Medical History: Severe Dementia Depression CAD s/p MI in [**2162**] c/b VF with stenting of the L circ, PCI to R PDA with DES in [**2169**] COPD Recent ARDS s/p appendectomy Type II DM Hypertension Spinal Stenosis Hyperlipidemia CDiff Zoster on rectal area . Surgical History s/p CCY s/p hernia repair s/p appendectomy Social History: Former smoker approx 30 pack year history, retired post-officer. Pt was living with wife but has been at rehab since complicated admission in [**2173-2-8**] Family History: His father died of a myocardial infarction at 84. His mother died of a myocardial infarction at 74. His three brothers, who died one of a motor vehicle accident and one of leukemia. Physical Exam: T 97 HR 95 BP 98/41 RR 29 Sats 95% on 6LNC General: NAD, comfortable, breathing comfortably with NC O2 HEENT: Sclera anicteric, dry mucus membranes, oropharynx clear Neck: no pre-cervical lymphadenopathy Lungs: Bilateral inspiratory rales, no rhonchi, no congestive cough CV: Irreg, mildly tachy, intermittent S4. PMI non-displaced Abdomen: soft, NT/ND, NABS, no rebound or guarding Ext: cool hands, warm feet, good distal pulses Pertinent Results: [**2173-4-15**] 01:55AM BLOOD WBC-11.2* RBC-3.29* Hgb-10.4* Hct-31.2* MCV-95 MCH-31.8 MCHC-33.4 RDW-17.2* Plt Ct-340 [**2173-4-14**] 07:15PM BLOOD WBC-11.4* RBC-3.49* Hgb-10.8* Hct-33.0* MCV-95 MCH-30.9 MCHC-32.7 RDW-17.5* Plt Ct-372 [**2173-4-15**] 01:55AM BLOOD PT-16.1* PTT-28.8 INR(PT)-1.4* [**2173-4-14**] 07:15PM BLOOD PT-14.8* PTT-28.8 INR(PT)-1.3* [**2173-4-14**] 07:15PM BLOOD Glucose-166* UreaN-6 Creat-0.6 Na-133 K-3.7 Cl-93* HCO3-31 AnGap-13 [**2173-4-15**] 01:55AM BLOOD Glucose-168* UreaN-6 Creat-0.6 Na-135 K-3.3 Cl-97 HCO3-32 AnGap-9 [**2173-4-15**] 01:55AM BLOOD CK(CPK)-31* [**2173-4-15**] 01:55AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2173-4-14**] 07:15PM BLOOD Albumin-2.6* [**2173-4-15**] 01:55AM BLOOD Calcium-7.5* Phos-1.3* Mg-1.7 [**2173-4-14**] 10:50PM BLOOD Type-ART Temp-37.2 pO2-66* pCO2-45 pH-7.48* calTCO2-34* Base XS-8 [**2173-4-14**] 07:16PM BLOOD Lactate-2.4* . CXR [**2173-4-14**]: FINDINGS: AP upright portable chest radiograph is obtained. As compared with the prior radiograph, there has been no significant change. Motion artifact somewhat limits evaluation. Bilateral extensive parenchymal opacities are again noted, consistent with the provided history of ARDS. There has been no significant interval change. Small bilateral pleural effusions cannot be excluded. Heart size is difficult to assess. No large pneumothorax is present. Bony structures appear intact. Brief Hospital Course: # Hypoxic Resp Distress: Pt with poor substrate given recent ARDS who p/w fever, increased O2 requirement and worsening in bilateral infiltrates concerning for PNA. Appeared clinically euvolemic to dry and large A-a gradient on ABG. There was no evidence of COPD exacerbation or acute CO2 retention. Oxygenation remained poor despite broad spectrum antibiotics, patient was unable to be weaned off O2, he remained on 6 L plus facemask. After discussion with HCP and patient on [**4-15**], decision was made to transition patient to CMO. IV antibiotics were continued at the family's request because they wanted to have some more time to spend with him. Patient passed away on [**2173-4-18**]. . # GI bleed: Pt presented with guaiac positive black stools, but had stable hematocrit at his baseline. He likely has a slow upper GI bleed. After patient was made CMO, morphine was used to treat abdominal pain. Medications on Admission: Sitagliptin 50mg daily Vancomycin 250mg po BID Ipratropium neb q6hrs Senna prn Clotrimazole TP Lasix 20mg IV Insulin SS Lactobacillus [**Hospital1 **] Levalbuterol neb q6hrs Omeprazole 40mg [**Hospital1 **] Sertraline 50mg daily Simvastatin 40mg daily Discharge Medications: Expired Discharge Disposition: Expired Discharge Diagnosis: expired Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired ICD9 Codes: 0389, 486, 2762, 5990, 496, 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6707 }
Medical Text: Admission Date: [**2142-9-27**] Discharge Date: [**2142-10-4**] Date of Birth: [**2063-3-27**] Sex: F Service: MEDICINE Allergies: Tetracycline Attending:[**First Name3 (LF) 30**] Chief Complaint: UTI Major Surgical or Invasive Procedure: None History of Present Illness: 79F with h/o multiple UTIs c/b urosepsis p/w acute mental status changes associated with cloudy urine with foul odor. Also noted to have involuntary muscle twitches. She recently recovered from an admission to [**Hospital1 **] [**Location (un) 620**] in late [**Month (only) 216**] where she was diagnosed with a UTI with urine culture showing VRE/E.Coli/Proteus and treated with linezolid and ertapenem. In ED: T99.3 134/54 18 94%RA U/A floridly +; given cefepime <br> Patient's family members currently not at bedside, but per nursing report, her mental status appears to be at baseline <br> She currently denies any fevers, chills, cough, shortness of breath, chest pain, palpiations, abdominal pain, change in appetite. She does complain of feeling hot all of the time. Past Medical History: 1. Chronic UTIs: Mulpiple prior admissions with urosepsis 2. Coronary artery disease: MI [**2135**] s/p stent placement 3. Peripheral vascular disease 4. Diabetes mellitus 5. Hypertension 6. Hyperlipidemia 7. Hypothyroidism 8. Anemia 9. Right renal staghorn calculus. 10. Polymyalgia Rheumatica 11. Dyspnea secondary to morbid obesity 12. Rheumatoid arthritis 13. Morbid obesity 14. Bladder diverticulum. 15. History of syncope secondary to poor glycemic control 16. History of C. difficile 17. Cholecystitis s/p cholecystostomy [**7-1**] 18. Status post sigmoidectomy with ileostomy 19. Groin abscess [**2141**] with non-healing wound Social History: Pt lives at [**Hospital **] Nursing Home. She is wheelchair-bound secondary to lower back and lower extremity joint pain. She has 3 children who live locally and are active in her healthcare. She has never smoked cigarettes. Family History: Non-contributory. Sister with [**Name (NI) 10322**] and colon cancer. Physical Exam: Physical Exam: vitals - T 99.1, BP 112/80, HR 73, 95% on 2L. gen - Obese female, lying flat in bed. Is sleeping but arousable. A&Ox2; responding appropriately to questions, speaking comfortably in full sentences heent - Large neck. Could not assess JVP. cv - RRR. No murmurs heard but heard sounds were distant. pulm - Assessed anteriorly and clear. abd - Soft and very obese. Non-tender. Non-healing wound in right groin ext - Warm; no edema; erythema without skin breakdown at site of previous ulcer Pertinent Results: [**2142-9-26**] 10:00PM GLUCOSE-134* UREA N-33* CREAT-1.3* SODIUM-138 POTASSIUM-4.9 CHLORIDE-100 TOTAL CO2-31 ANION GAP-12 <br> [**2142-9-26**] 10:00PM WBC-13.3* RBC-3.93* HGB-12.0 HCT-35.2* MCV-90 MCH-30.5 MCHC-34.0 RDW-16.6* [**2142-9-26**] 10:00PM NEUTS-80.7* LYMPHS-11.9* MONOS-2.8 EOS-4.5* BASOS-0.2 <br> [**2142-9-26**] 10:53PM LACTATE-1.1 <br> [**2142-9-26**] 10:20PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.008 [**2142-9-26**] 10:20PM URINE BLOOD-MOD NITRITE-POS PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-MOD [**2142-9-26**] 10:20PM URINE RBC-0-2 WBC-[**11-15**]* BACTERIA-MANY YEAST-NONE EPI-0-2 TRANS EPI-[**2-28**] Brief Hospital Course: 79 F with known staghorn caliculi, h/o urosepsis, and multidrug resistant UTIs, presenting from her nursing home with muscle twitching and ?change in mental status. . Staghorn calculus: Pt has a h/o R staghorn calculus. She had a recent UTI with urine culture showing VRE and she was placed on linezolid and ertapenem to treat E. coli and proteus and VRE. She was noted to have cloudy urine x 1 day at her nursing home, and mental status slightly off baseline. She received a dose of cefepime in the ED and then the following day was started on meropenem based on prior urine culture results and sensitivities. By the morning after admission, the pt felt she was back to her baseline mental status. A renal ultrasound showed a continued R staghorn calculus, but no L staghorn calculus, no hydronephrosis, and no perinephric abscess. Urology was consulted as the patient had been seen by Dr. [**Last Name (STitle) 3748**] as an outpatient and he had been planning to treat the staghorn calculus as an outpatient in [**11-3**], but elected to perform the procedure while she is hospitalized. Patient underwent lithotripsy on [**2142-10-1**]. Transferred to [**Hospital Unit Name 153**] for further management and particularly due to post-procedure risk of sepsis/DIC. Did extremely well in ICU - hemodynamically stable with no evidence of active bleeding. Antibiotic coverage with meropenem. WBC elevated, though febrile and with no symptoms indicating active infection. Per urology recs on [**2142-10-2**], removed Foley and started Flomax 0.4mg QHS to help pass stones. # Pannus Wound: Pt had ulcerations under left side of pannus. This wound was recently examined by her [**Last Name (LF) 5059**], [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2819**], who per report saw her several weeks ago at which time he thought the wound looked alright, and was unlikely to ever heal. At that time she had a fistula gram which did not clearly demonstrate a track, rather the contrast terminated in the subcutaneous tissue adjacent to the abdominal wall Medications on Admission: levothyroxine 150mg ASA 81mg prednisone 5mg MVI Colace Loratadine Prilosec Cymbalta 20mg Hydroxychloroquine 400mg gabapentin 600mg tid artifical tears Morphine Sulfate 30mg CR oxycodone 5mg tabs prn metoprolol 25 mg Senna lidoderm patches 5% lorazepam .5mg prn albuterol/ipratropium Humulin 48U qam/12Uqhs nitro prn Discharge Disposition: Extended Care Facility: [**Doctor Last Name **] Nursing & Rehabilitation Center - [**Location (un) **] Discharge Diagnosis: Urinary Tract Infection with sepsis Acute Renal Failure Right staghorn calculi Non-healing left groin fistula Discharge Condition: stable Discharge Instructions: You were admitted with a urinary tract infection. You were treated with antibiotics for this. You also had acute kidney failure, but this resolved with IV fluids. Followup Instructions: Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2142-10-18**] 10:15 Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Doctor Last Name **] Phone:[**Telephone/Fax (1) 274**] Date/Time:[**2142-10-25**] 10:30 Provider: [**Name10 (NameIs) **] RM 1 [**Name10 (NameIs) **]-PREADMISSION TESTING Date/Time:[**2142-10-25**] 11:30 ICD9 Codes: 0389, 5849, 5990, 4019, 2449
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6708 }
Medical Text: Admission Date: [**2167-7-16**] Discharge Date: [**2167-7-21**] Date of Birth: [**2091-1-7**] Sex: F Service: MEDICINE Allergies: Peanut Attending:[**First Name3 (LF) 2817**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: Intubation and Mechanical Ventilation History of Present Illness: 76 yo F w/ h/o COPD on home O2 and multiple COPD flares in the setting of non-compliance some of which required intubation presents to the ER w/ SOB that has been worsening over the last 2 weeks. The daughter reported to the [**Name (NI) **] physicians that she is not compliant w/ home O2, meds and is still smoking. Reported no CP, nausea or vomiting. In the ED, initial vs were: 98, 89, 133/68, R 30 O2 sat84 on 3L O2 ->97 on NRB and was in acute resp distress. Initial ABG: 7.25/80/72/37. Patient received Magnesium, 125mg solumedrol, nebs, ceftriaxone, and azithromycin. Put on bipap, repeat ABG: 7.2/94/457. Intubated and initially put on 500 X 16 with FiO2 100%, peep 7. I/E [**12-1**] and on those settings she had no autopeep per respiratory and abg was: 7.27/67/398. OG tube in place. ETT in place per latest XR. On Versed/fentanyl. repeat ABg: 7/27/67/400. Access is peripherals only. On transfer, VS were 98 64 129/83 19 99% on current vent settings: 500X 16 40% FIO2. On the floor, patient was intubated and sedated on fent/midaz. An A-line was placed under sterile conditions in the right radial artery. Review of systems: unable - intubated/sedated Past Medical History: COPD, on O2 at home (2L, recently increased to 4L) followed by Dr. [**Last Name (STitle) 575**] allergic rhinitis Depression Anxiety Osteopenia Tobacco Abuse Social History: Pt had been previously estranged from family and now has re-established contact. [**Name (NI) **]-term and current smoker. Family History: NC Physical Exam: T: 97.3 BP:116/75 P:72 R: 19 O2: 98% on 470X19, 0.4, 8 General: Intubated/sedated HEENT: Sclera anicteric, dryMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: decreased breath sounds on the left CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present GU: foley Ext: warm, well perfused, 2+ pulses, No edema neuro: sedated Skin: no breakdown Pertinent Results: Labs: CBC: [**2167-7-16**] 08:00PM BLOOD WBC-6.4 RBC-5.73* Hgb-19.9*# Hct-58.1*# MCV-101*# MCH-34.8*# MCHC-34.3 RDW-14.2 Plt Ct-143*# [**2167-7-18**] 04:47AM BLOOD WBC-10.9# RBC-5.38 Hgb-17.7* Hct-55.5* MCV-103* MCH-32.9* MCHC-31.9 RDW-14.1 Plt Ct-182 [**2167-7-21**] 05:20AM BLOOD WBC-8.1 RBC-5.60* Hgb-18.4* Hct-56.8* MCV-101* MCH-32.7* MCHC-32.3 RDW-13.8 Plt Ct-154 Coagulation Studies: [**2167-7-21**] 05:20AM BLOOD PT-11.3 PTT-32.3 INR(PT)-0.9 Chemistries: [**2167-7-16**] 08:00PM BLOOD Glucose-183* UreaN-21* Creat-0.9 Na-146* K-4.4 Cl-104 HCO3-34* AnGap-12 [**2167-7-21**] 05:20AM BLOOD Glucose-166* UreaN-32* Creat-0.8 Na-144 K-3.6 Cl-102 HCO3-35* AnGap-1108/24/10 05:20AM BLOOD Calcium-9.4 Phos-3.1 Mg-2.1 [**2167-7-17**] 03:52AM BLOOD Calcium-9.3 Phos-2.8 Mg-2.2 Liver Function Tests: [**2167-7-19**] 05:01AM BLOOD ALT-31 AST-19 LD(LDH)-153 AlkPhos-87 TotBili-0.3 Cardiac Enzymes: [**2167-7-16**] 08:00PM BLOOD cTropnT-<0.01 [**2167-7-17**] 03:52AM BLOOD CK-MB-6 cTropnT-<0.01 ABGs: [**2167-7-16**] 08:15PM BLOOD Type-ART pO2-72* pCO2-80* pH-7.25* calTCO2-37* Base XS-4 [**2167-7-20**] 12:48PM BLOOD Type-ART Temp-35.8 FiO2-35 O2 Flow-3 pO2-51* pCO2-46* pH-7.44 calTCO2-32* Base XS-5 Microbiology: blood, urine, sputum cultures no growth to date. mrsa swab - negative. . CXR ([**7-16**]) - FINDINGS: The study is limited secondary to positioning. The patient was imaged in a lordotic and rotated orientation. Within those limitations, the lungs are clear without consolidation or edema. The mediastinum is grossly stable. The cardiac silhouette is within normal limits for size. No effusion or pneumothorax is noted. Degenerative changes are noted throughout the mid and lower thoracic spine. IMPRESSION: Limited study with no definite acute pathology identified. KUB ([**7-19**]) - INDICATION: Abdominal pain and hypoactive bowel sounds, concern for ileus or obstruction. TECHNIQUE: Portable supine and left lateral decubitus radiographs of the abdomen. FINDINGS: Moderate amount of stool is seen in the large bowel with an otherwise unremarkable bowel gas pattern. There is no evidence of obstruction. There is no free intraperitoneal air seen. There is no acute fracture, or bony abnormality. IMPRESSION: No evidence of ileus or obstruction. Moderate amount of stool in the colon. EKG ([**7-16**]) Sinus rhythm. Baseline artifact. Possible biatrial abnormality. QS deflections in leads V1-V2. Possible septal myocardial infarction, age indeterminate. Compared to the previous tracing of [**2165-10-2**] artifact is new. TRACING #1 Rate PR QRS QT/QTc P QRS T 79 150 74 392/425 71 5 55 Brief Hospital Course: Assessment and Plan: Mrs. [**Known lastname 19376**] is a 76yo F with severe COPD on 4 L home O2 admitted to the MICU with hypercarbic respiratory failure. . # Hypercarbic respiratory failure: Patient's hypercarbic respiratory failure was thought to be due to a COPD exacerbation in the setting of medication non-compliance, resumption of smoking. She was noted to be hypercarbic on admission on serial ABGs. She is also likely a chronic retainer of CO2 given the severity of her COPD and her chronically elevated bicarbonates, and her serial ABGs demonstrating an underlying chronic respiratory acidosis. She appeared clinically euvolemic on exam, so acute heart failure exacerbation was less likely. Her sputum, blood, and urine cultures showed no evidence of underlying infection. She was admitted to the MICU, underwent intubation and mechanical ventilation, received nebulizers with ipratroprium and albuterol around the clock, IV steroids (solumedrol). She also initially received Azithromycin and Ceftriaxone for treatment of possible community acquired pneumonia -- sputum returned without any growth so antibiotics were tapered, and she completed 5 days of Azithromycin in the hospital. She was eventually extubated to BiPAP. Her oxygen was weanred to nasal cannula, with oxygen saturations between 88-95% on [**3-3**] L NC. She occasionally desaturates down to 80% when eating or beig turned, which returns to her baseline oxygen saturations with repositioning and increased oxygen delivery. She was weaned to prednisone and was discharged on an oral prednisone taper. H2 blocker was started for GI prophylaxis and aspirin was held in setting of steroids -- latter can be restarted once prednisone taper is stopped. She will need rehabilitation with focus on pulmonary treatment. # Smoking cessation: Dicussed with patient, she will stop smoking. Nicotine patch give in-house. # Breast mass: Noted on left breast on physical exam. Recent normal mammogram in [**2165**] with some fibrocystic changes. Would defer this to outpatient primary care physician. # Secondary Polycythemia: Elevated Hematocrit chronic, likely from uncorrected hypoxemia and history of smoking. Would recommend continued monitoring. Medications on Admission: Ocygen 4L NC with exertion and at night Ketoconazole cream Advair 250/50 [**Hospital1 **] Spiriva 1puff daily ASA 325mg daily Clonazepam 0.5mg TID PRN Nicotine patch ProAir HFA 2 puffs QID PRN lasix 20mg PO daily Mucinex 600mg [**Hospital1 **] Mupiricin ointment Oxycodone-acetaminophen TID Colace [**Hospital1 **] Discharge Medications: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 2. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 3. Prednisone 20 mg Tablet Sig: 2.5 Tablets PO daily () for 2 days. 4. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO daily () for 2 days: After 50 mg dose has been given for 2 days. 5. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO daily () for 2 days: After 40 mg dose has been given for 2 days. 6. Prednisone 20 mg Tablet Sig: One (1) Tablet PO daily () for 2 days: After 30 mg dose has been given for 2 days. 7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO daily () for 2 days: After 20 mg dose has been given for 2 days. 8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) NEB Inhalation Q4H (every 4 hours). 10. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) NEB Inhalation Q4H (every 4 hours) as needed for wheezing. 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 12. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed for constipation . 13. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for anxiety. 14. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) Unit/mL Injection Injection TID (3 times a day). 15. Mucinex 600 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO twice a day. 16. Mupirocin Topical 17. Ketoconazole Topical 18. Famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day for 10 days. Discharge Disposition: Extended Care Facility: [**Hospital **] Hospital - [**Hospital1 8**] Discharge Diagnosis: Primary Diagnosis: COPD exacerbation . Secondary Diagnoses: Polycythemia, Stable Breast Mass, Anxiety Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair advancing to Ambulatory with assistance as tolerated from respiratory standpoint. Discharge Instructions: You were admitted to the hospital for a COPD exacerbation. You were initially intubated and placed on a ventilator to help you breathe. You were treated with antibiotics, steroids, and nebulizer treaments. You were successfully extubated and weaned to oxygen by nasal cannula only. -------------- The following changes were made to your medications: You should use Albuterol NEBULIZER and Ipratropium Bromide NEBULIZER while in rehab instead of ADVAIR, PROAir, and SPIRIVA INHALERS. You can return to using ADVAIR, PROAir, and SPIRIVA INHALERS when you return home. . You were STARTED on a taper of PREDNISONE that will finish in 10 days. . Your Aspirin was HELD until you finish your PREDNISONE taper. . You were started on PEPCID (FAMOTIDINE) which you should continue while you take PREDNISONE. . Your PERCOCET (OXYCODONE-ACETAMINOPHEN) was STOPPED as you were not having any pain. . You should STOP SMOKING. Followup Instructions: You should follow-up with your PCP regarding your COPD within 1 week. You should continue your outpatient follow-up of your breast mass. Completed by:[**2167-7-21**] ICD9 Codes: 2762, 3051
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Medical Text: Admission Date: [**2172-5-19**] Discharge Date: [**2172-5-26**] Date of Birth: [**2172-5-19**] Sex: M Service: NEONATOLOGY weighing 2485 gms and admitted to the NICU from L&D for prematurity and respiratory distress. At the time of discharge he is 7 days old and corrected age of 35 [**4-14**] wks. Mother is a 32 yr old gravida 8 para 1 now 2 with Pregnancy was complicated by presence of anticardiolipin antibodies which was treated with levonox. She also had low platelets and pregnancy induced hypertension. [**Doctor First Name **] had apgars of 8,9. His initial physical examination was temp of 98.9, HR of 140, RR of 2485gms (75%), length 46.5 (50%) and head circumference of limb pulses felt, mild palpable, anus patent, no hip clicks, pink and well perfused. Physical assessment at that time was 34 [**4-14**] wk neonate with respiratory distress to rule out RDS. HOSPITAL COURSE: Respiratory: he was initially started on CPAP of 6, but because of increasing oxygen requirement and distress he was intubated and given one dose of survanta. After nine hours of ventilation he spontaneously extubated and was put back on CPAP. He remained on CPAP until [**5-22**] and then was weaned to nasal cannula. He was quickly weaned to room air and has been on room air since [**5-24**]. There has been no episodes of apnea or bradycardia. Breath sounds are clear and equal with baseline respiratory rate between 30s and 60s. Cardiovascular: A systolic murmur was noted soom after birth, which became softer and resolved within a few days of life. The infant is pink and well perfused. Infectious disease: he was started on Ampicillin and Gentamycin for 48 hour rule out pending blood cultures. CBC was benign. Blood cultures revealed no growth. Antibiotics were discontinued 48 hours later. Fluid and nutrition: [**Doctor First Name **] was started initially on D10W at 80 cc per kilogram, which was restricted to 60 cc/ kg on day two, because of a sodium of 129. Subsequently fluids were increased and now is on ad lib feeds of Neosure 20 or breast milk 20. His last set of electrolytes on [**5-23**] were sodium 142, potassium 5.8, chloride 108, total CO2 of 23. Bili: He was started on phototherapy on [**5-22**] for a bili of 9.8 subsequently bilirubin came down and his phototherapy was discontinued on [**5-25**] with a bili of 8.1/.3. His rebound bili on [**5-26**] was 7.5/.2. His highest bilirubin was 12.2/.3 on [**5-23**]. Heme: his initial hematocrit was 43 and platelet count of 392. Neurology: no issues. Others: He has passed hearing screen both ears. He had a car seat test, which he has passed. He also received his hepatitis B vaccine. His newborn screen has been sent. CONDITION ON DISCHARGE: discharge weight: 2390 gm. Stable, preterm neonate with resolved RDS now in room air and on ad lib feeds. The pediatrician is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 42720**], phone number is [**Telephone/Fax (1) 42721**]. CARE AND RECOMMENDATIONS: Feeds: he is on ad lib bottle feeds every three to four hours with Neosure 20 or breast milk of 20. He is on Fer-In-[**Male First Name (un) **]. Follow up appointment with pediatrician on Thursday. DISCHARGE DIAGNOSES: 1. Prematurity. 2. RDS. 3. Rule out sepsis. 4. Indirect hyperbilirubinemia. [**Name6 (MD) **] [**Name8 (MD) 38353**], M.D. [**MD Number(1) 38354**] Dictated By:[**Last Name (STitle) 42130**] MEDQUIST36 D: [**2172-5-26**] 11:25 T: [**2172-5-26**] 11:37 JOB#: [**Job Number 42722**] ICD9 Codes: V290, V053, 769, 7742
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Medical Text: Admission Date: [**2183-1-5**] Discharge Date: [**2183-1-11**] Date of Birth: [**2107-1-16**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1167**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: Cardiac catheterization with DES to RCA and POBA to PDA History of Present Illness: 75 M h/o severe CAD s/p CABG [**2167**], s/p recent complicated admission ([**Date range (1) 107779**]/07) for NSTEMI with multiple interventions, presented to ED after calling EMS c/o increased SOB. Patient reports that he had noticed increased BLE edema over the last few days PTA. Yesterday, he noted more SOB and diaphoresis. Pt reported taking SLNTG x3 at home with some relief of these symptoms. BP 160/80, RR 36, O2sat 91-92% in field per MICU note. Patient reports being compliant with his medications and denies any change in diet recently. He did have 1 week of a nonproductive cough. In the ED, HR 63, BP 143/77, SaO2 85% RA, increasing to 90-92% on nonrebreather (no T recorded). Pt refused CPAP, stated that he would prefer intubation, and was ultimately intubated for increasing WOB/SOB. Pt then received furosemide 80 mg IV, nitro gtt, and ASA 300mg PR. TropT 0.03 noted on first set of CE. He put out only 200mL to the furosemide. He was transferred to the MICU. In the MICU, he received diuril 250mg and furosemide 100mg IV once. To this he has continually put out urine to over 2.5L negative thus far. He was awake and alert the morning after admission and was extubated at 9am. Since then, he has not received any more diuretics, but continues to make urine. He has been on room air with sats in the 90's. Currently, he complains of some bilateral leg pain secondary to the swelling. No CP, no SOB, no n/v, no f/c, no diarrhea or abdominal pain. +sore throat from intubation. Past Medical History: PAST MEDICAL HISTORY: 1. Coronary artery disease ---CABG ([**2167**]) - LIMA-->LAD - SVG-->RCA - SVG-->OM ---PCI ([**11/2176**]) - Ostial LIMA-LAD stent --> restenosis and brachytherapy ([**5-/2177**]) - Stenotic LIMA to the LAD stented - SVG to the PDA (patent) - SVG to the RCA (occluded) ---PCI ([**1-/2180**]) - SVG-RCA and SVG-OM (occluded) - LIMA-LAD (patent) - RCA and r-PDA stented (DES) ---PCI ([**3-/2180**]) - rPDA stented stented (Taxus) - r-PL balloon rescue - ostial RCA stented (DES) ---PCI ([**5-/2180**]) - LMCA-LCx stented (DES) - RCA stented (DES) ---PCI ([**5-/2181**]) - Left subclavian artery stented - [**Name (NI) 107781**] PTCA ---PCI ([**8-/2182**]) - RPDA POBA - RCA POBA ---PCI ([**8-/2182**]) - ostial LIMA stented (Cypher DES) . 2. Congestive heart disease - Systolic and [**Last Name (LF) 107778**], [**First Name3 (LF) **] 23% ([**9-16**]) 3. Valvular disease - 1+ AR - 2+ MR 4. Atrial fibrillation 5. Episode of atrial tachycardia ([**2181**]) 6. Episode of phase 4 block secondary to PVC ([**9-/2182**]) . Cardiac Risk Factors: (+) Diabetes (+) Dyslipidemia (+) Hypertension . OTHER PAST HISTORY 1. Peripheral [**Year (4 digits) 1106**] disease - Right CEA ([**7-/2168**]) - Left fem-bk [**Doctor Last Name **] w/ ISSVG ([**8-/2168**]) - Left fem-pt w/ vein ([**12-11**]) - Right CFA-ak [**Doctor Last Name **] w/ NRSVG ([**1-11**]) - Bilateral 5th toe amps ([**1-11**]) - Successful atherectomy of the right anterior tibial and popliteal arteries ([**3-14**]) - Successful cryoplasty of the L fem-[**Doctor Last Name **] graft ([**4-13**]) 2. Chronic kidney disease 3. Grade II internal hemrohrroids 4. Colonic diverticulosis 5. GERD 6. Acalculous cholecystitis s/p indwelling gallbladder catheter 7. Obstructive lung disease? 8. Low back pain Social History: No current tobacco use. 60+ pack-year history. Past heavy drinker. Lives alone, son lives upstairs from him. Family History: No family history of sudden cardiac death or early coronary artery disease. Physical Exam: Physical Exam: VS: T 97.3, BP 104/54 (99-120/41-58), HR 80 (76-90), O2sat 96% on RA RR 17. In 1030/Out 3476 net 2446 (LOS negative 2837mL) Gen: tired appearing male with eyes closed but awakens to answer questions appropriately HEENT: NCAT, dry MM, clear OP, PERRL, EOMI, anicteric sclera, non-injected conjunctiva. Neck: Elevated JVP to edge of jaw CV: difficult to hear secondary to upper airway secretions, but RRR, could not appreciate m/r/g Chest: clear bilaterally without w/r/r with mild crackles at R base. Anterior breath sounds obscured with upper airway secretion noises. Abd: Soft, NT, ND, BS+. Ext: 2+ BLE, very dry skin. Pertinent Results: [**2183-1-5**] 06:30PM BLOOD WBC-9.0 RBC-3.83* Hgb-10.8* Hct-34.7* MCV-91 MCH-28.3 MCHC-31.2 RDW-15.6* Plt Ct-217 [**2183-1-7**] 03:05AM BLOOD WBC-4.7 RBC-3.29* Hgb-9.3* Hct-28.5* MCV-87 MCH-28.3 MCHC-32.6 RDW-15.7* Plt Ct-167 [**2183-1-7**] 10:47AM BLOOD WBC-5.5 RBC-3.50* Hgb-10.1* Hct-30.4* MCV-87 MCH-28.8 MCHC-33.1 RDW-15.9* Plt Ct-171 [**2183-1-10**] 06:07AM BLOOD WBC-3.6* RBC-3.13* Hgb-8.8* Hct-27.3* MCV-87 MCH-28.1 MCHC-32.2 RDW-15.5 Plt Ct-164 [**2183-1-11**] 06:23AM BLOOD WBC-3.0* RBC-2.96* Hgb-8.1* Hct-25.8* MCV-87 MCH-27.4 MCHC-31.4 RDW-15.4 Plt Ct-129* [**2183-1-11**] 09:14AM BLOOD Hct-31.0* [**2183-1-5**] 06:30PM BLOOD PT-14.1* PTT-27.1 INR(PT)-1.2* [**2183-1-6**] 02:14AM BLOOD PT-12.7 PTT-20.7* INR(PT)-1.1 [**2183-1-11**] 06:23AM BLOOD PT-13.1 PTT-31.3 INR(PT)-1.1 [**2183-1-11**] 06:23AM BLOOD Ret Aut-2.1 [**2183-1-5**] 06:30PM BLOOD Fibrino-509* [**2183-1-11**] 06:23AM BLOOD calTIBC-316 Hapto-207* Ferritn-79 TRF-243 [**2183-1-5**] 06:30PM BLOOD Glucose-207* UreaN-30* Creat-2.5* Na-141 K-5.8* Cl-105 HCO3-20* AnGap-22* [**2183-1-5**] 09:35PM BLOOD Glucose-192* UreaN-31* Creat-2.5* Na-142 K-4.5 Cl-106 HCO3-22 AnGap-19 [**2183-1-8**] 06:00AM BLOOD Glucose-122* UreaN-44* Creat-2.9* Na-138 K-3.8 Cl-104 HCO3-24 AnGap-14 [**2183-1-11**] 06:23AM BLOOD Glucose-129* UreaN-32* Creat-2.6* Na-142 K-4.1 Cl-101 HCO3-28 AnGap-17 [**2183-1-5**] 06:30PM BLOOD CK(CPK)-146 Amylase-102* [**2183-1-6**] 02:14AM BLOOD CK(CPK)-188* [**2183-1-6**] 10:03AM BLOOD CK(CPK)-207* [**2183-1-6**] 04:02PM BLOOD CK(CPK)-194* [**2183-1-9**] 05:26AM BLOOD CK(CPK)-89 [**2183-1-11**] 06:23AM BLOOD LD(LDH)-247 TotBili-0.4 [**2183-1-5**] 06:30PM BLOOD CK-MB-4 cTropnT-0.03* [**2183-1-6**] 02:14AM BLOOD CK-MB-13* MB Indx-6.9* cTropnT-0.20* proBNP-8368* [**2183-1-6**] 10:03AM BLOOD CK-MB-11* MB Indx-5.3 cTropnT-0.24* proBNP-9154* [**2183-1-7**] 10:47AM BLOOD CK-MB-4 cTropnT-0.21* [**2183-1-5**] 09:35PM BLOOD Calcium-9.3 Phos-5.4*# Mg-2.3 [**2183-1-6**] 02:14AM BLOOD Calcium-9.6 Phos-4.4 Mg-2.4 [**2183-1-11**] 06:23AM BLOOD Calcium-9.4 Phos-4.2 Mg-2.2 Iron-37* Notable labs: 143 104 35 133 -------------< 3.6 25 2.6* (elevated from baseline 1.8) CK: 194 MB: 7 Trop-T: 0.25 * ([**2183-1-6**] 10am: CK: 207 MB: 11 MBI: 5.3 Trop-T: 0.24 [**2183-1-5**] 2am: CK: 188 MB: 13 MBI: 6.9 Trop-T: 0.20) Ca: 9.3 Mg: 2.1 P: 3.4 proBNP: 9154 WBC 5.5 Hgb 11.5 HCT 34.4 PLT 172 MCV 88 PT: 12.7 PTT: 20.7 INR: 1.1 EKG: Rate 100bpm, rhythm, Axis LAD, RBBB, ST depressions at V2-V3 new but ST depressions in V4-6 appear chronic. STUDIES: [**2183-1-5**] CXR: Cardiomegaly and moderate CHF [**2183-1-6**]: no more fluid overload. ETT tube in place . Echo [**2183-1-6**]: The left atrium is moderately dilated. The estimated right atrial pressure is 0-5 mmHg. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. There is severe global left ventricular hypokinesis with best preserved motion in the anteroseptum (LVEF = 25 %). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). Right ventricular chamber size is normal. with mild global free wall hypokinesis. There are three aortic valve leaflets. The aortic valve leaflets are moderately thickened. There is mild aortic valve stenosis (area 1.6 cm2). Mild to moderate ([**12-11**]+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Moderate (2+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is borderline pulmonary artery systolic hypertension. Mild pulmonic regurgitation is seen. There is a trivial/physiologic pericardial effusion. Compared with the prior study (images reviewed) of [**2182-9-27**], regional left ventricular dysfunction now extends to the anterior and anterolateral walls. The overall ejection fraction is likely decreased. The severity of aortic regurgitation may have increased slightly. [**2183-1-8**] Cardiac Cath: FINAL DIAGNOSIS: 1. Three vessel coronary artery disease. 2. Patent LIMA-LAD 3. Stenting of ostial and mid RCA with DES and POBA to ostial PDA. [**2183-1-8**] ECG: Sinus rhythm Ventricular premature complex Marked left axis deviation Left atrial abnormality RBBB with left anterior fascicular block Since previous tracing of the same date, no significant change Brief Hospital Course: 75 year old male with history of CAD s/p CABGx3 and multiple PCI's, CHF with EF 30%, diastolic and systolic HF, CRI, HTN, now presenting with SOB likely [**1-11**] CHF. Pt was intubated in ED and sent to the MICU. He was extubated the following day and transferred out to the Cardiology floor. # Respiratory distress: Respiratory distress likely combination of COPD and CHF, but more CHF given bilateral lower exttremity edema, CXR finding of fluid overload, and overload on exam initially. Mr. [**Known lastname 63208**] has a known LVEF of 25% based on ECHO here. Patient was intubated in the ED and transferred to the MICU. He was much improved the following day and was extubated successfully. He was treated with IV Furosemide during this time. He was transferred to the Cardiology Service and was placed on a Lasix drip for further diuresis. Given his new onset worsening left ventricular function, he was sent for cardiac cath which was significant for 3VD and is now s/p stenting of ostial and mid RCA with DES and POBA to ostial PDA. #CHF: Systolic acute on chronic CHF exacerbation as above. Patient was to continue carvedilol 12.5 mg [**Hospital1 **], isosorbide dinitrate 20mg TID. Furosemide was incresed to 80mg [**Hospital1 **] . #CAD: CABG x 3 in [**2167**] (LIMA-LAD, SVG-OM, SVG-PDA) with only LIMA-LAD patent multiple PCI's and multiple stents placed. Patient has tropopin leak up to 0.25 up from 0.03. This was thought to be due to demand ischemia as CK levels were not elevated. Patient was sent for Cardiac Cath as above. He is to continue home regimen of clopidogrel 75mg daily, ASA 325mg daily, simvastatin 80mg daily, isosorbide dinitrate 20mg TID. Pt started on Carvedilol 12.5 mg [**Hospital1 **]. # Rhythm: Atrial fibrillation: Pt not anticoagulated [**1-11**] massive GI bleed; rate controlled only with nondihydropyridine nifedipine at home. Switched to carvedilol this admission per cardiology. Patient was monitored for bronchospasm given hx of COPD. He did not have any adverse reaction and was discharged on Carvedilol for management of his A-fib and CHF. # COPD: Pt has known obstructive lung disease [**1-11**] extensive smoking history. He is to continue on his home Combivent. . # CRI: Baseline Cr (1.7-2.2), now elevated to 2.6 and remained there upon discharge. ACE-I was held and will be restarted by Dr. [**First Name (STitle) 437**] in clinic if kidney function improves. . # HTN: Patient is to continue Carvedilol, Isosorbide dinitrate, Amlodipine # Diabetes mellitus: Cont home glipizide . # Dyslipidemia: Continued simvastatin 80 daily. # Phase 4 Paroxysmal AV block: Patient has been seen by Dr. [**Last Name (STitle) **] regarding ICD/PM placement. This should be follow up by his PCP. Medications on Admission: MEDICATIONS ON ADMISSION: ([**First Name8 (NamePattern2) **] [**Doctor Last Name **] [**2182-12-16**] OMR note): Nifedipine 60 mg--one tablet by mouth once a day ASPIRIN 325MG--Take one by mouth every day Amlodipine 5 mg--one tablet by mouth once a day CLOPIDOGREL BISULFATE 75MG--One by mouth every day COMBIVENT 103-18 mcg/Actuation--take 2 puffs three times a day as needed for wheezing FUROSEMIDE 20 mg--three tablets by mouth once a day GLIPIZIDE 5 mg--take 1 tablet(s) by mouth once a day 1 hour after a meal ISOSORBIDE DINITRATE 20 mg--one tablet by mouth three times a day NITROGLYCERIN 400 MCG (1/150 GR)--Take as directed as needed for chest pain PROTONIX 40 mg--take 1 tablet(s) by mouth once a day (20 minutes before a meal) ROXICET 5 mg-325 mg--take 1 tablet(s) by mouth four times a day as needed for pain (twenty-eight day supply) SIMVASTATIN 80 mg--take 1 tablet(s) by mouth at bedtime ***** Pt does not appear to be on LISINOPRIL per PCP [**2182-12-16**] note, although he was discharged on lisinopril after his last hospital admission. ***** Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Isosorbide Dinitrate 10 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 5. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Petrolatum Ointment Sig: One (1) Appl Topical TID (3 times a day) as needed. Disp:*1 tube* Refills:*2* 7. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day: 1 hour after a meal. 8. Combivent 18-103 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation TID PRN as needed for shortness of breath or wheezing. 9. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 10. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Sublingual q5min PRN as needed for chest pain: one tablet every 5min for a total of 3 doses if needed for chest pain. 11. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. 12. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO once a day. 13. Roxicet 5-325 mg Tablet Sig: One (1) Tablet PO QID prn as needed for pain. 14. Furosemide 80 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary: Systolic Heart Failure Exacerbation Coronary Artery disease s/p PCI with DES to RCA and POBA to PDA Secondary: - Coronary Artery Disease - Atrial Fibrillation, not anticoagulated due to massive GI bleed [**2176**] - PVD with B fem to distal bypass - Hypertension - Hypercholesterolemia - COPD - DM2 - GERD - Chronic renal insufficiency baseline 1.5 - 2.0 Discharge Condition: Stable Discharge Instructions: You were admitted into [**Hospital1 69**] for treatment of your Congestive Heart Failure. You were in severe respiratory distress on arrival and you were intubated and placed on a breathing machine for 24 hours. Your heart failure has been treated successfully with Intravenous Diuretics. An Ultrasound of the heart was done which showed worsening heart function. A cardiac catheterization was done to evaluate your arteries. You had a new occlusion of your right coronary artery which was opened with a drug eluting stent. A balloon was also used to open up a second artery. Please stop taking your Lisinopril for the time being. Your kidney function has slightly worsened with the diuresis and you should not take your Lisinopril as it may contribute to worsening kidney function. Your kidney function will be reevaluated by Dr. [**First Name (STitle) 437**] at your visit with him. Your Lasix has been increased from Lasix 60mg daily to Lasix 80mg twice per day. Please continue with your remaining regular home medications. Please attend recommended follow up below. If you experience worsening chest pain, shortness of breath, palpitations, nausea, vomiting, increased leg swelling, dizziness, lightheadedness, fainting or any other concerning symptoms then please call your doctor or report to the nearest emergency room. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Followup Instructions: Please call your new Cardiologist, Dr. [**First Name (STitle) 437**] at [**Telephone/Fax (1) 3512**] to set up an appointment to be seen on [**2183-1-23**]. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5377**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2183-1-22**] 8:20 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5377**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2183-3-5**] 8:20 ICD9 Codes: 4254, 5849, 5859, 4280, 4439, 4019, 2720, 412
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Medical Text: Admission Date: [**2172-11-30**] Discharge Date: [**2172-12-5**] Service: HISTORY OF PRESENT ILLNESS: The patient is an 80 year old woman status post myocardial infarction [**2172-11-14**] who returned to the medical center for coronary artery bypass graft. The patient had presented to an outside medical center on [**2172-11-14**] with anginal equivalent symptoms of diaphoresis and increased shortness of breath. She was evaluated at the medical center and then transferred to the [**Hospital6 256**] for further management. The patient was discharged following her initial hospitalization with plan to return to the [**Hospital6 1760**] for coronary artery bypass graft on [**2172-11-30**]. PAST MEDICAL HISTORY: Myocardial infarction, congestive heart failure, hypertension, nephrolithiasis, tuberculosis, Pott's disease, anemia, coronary artery disease. PAST SURGICAL HISTORY: Total abdominal hysterectomy/ bilateral salpingo-oophorectomy, left kidney surgeries, right inguinal hernia repair, laminectomy for spinal infection (tuberculosis). ALLERGIES: Intravenous contrast, Morphine, Lasix (? the patient believes this may have been an adhesive sensitivity). MEDICATIONS ON ADMISSION: Labetalol 100 b.i.d.; Lipitor 40 q.d., Celebrex 200 q.d., Prilosec 20 b.i.d.; Tegretol 100 mg q.h.s., Oxycontin 30 mg b.i.d., Lisinopril 5 mg q.d., Ecotrin one tablet q.d., multivitamin one tablet q.d. Glucosamine chondroitin one pill q.d. HOSPITAL COURSE: The patient was admitted to the medical center on [**2172-11-30**] and taken to surgery where she had a four vessel bypass with left internal mammary artery being grafted to the left anterior descending and a saphenous vein graft to the right PL and also with a vein graft to the obtuse marginal and diagonal sequentially. The surgery was performed without complications and the patient thereafter transferred to the CSRU for continued management. The patient's stay in the CSRU was relatively uneventful. She did require frequent chest tube site dressing changes for some persistent drainage. Her hematocrit remained stable. It was suspected that one or more of the tubes may have been clogged with fluid, possibly escaping around the insertion site. The patient was transferred to the Cardiothoracic Surgery Floor on postoperative day #1 where she continued to have persistent drainage from her chest tube sites with frequent dressing changes required. Her hematocrit continued to be monitored and remained stable. The patient was without complaints. Late on postoperative day #1 the patient was noted to be bradycardiac to the 40s following a dose of Lopressor. The decision was made to discontinue the patient's beta blockers and the patient's pacing box was left in place and set to provide pacing if the patient's heartrate was to go below 50 permanently. The patient remained alert and oriented during the periods of bradycardia. After beta blocker the patient's sinus rhythm stabilized in the 80s to 90s. Physical therapy was initiated but it was found that the patient had some gait instability. Some of this was attributable to the patient's known history of spine disease. The patient was better able to ambulate with a brace which he used prior to admission. The remainder of the patient's hospitalization was uneventful. She did develop a rash on her back which was suspected to be an allergic reaction to the linen. The patient also had some erythema develop on both sides of her mouth where tape was used to secure her endotracheal tube during surgery. DISCHARGE CONDITION: Stable. DISCHARGE MEDICATIONS: 1. Motrin 400 mg p.o. q. 8 prn 2. Atorvastatin 40 mg p.o. q.d. 3. Carbamazepine 100 mg p.o. q.h.s. 4. Celebrex 200 mg p.o. q.d. 5. Oxycodone sustained release 30 mg p.o. q. 12 hours 6. Dulcolax 10 mg p.r. prn 7. Milk of magnesia 30 ml p.o. q.h.s. prn 8. Percocet one to two tablets p.o. q. 4-6 hours prn 9. Enteric coated Aspirin 325 mg p.o. q.d. 10. Ranitidine 150 mg p.o. b.i.d. 11. Colace 100 mg p.o. b.i.d. 12. Potassium chloride 20 mEq p.o. q. 12 hours times ten days 13. Lasix 20 mg p.o. q. 12 hours times ten days 14. Lisinopril 2.5 mg p.o. q.d. **The patient's blood pressure medications will need to be titrated. The patient's Lisinopril was restarted on the day of discharge. FO[**Last Name (STitle) 996**]P: The patient is to follow up with Dr. [**Last Name (Prefixes) **] four weeks following discharge. The patient is also to follow up with her primary care physician in one to two weeks following discharge. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Name8 (MD) 997**] MEDQUIST36 D: [**2172-12-5**] 08:51 T: [**2172-12-5**] 09:02 JOB#: [**Job Number 44974**] ICD9 Codes: 4280, 4271, 4019
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Medical Text: Admission Date: [**2125-9-13**] Discharge Date: [**2125-9-18**] Date of Birth: [**2055-6-5**] Sex: F Service: MEDICINE Allergies: Ampicillin / Aspirin Attending:[**Doctor First Name 2080**] Chief Complaint: Diarrhea Major Surgical or Invasive Procedure: None History of Present Illness: 70 y/o lady with h/o recurrent C.diff colitis since [**Month (only) 958**] of [**2124**] presenting worsening diarrhea. Patient has noticed increased amount of bowel movements > 10 per day in the last two days. She has noticed some bright blood and dark colored stool occasionally. She has a hard time explaining the quality and quantitiy of stool. Her appetite was very poor and did not eat in the last two days. Denies nausea/vomitting. She had mild abdominal pain prior to bowel movement yesterday. She felt very tired and decided to come to the ED. . In the ED, initial vs were: T97.4 P95 BP128/65 R20 O292% sat in RA. She spiked a temp to 102.4 approx 5 hours after presentation. Patient recieved 1 gram of tylenol and became afebrile. She initially recieved 1 L NS. Her SBP dropped to 80s (per verbal signout) and she was started on peripheral levophed and additional 2 L NS were given. Patient refused central line. She had 2 PIV (18G) placed in ED per verbal signout. CXR was concerning LLL PNA. Patient was also given 1 gram of IV vancomycin, 500 mg IV flagyl, 750 mg IV levofloxacin and 2 grams of IV calcium. . On the floor, patient was comfortable. . Review of sytems: Denies fevers at home, chills, night sweats, headache, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied arthralgias or myalgias, new weakness or numbness. Has chronic right shoulder weakness. Past Medical History: - Recurrent C Diff colitis beginning [**1-/2125**], last episode and hospitalization [**2125-8-1**] to [**2125-8-10**], confirmed colitis on CT and flex-sig without pseudomembranes and patient refused biopsy, was treated with a pulse and taper dose of vancomycin (completed on [**2125-9-2**]), Florastor [**Hospital1 **], and was started on rifaximin 400 mg [**Hospital1 **] on [**2125-9-3**]. - RUE DVT following PICC Placement in [**2125-7-20**], on coumadin - Anxiety - HTN - CAD s/p NSTEMI in the setting of demand ischemia in [**Month (only) 958**] of [**2124**] - s/p ORIF of R wrist in [**1-/2125**] - Anemia Social History: Usually lives alone and is able to do activities of daily living including driving herself but since her MI in [**Month (only) 958**] she has been afraid to leave the house and her son has been living with her to help with activities around the house. She has a neice who works in the [**Name (NI) 13042**] at [**Hospital1 18**]. Quit tobacco in [**2-5**] but smoked for 50 years [**12-1**] ppd before that. No alcohol or other drug use. Family History: One brother with kidney tumor, CHF, OA, obesity. Dad had DM. Physical Exam: Vitals: T:97.3 BP:101/44 P:84 R: 18 O2: 96% on 2LNC General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP 7cm Lungs: distant BS diffusely, no wheezes, rales, ronchi Heart: Regular rate and rhythm, normal S1 + S2, I/VI holosystolic murmur at left lower sternal border Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, no clubbing, cyanosis or edema Guaic negative in ED Pertinent Results: Admission Labs: [**2125-9-13**] 03:09PM GLUCOSE-109* UREA N-18 CREAT-0.8 SODIUM-134 POTASSIUM-4.5 CHLORIDE-106 TOTAL CO2-19* ANION GAP-14 [**2125-9-13**] 03:09PM ALT(SGPT)-29 AST(SGOT)-30 LD(LDH)-183 ALK PHOS-170* TOT BILI-0.4 [**2125-9-13**] 03:09PM GGT-153* [**2125-9-13**] 08:41AM GLUCOSE-109* UREA N-20 CREAT-0.9 SODIUM-135 POTASSIUM-5.0 CHLORIDE-106 TOTAL CO2-22 ANION GAP-12 [**2125-9-13**] 08:41AM ALBUMIN-3.1* CALCIUM-7.6* PHOSPHATE-3.5 MAGNESIUM-1.6 [**2125-9-13**] 08:41AM WBC-4.5# RBC-3.04* HGB-9.2* HCT-28.2* MCV-93 MCH-30.1 MCHC-32.4 RDW-14.8 [**2125-9-13**] 04:35AM LACTATE-1.4 K+-5.0 [**2125-9-12**] 11:08PM CALCIUM-9.6 PHOSPHATE-3.4 MAGNESIUM-1.8 [**2125-9-12**] 11:08PM NEUTS-84* BANDS-9* LYMPHS-3* MONOS-3 EOS-0 BASOS-0 ATYPS-0 METAS-1* MYELOS-0 . CT Abd/Pelvis: IMPRESSIONS: 1. Wall thickening and stranding along the colon from the splenic flexure through the sigmoid colon, similar to that seen on [**2125-8-1**]. Findings again represent nonspecific colitis, possibly ischemic, infectious or inflammatory in etiology. No free air, definite abscess, pneumatosis, or portal gas seen. 2. Left kidney with hyperdense cyst and other subcentimeter hypodensities. 3. Atherosclerotic disease. . Stool cx: /15/09 1:55 am STOOL CONSISTENCY: SOFT **FINAL REPORT [**2125-9-17**]** FECAL CULTURE (Final [**2125-9-14**]): NO SALMONELLA OR SHIGELLA FOUND. CAMPYLOBACTER CULTURE (Final [**2125-9-15**]): NO CAMPYLOBACTER FOUND. CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2125-9-13**]): REPORTED BY PHONE TO [**Doctor Last Name **] KITCHEN ON [**2125-9-13**] AT 1:10PM. CLOSTRIDIUM DIFFICILE. FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA. (Reference Range-Negative). A positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). Brief Hospital Course: C. difficile colitis/Sepsis: Given history of recurrent C. difficile colitis, diarrhea, and sepsis, etiology was presumed to be CDAD, confirmed on stool cx. She was started on PO vanco, IV flagyl empirically. CT scan demonstrated colitis. Patient was admitted to the ICU for aggressive IVF, though patient refused central line. She was briefly on peripheral levophed. ID and GI were consulted. After adequate resuscitation, she stabilized clinically and was transferred to the medical floor. Her diarrhea improved, though her flagyl was stopped after she developed parasthesias. Reviewing the record, it appeared that she stopped her previous taper early. Therefore, a more aggressive taper was pursued, deferring possible fecal transplantation to the outpatient setting, as well as rifamixin. . ARF: Likely pre-renal. Resolved with IVF resusitation . h/o DVT: Coumadin was reversed initially. However, once she stabilized it was restarted with lovenox bridge. She will need close follow up to ensure her coumadin returns to therapeutic range 2-3 and was dicharged on warfarin 4mg daily and lovenox 40mg SC q12 to bridge . Plexopathy: Continued coumadin . HTN, benign: will restart home antihypertensives on discharge . Chronic diastolic CHF: was euvolemic on exam. Continued home medications Medications on Admission: Citalopram 40 mg daily Gabapentin 100 mg TID Alprazolam 1 mg TID prn Lisinopril 10 mg daily Metoprolol Tartrate 12.5 mg [**Hospital1 **] Pantoprazole 40 mg daily Oxycodone 5 mg q6h prn pain Trazodone 50 mg qhs prn Vitamin D-3 800 units daily Calcium Carbonate 500 mg (1,250 mg) 2tabs daily Multivitamin daily Lidocaine HCl 5 % Ointment topical TID prn rectal pain Warfarin 6 mg for the first day follwed by 4 mg in the next two days Discharge Medications: 1. Vancomycin 125 mg Capsule Sig: One (1) Capsule PO as directed: 125mg 4 times per day through [**2125-9-26**], 14 days, then 125mg 2 times per day through [**2125-10-3**], 7 days, then 125mg 1 time per day through [**2125-10-10**], 7 days, then 125mg every other day through [**2125-10-18**], 8 days, then 125mg every 3rd day through [**2125-11-2**], 15 days. Disp:*90 Capsule(s)* Refills:*0* 2. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable PO DAILY (Daily). 7. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 9. Alprazolam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 10. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 11. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO Once Daily at 4 PM: please have INR checked 2 days after discharge and adjust according to your PCP. [**Name10 (NameIs) 18303**] INR [**1-2**]. 12. Outpatient [**Name (NI) **] Work PT/INR on [**2125-9-20**], [**2125-9-22**]. to fax to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20561**] Phone: [**Telephone/Fax (1) 26190**] Fax: [**Telephone/Fax (1) 81080**] 13. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) injection Subcutaneous Q12 HR (): subcutaneously until INR 2. Disp:*10 injection* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: # C-diff colitis, protracted # Sepsis due to c-diff colitis # acute exacerbation of diastolic heart failure # Acute renal failure # Right brachial plexopathy # Peripheral neuropathy, new; likely d/t Flagyl # Anticoagulation on coumadin Discharge Condition: stable, diarrhea, improved Discharge Instructions: You were admitted with recurrent diarrhea due to your c-diff infection. Please take your medications as prescribed. It will be very important to complete the full course of vancomycin, even if you start feeling better. You will be tapered off this medication. Please seek medical attention if you develop worsened diarrhea, abdominal pain, blood in your stools, fevers, chills, or any other concerns. Also, your coumadin is not in the desired range. You will need to take Lovenox injections until your coumadin level is therapeutic. . New medication: Vancomycin, oral: 125mg 4 times per day through [**2125-9-26**], 14 days, then 125mg 2 times per day through [**2125-10-3**], 7 days, then 125mg 1 time per day through [**2125-10-10**], 7 days, then 125mg every other day through [**2125-10-18**], 8 days, then 125mg every 3rd day through [**2125-11-2**], 15 days . Lovenox 40mg subcutaneously twice daily until INR is 2. . Appointments have been made for you. Please return to the hospital if you experience fevers/chills, worsening abdominal pain, lightheadedness, or any other symptoms. Followup Instructions: Appointment #1 MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20561**] Specialty: Internal Medicine / PCP Date and time: Monday, [**10-1**], 1:20pm Location: One Pearl St, [**Hospital1 1474**] MA Phone number: [**Telephone/Fax (1) 26190**] Special instructions if applicable: . Appointment #2 MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2643**] Specialty: Gastroenterology Date and time: Monday, [**10-15**], 11am Location: [**Last Name (NamePattern1) **], [**Hospital Ward Name **] Buidling [**Location (un) **], [**Location (un) 86**] Phone number: [**Telephone/Fax (1) 463**] ICD9 Codes: 0389, 5849, 412, 496, 2767, 4280
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Medical Text: Admission Date: [**2164-12-20**] Discharge Date: [**2164-12-25**] Date of Birth: [**2084-10-17**] Sex: F Service: CARDIOTHORACIC Allergies: Protamine Attending:[**First Name3 (LF) 1267**] Chief Complaint: DOE/CHF Major Surgical or Invasive Procedure: [**2164-12-20**] - Aortic Valve Replacement (19mm St. [**Male First Name (un) 923**] Mechanical Valve) History of Present Illness: The patient is an 80-year-old woman with diabetes and renal failure who presented with recurrent congestive heart failure. She was noted to have severe aortic stenosis. Catheterization showed normal coronary arteries. It was elected to proceed with aortic valve replacement with mechanical valve. Past Medical History: 1)History of GIB of unknown cause; numerous diverticula on C-scope 2) L colectomy with transverse colostomy for GIB (D/C [**11-12**]) 3) Diastolic CHF (EF 65-75%) 4) s/p trach placement after prolonged intubation in ICU (at time of colectomy) 5) Severe AS ([**Location (un) 109**] 0.7cm2, pk gradient 91mmHg, mean gradient 55mmHg on [**6-13**] TTE 6) HTN 7) Elevated cholesterol 8) Diabetes type 2 9) CKD - baseline creat 2.5-3 10) Bilat total knee replacment 11) Multiple skin lesions removed by general and plastic surgery 12) Hypothyroid Social History: Lives at home with husband, [**Name (NI) **] 3 sons and 1 daughter. Is a non-smoker, no alcohol use, no history of illicit drug use. Retired, former manager. No h/o IVDU. Family History: No colon CA, otherwise unremarkable. Has 3 sons and 1 dtr. Physical Exam: 63 sr 18 150/61 68" 222lbs GEN: NAD SKIN: Unremarkable HEENT: Unremarkable NECK: Supple, FROM LUNGS: CTA HEART: RRR, Loud SEM, NlS1-S2 ABD: Soft, NT/ND, NABS EXT: 2+ LE edema, Pulses palp except nonpalp DP. NEURO: Nonfocal, unsteady gait Pertinent Results: [**2164-12-24**] 08:15AM BLOOD WBC-4.5 RBC-3.25* Hgb-10.1* Hct-31.3* MCV-96 MCH-30.9 MCHC-32.1 RDW-16.3* Plt Ct-183 [**2164-12-20**] 11:06AM BLOOD WBC-9.2# RBC-3.11*# Hgb-9.8*# Hct-29.3*# MCV-95 MCH-31.4 MCHC-33.2 RDW-17.1* Plt Ct-177 [**2164-12-20**] 11:06AM BLOOD Neuts-62.2 Lymphs-36.5 Monos-0.5* Eos-0.7 Baso-0.1 [**2164-12-25**] 05:42AM BLOOD PT-16.1* PTT-70.5* INR(PT)-1.4* [**2164-12-24**] 08:15AM BLOOD PT-13.9* PTT-35.5* INR(PT)-1.2* [**2164-12-23**] 01:10PM BLOOD PT-12.9 INR(PT)-1.1 [**2164-12-22**] 06:38AM BLOOD PT-13.7* PTT-30.9 INR(PT)-1.2* [**2164-12-20**] 12:12PM BLOOD PT-14.8* PTT-47.3* INR(PT)-1.3* [**2164-12-20**] 11:06AM BLOOD PT-15.7* PTT-48.0* INR(PT)-1.4* [**2164-12-24**] 08:15AM BLOOD Glucose-109* UreaN-45* Creat-5.0*# Na-137 K-3.9 Cl-101 HCO3-27 AnGap-13 [**2164-12-20**] 12:12PM BLOOD UreaN-21* Creat-2.9* Cl-105 HCO3-28 [**2164-12-24**] 08:15AM BLOOD Calcium-8.5 Phos-3.5 Mg-2.5 [**2164-12-24**] 09:00AM BLOOD PTH-290* Cardiology Report ECG Study Date of [**2164-12-24**] 7:58:44 AM Sinus rhythm. Compared to previous tracing of [**2164-12-20**] no diagnostic change. Read by: [**Last Name (LF) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 975**] Intervals Axes Rate PR QRS QT/QTc P QRS T 79 124 104 422/455 57 20 71 RADIOLOGY Final Report CHEST (PORTABLE AP) [**2164-12-24**] 2:59 PM CHEST (PORTABLE AP) Reason: evaluate effusion - in HD please check with RN that pt on fl [**Hospital 93**] MEDICAL CONDITION: 80 year old woman with s/p avr REASON FOR THIS EXAMINATION: evaluate effusion - in HD please check with RN that pt on floor INDICATION: Followup. FINDINGS: Comparison to [**2164-12-22**]. The right-sided sheath in the jugular vein has been removed. All other invasive and monitoring devices are in unchanged position. The effusions are small and limited to the very area of the pleural sinuses. In unchanged manner, the silhouette of the heart is enlarged. Slight aortic calcification. Subtle signs of fluid overload. IMPRESSION: Cardiomegaly with signs of fluid overload, unchanged extent of bilateral pleural effusions. DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**] DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**] Approved: MON [**2164-12-24**] 5:14 PM RADIOLOGY Preliminary Report [**Numeric Identifier **] PICC W/O PORT [**2164-12-24**] 12:01 PM Reason: no IV access [**Hospital 93**] MEDICAL CONDITION: 80 year old woman with s/p AVR w/ chronic renal failure, on HD REASON FOR THIS EXAMINATION: no IV access PICC LINE PLACEMENT INDICATION: IV access needed for antibiotics. The procedure was explained to the patient. A timeout was performed. RADIOLOGISTS: Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 4686**] performed the procedure. Dr. [**Last Name (STitle) 4686**], the Attending Radiologist, was present and supervised the entire procedure. TECHNIQUE: Using sterile technique and local anesthesia, the right brachial vein was punctured under direct ultrasound guidance using a micropuncture set. Hard copies of ultrasound images were obtained before and immediately after establishing intravenous access. A peel-away sheath was then placed over a guidewire and a 5 French double-lumen PICC line measuring 35 cm in length was then placed through the peel-away sheath with its tip positioned in the SVC under fluoroscopic guidance. Position of the catheter was confirmed by a fluoroscopic spot film of the chest. The peel-away sheath and guidewire were then removed. The catheter was secured to the skin, flushed, and a sterile dressing applied. The patient tolerated the procedure well. There were no immediate complications. IMPRESSION: Uncomplicated ultrasound and fluoroscopically guided 5 French double-lumen PICC line placement via the right brachial venous approach. Final internal length is 35 cm, with the tip positioned in SVC. The line is ready to use. DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3904**] DR. [**First Name (STitle) **] [**Name (STitle) **] PreliminaryApproved: MON [**2164-12-24**] 4:48 PM [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname 2995**] [**Hospital1 18**] [**Numeric Identifier 97470**] (Complete) Done [**2164-12-20**] at 10:14:31 AM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) 1112**] W. [**Hospital Unit Name 927**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2084-10-17**] Age (years): 80 F Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: Abnormal ECG. Aortic valve disease. Congestive heart failure. Dizziness. Hypertension. Left ventricular function. Pulmonary hypertension. ICD-9 Codes: 428.0, 402.90, 786.05, 440.0, 424.1 Test Information Date/Time: [**2164-12-20**] at 10:14 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2007AW2-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Inferolateral Thickness: *1.5 cm 0.6 - 1.1 cm Left Ventricle - Ejection Fraction: 45% to 55% >= 55% Aorta - Ascending: 3.0 cm <= 3.4 cm Aortic Valve - Peak Velocity: *3.0 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *40 mm Hg < 20 mm Hg Aortic Valve - Valve Area: *0.8 cm2 >= 3.0 cm2 Findings LEFT ATRIUM: Mild LA enlargement. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or color Doppler. LEFT VENTRICLE: Moderate symmetric LVH. Normal LV cavity size. Mildly depressed LVEF. RIGHT VENTRICLE: RV hypertrophy. Mildly dilated RV cavity. Borderline normal RV systolic function. AORTA: Normal aortic diameter at the sinus level. Focal calcifications in aortic root. Normal ascending aorta diameter. Simple atheroma in ascending aorta. Normal aortic arch diameter. Simple atheroma in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Moderately thickened aortic valve leaflets. No masses or vegetations on aortic valve. Moderate-severe AS (area 0.8-1.0cm2). Trace AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. Moderate mitral annular calcification. Calcified tips of papillary muscles. Mild (1+) MR. TRICUSPID VALVE: Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. PERICARDIUM: Trivial/physiologic 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 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. 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 atrial septal defect is seen by 2D or color Doppler. 2. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is mildly depressed (LVEF= 45-50%). 3. The right ventricular free wall is hypertrophied. The right ventricular cavity is mildly dilated. Right ventricular systolic function is borderline normal. 4. There are simple atheroma in the ascending aorta. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. 5. There are three aortic valve leaflets. The aortic valve leaflets are moderately thickened. No masses or vegetations are seen on the aortic valve. There is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). Trace aortic regurgitation is seen. The annulus is heavilyb calcified and measures 19 mm. 6. The mitral valve leaflets are moderately thickened. Mild (1+) mitral regurgitation is seen. 7. There is a trivial/physiologic pericardial effusion. POST-CPB: On infusions of epinephrine and levophed. Well-seated mechanical valve in the aortic position. No AI. AS gradient 20 peak, 13 mean at Cardiac Output of 7 L/min. Preserved LV systolic function on inotropic support. Mild inferior hypokinesis. LVEF=50%. Flow seen in LMCA and RCA. Protamine reaction with hypotension and CCO=8-9 L/min. Rx'd epi boluses. LV SAX shows underfilled LV with good systolic function. Aorta intact post decannulation. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2164-12-20**] 16:50 Brief Hospital Course: Ms. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2164-12-20**] for surgical management of her aortic valve disease. She was taken directly to the operating room where she underwent an aortic valve replacement using a 19mm St. [**Male First Name (un) 923**] Mechanical valve. Please see operative note for details. Postoperatively she was taken to the intensive care unit for monitoring. On postoperative day one, she underwent dialysis to remove volume. On postoperative day two, she awoke neurologically intact and was extubated. Coumadin was started for anticoagulation. She was later transferred to the step down unit for further recovery. The physical therapy service was consulted for assistance with her postoperative strength and mobility. The renal service continued to follow her and she continued with hemodialysis as prior to surgery. She was started on heparin while her INR was subtherapeutic. The heparin should continue until her INR is 2. She is due for HD Wednesday [**12-26**]. Medications on Admission: lasix 100", fluticasone 50', diovan 160", levothyroxine 75', hydrazaline 50"', Labetolol 400", Procrit [**Numeric Identifier 961**] q mon, protonix 40', simvastatin 20', iron 325' 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. Heparin (Porcine) in D5W 100 unit/mL Parenteral Solution Sig: 1000 (1000) units/hr Intravenous ASDIR (AS DIRECTED): goal PTT 60-80 do NOT bolus discontinue when INR > 2.0 . 4. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) Injection QMOWEFR (Monday -Wednesday-Friday). 5. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 6. PICC line PICC line care per protocol 7. Hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 11. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 12. Warfarin 1 mg Tablet Sig: goal INR 2.5-3.0 Tablets PO DAILY (Daily) as needed for mech AVR: please dose based on INR result - goal INR 2.5-3.0 with PT/INR checked daily until off heparin and then mon/wed/fri for continued dosing . She has received 3mg coumadin [**12-22**] and [**12-23**] 5mg coumadin [**12-24**] and [**12-25**] Discharge Disposition: Extended Care Facility: [**Hospital3 672**] Hospital/Radius Discharge Diagnosis: Aortic stenosis s/p avr s/p Aortic valvuloplasty CHF (Diastolic dysfunction LVEF 65% Diabetes mellitus CRI baseline creatinine 3.0 Hypothyroid GIB Obesity s/p vein stripping 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. 6) No driving for 1 month. 7) Call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**] Follow-up with Dr. [**First Name (STitle) 437**] after discharge from rehab Follow-up with PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1266**] after discharge from rehab [**Telephone/Fax (1) 608**] Follow up with Dr [**Last Name (STitle) 4883**] [**Telephone/Fax (1) 20422**] Please call all providers for appointments. Scheduled Appointments: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4450**], M.D. Phone:[**Telephone/Fax (1) 4451**] Date/Time:[**2165-3-20**] 10:40 Dialysis - please refer back to [**Location (un) **] [**Location (un) **] when dc from rehab Provider: [**Name10 (NameIs) 1344**] [**Last Name (NamePattern4) 3125**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2165-1-3**] 9:20 Completed by:[**2164-12-25**] ICD9 Codes: 4241, 5856, 4280, 2720, 2449, 4168
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6714 }
Medical Text: Admission Date: [**2163-3-3**] Discharge Date: [**2163-3-12**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 465**] Chief Complaint: fever, altered metal status Major Surgical or Invasive Procedure: Left Internal Jugular Central Line Placement History of Present Illness: [**Age over 90 **] y/o M with PMH sig for dementia, bladder CA, h/o chronic C diff diarrhea, who presents from NH after being found to have altered mental status. History obtained through family and his personal nurse. The patient currently a resident at Heathwood NH and his recent history begins one day prior to admission when he was found to have pulled out his chronic indwelling foley catheter. Through the remainder of the day, he had progressive deterioration in his mental status. In the evening, the pt was noted to have episodes of emesis and loose stools. His temperature was checked and was found to be 101.1. In addition, patient noted to have hematuria. Per ED notes, pt is normally high functioning, but has had significant change in mental status over the course of past 24-48 hours. . In ED, VS were 101.8, hr of 70, BP 91/30, was 100% on non-rebreather, lactate 9.4 and WBC 31. Pt was placed on sepsis protocol, sepsis CVL placed, given levo/vanc/flagyl, decadron and albumin. Patient received 11 L of fluid, but only had 100 cc of urine output. U/A showed large LE, 21-50 wbc, >50 rbc. Pt was initially placed on levophed, but SVO2 remained 50-58%. Pt then changed to dobutamine, with increase of SVO2 to >70%, dobutamine then titrated to 1.3 mcg.. Upon arrival to MICU, patient's lactate had improved to 3.5, temp resolved to 98.9. Pt was still on 1.3 of dobutamine w/ SVO2 in 70's. . MICU COURSE: Pt was admitted to unit with improved lactate and SvO2 of 71%. The dobutamine was weaned off, but his CVP was [**5-12**] so another 500cc of fluids were administered. His levaquin/vanc/flagyl were continued, but around midnight his blood cultures came back positive for gram negative rods so his coverage was broadened to ceftaz to better cover for pseudomonas/klebsiella. . Unable to give meaningfull/reliable history. Per son-in-law, last week he was much more alert and eating fine. Secretions and difficulty swallowing, as well Past Medical History: 1) Bladder CA , last cystoscopy [**6-8**] with no evidence of recurrence 2) Atonic bladder 3) s/p TURP 4) Chronic C diff since [**6-8**] treated with PO Flagyl and Vancomycin intermittently since [**6-8**] 5) ? of history of DVT vs. thrombophlebitis, recently on coumadin Social History: Retired plastic surgeon. Family History: Noncontributory Physical Exam: Gen: awake, responsive but oriented only to person, not place or year. VS: T 97 BP: 133/100 HR 65 RR 25 Sat 100% on RA HEENT: PERRL, sclera anicteric Neck: no JVD, no carotid bruits, no LAD Chest: Upper airway secretions audible, coughing, rhonchi b/l anteriorly, Palpable lymph node in right axilla. Heart: RRR. Distant heart sounds, no M/G/R Abd: NABS, soft, NT, ND, no palpable masses Ext: No edema. DP pulses faint B/L. Neuro: mild tremor of upper ext. [**4-8**] distal muscle strenth in LE. 4/5 strength with handgrips. Pertinent Results: [**2163-3-3**] 9:40 am BLOOD CULTURE LINE OR SITE NOT NOTED. **FINAL REPORT [**2163-3-7**]** AEROBIC BOTTLE (Final [**2163-3-6**]): ESCHERICHIA COLI. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 106616**] ([**2163-3-3**]). ANAEROBIC BOTTLE (Final [**2163-3-7**]): ESCHERICHIA COLI. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 106616**] ([**2163-3-3**]). PROTEUS MIRABILIS. FINAL SENSITIVITIES. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PROTEUS MIRABILIS | AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- 8 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ 4 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ =>16 R LEVOFLOXACIN---------- =>8 R MEROPENEM-------------<=0.25 S PIPERACILLIN---------- 32 I PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ 8 I TRIMETHOPRIM/SULFA---- =>16 R [**2163-3-3**] 11:50 am BLOOD CULTURE VENIPUNCTURE #2. **FINAL REPORT [**2163-3-6**]** AEROBIC BOTTLE (Final [**2163-3-6**]): ESCHERICHIA COLI. IDENTIFICATION AND SENSITIVITIES PERFORMED FROM ANAEROBIC BOTTLE. ANAEROBIC BOTTLE (Final [**2163-3-5**]): [**2163-3-4**] REPORTED BY PHONE TO [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 106617**] AT 1:00 AM. ESCHERICHIA COLI. FINAL SENSITIVITIES. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- =>32 R CEFAZOLIN------------- 16 I CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ 4 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S IMIPENEM-------------- <=1 S LEVOFLOXACIN----------<=0.25 S MEROPENEM-------------<=0.25 S PIPERACILLIN---------- =>128 R PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- =>16 R [**2163-3-5**] 3:44 pm URINE **FINAL REPORT [**2163-3-8**]** URINE CULTURE (Final [**2163-3-8**]): ENTEROCOCCUS SP.. >100,000 ORGANISMS/ML.. ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. 2ND MORPHOLOGY. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | ENTEROCOCCUS SP. | | AMPICILLIN------------ =>32 R <=2 S LINEZOLID------------- 2 S NITROFURANTOIN-------- 32 S <=16 S VANCOMYCIN------------ =>32 R <=1 S [**2163-3-6**] 9:57 am URINE **FINAL REPORT [**2163-3-9**]** URINE CULTURE (Final [**2163-3-9**]): ENTEROCOCCUS SP.. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ =>32 R LINEZOLID------------- 2 S NITROFURANTOIN-------- <=16 S VANCOMYCIN------------ =>32 R [**2163-3-6**] 7:14 pm STOOL CONSISTENCY: LOOSE Source: Stool. **FINAL REPORT [**2163-3-8**]** FECAL CULTURE (Final [**2163-3-8**]): NO SALMONELLA OR SHIGELLA FOUND. CAMPYLOBACTER CULTURE (Final [**2163-3-8**]): NO CAMPYLOBACTER FOUND. CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2163-3-7**]): FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA. Reference Range: Negative. [**2163-3-9**] 12:07 am STOOL CONSISTENCY: LOOSE Source: Stool. FECAL CULTURE (Pending): CAMPYLOBACTER CULTURE (Final [**2163-3-11**]): NO CAMPYLOBACTER FOUND. CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2163-3-9**]): FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA. Reference Range: Negative. Brief Hospital Course: [**Age over 90 **] y/o M w/ history of transitional cell ca, chronic c.diff, urinary retention with chronic indwelling catheter, had Urosepsis from E. Coli/Proteus/VRE likely from UTI. The pt's status continued to decline despite treatment of all of his medical problems. A family meeting was held, and, based on his previous expressed wishes prior to illness and his families desires to avoid further suffering with a baseline poor quality of life, he was made comfort measures only and expired on [**2163-3-12**]. His isues during his stay were as follows: . 1. E. Coli/Proteus Sepsis: Treated originally with Levo based on culture and sensitivities showing levo sensitive E. Coli. Changed to Ceftriaxone to cover Proteus and E coli. . 1b. VRE in UTI: Grew out of UCx. Resistant to ampicillin/vancomycin. Treated with Linezolid (started [**2163-3-8**]). Was on VRE precautions. . 2. h/o C.Diff: Chronic C. Diff carrier. He was on PO vanco and flagyl at the nursing home. At [**Hospital1 18**], C. diff toxin was negative x2. He was kept on C. Diff contact precautions. . 3. ARF: He had a creatinine of 3.8 on admission due to pre renal azotemia from hypovolemia in the setting of sepsis. He has a h/o BPH w/ TURP, but Renal U/S showed no evidence of hydronephrosis or chronic obstruction. He has an indwelling foley catether at baseline. He responded well to aggressive fluid hydration. . 4. BPH: H/o in past. Likely reason for his chronic foley in addition to bladder atonia/h/o turp/bladder Ca. We held his flomax, proscar as he had a foley in. . 5. Dementia: He has been off his baseline for 5 years. We held his outpatient regimen of aricept as he was unable to take PO's. . 6. Non Gap Hypercholeremia Acidosis: Likely due to aggressive normal saline hydration. He had hypernatremia which resolved. . 7. Leukocytosis: Improved from 31 on admission to 11. Likely due to UTI/Sepsis. Stool studies were negative. . 8. Anemia: Likely due to bone marrow suppresion from sepsis. Baseline Hct of 39 on admission. Last Hct 25. . 9. Thrombocytopenia: Likely Marrow supression from sepsis. Baseline Plt count of 165. HIT Ab negative. Returned to baseline. . 10. Elevated INR: Likely due to poor nutrition and antibiotics. Given 1 mg SQ vit K with improvenment. . 11. LFT elevation: Likely due to sepsis. Hep B neg, Hep C neg, Hep A Ab positive (indicating past exposure to Hep A). Resolved. . 12. F/E/N: NPO except medications given secretions. Failed Speech and swallow eval. Unable to place Fluro guided post pyloric NG tube. Patient would not want PEG or long term feeding. . Code: DNR/DNI . Communication: [**First Name4 (NamePattern1) 6480**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 106618**] (h), [**Telephone/Fax (1) 106619**] (c). Medications on Admission: Vitamin c 1 tab [**Hospital1 **] ferrous sulfate 1 tab aricept 10mg po qd prilosec 20mg qd flomax 0.4 mg po qd proscar 5mg po qd vancomycin 125mg po bid (x2wks from [**2-16**]) lactobacillus 1 pkt [**Hospital1 **] remeron 22.5mg hs coumadin 6.5mg po qd (d/c [**2-13**]) fleets enema PRN tylenol prn dulcolax prn cholestyramine foley cath check twice qShift Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain for 1 weeks. Disp:*56 Tablet(s)* Refills:*0* 2. Scopolamine Base 1.5 mg Patch 72HR Sig: Two (2) Patch 72HR Transdermal every seventy-two (72) hours for 1 months. Disp:*20 Patch 72HR(s)* Refills:*0* 3. Morphine Concentrate 20 mg/mL Solution Sig: 5-10 mg PO Q1H (every hour) as needed for discomfort, RR> 20. Disp:*QS mg* Refills:*0* 4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for discomfort, RR>20. Disp:*180 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Discharge Diagnosis: E. Coli and Proteus Sepsis Vancomycin Resistant Enterococcal Urinary Tract infection Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**] Completed by:[**2163-3-29**] ICD9 Codes: 5849, 5990, 2762, 2760, 2875, 2768
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6715 }
Medical Text: Admission Date: [**2109-5-24**] Discharge Date: [**2109-6-4**] Date of Birth: [**2044-4-23**] Sex: F Service: MEDICINE Allergies: Codeine / Oxycodone Attending:[**First Name3 (LF) 759**] Chief Complaint: Weakness Major Surgical or Invasive Procedure: CVVH with line placed [**2109-5-25**], subsequently removed [**2109-5-28**] with placement of temporary HD line for initiation of HD A line placed [**2109-5-25**], subsequently removed Temporary HD line removed for tunnelled HD line [**2109-6-3**] History of Present Illness: 65 y/o F with h/o CABG and DM2 presented with fever, malaise, cough since Monday and severe weakness today. Per husband she has had chronic DOE with inability to walk for long periods of time without resting. She has been seen by a cardiologist for this but not a pulmonologist. On Monday she started having a cough productive of green sputum without blood. She also had shaking chills and fevers. Yesterday she started having diffuse muscle aches and profound weakness as well as diarrhea. Today she attempted to get out of bed and fell and could not get up so her husband called 911. She was brought to the ER at NWH where she told them she also had not urinated since thursday morning ([**2109-5-23**]). At NWH she appeared mottled and lips were blue. O2 Sat was 93% on 2L NC. Because she appeared blue she was placed on NRB. Also originally SBP 140sand reportedly was borderline hypotensive her lowest systolic pressure being 105, which responded to fluids (2L NS). She was also incontinent of stool and had numerous foul smelling loose BMs. A CXR showed "right paratracheal soft tissue density" and a repeat CXR showed persistent right soft tissue density and right apical consolidation. Since she had a markedly elevated white cell count 20 so she was treated with CTX/Vanc/Flagyl/Azithro. Labs also revealed acute renal failure, lactate of 6.6 and a markedly elevated AST. There were no unit beds there and so she was thransfered here. . In the ED, initial vs were: T:100.6 HR:106 BP:96/74 RR:22 O2Sat:88RA. Spiked temp to 102.8, RR was 40. Placed on NRB and sats up to 100%. On exam guaiac pos brown stool from below. ED got history that patient had been taking two tabs apap 2Xdaily for the last week and thought she may have APAP OD so started NAC per recs from ED physician who is [**Name Initial (PRE) **] tox attending. APAP level was negative. Received 2.5L in the ED and then noted to be tachypneic and rhonchorus so was placed on CPAP. VS prior to transfer to floor: Hr 113 RR 35 Sat 98 BP 128/74 (stable in ED) . On the floor, patient was initially tachypneic to 40 with tidal volumes of 110 on Bipap 10/5. She appeared uncomfortable but was able to talk to us. She denied chest pain but endorsed severe muscle aches, worse in her legs that had started yesterday. She also endorsed severe muscle weakness causing her to crawl on the floor to get to the bathroom and making it hard for her to get out of bed. She denied urinary symptoms. Endorsed diarrhea X 1 day. Also endorsed cough productive of green sputum X 1 week. no hemoptysis. . Review of systems: (+) Per HPI (-) Denies headache, sinus tenderness, rhinorrhea or congestion. Denies chest pain, chest pressure, palpitations. Denies nausea, vomiting, constipation, abdominal pain. Denies dysuria. Denies rashes or skin changes. Past Medical History: Diabetes Type 2 CABG [**2095**] (triple bypass) TTP 30 years ago breast cancer s/p lumpectomy and XRT on left Social History: Works as a secretary for a senior living center. Lives at home with husband - [**Name (NI) 1139**]: Quit 25 years ago - Alcohol: Occasional - Illicits: None Family History: Daughter healthy Physical Exam: Vitals: T: 101.2 BP:111/71 P:117 R: 30 O2:90% on Shovel mask General: Alert, oriented, tachypneic HEENT: Sclera anicteric, dry MM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Crackles at bases with occasional expiratory wheeze CV: Tachycardic and regular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: erythematous, non-tender 6cm nodule on right shoulder. No other rashes. Neuro: A+OX 3 but repeats herself and per husband not all history is entirely accurate Pertinent Results: Admission labs: [**2109-5-24**] 06:10PM BLOOD WBC-20.0* RBC-4.25 Hgb-14.1 Hct-42.8 MCV-101* MCH-33.2* MCHC-33.0 RDW-16.6* Plt Ct-227 [**2109-5-24**] 06:10PM BLOOD Neuts-67 Bands-24* Lymphs-5* Monos-3 Eos-1 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2109-5-24**] 06:10PM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-NORMAL Macrocy-2+ Microcy-NORMAL Polychr-NORMAL [**2109-5-24**] 06:10PM BLOOD PT-15.0* PTT-26.7 INR(PT)-1.3* [**2109-5-24**] 06:10PM BLOOD Plt Ct-227 [**2109-5-24**] 06:10PM BLOOD Glucose-86 UreaN-42* Creat-2.3* Na-138 K-4.0 Cl-108 HCO3-13* AnGap-21* [**2109-5-24**] 06:10PM BLOOD ALT-741* AST-3533* LD(LDH)-4185* CK(CPK)-[**Numeric Identifier 86085**]* AlkPhos-148* TotBili-2.3* [**2109-5-24**] 06:10PM BLOOD Lipase-14 [**2109-5-24**] 06:10PM BLOOD cTropnT-1.46* [**2109-5-24**] 06:10PM BLOOD Albumin-2.6* UricAcd-5.9* [**2109-5-24**] 10:05PM BLOOD Calcium-6.7* Phos-6.1* Mg-2.1 [**2109-5-24**] 10:05PM BLOOD TSH-1.5 [**2109-5-24**] 06:10PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2109-5-24**] 06:16PM BLOOD Type-ART Temp-39.3 FiO2-100 pO2-113 pCO2-31* pH-7.33 calTCO2-17* Base XS--8 AADO2-565 REQ O2-94 Intubat-NOT INTUBA Comment-NRB [**2109-5-24**] 06:16PM BLOOD Glucose-87 Lactate-2.6* Na-135 K-3.4* Cl-108 [**2109-5-26**] 02:50PM BLOOD O2 Sat-86 [**2109-5-24**] 06:16PM BLOOD freeCa-0.98* . . CXR ([**5-24**]): 1. Thickening of the right paratracheal stripe, can represent mass or vascular structures. This can be further evaluated by CT. 2. No evidence of pneumonia or overt pulmonary edema. . CXR ([**5-24**]): 1. Widening of the upper right mediastinal contour, incompletely characterized, and requiring a dedicated chest CT for more complete assessment when the patient's condition allows. 2. Fluctuating right upper lobe opacity is possibly due to aspiration or atelectasis. 3. Small right effusion. . CXR ([**5-25**]): Previously described abnormality in right mediastinal contour is unchanged and could potentially represent lymphadenopathy. Slight worsening of opacities in right upper lobe concerning for pneumonia. New interstitial opacities likely reflect interstitial edema. Unchanged small right effusion. . CXR ([**5-29**]): Multifocal pneumonia has worsened and mild pulmonary edema has developed since [**5-27**]. Moderate cardiomegaly increased. Pleural effusions are small, if any. The previous right upper paratracheal fullness is no longer evident. I wonder if this patient has had a gastric pull-up or has an otherwise normal esophagus to account for the change over such a short interval. Alternatively, a mediastinal abscess could have drained internally. . TTE ([**2109-5-25**]): Suboptimal image quality.The left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. 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 (although inferior and infero-lateral severe hypokinesis is suggested). Overall left ventricular systolic function is probably mildly depressed (LVEF= 40-45 %). The right ventricular cavity is mildly dilated with depressed free wall contractility. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets are moderately thickened. There is mild aortic valve stenosis (valve area 1.2-1.9cm2). No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mitral regurgitation is present but cannot be quantified. The tricuspid valve leaflets are mildly thickened. Tricuspid regurgitation is present but cannot be quantified. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. . Abdominal US ([**2109-5-25**]): 1. Limited evaluation. Increased hepatic echogencity is suggested, which is non-specific but may be due to fatty infiltration. However, more serious forms of liver disease such as significant cirrhosis/fibrosis cannot be excluded on this study. 2. Patent portal vein with appropriate direction of flow. 3. Normal-appearing kidneys bilaterally with no evidence of hydronephrosis. . Upper Extremity US ([**5-27**]): No ultrasound evidence of deep venous thrombosis of the right upper extremity. Brief Hospital Course: Ms. [**Known lastname **] is a 65yo F with h/o CABG, treated BrCA, and HL on statin admitted with hypoxia, fever and rhabdomyolysis of unclear etiology. . # Hypoxia: The patient was hypoxic on admission in the MICU with A-a gradient 560. She reported having a cough productive of green/yellow sputum, and CXR showed evidence of multifocal pneumonia. She was started initially on Vanc, Flagyl, Cefepime, Azithro which was switched to Vanc and Levofloxacin [**2109-5-26**] and then switched to only Cefepime. Pt was initially on face mask in ICU which was then titrated to NC prior to transfer to the floor. Pt's respiratory status improved with antibiotics as well as removal of fluid with CVVH. Of note, nursing did note some wheezing at night and thought pt might have some element of OSA as well. The patient was transferred to the floor, and went into respiratory distress in the setting of atrial fibrillation with rapid ventricular rate. Her rate was controlled with use of metoprolol and a one time diltiazem dosing with improvement of her respiratory status. She underwent ultrafiltration with dialysis and was weaned on her oxygen. On subsequent transfer to the floor, the patient was breathing comfortably. She had one episode of dyspnea on laying down to sleep. EKG was unchaged and symptoms improved with sitting. She underwent hemodialysis the following day with improvement of her respiratory status, and was able to be weaned to room air. . # Rhabdomyolysis/Myositis: On admission, pt's CK was 200K. Rheum was consulted and believed the etiology was [**2-26**] myositis and noted that lung involvment gives worse prognosis. Suggested sending viral studies including flu swab and aldolase to check if its really muscle (send out). They also recommended a non-con CT scan of the chest to eval the parenchyma for myositis however pt was not stable enough for this. Aldolase was not sent but CMV and EBV both returned IgG positive but IgM negative. [**Doctor First Name **] returned negative. The pt's rhabdomyolysis was believed to be [**2-26**] myositis +/- contribution of statin (pt had been on atorvastatin for a long period of time with chronically elevating doses but not recent dose change). Statin was held this admission. With CVVH, the pt's CK gradually decreased. Physical therapy was consulted and saw the patient while in-house. She was discharged to rehab with PT services. . # Strep pneumo bacteremia: 1/4 bottles grew Srep pneumo from OSH blood cultures ([**5-23**]). Pt was initially covered on vanco and cefepime. Vanco was d/c'd [**5-27**] and pt remained on cefepime for coverage at time of transfer out of ICU on [**5-28**]. OSH sensitivities returned resistant to oxacillin, sensitive to PCN with MIC 0.094, and sensitive to ceftriaxone with MIC 0.064. The patient was discharged on a 14 day course of cefepime. . # Multifocal pneumonia: The patient presented with a multifocal pneumonia. Sputum culture did not reveal any organisms. She was broadly covered with vancomycin, cefepime and levofloxacin/azithromycin. She was discharged on a 14 day course of Cefepime. . # Liver Disease: Patient had elevated ALT, AST, LDH on admission which was attributed to myositis/rhabdo and hypotension (shock liver). APAP level was negative. With treatment and resolution of the underlying issues, LFTs trended down. The patient also had an elevated INR and TBili on admission which was more consistent with a primary liver abnormality. Of note, the pt did have an abd U/S on [**5-25**] which showed: "Increased hepatic echogencity, which is non-specific but may be due to fatty infiltration. However, more serious forms of liver disease such as significant cirrhosis/fibrosis cannot be excluded on this study." Hepatitis serologies were sent and showed no exposure to Hep B or Hep C including no immunity to Hep B from vaccination. In the end, the pt's LFTs abnormalities were thought [**2-26**] rhabdo and trended down over the course of admission. . # Acute Renal Failure: Pt was anuric on admission, and was found to be in ATN [**2-26**] rhabdomyolysis. Renal was consulted and placed a femoral line for CVVH on [**2109-5-25**]. Renal ultrasound [**2109-5-25**] showed no hydronephrosis and normal-appearing kidneys. She was transitioned from CVVH to HD on [**2109-5-28**]. The patient's femoral line was removed and a temporary HD line was placed by IR. The patient continued to be anuric and a tunnelled HD line was placed on [**2109-6-3**] with the hope that her renal function would improve over the next several weeks as an outpatient. . # Arrhythmia: Pt had frequent ectopy with PACs and NSVT on admission. On [**5-27**], she was noted to have A fib with RVR which improved with fluid removal. She was started on ASA. Given her CHADS score of 3, she should discuss the initiation of coumadin for outpt anticoagulation with her PCP or [**Name Initial (PRE) **] cardiologist to lower her long-term risk. However, she did not have any further episodes of a fib on telemetry and anti-coagulation was not initiated in-house given her one episode of afib was in the setting of fluid overload. Her metoprolol was uptitrated to 50 TID for rate control. . # Diarrhea: Per report from OSH, patient had profuse diarrhea at OSH which had resolved on arrival to [**Hospital1 18**] ICU. She was briefly on flagyl but this was d/c'd on [**5-26**] when C diff was negative. . # Elevated Cardiac Enzymes: Patient did not have chest pain, but did have dyspnea as described above. CK and Trop were initially elevated on admission but this was attributed to severe rhabdomyolysis and ARF. CE's down-trended subsequently. Of note, TTE on [**5-25**] showed LVEF 40-45% and inferior and infero-lateral severe hypokinesis. EKG showed no acute ST changes concerning for ischemia. . # DM2: Pt was continued on ISS while hospitalized. . # Communication: Patient, husband and daughter, [**Name (NI) 1060**] C:[**Telephone/Fax (1) 86086**] H:[**Telephone/Fax (1) 86087**] # Code: Full (discussed with patient and ICU consent signed) Medications on Admission: Medications at home: Ambien 5mg QHS Lipitor 80mg daily Norvasc 10mg daily Diovan 80mg daily Metoprolol 100mg [**Hospital1 **] Aspirin 81mg daily Lasix 20mg daily Allopurinol 300mg daily Humulin 40units QAM, 34units QPM, Humalog 24 units at supper . Discharge Medications: 1. Heparin (Porcine) 1,000 unit/mL Solution Sig: One (1) Injection PRN (as needed) as needed for line flush. 2. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime. 3. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*0* 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 6. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed for sob, wheeze. 7. Humulin 70/30 100 unit/mL (70-30) Suspension Sig: Forty (40) units Subcutaneous qAM: with breakfast. 8. Humulin 70/30 100 unit/mL (70-30) Suspension Sig: Thirty Four (34) units Subcutaneous qPM: with dinner. 9. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale Subcutaneous as directed: please see attached sliding scale. 10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for pain: Please taper as tolerated. Disp:*30 Tablet(s)* Refills:*0* 11. Cefepime 1 gram Recon Soln Sig: One (1) Recon Soln Injection Q24H (every 24 hours) for 5 days: Last dose on [**6-9**]. Disp:*5 Recon Soln(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Hospital3 105**] Northeast - [**Hospital1 **] Discharge Diagnosis: Rhabdomyolysis Multifocal Pneumonia Acute Renal Failure Secondary Diagnosis: Diabetes 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: You were admitted to the hospital with pneumonia, rhabdomyolysis (breakdown of your muscles), and acute renal failure (kidney injury). You were treated with antibiotics for your pneumonia. Blood tests showed your rhabdomyolysis resolved during your hospital stay. Because of your renal failure, you underwent hemodialysis and will continue dialysis sessions as an outpatient. The following changes to your home medications: - Cefepime was added for a total 14 day course, last dose on [**6-9**] - Pantoprazole was added - Albuterol nebulizers were added - Tramadol was added for pain, to be decreased as tolerated and discontinued when possible - Metoprolol was switched from 100mg twice daily to 75mg three times daily - Humalog 24mg with supper was switched to a Humalog sliding scale - Aspirin was increased to 325mg daily - Amlodipine was stopped - Valsartan was stopped - Lasix was stopped - Allopurinol was stopped; please discuss the possibility of re-starting this medication with your primary care physician on [**Name9 (PRE) 702**] - Atorvastatin was stopped Followup Instructions: You will be followed by the Renal team for dialysis at rehab. You should follow up with a Nephrologist within 1-2 weeks, or as directed by the Renal team, to monitor your kidney function. Please follow up with your primary care physician [**Name Initial (PRE) 176**] [**2-27**] weeks. ICD9 Codes: 5845, 486, 2762, 4271, 5990, 4280, 311
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Medical Text: Unit No: [**Numeric Identifier 71119**] Admission Date: [**2185-3-9**] Discharge Date: [**2185-5-12**] Date of Birth: [**2185-3-9**] Sex: M Service: NB HISTORY: This is a 28-2/7 week gestation twin A delivered preterm by cesarean section due to progressive preterm labor. The mother is a 31-year-old primigravida with an estimated date of confinement of [**2185-5-29**]. Prenatal screens were as follows: Blood type O positive, antibody negative, hepatitis B surface antigen negative, RPR nonreactive, rubella immune, GBS unknown. The pregnancy was conceived by IVF, complicated by gestational diabetes, growth discrepancy, then shortened cervix. She was admitted to [**Hospital1 346**] 1 month prior to delivery, beta complete. On the morning of delivery the mother was noted to be 6 cm dilated, and she was therefore delivered by cesarean section. No intrapartum antibiotic prophylaxis was given. In the operating room, the baby had spontaneous cry. He required brief blow-by oxygen for pallor and mild cyanosis. Heart rate was always greater than 100. Apgars were 8 and 9. He was transferred to the Neonatal Intensive Care Unit for further evaluation and management of prematurity. PHYSICAL EXAMINATION AT DISCHARGE: The discharge weight is 2495 grams, about 25th percentile. The baby is [**Name2 (NI) **] and comfortable in open crib. HEENT: Anterior fontanelle is open and flat. Mucous membranes moist. No neck masses. No cleft palate. Red reflex is present bilaterally. Cardiovascular: Regular rate and rhythm. No murmur heard. Strong femoral pulses. Respiratory: Breath sounds are clear to auscultation bilaterally. There are no retractions. Abdomen is soft, nontender, nondistended. No masses are palpated. Extremities are [**Name2 (NI) **] and well perfused. He is moving all extremities equally. Hips are stable. Back is straight with no [**Hospital1 **] or dimples. GU: Baby is circumcised with improved penile edema. Bruise at base of penis. Testes are descended. Anus is patent. Neuro: Patient is active and alert with a strong suck and grasp. Tone is appropriate for age. Skin is intact. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: Respiratory: The baby was initially intubated for respiratory distress. He received Survanta x1. He was weaned to CPAP by day of life 2. On day of life 27, he was transitioned to nasal cannula oxygen for about 3 days and then restarted on CPAP on day of life 31. He remained on CPAP for another 6 days and then transitioned to room air on day of life 37. He was initially started on caffeine. That was discontinued on day of life 52. Following discontinuation of caffeine, he had a few self resolved quick spells with feedings, last reported on [**5-2**]. He has had not had any spells in room air since that time. Cardiovascular: The baby remained stable throughout hospitalization. Fluids, electrolytes and nutrition: The baby was initially made n.p.o. He was started on trophic feeds on day of life 3 and slowly advanced on feedings. He worked up to full volume by day of life 7. Calories were gradually increased as tolerated to a maximum of breast milk 30 calories per ounce with beneprotein. On [**4-20**], he had bloody stools and a necrotizing enterocolitis (NEC) evaluation was initiated . Blood culture, stool culture, clinical exams, and abdominal xrays were all reassuring. He underwent bowel rest and was given Zosyn for about 5 days. Breastmilk was restarted without any further difficulties. He is currently on breast milk 24 calories per ounce. He has been taking all p.o. feeds for about 6 days. The length on [**5-9**] was 48 cm (about 50 %ile) and head circumference was 31.5 cm (about 25 %ile). Gastrointestinal: The baby was on phototherapy for about a week in the first 10 days of life. It was discontinued on day of life 11. The maximum total bilirubin was 6 on day of life 9. Hematology: The baby's initial hematocrit was 40.3. He was started on ferrous sulfate and vitamin E on day of life 13. Follow up hematocrit on day of life 30 was 26.2 with a retic of 4.7. Iron was increased to 6 mg per kilo per day at that time. Follow-up hematocrit on day of life 43 was 24.6. Repeat hematocrit on the day of discharge was 25.9 with a retic of 3.9. The baby was never transfused. Infectious disease: The baby was initially started on ampicillin and gentamicin which was discontinued after 48 hours of negative blood cultures. The baby underwent another sepsis evaluation on [**4-20**] for bloody stools and rule out necrotizing enterocolitis. Please refer to Fluids, electrolytes and nutrition section for additional details. On routine surveillance cultures, the baby was found to be colonized with MRSA. He has been on contact precautions throughout the remainder of his hospitalization. Neurology: Head ultrasounds on [**3-17**] and [**4-7**] were both normal. Sensory: 1. Audiology: Hearing screening was performed with automated auditory brainstem responses. The baby passed the hearing screen prior to discharge. 2. Ophthalmology: Eyes examined most recently on [**2185-5-9**] revealed immaturity of the retinal vessels on the right side, but no ROP as of yet. The retinal vessels in the left eye were mature. A follow-up exam is recommended 3 weeks from the last exam. Condition at discharge: Stable with good growth. Discharge disposition: Home Name of primary pediatrician: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 17562**] Phone [**Telephone/Fax (1) 42639**] Fax [**Telephone/Fax (1) 71120**] Care/recommendations: 1. The baby will be discharged home on breastmilk 24 Cal/oz (with Similac Powder) 2. Medications are ferrous sulfate- concentration 25 mg/ml- 10 mg Q24H (= 0.4 ml or 4mg/kg/day) and multivitamins 1 ml po Q24H. 3. Iron and Vitamin D supplementation: - iron supplementation is recommended for preterm and low birth weight infants until 12 months corrected age. - all infants fed predominantly breast milk should receive vitamin D supplementation at 200 International Units (may be provided as a multivitamin preparation) daily until 12 months corrected age. 4. The baby passed his car seat test prior to discharge. 5. The last state newborn screen on [**2185-4-20**] was normal. 6. The baby received his first hepatitis B vaccine on [**2185-4-8**]. His 2 month vaccinations were also given. Pediarix and HIB were given on [**5-10**] and Prevnar given on [**5-11**]. 7. Immunizations recommended: - Synagis RSV prophylaxis should be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following four criteria: 1) born at <32 weeks; 2) born between 32 and 35 weeks with 2 of the following: daycare during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities, or school age siblings; 3) chronic lung disease; or 4) hemodynamically significant CHD. - 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. -This infant has not received rotavirus vaccine. The American Academy of Pediatrics recommends initial vaccination of preterm infants at or following discharge from the hospital if they are clinically stable and at least 6 weeks but fewer than 12 weeks of age. Follow-up Appointments: - Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 17562**] on Friday [**2185-5-13**] - Recommended follow-up eye exam on [**2185-5-30**] - VNA has been scheduled - referral to early intervention made Discharge Diagnoses: - prematurity - infant of diabetic mother - respiratory distress syndrome - apnea of prematurity - anemia of prematurity - hyperbilirubinemia - sepsis evaluation, ruled-out - necrotizing enterocolitis evaluation, ruled out - MRSA colonization [**Name6 (MD) **] [**Last Name (NamePattern4) **], [**MD Number(1) 55472**] Dictated By:[**Name8 (MD) 71121**] MEDQUIST36 D: [**2185-5-11**] 19:10:42 T: [**2185-5-11**] 19:57:28 Job#: [**Job Number 71122**] ICD9 Codes: 769, 7742, V290
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Medical Text: Admission Date: [**2135-1-9**] Discharge Date: [**2135-1-14**] Date of Birth: [**2059-1-19**] Sex: F Service: NSU HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname 41915**] was in her usual state of health until approximately four days prior to admission when she began to have upper respiratory symptoms. On the evening of admission, she apparently fell and hit her head. On the day of admission to [**Hospital3 **], she developed moderate epigastric pain and some pain in her chest. She was admitted to the hospital and ruled out for a myocardial infarction. Serum sodium was 116 on her admission. Her mental status was noted to deteriorate after the admission, and she was sent to the Intensive Care Unit to correct her sodium. Sodium increased to 119. She appeared to be come more alert. A CAT scan was done which showed a suprasellar mass, and she was transferred to [**Hospital1 190**] for further care. REVIEW OF SYSTEMS: Headaches for the last week, double vision in the morning for the last week, nausea, and occasional chest pain. PAST MEDICAL HISTORY: Remarkable for GERD, hypertension, osteoarthritis, type 2 diabetes, and increased cholesterol. MEDICATIONS ON ADMISSION: Avandia 4 mg twice daily, folic acid 1 mg twice daily, aspirin 81 mg once daily, Lipitor 10 mg once daily, Protonix 40 mg once daily, niacin 500 mg once daily, Cardizem CD 240 mg once daily, and Celebrex 200 mg once daily. ALLERGIES: She has no known drug allergies. SOCIAL HISTORY: She lives with her daughter and husband. She is not a smoker and drinks no alcohol. PHYSICAL EXAMINATION ON PRESENTATION: The blood pressure was 127/46, the heart rate was 66, and 100 percent on room air. She had a hematoma over the right occiput area. Pupils were pinpoint. She had a goiter on the right side. The lungs were clear bilaterally. Heart showed a regular rate and rhythm. Normal S1 and S2. A 2/6 systolic murmur. The extremities showed no edema. Gastrointestinal examination showed the abdomen to be soft and nontender. On neurologic examination, she was awake, alert, and oriented times three. She followed commands. She was in no acute distress. She was lightheaded. No diplopia. The pupils were pinpoint. Extraocular movements were full. The visual fields were intact. She had slight left droop. Sensation was intact to light touch. Motor examination showed her to be [**4-7**] throughout the upper and lower extremities. Unable to elicit reflexes, and the toes were downgoing. Name and comprehension were intact. SUMMARY OF HOSPITAL COURSE: She was admitted to Neurosurgery and was to have neurologic checks every hour. Her sodium was to be checked every 4 hours, and she was started on salt tablets 2 grams three times per day. She was also ordered to have a MRI with and without contrast. She was also given Venodyne's, subcutaneous heparin, and Protonix. She was seen by Dr. [**First Name (STitle) **] who felt that she had a pituitary adenoma and wanted her evaluated by Endocrine, who did see the patient, who recommended laboratory work; all of which was done, and to start her on steroids. She also had formal visual field testing. She was also seen by Dr. [**First Name (STitle) **] of ENT who will perform elective surgery with Dr. [**First Name (STitle) **]. The patient is to undergo a transsphenoidal resection of the pituitary tumor. DISCHARGE STATUS: She was discharged to home. DISCHARGE FOLLOWUP: She is scheduled to follow up with Endocrine laboratories in one week and then follow up in the [**Hospital 1800**] Clinic. She will then have her surgery scheduled electively and will likely be done in the beginning of [**Month (only) 958**] by both Drs. [**First Name (STitle) **] and [**Name5 (PTitle) **]. CONDITION ON DISCHARGE: The patient was discharged to home in stable condition. MEDICATIONS ON DISCHARGE: Folic acid, atorvastatin, famotidine, niacin, diltiazem, levothyroxine, Bactrim, ferrous sulfate, sodium chloride, and Percocet. DISCHARGE DIAGNOSES: 1. Pituitary adenoma. 2. Urinary tract infection. 3. Anemia. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2135-1-14**] 14:08:52 T: [**2135-1-14**] 17:19:40 Job#: [**Job Number 41916**] ICD9 Codes: 5990, 4019, 2720
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Medical Text: Admission Date: [**2165-12-23**] Discharge Date: [**2165-12-26**] Date of Birth: [**2120-9-9**] Sex: F Service: NEUROSURGERY Allergies: Penicillins Attending:[**First Name3 (LF) 1835**] Chief Complaint: Metastatic Melanoma Major Surgical or Invasive Procedure: [**2165-12-23**]: Left Craniotomy for Mass Resection History of Present Illness: Patient is a 45F with history of metastatic melanoma, and known metastasis to tbe brain, who presents for elective admission for left sided cranitotomy. Past Medical History: Oncology History: Metastatic melanoma - resection of a right shoulder lesion with pathology revealing a 0.47 mm thick, [**Doctor Last Name 10834**] level II melanoma in 01/[**2159**]. She underwent wide local excision at that time. She was well until late [**2162**] when she developed a forehead nodule with eventual biopsy in [**8-/2163**] revealing melanoma. - PET CT scan revealed uptake in the right frontal bone, a 2 cm soft tissue mass in the ascending colon and in the right tibia. - S/p cyber-knife radiation to the skull on [**2163-10-11**] and began HD IL-2 therapy on [**2163-11-14**]. - S/p XRT to the right tibia completed on [**2164-3-15**]. - [**10-1**] developed frontal HA's and forgetfullness, found to have right frontal heterogeneously enhancing mass suggestive of a metastasis. Underwent resection with Dr. [**Last Name (STitle) **] followed by Cyberknife radiosurgery to the resection cavity from [**2164-11-6**] to [**2164-11-8**]. The pathology was metastatic melanoma. [**2164-12-26**] - Curettage and cementing R tibia metastatic lesion. [**2165-2-19**] - new bony prominence in the right orbital region, evaluated with MRI that also revealed three new small brain parenchymal metastases in the left posterotemporal lobe, left cerebellum, and left inferior frontal lobe. - PET/CT on [**2165-2-27**] revealed an FDG-avid mass arising from the stomach wall and an FDG-avid soft tissue area adjacent to the right ureter - [**2165-3-6**] C1WK1 Ipilimumab #08-062 (CTLA-4 Ab) Social History: She lives with her husband and two children. She lives on the [**Location (un) **]. She was a teacher. No tobacco. She rarely drinks alcohol. Family History: Mother had pancreatic cancer and diabetes at 63. Her grandmother's brother died of melanoma and her great grandmother died of colon cancer. Physical Exam: On Discharge: Alert, oriented to person place and date with some prompting. PERRL, face is with slight left NL fold flattening. Full strength in upper and lower extremities. Wound is clean, dry and intact without reddness, or drainage. Pertinent Results: Labs on Admission: [**2165-12-23**] 05:45PM BLOOD WBC-8.6 RBC-3.91* Hgb-11.0* Hct-33.6* MCV-86 MCH-28.2 MCHC-32.9 RDW-14.4 Plt Ct-597* [**2165-12-24**] 01:50AM BLOOD PT-11.9 PTT-24.9 INR(PT)-1.0 [**2165-12-23**] 05:45PM BLOOD Glucose-126* UreaN-14 Creat-0.6 Na-142 K-3.9 Cl-104 HCO3-27 AnGap-15 [**2165-12-23**] 05:45PM BLOOD Calcium-9.5 Phos-2.7 Mg-2.0 Labs on Discharge: [**2165-12-25**] 04:40AM BLOOD WBC-8.9 RBC-3.77* Hgb-10.7* Hct-33.5* MCV-89 MCH-28.5 MCHC-32.0 RDW-14.4 Plt Ct-486* [**2165-12-25**] 04:40AM BLOOD PT-11.6 PTT-26.4 INR(PT)-1.0 [**2165-12-25**] 04:40AM BLOOD Glucose-93 UreaN-11 Creat-0.6 Na-138 K-4.1 Cl-101 HCO3-29 AnGap-12 [**2165-12-25**] 04:40AM BLOOD Calcium-9.0 Phos-3.0 Mg-2.0 Imaging: Post-op MRI Head: IMPRESSION: 1. Status post resection of the left parietotemporal lobe lesion, with post- surgical changes as detailed above. There are no findings specific for residual or recurrent neoplasm, although continued followup as the hemorrhage resolves will help further evaluate this region. There is an increase in the surrounding edema post surgery. 2. Stable right frontal lobe resection cavity, with areas of nodular enhancement and decreased diffusion. The findings may represent post- radiation treatment, although continued followup will help ensure that there is no evidence of residual or recurrent neoplasm. 3. Stable focus of enhancement in the left cerebellar hemisphere, without a new focus of abnormal enhancement. 4. Stable right frontal calvarial lesion without interval change. 5. Mucosal sinus disease, with air-fluid levels and debris in the maxillary sinuses bilaterally. Brief Hospital Course: Patient is a 45F with history of metastatic melanoma, with know metastasis to the brain. She was admitted to the neurosurgery service on [**2165-12-23**] for elective left craniotomy for adjunct treatment. Post-operatively, she was returned to the neuro intensive care until for close monitoring and surveillance. After being observed to be stable, she was transferred to the neuro floor. On POD#2, she also received her planning session for cyberknife, and was tranported to the [**Hospital Ward Name **], where CK treatment was carriede out to her cerebellar lesion. She was seen and evaluated by physical therapy and occupational therapy. It was determined that she would be appropriate for disposition to home with services. This was arranged, and she was discharged on [**2165-12-26**], with appropriate pain medication, with pain in good control. Medications on Admission: Dexamethasone 2mg"',Keppra 500mg",Docusate 100mg",Lovenox 40mg',y Fexofenadine 60mg", MVI,Pantoprazole 40mg',Ranitidine 150mg" Discharge Medications: 1. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets 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. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). Disp:*90 Tablet(s)* Refills:*0* 4. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 6. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q12H (every 12 hours). Disp:*60 Tablet Sustained Release(s)* Refills:*0* 7. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain: for breakthrough pain. Disp:*60 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Last Name (un) 19700**] Nursing Association Discharge Diagnosis: Metastatic Melanoma Discharge Condition: Neurologically Stable Discharge Instructions: GENERAL INSTRUCTIONS WOUND CARE: ?????? You or a family member should inspect your wound every day and report any of the following problems to your physician. ?????? Keep your incision clean and dry. ?????? You may wash your hair with a mild shampoo 24 hours after your sutures are removed. ?????? Do NOT apply any lotions, ointments or other products to your incision. ?????? DO NOT DRIVE until you are seen at the first follow up appointment. ?????? Do not lift objects over 10 pounds until approved by your physician. DIET Usually no special diet is prescribed after a craniotomy. A normal well balanced diet is recommended for recovery, and you should resume any specially prescribed diet you were eating before your surgery. Be sure however, to remain well hydrated, and increase your consumption of fiber, as pain medications may cause constipation. MEDICATIONS: ?????? Take all of your medications as ordered. You do not have to take pain medication unless it is needed. It is important that you are able to cough, breathe deeply, and is comfortable enough to walk. ?????? Do not use alcohol while taking pain medication. ?????? Medications that may be prescribed include: -Narcotic pain medication such as Dilaudid (hydromorphone). -An over the counter stool softener for constipation (Colace or Docusate). If you become constipated, try products such as Dulcolax, Milk of Magnesia, first, and then Magnesium Citrate or Fleets enema if needed). Often times, pain medication and anesthesia can cause constipation. ?????? You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc, as this can increase your chances of bleeding. ?????? You are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (Prilosec, Protonix, or Pepcid), as these medications can cause stomach irritation. Make sure to take your steroid medication with meals, or a glass of milk. ACTIVITY: The first few weeks after you are discharged you may feel tired or fatigued. This is normal. You should become a little stronger every day. Activity is the most important measure you can take to prevent complications and to begin to feel like yourself again. In general: ?????? Follow the activity instructions given to you by your doctor and therapist. ?????? Increase your activity slowly; do not do too much because you are feeling good. ?????? You may resume sexual activity as your tolerance allows. ?????? If you feel light headed or fatigued after increasing activity, rest, decrease the amount of activity that you do, and begin building your tolerance to activity more slowly. ?????? DO NOT DRIVE until you speak with your physician. ?????? Do not lift objects over 10 pounds until approved by your physician. ?????? Avoid any activity that causes you to hold your breath and push, for example weight lifting, lifting or moving heavy objects, or straining at stool. ?????? Do your breathing exercises every two hours. ?????? Use your incentive spirometer 10 times every hour, that you are awake. WHEN TO CALL YOUR SURGEON: With any surgery there are risks of complications. Although your surgery is over, there is the possibility of some of these complications developing. These complications include: infection, blood clots, or neurological changes. Call your Physician Immediately if you Experience: ?????? Confusion, fainting, blacking out, extreme fatigue, memory loss, or difficulty speaking. ?????? Double, or blurred vision. Loss of vision, either partial or total. ?????? Hallucinations ?????? Numbness, tingling, or weakness in your extremities or face. ?????? Stiff neck, and/or a fever of 101.5F or more. ?????? Severe sensitivity to light. (Photophobia) ?????? Severe headache or change in headache. ?????? Seizure ?????? Problems controlling your bowels or bladder. ?????? Productive cough with yellow or green sputum. ?????? Swelling, redness, or tenderness in your calf or thigh. Call 911 or go to the Nearest Emergency Room if you Experience: ?????? Sudden difficulty in breathing. ?????? New onset of seizure or change in seizure, or seizure from which you wake up confused. ?????? A seizure that lasts more than 5 minutes. Important Instructions Regarding Emergencies and After-Hour Calls ?????? If you have what you feel is a true emergency at any time, please present immediately to your local emergency room, where a doctor there will evaluate you and contact us if needed. Due to the complexity of neurosurgical procedures and treatment of neurosurgical problems, effective advice regarding emergency situations cannot be given over the telephone. ?????? Should you have a situation which is not life-threatening, but you feel needs addressing before normal office hours or on the weekend, please present to the local emergency room, where the physician there will evaluate you and contact us if needed. Followup Instructions: FOLLOW UP APPOINTMENT INSTRUCTIONS ??????Please return to the office in 10-14days (from your date of surgery) for removal of your staples/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 [**2166-1-20**] 12:35pm. 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. ??????You will need an MRI of the brain. This has been scheduled for you on Date/Time:[**2166-1-20**] 12:35pm. Please call Phone:[**Telephone/Fax (1) 327**] if you need to change this appointment. Completed by:[**2165-12-26**] ICD9 Codes: 2859
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Medical Text: Admission Date: [**2178-7-16**] Discharge Date: [**2178-7-30**] Date of Birth: [**2099-9-16**] Sex: M Service: MEDICINE Allergies: Amoxicillin Attending:[**First Name3 (LF) 2074**] Chief Complaint: worsening SOB and chest pressure Major Surgical or Invasive Procedure: Cardiac catheterization History of Present Illness: 78 M with PMH HTN, hypercholesterolemia, Parkinson's Disease, CRF (baseline Cr 1.2-1.5), presents with worsening SOB, chest pressure, N/V, sweating. Pt denied fever, chills or cough. He notes PND and orthopnea. Recieved Lasix 80IV, and NTG at HebReb with some relief. No cough, no sputum, no F/C. +PND, +orthopnea, worsening SOB since discharged from [**Hospital1 18**]. . Pt was recently discharged 1 wk ago for sepsis secondary to MRSA aspiration pneumonia (requiring pressors, intubation), stress dose steroids (adrenal insufficiency). Hospital course complicated by hypertensive episodes and acute renal failure. He was treated with and discharged on Vanco/Levo/Flagyl. . In the [**Name (NI) **], pt was found to be tachypneic, tachycardic, BP 199/113. Pt was started on NTG drip, given Lasix 80 IV x1, which improved his SOB. Pt's chest pressure improved on NTG, and he had good urine output. EKG showed rate 116, 0.[**Street Address(2) 1755**] elevations in V2-V3 (J point elevation), troponin 2.09. Past Medical History: [**Last Name (un) 3562**] disease Hypertension Chronic lower back pain Chronic renal insufficiency (baseline creat 1.2-1.5) CAD h/o melanoma s/p resection 20yrs ago Gerd BPH Social History: Lives at [**Hospital 100**] Rehab with his wife. A former International Relations professor. independent in most ADLs. Smoked previously, but quit 45 years ago, had 5 years of 1ppd. Occasional alcohol at special occasions, dinner. No IVDA. Family History: son and daughter have renal cysts Physical Exam: Vitals: BP: 160/104 P: 98 RR: 24 Oxygen sat: 96% on RA FS 172 Gen: NAD in bed, not acutely SOB HEENT: JVD to 10 cm, no LAD Lungs: Rales in bases bilaterally Heart: [**1-11**] apical SEM, no r/g Abd: Distended, +BS, obese, soft, diffusely mildly tender, 3+ hip/sacral edema, scars. Guiaic negative. Neuro: [**3-10**] motor LUE, [**4-9**] motor RUE, [**2-7**] motor LEs, 3+ lower extremity edema Pertinent Results: CXR [**7-16**]: 1. Moderate congestive failure. 2. Unchanged parenchymal opacities bilaterally within the lower lobes. These were previously described as aspiration pneumonia. 3. Small bilateral pleural effusions. . Echo [**7-10**]: The left atrium is mildly dilated. Left ventricular wall thicknesses are normal. LV systolic function appears depressed however views are technically suboptimal for assessment of regional wall motion. Resting regional wall motion abnormalities include mid to distal septal/anterior, apical and basal inferior hypokinesis (estimated ejection fraction ?35-40%. No definite apical thrombus seen but cannot exclude. The aortic valve leaflets (3) are mildly thickened. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. Compared with the report of the prior study (tape unavailable for review) of [**2177-1-16**], left ventricular systolic function is now significant impaired and mitral regurgitation is now more prominent. . Stress MIBI [**7-10**]: Moderate fixed inferior wall perfusion defect. Transient ischemic dilatation of the left ventricle. Moderate global hypokinesis with LV EF of 38%. . Cardiac catheterization [**7-10**]: 1. Selective coronary angiography in this right dominant circulation demonstrated three vessel disease. The LMCA was very short versus dual ostia. The LAD was calcified and diffusely diseased. There was a 50% proximal stenosis and then a 70% stenosis after the takeoff of the D1. The distal LAD had moderate diffuse disease. The D1 had moderate diffuse disease proximally. The LCx had a 60% ostial stenosis and then a serial 70% stenosis in the proximal segment. There was moderate diffuse disease in the distal LCx. The OM1 had an 80% stenosis at its origin. The L-PL had mild diffuse disease. The RCA was totally occluded which appeared chronic. There were moderate left to right collaterals. 2. Resting hemodynamics from right heart catheterization demonstrated mildly elevated right and left heart filling pressures (RVEDP=13mmHg, mean PCWP=17mmHg). There was moderate pulmonary and systemic arterial hypertension (PA=47/17mmHg, Ao=170/67mmHg). The calculated cardiac output by the Fick method was 6.4 L/min with a cardiac index of 2.8. Moderate hypoxemia was noted with an arterial oxygen saturation of 88% on 2L O2 by nasal cannula. 3. A cardiothoracic surgery evaluation is recommended. However, given that this patient may not be an ideal surgical candidate given his comorbidities, a persantine MIBI may be consider. This would allow identification of a major area at risk for ischemic which then can potentially be intervened upon via PCI. Brief Hospital Course: A/P: 78 M with PMH of HTN, hypercholesterolemia, Parkinson's ds, CRF (with baseline Cr 1.2-1.5), discharged 1 wk ago for MRSA aspiration pna (requiring pressors, intubation), d/ced on Vanco/Levo/Flagyl, presented on [**2178-7-16**] with worsening SOB, chest pressure, N/V, sweating, found to have NSTEMI. . 1. NSTEMI: Though it was a NSTEMI, his echo shows a large area of hypokinesis which is new. He was pain free after admission and his CK trended downward. His cath was initially deferred secondary to worsened CRI. During this time, he was maintained on ASA/BB/heparin/statin. He was originally started on a nitro drip but this was d/c in favor of hydralazine and isordil during this time period. His ace-i was held secondary to his worsening renal function but restarted once his kidney function normalized. As his creatinine improved he was taken to cath where he was seen to have 3VD. He was evaluated by cardiac surgery who felt that he was too high risk to intervene on. He had a stress MIBI showing global hypokinesis with transient ischemic dilitation suggesting that a focused PCI would not be effective. It was decided to medically manage the patient. . 2. SOB: On admission he was volume-overloaded by exam and CXR and was unable to lie flat for any period of time. This was also complicated by an infectious picture. He was originally maintained on a nitroglycerin drip that was titrated off over his admission and replaced by hydralazine and isordil. Because of his previous admission for PNA, vancomycin/flagyl/ceftazidime were continued for a 10d course. His CXR gradually improved and he began autodiuresing. He was able lie flat and his O2 requirement was weaned. His hydralazine and isordil were switched to an ace-i prior to d/c. . 3. Anemia: On admission, the pt had a baseline HCT of 27-33 and iron studies c/w an anemia of chronic disease. Secondary to his ischemia, he was transfused x3 units over three days to maintain his HCT over 30. He remained guaiac negative throughout his admission and was maintained on GI prophylaxis. . 4. Tachyarrhythmia: He had an episode of afib on the day after admission that was self limited and never recurred. He was maintained on bblocker for rate control throughout his admission and had no further episodes. . 5. Hypertension: His hypertension was initially managed with metoprolol which was titrated up to 75tid but further titration was limited by HR. He was initially also maintained isordil and hydralazine but these were switched to lisinopril as his creatinine normalized. His lisinopril was titrated up to 40qd on the day of discharge as his SBP was still in the 160s. He will need continued outpatient management of his blood pressure meds and will need to have his BP checked at his rehab facility. . 6. Hypercholesterolemia: He was maintained on a statin throughout his admission. . 7. Lower back pain: He received his outpatient oxycodone doses while hospitalized. . 8. Parkinson's Disease: He was maintained on carbidopa/levadopa at home doses. . 9. GERD: He was fed a cardiac diet and kept on a PPI. . 10. BPH: He remained on his outpatient meds and had a foley throughout his stay in the CCU. . 11. FEN: Lytes were repleted prn. . 12. CODE: He is a full code . Medications on Admission: aspirin 325 senna 17.2bid gabapentin 600 zoloft 100 zocor 80 oxycodone 20bid tamsulosin 0.4 imdur 60 docusate 100bid toprol 50 lisinopril 20 carbidopa/levodopa 25/100 qid amlodipine 10 tolterodine 4 prevacid 30 finasteride 5 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. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 3. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). Disp:*60 Capsule(s)* Refills:*2* 4. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Oxycodone 20 mg Tablet Sustained Release 12HR Sig: One (1) Tablet Sustained Release 12HR PO Q12H (every 12 hours). Disp:*60 Tablet Sustained Release 12HR(s)* Refills:*0* 7. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO HS (at bedtime). Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*2* 8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 9. Carbidopa-Levodopa 25-100 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Disp:*120 Tablet(s)* Refills:*2* 10. Tolterodine Tartrate 2 mg Tablet Sig: Two (2) Tablet PO QHS (once a day (at bedtime)). Disp:*60 Tablet(s)* Refills:*2* 11. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 12. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*2* 13. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 14. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 15. Hydrocortisone 2.5 % Cream Sig: One (1) Appl Rectal [**Hospital1 **] (2 times a day). Disp:*1 tube* Refills:*2* 16. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed). 17. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY Take 1 tab po qd. #30. Refills: 3 18. Furosemide 20 mg PO DAILY #30. Refills: 3 Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - LTC Discharge Diagnosis: NSTEMI Discharge Condition: Stable Discharge Instructions: 1. Please take all medications as prescribed. 2. Please keep all appointments with physicians as below. 3. Please return to the emergency room if you experience chest pain, shortness of breath, palpitations. Followup Instructions: Primary Care Appointment: [**Name6 (MD) 8741**] [**Name8 (MD) 9529**], MD Where: [**Hospital 273**] [**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2178-8-12**] 2:30 Cardiologist Appointment: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD Where: [**Hospital 273**] CARDIAC SERVICES Phone:[**Telephone/Fax (1) 4022**] Date/Time:[**2178-9-7**] 2:30 Completed by:[**2178-7-30**] ICD9 Codes: 4280, 5070, 2762, 2720
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Medical Text: Admission Date: [**2140-2-1**] Discharge Date: [**2140-2-9**] Service: CCU HISTORY OF PRESENT ILLNESS: The patient is an 89 year old female with a history of coronary artery disease status post remote history of MI who presented to [**Hospital3 4527**] in the a.m. of [**2-1**] with severe substernal chest pain radiating to her back since [**46**]:00 p.m. the night before. She reported shortness of breath and orthopnea overnight. She said that her symptoms were reminiscent of her prior angina several months ago. At [**Hospital3 4527**] her heart rate was 115, blood pressure 140/83. EKG showed [**Street Address(2) 4793**] depression in lead 1 and questionable J point elevation in V2 and V3. She also had [**Street Address(2) 4793**] elevation in lead 3. She was 91 to 92 percent on 4 liters nasal cannula at this time. She received 5 mg of IV Lopressor, aspirin, Lovenox, Integrilin, nitropaste, Benadryl 25 and prednisone 40. She [**Street Address(2) 4351**] had relief of her pain with these interventions. Chest x-ray at [**First Name (Titles) 4527**] [**Last Name (Titles) 4351**] showed no evidence of CHF or infiltrate. She had a CT of the thorax and abdomen which was negative for dissection. She was pain free on arrival to [**Hospital1 18**]. In the cath lab at [**Hospital1 18**] she received 20 mg of IV Lasix, Integrilin and nitroglycerin drip. Cardiac cath revealed multivessel disease including left main coronary artery with a mid 60 to 70 percent lesion, LAD with a proximal 70 percent lesion, 90 percent mid-lesion, 40 percent mid-lesion. Left circumflex had a 60 percent ostial lesion and 60 to 70 percent mid-lesion. She also had proximal RCA subtotal occlusion. Her cardiac index was 2.12. Her PA pressures were 45/27 with a wedge of 33. PAST MEDICAL HISTORY: Spinal stenosis. Abdominal aortic aneurysm infra-renal approximately 4 cm. Coronary artery disease with a distant history of MI in [**2130**]. Hyperlipidemia. Poor balance. Borderline hypertension on no medications. SOCIAL HISTORY: The patient reports that her husband died two weeks ago here in the MICU at [**Hospital1 18**]. She denies any tobacco or drug use. She reports occasional alcohol use. FAMILY HISTORY: Noncontributory. ALLERGIES: Bactrim, codeine, Naprosyn, apples, pears, tuna, "antibiotics," fish, iodine. MEDICATIONS: Medications on transfer included Lopressor, Lovenox, Integrilin drip, aspirin 325, prednisone 40 mg q.d., Benadryl, Lipitor, nitroglycerin drip, heparin drip, Mucomyst. Home medications included B-12, Lipitor at an unknown dose, aspirin. PHYSICAL EXAMINATION: On presentation the patient had a temperature of 95.5, heart rate 91, blood pressure 160/90, respirations 18, oxygen saturation 96 percent on 100 percent nonrebreather. In general, she was in no acute distress, alert and oriented times three. HEENT exam revealed pupils that were equally round and reactive to light. Extraocular muscles were intact. Oropharynx was without lesions or exudate and she had moist mucous membranes. Neck exam revealed JVP approximately half way to the angle of the jaw. Lungs were clear anteriorly, however, she was not able to sit up. Abdomen was soft, nondistended, nontender. There were good bowel sounds. She had a palpable pulsatile mass in the mid-abdominal region consistent with abdominal aortic aneurysm. It was nontender to palpation, but pulsatile. Stools were OB negative at [**Hospital3 4527**]. Heart was regular and there was a 2/6 systolic ejection murmur heard best at the left upper sternal border. She had no gallop or rubs. Extremities were thin without cyanosis, clubbing or edema. She had 1 to 2+ dorsalis pedis pulses bilaterally. LABORATORY DATA: Laboratories at [**Hospital3 4527**]: CBC with white count 6.5, hematocrit 33.3, platelets 170. Chemistries revealed sodium 138, potassium 4.7, chloride 103, bicarb 24, BUN 22, creatinine 1.3, glucose 106. She had an INR of 1.2, PTT 27. ALT 123, AST 85, t-bili 0.5, lipase 135, amylase 33. CK 109, MB 8.9, MBI 8.2, troponin 5.2. Cardiac cath results are as mentioned above. EKG at [**Hospital3 4527**] revealed sinus tachycardia with a rate of 103 beats per minute. She had normal axis and normal intervals. She had 1 mm S elevations/J point elevations in leads V2 and V3. She had flipped T waves in V5 and V6. She had [**Street Address(2) 4793**] depression in lead 1. She had [**Street Address(2) 4793**] elevation in lead 3 and a Q wave in lead 3. HOSPITAL COURSE: 1. Cardiovascular. In regard to ischemia and CAD, the patient presented with unstable angina with three vessel disease by cath with LAD lesion being the likely culprit of her symptoms. She was given aspirin, heparin, Integrilin and subsequently started on a beta blocker after her congestive heart failure improved. She was also started on a statin. She was initially resistant to the idea of CABG and there was plan for PTCA of LAD the morning after admission. Serial CKs and troponins were followed which peaked and then began to decline. The night of admission she received 2 mg of Haldol and 0.5 mg of Ativan and subsequently became very lethargic and somewhat unarousable. Her waxing and [**Doctor Last Name 688**] mental status delayed her repeat cardiac cath, however, she subsequently underwent cardiac cath on [**2140-2-5**] which revealed 90 percent mid-LAD lesion with mild proximal OM disease. She had successful PTCA and stenting of the LAD. Final diagnosis was three vessel coronary artery disease with successful stenting of the mid-LAD. As mentioned above, she was continued on aspirin, a beta blocker, a statin and ACE inhibitor was held due to elevated creatinine, however, it was restarted on the day of discharge. In regard to her pump function, she had evidence of elevated filling pressures in the cath lab here. She was diuresed with Lasix overnight the first night of admission to desaturate her wedge to 15 to 20. She was continued on nitro drip which was stopped the following morning. She had a chest film the day after admission which revealed evidence of congestive heart failure. She had an echo on [**2140-2-1**] which revealed severe global left ventricular hypertrophy consistent with multivessel CAD or another diffuse process. She had mild aortic regurgitation. Her pulmonary artery systolic pressures were elevated. She had mild mitral regurgitation. She had an ejection fraction of 20 percent. She was subsequently diuresed for several days until she became euvolemic. At this time she experienced an elevation in her creatinine to 2.2, which was felt to be a combination of diuresis in the setting of two exposures to contrast. She was started on lisinopril 2.5 mg q.d. on the day of discharge. Rhythm. The patient had no rhythm issues throughout admission. 2. Renal. As mentioned above, the patient experienced some renal failure during her admission with peak creatinine of 2.2. It was felt this was most likely secondary to diuresis in the setting of exposure to dye in someone with a known iodine allergy. She was premedicated prior to both catheterizations with Benadryl and steroids as well as Mucomyst. Her creatinine continued to decline prior to discharge as she began to auto-diurese. It was felt safe to start an ACE inhibitor with lisinopril 2.5 mg p.o. q.day on the day of discharge. 3. Neurologic. As mentioned above, the patient was given Haldol and Ativan the night of admission for agitation and combativeness. She was given a very small dose, however, in the setting of likely renal failure, she became extremely sedated and unresponsive on these medications. A neurology consult was obtained and it was felt that her mental status changes were most likely multifactorial in the setting of underlying dementia and poor substrate. She had a CAT scan of her head which was negative. She had TSH which was slightly elevated with normal free T4. She had normal B-12 and folate. It was not felt necessary to perform an LP, given her improving mental status and lack of fever and white cell count. It was felt most likely that her mental status changes were due to medication effect and sedating meds were thereon avoided. On the day of discharge she was awake, alert and oriented times three intermittently with some waxing and [**Doctor Last Name 688**] confusion. 4. Musculoskeletal. The patient became extremely weak throughout admission and was seen by physical therapy the day prior to discharge. It was felt that she would most likely benefit from subacute rehabilitation. 5. Hypernatremia. It was noted the day before discharge that the patient was hypernatremic to 152. It was felt that this was most likely secondary to aggressive diuresis in the setting of lack of access to free water. Her free water dose was adjusted and she was replaced with D5W with half of her deficit being replaced in the first 24 hours. It was also felt that her hypernatremia was possibly responsible for some of her mental status changes. 6. Endocrine. In the workup of the patient's mental status changes, it was noted that she had an elevated TSH with a normal free T4, possibly reflecting subclinical hypothyroidism. It was recommended that this be followed up as an outpatient. DISCHARGE DIAGNOSES: 1. Coronary artery disease status post stent to LAD. 2. Dementia. 3. Hypernatremia. DISCHARGE MEDICATIONS: 1. Lisinopril 2.5 mg q.d. 2. Toprol XL 100 mg q.d. 3. Plavix 75 mg q.d. 4. Lipitor 10 mg q.d. 5. Aspirin 325 mg q.d. 6. Multivitamin. CONDITION ON DISCHARGE: At the time of discharge the patient was with improved spirits, was denying chest pain or shortness of breath. She was having waxing and [**Doctor Last Name 688**] mental status changes with intermittently being confused and disoriented to place. However, she was in good spirits and felt ready to go to rehab and then subsequently home following rehab. FOLLOWUP: The patient will be discharged to [**Hospital **] Rehab and will require followup with a cardiologist and with her PCP at the time of discharge. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-426 Dictated By:[**Last Name (NamePattern1) 9820**] MEDQUIST36 D: [**2140-2-8**] 13:19 T: [**2140-2-8**] 13:32 JOB#: [**Job Number 49863**] ICD9 Codes: 4280, 2760, 5849, 5990
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Medical Text: Admission Date: [**2127-2-10**] Discharge Date: [**2127-2-14**] Date of Birth: [**2088-11-1**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 7055**] Chief Complaint: Chest pressure Major Surgical or Invasive Procedure: none History of Present Illness: 38 M with PMH ARDS [**2122**], presents with SSCP x 2 days. SSCP started suddenly on Sat (time unknown), [**6-16**], pt holds up clenched fist to describe chest pressure, constant but worse with exertion, no noticed relief with rest, no association with food, radiated to back of L shoulder which ached. Pt has had severe fatigue, sore throat, diffuse myalgias. No F/C/N/V/diaphoresis, no SOB. SSCP was relieved at 1 am on Sun AM, and pt slept to see if CP would resolve by Sun morning. Pt woke up on Sun AM and still had SSCP. He went to [**Hospital 47**] Hospital, where he was found to have STE in anterolateral leads, NSR 92. Pt was placed on ASA, heparin, integrilin, and was taken to emergent cath. . At cath, pt was found to have 100% proximal LAD occlusion, RCA generally patent, LCX generally patent. Was able to pass wire down LAD, but LAD took a sharp U-turn anteriorly, and had no flow in LAD on contrast injection. Stented mid-LAD, with minimal flow to LAD. Wire was maneuvered more distally into LAD and contrast injection showed perforation into distal LAD, with contrast flowing into ventricle (likely LV). Perforation appeared to be into the ventricle, not into the pericardium. Balloon was inflated for relatively prolonged periods at 2 sites near perforation, which was successful in diminishing contrast leakage from LAD. Pt was airlifted to [**Hospital1 18**], hemodynamically stable with HR 80s, BP 110-120s, for further management of LAD perforation. Past Medical History: Was hospitalized for 2.5 mo with intubation at [**Hospital3 **] for ARDS and a "mold lung infection" in [**2122**], was in coma for 1 month. Otherwise has never been hospitalized. Hypercholesterolemia Social History: Used to be heavy EtOH user but last drink few mo ago. 23 pky smoking hx per one person's history, 46 pky smoking hx per another person's history. +marijuana use, last 1.5 weeks ago, never tried cocaine, heroin. Lives with father and stepmother. Family History: Father had MI at 52, quintuple bypass at 66. Physical Exam: 97.0 / 101/68 / 94 / 16-24 / 100% 2.5L nc Gen: Sleepy in bed HEENT: JVD difficult to assess, no LAD, dry mm Lungs: Rales diffuse bl Heart: [**2-10**] holosystolic blowing murmur heard best at apex, no r/g, regular, tachy Abdomen: Soft, ND, NT, +BS, mildly obese Extr: No c/c/e, 2+ DP bilaterally, minimal bleeding Neuro: [**4-11**] motor in UE, sensation equal and intact bl Skin: No ecchymoses, no rash Pertinent Results: EKG: STE in anteroseptal leads . CXR: Swan ends in PA, mediastinum little wide, focal indentation in trachea around L clavicle area (narrowed trachea 15-20% likely from intubation) . Echo: Conclusions: The left atrium is elongated. The left ventricular cavity size is normal. LV systolic function appears moderately to severely depressed. Resting regional wall motion abnormalities include anteroseptal hypokinesis/akinesis, mid to distal anterior akinesis, apical akinesis/dyskinesis. No definite apical thrombus seen but cannot exclude. Right ventricular chamber size is normal. There is focal hypokinesis of the apical free wall of the right ventricle. The aortic root is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no regurgitation. There is no aortic valve stenosis. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. There is a small pericardial effusion. There are no echocardiographic signs of tamponade. . Cath at OSH: Proximal 100% LAD occlusion, poor flow upon opening LAD, LAD Class III perforation with extravasation of contrast into RV. RCA and LCX are patent. . [**2127-2-10**] 11:36PM CK(CPK)-137 [**2127-2-10**] 11:36PM CK-MB-13* MB INDX-9.5* cTropnT-2.07* [**2127-2-10**] 12:09PM CK(CPK)-142 [**2127-2-10**] 12:09PM CK-MB-17* MB INDX-12.0* cTropnT-2.03* [**2127-2-10**] 12:09PM HCT-35.1* [**2127-2-10**] 09:30AM ETHANOL-NEG bnzodzpn-NEG barbitrt-NEG [**2127-2-10**] 09:30AM URINE HOURS-RANDOM [**2127-2-10**] 09:30AM URINE bnzodzpn-POS barbitrt-NEG opiates-POS cocaine-NEG amphetmn-NEG mthdone-NEG [**2127-2-10**] 09:23AM HCT-33.8* [**2127-2-10**] 06:19AM O2 SAT-71 [**2127-2-10**] 05:06AM TYPE-ART PO2-136* PCO2-35 PH-7.35 TOTAL CO2-20* BASE XS--5 [**2127-2-10**] 05:06AM O2 SAT-97 [**2127-2-10**] 05:06AM freeCa-1.06* [**2127-2-10**] 04:42AM GLUCOSE-98 UREA N-20 CREAT-1.0 SODIUM-136 POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-19* ANION GAP-16 [**2127-2-10**] 04:42AM CK(CPK)-127 [**2127-2-10**] 04:42AM CK-MB-12* MB INDX-9.4* cTropnT-2.25* [**2127-2-10**] 04:42AM CALCIUM-7.2* PHOSPHATE-4.8* MAGNESIUM-1.6 [**2127-2-10**] 04:42AM WBC-13.7* RBC-3.90* HGB-11.7* HCT-34.4* MCV-88 MCH-30.1 MCHC-34.0 RDW-12.5 [**2127-2-10**] 04:42AM PLT COUNT-204 [**2127-2-10**] 04:42AM PT-14.1* PTT-38.9* INR(PT)-1.2* Brief Hospital Course: 38 M with PMH ARDS [**2122**], presents with STEMI and perforated LAD post-stenting, with partial revascularization. . # Cardiac: Ischemia: Subacute anteroseptal STEMI upon presentation, likely 3-5 days old. Proximal 100% LAD occlusion with mid-LAD stent, but LAD flow was not restored, LAD territory likely unable to be recovered. LAD was perforated during procedure. Post-cath, hemos were CO: 5.9, Index: 2.76, Wedge 17, PAP 28/15. On ASA, plavix, statin, ACE, BB. Will follow up for repeat TTE to assess EF for possible ICD in 1 month. . Pump: EF 30% on TTE after STEMI, wedge 21-22, severe anteroseptal and inferior hypokinesis, small anterior pericardial effusion. Pt was discharged on coumadin for 1 month for large anteroseptal infarct with apical hypokinesis. He needs INR checks for goal INR 2.0-3.0, and was discharged on lovenox for bridge to coumadin. Immediately post-cath, patient had a murmur on exam, but after 24 hrs, pt did not have a murmur for the remainder of admission. . Rhythm: Pt was in NSR on tele. . # Class III LAD perforation: LAD was perforated into LV at the location of distal LAD. LAD perforation complications include: pericardial tamponade, MI, intramural hematoma, arrhythmia, coronary dissection, cardiogenic shock. Treatment is either CABG for emergent revascularization or prolonged inflation with PTCA balloon or perfusion catheter or stent. . The PTCA balloon was put up for extended period in 2 sites in the LAD, to inhibit extravasation of contrast post-LAD perforation. Perforations are classified into: Class I - extraluminal crater without extravasation Class II - pericardial or myocardial blushing Class III - perforation 1 mm in diameter with contrast streaming and cavity spilling . Serial pulsus checks were negative. CABG was not recommended to patient because MI likely occurred 3-4 days before presentation (according to presenting cardiac enzymes) so myocardium cannot be reperfused with revascularization. Medications on Admission: Medications on Admission: Lipitor Wellbutrin . ALL: PCN Discharge Medications: 1. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 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. Atorvastatin 80 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 Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime): Start taking this medication on [**2127-2-17**]. Disp:*30 Tablet(s)* Refills:*2* 7. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 8. Warfarin 7.5 mg Tablet Sig: One (1) Tablet PO at bedtime for 3 days: Take one tablet on [**2127-2-14**], [**2127-2-15**], and [**2127-2-16**], then start taking Warfarin 5 mg by mouth every night instead. Disp:*3 Tablet(s)* Refills:*0* 9. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: [**12-9**] Tablet, Sublinguals Sublingual PRN (as needed) as needed for chest pain. Disp:*30 Tablet, Sublingual(s)* Refills:*0* 10. Enoxaparin 100 mg/mL Syringe Sig: Ninety (90) mg Subcutaneous Q12H (every 12 hours). Disp:*20 20 syringes ([**2120**] mg total)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Large ST elevation Myocardial Infarction LAD perforation into left ventricle Discharge Condition: hemodynamically stable Discharge Instructions: 1. Please eat a low salt diet. No more than 2 mg per day. 2. Weigh yourself daily. If you have a weight gain > 3 lbs, please call your doctor. 3. Please take all medications as prescribed. ALWAYS take your aspirin and plavix. 4. Please keep all follow-up appointments. You have an appointment for an echocardiogram in 1 month followed by an appointment with an electrophysiology cardiologist, Dr. [**Last Name (STitle) **]. Followup Instructions: 1. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 285**] Date/Time:[**2127-3-11**] 2:30. [**Hospital1 **] [**Last Name (Titles) 516**], [**Hospital Ward Name 23**] 7 2. Please make a followup appointment with Dr. [**Last Name (STitle) 1655**]. INR check Monday morning in Dr.[**Name (NI) 64536**] office. Completed by:[**2127-2-14**] ICD9 Codes: 3051
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Medical Text: Admission Date: [**2112-8-9**] Discharge Date: [**2112-8-25**] Date of Birth: [**2066-11-3**] Sex: M Service: CARDIAC SURGERY HISTORY OF THE PRESENT ILLNESS: The patient is a 45-year-old gentleman who is status post inferior wall MI on [**2112-7-1**]. At that time, he underwent a PTCA stent to his RCA. At the time of his cardiac catheterization, it was noted that he had multiple LAD and LCX lesions. It was elected to discharge the patient to home and have the patient come back to the Cardiac Catheterization Laboratory at a later date for treatment of those lesions. The patient was admitted on [**2112-8-9**] for repeat cardiac catheterization. PAST MEDICAL HISTORY: 1. Hypertension. 2. Hyperlipidemia. 3. Type 2 diabetes, now insulin-dependent. 4. Coronary artery disease, status post myocardial infarction. 5. Status post kidney surgery, type unknown, as a child. ALLERGIES: Penicillin. PREOPERATIVE MEDICATIONS: 1. Plavix 75 mg p.o. q.d. 2. Enteric coated aspirin 325 mg p.o. q.d. 3. Zestril 5 mg p.o. q.d. 4. Lipitor 20 mg p.o. q.d. 5. Lopressor 100 mg p.o. b.i.d. 6. Protonix 40 mg p.o. q.d. 7. NPH insulin 18 units subcutaneously b.i.d. 8. Humalog sliding scale. PREOPERATIVE LABORATORY DATA: Significant for a hematocrit of 40.7, potassium 4.5, BUN 18, creatinine 0.9. HOSPITAL COURSE: The patient was taken to the Cardiac Catheterization Laboratory on [**2112-8-9**] where he was started on an Integrelin infusion and given a heparin bolus. During the cardiac catheterization, an attempted PCI of the LAD was undertaken. During the PCI, the patient began to develop chest pain and ST segment elevations. There was no flow through the LAD and no improvement in the flow with vasodilators. Due to the patient's continued chest pain, an intra-aortic balloon pump was inserted in the Cardiac Catheterization Laboratory and the patient was taken emergently to the Operating Room by Dr. [**Last Name (STitle) **] for coronary artery bypass. In the Operating Room, the patient underwent a CABG times three with SVG to LAD, SVG to diagonal, and SVG to OM. Due to the patient's coagulation status preoperatively with the patient being on Plavix and Integrelin, the patient had a large amount of chest tube output in the Operating Room and postoperatively. The patient was transferred to the Intensive Care Unit on a large amount of pressors due to a low blood pressure. In the Intensive Care Unit, the patient had approximately 2 liters of chest tube drainage in the first hour in the Intensive Care Unit. The patient was quickly taken back to the Operating Room. In the Operating Room, there were found only small areas of bleeding which were repaired. The patient's coagulopathy was corrected and the patient was again transferred back to the Intensive Care Unit on epinephrine and Amiodarone in stable condition. Please see the operative note for further details. On the evening of postoperative day number one, the patient required large amounts of blood products. The patient continued on his intra-aortic balloon pump. It was elected to keep the patient intubated on the night of postoperative day number one. The patient's chest tube output was considerably decreased. The patient was moderately hypoxic. The chest x-ray showed volume overload. By postoperative day number two, the patient's coagulopathy had been corrected and he was hemodynamically stable. The intra-aortic balloon pump was removed without complications. The patient required large amounts of diuresis over the next several days for the patient's oxygenation and enable the patient to wean on the ventilator. On postoperative day number three, it was noted that the patient had a large right-sided pleural effusion. A right pleural chest tube was inserted with 1,500 cc of old dark blood and improvement in the patient's chest x-ray. After the chest tube was inserted, the patient began complaining of the sensation of shortness of breath and became tachypneic. A repeat chest x-ray was performed which showed no pneumothorax, no effusion; however, the patient's endotracheal tube was noted to be high. This was advanced. However, the patient continued to remain anxious. The patient's oxygenation improved with sedation. By postoperative day number four, the patient had been weaned off of his pressors and was started on a low-dose beta blocker. The patient was noted to have a dropping platelet count. A heparin antibody test was sent which was subsequently negative. The patient had been started on Plavix as he still had a stent to his RCA. It was recommended by Dr. [**Last Name (STitle) **] that the patient be transfused platelets and given Plavix as the concern for keeping the stent patent. On the evening of postoperative day number four, the patient began draining large amounts of bloody fluid from his sternal incision which was thought to be a liquefying hematoma. On postoperative day number five, the patient continued to have a large amount of drainage and Dr. [**Last Name (STitle) **] decided to return the patient to the Operating Room for tightening of the sternal wires as he thought the drainage was due to a sternal dehiscence. The patient tolerated this procedure well and returned to the Intensive Care Unit and remained intubated throughout. On the evening of postoperative day number five, the patient was weaned and extubated from mechanical ventilation and required vigorous chest PT to maintain oxygen saturation, had a moderate productive cough. It was also noted on the evening of postoperative day number five that the patient had icteric sclerae. A bilirubin was sent which was noted to be elevated at 6.8. A right upper quadrant ultrasound was obtained on postoperative day number eight which showed evidence of increased echogenicity consistent with fatty infiltration of the liver. No focal liver lesions. No evidence of intrahepatic or extrahepatic biliary ductal dilatation, common bile duct normal in size, unremarkable gallbladder without stones. Limited view of the pancreas due to overlying bowel gas. The patient continued on IV vancomycin prophylactically for the multiple reoperations and the sternal drainage. The patient was transferred from the Intensive Care Unit to the floor on postoperative day number seven. The patient was again noted to have a moderate amount of serosanguinous drainage from the sternal incision as well as a moderate amount of drainage from his right lower extremity vein harvest site. On postoperative day number nine, Dr. [**Last Name (STitle) **] evaluated the patient and applied Dermabond to the sternal incision; however, on postoperative day number ten, the patient continued to drain serosanguinous fluid from his incisions. It was decided by Dr. [**Last Name (STitle) **] that the patient would return to the Operating Room for sternal rewiring. At this time, the patient had begun complaining of nausea and abdominal pain. The patient was noted to have elevated amylase and lipase. The patient was changed to clear liquids and made n.p.o. for the Operating Room. The patient's Operating Room was delayed due to scheduling. On the evening of postoperative day number nine, the patient's sternal drainage became very minimal so it was elected to delay surgery. With the patient becoming n.p.o., the patient's amylase and lipase were decreased. The patient continued to be n.p.o. and subsequently his nausea and left upper quadrant pain subsided. His amylase and lipase continued to decrease. His sternal incision drainage decreased to nothing. The patient continued on his vancomycin. On postoperative day number 14, the patient's amylase and lipase had decreased sufficiently. The patient had tolerated clear liquids. The patient was started on a regular diet. On the night of postoperative day number 14, after one meal, the patient had again elevated amylase and lipase. The patient was switched to a low-fat diet and the patient's amylase and lipase continued to trend down. The patient's sternal drainage had stopped and by postoperative day number 16, the patient was cleared for discharge to home. DISCHARGE DIAGNOSIS: 1. Coronary artery disease. 2. Status post emergent coronary artery bypass graft. 3. Status post reoperation for bleeding. 4. Postoperative sternal drainage. 5. Status post sternal rewire for sternal dehiscence. 6. Postoperative pancreatitis. 7. Insulin-dependent diabetes mellitus. CONDITION ON DISCHARGE: T maximum 98.6, pulse 90, sinus rhythm, blood pressure 106/60, respiratory rate 14, room air oxygen saturation 96%. The patient was awake, alert, oriented times three, ambulating independently with a nonfocal neurological examination. The heart revealed a regular rate and rhythm without rub or murmur. The lungs were clear bilaterally. The abdomen was with positive bowel sounds, soft, nontender, nondistended. He was tolerating a low-fat diet. He had no nausea or vomiting. He was having regular bowel movements. The sternal incision showed peeling Dermabond. No drainage. No erythema. The sternum was stable. The right lower extremity showed resolving ecchymosis with a small amount of serosanguinous drainage from the medial knee and a small amount of resolving erythema at the distal incision right above the ankle. LABORATORY/RADIOLOGIC DATA: White blood cell count 7.7, hematocrit 40, platelet count 279,000. Sodium 135, potassium 4.4, chloride 98, bicarbonate 26, BUN 22, creatinine 1.0, glucose 120. AST 64, ALT 93, alkaline phosphatase 129, amylase 168, lipase 247, total bilirubin 2.1. DISCHARGE MEDICATIONS: 1. Lopressor 75 mg p.o. b.i.d. 2. Colace 100 mg p.o. b.i.d. 3. Enteric coated aspirin 325 mg p.o. q.d. 4. Plavix 75 mg p.o. q.d. 5. Protonix 40 mg p.o. q.d. 6. Lipitor 20 mg p.o. q.d. 7. Combivent MDI two puffs q. six hours p.r.n. 8. Levofloxacin 500 mg p.o. q.d. times two weeks. 9. Lasix 20 mg p.o. b.i.d. times seven days. 10. Potassium chloride 20 mEq p.o. b.i.d. times seven days. 11. Guaifenesin elixir 10 cc p.o. q. six hours p.r.n. 12. NPH insulin 18 units subcutaneously b.i.d. 13. Humalog sliding scale per the patient to maintain a blood sugar of 120 or less. DISPOSITION: The patient is to be discharged to home in stable condition. FOLLOW-UP: The patient is to follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 12491**], in one week for recheck of his amylase and lipase. The patient was instructed to call Dr.[**Name (NI) 12492**] office immediately if he has any abdominal pain,nausea, or any drainage from his sternal or leg incisions. The patient is to follow-up with Dr. [**Last Name (STitle) 911**] in two to three weeks. The patient is to follow-up with Dr. [**Last Name (STitle) **] in three to four weeks. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Last Name (NamePattern1) 1541**] MEDQUIST36 D: [**2112-8-25**] 02:48 T: [**2112-8-25**] 16:57 JOB#: [**Job Number 12493**] ICD9 Codes: 4111, 5119
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Medical Text: Admission Date: [**2179-1-19**] Discharge Date: [**2179-1-28**] Date of Birth: [**2138-1-31**] Sex: M Service: CARDIOTHORACIC Allergies: Codeine Attending:[**First Name3 (LF) 2969**] Chief Complaint: [**Doctor Last Name 15532**] esophagus with intramucosal cancer of the distal esophagus. Major Surgical or Invasive Procedure: transhiatal esophagectomy History of Present Illness: Mr. [**Known lastname **] is a 40-year-old gentleman with longstanding reflux disease status post a Nissen fundoplication in the remote past. He has gone on to develop [**Doctor Last Name 15532**] esophagus, and on serial biopsies has been found to have high-grade dysplasia and by pathologic review evidence for intramucosal cancer. Past Medical History: Barrett's esophagus, HTN, small bowel resection, splenorrhaphy [**2159**], Nissen [**2162**] Physical Exam: general: well appearing male in NAD HEENT: unremarkable chest: CTA bilat, COR RRR S1, S2 abd: soft, round, NT, ND, +BS w/ prev well healed abd scar. extrem: No C/C/E neuro: alert and oriented x3 Pertinent Results: [**2179-1-24**] CXR IMPRESSION: Slight decrease in left-sided pleural effusion. Airspace disease at the left base. Patchy increase in density at the right base may represent some subsegmental atelectasis or early airspace disease. [**2179-1-19**] Pathology Tissue: ESOPHAGUS AND PROXIMAL [**2179-1-19**] [**Last Name (LF) **],[**First Name3 (LF) 2389**] M. Not Finalized Brief Hospital Course: pt was admitted and taken to the OR for transhiatal esophagectomy and J-tube placement. An NGT for gastric decompression and JP drain to bulb sxn at neck anastomosis to facilitate drainage. An epdiural was placed for pain control. Pt was admitted to the ICU overnoc and extubated on POD#1 and transferred from the ICU. Post op course was uneventful -Trophic tube feeds were started on POD#3 and remained on IVF for hydration while NPO. NGT was d/c'd on POD# 4. Pt was ambulating independently in hallway w/ sats mid 90's on roomair. Epidural was d/c'd on POD#6 and transitioned to PCA for apin control. On POD # 7 pt given trail of po grape juice w/o any evdience of grape juice via the [**Doctor Last Name **] at the neck anastomotic site. Pt was then started on clear liquids and tube feed was slowly increased to goal. Pain was controlled on po roxicet. Pt was d/c'd to home on POD# 9 w/ continous tube feeds, full liqs to soft solid diet and VNA services. Medications on Admission: lisinopril, prevacid . Discharge Medications: 1. Replete/Fiber Liquid Sig: Seventy (70) ml PO per hour: may cycle as [**Last Name (un) 1815**]. Disp:*QS x 1 month QS x 1 month* Refills:*11* 2. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO once a day. Disp:*30 tabs* Refills:*2* 3. Lopressor 50 mg Tablet Sig: [**11-24**] Tablet PO twice a day. Disp:*15 Tablet(s)* Refills:*2* 4. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs PO Q4-6H (every 4 to 6 hours) as needed. Disp:*420 ML(s)* Refills:*0* 5. Motrin 100 mg/5 mL Suspension Sig: Four Hundred (400) mg PO every eight (8) hours. Disp:*600 ml* Refills:*2* 6. feeding pump feeding pump and supplies one month supply with 11 refills 7. tube feeding flush flush with 50cc water every 8 hours while in use, before and after instillation of liquid medications, before and after tube feed discontinuation, or when not in use. 8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: Androscroggin VNA Discharge Diagnosis: Barrett's esophagus, HTN, small bowel resection, splenorrhaphy [**2159**], Nissen [**2162**] transhiatal esophagectomy Discharge Condition: good-requires tube feeds to meet nutritional needs Discharge Instructions: Please call Dr.[**Doctor Last Name 4738**] office if you develop chest pain, shortness of breath, fever, chills, redness or drainage from your incision sites, Also call if you have difficulty swallowing or do not tolerate tube feeding (diarrhea, vomiting)or if the feeding tube becomes loose or falls out. If your feeding tube falls out, bring the tube and immediately go the nearest ER and have it replaced. Call Dr.[**Name (NI) **] office [**Telephone/Fax (1) 170**] and update us regarding the feeding tube. Continue on a soft solids diet until you are seen in follow up. Followup Instructions: Please report to [**Hospital Ward Name 23**] 4 at [**2179-2-11**] 10:30am for a barium swallow then proceed to your follow up appointment with Dr. [**Last Name (STitle) **]. You have a follow up appointment with Dr. [**Last Name (STitle) **] on [**2179-2-11**] at [**Hospital Ward Name **] clinical center [**Location (un) **]. Completed by:[**2179-1-28**] ICD9 Codes: 5180, 4019, 3051
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Medical Text: Admission Date: [**2128-7-21**] Discharge Date: [**2128-7-27**] Date of Birth: [**2067-1-7**] Sex: M Service: MEDICINE Allergies: Penicillins / E-Mycin Attending:[**First Name3 (LF) 800**] Chief Complaint: diabetic foot ulcer, hypotension Major Surgical or Invasive Procedure: I+D of R diabetic foot ulcer History of Present Illness: 61yo M with h/o DM, dementia, MR admitted to podiatry with diabetic right foot ulcer s/p I+D in OR on [**2128-7-21**] transferred from PACU to MICU for hypotension. Per records and ED attending patient was found down at [**Hospital3 **] this morning in feces and urine. He was brought to the ED where he had a temp to 101, sinus tach to 150s, WBC 18, and cellulitis on right foot with purulent ulcer and streaking up leg to groin with track. Mental status was "alittle out of it" but at baseline per family. Got 4L NS in the ED and APAP and HR down to 120s. XR foot didnt show evidence of osteo but had track with pus through ulcer. Broad spec abx were given (vanc/ctz/cipro/flagyl) and he was evaluated by podiatry and vascular surgery who recommended sending him to the OR for I+D. . In the OR the patient underwent I+D, received fent (75mg)/midaz (3mg), esmolol and metoprolol for sinus tach in the 150s and neo for hypotension (100s/50s) and 5L drained 10cc pus from right foot, EBL 50mL, packed with saline wet-dry dressing change. Per anesthesia he's had tachycardia treated with esmolol and hypotensive (100s/50s). superficial culture taken in ED and deep cultures taken in OR as well. Will likely need debridement and head of Metatarsal removed over the next few days by podiatry. . On the floor, patient is sleeping but arousable. Denies pain. Denies chest pain and denies palpitations. Past Medical History: DM2 Vascular dementia Asthma Hypertension Barretts esophagus . PAST SURGICAL HISTORY: (per OMR) Open reduction and internal fixation fracture both bones of the forearm [**6-/2117**], pheochromocytoma [**2110**] Social History: (per OMR) Smoking: Nonsmoker. ETOH: Social drinking. Physical Exercise: Patient has been moderately physically active. Family History: non-contributory Physical Exam: Vitals: T:97.1 BP:91/40 P:140 R:25 O2:97 on 5L NC General: somnolent but arousable, answers questions appropriately but falls asleep mid-interview HEENT: Sclera anicteric, very dry MM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Upper airway snoring sounds but otherwise Clear to auscultation bilaterally, no wheezes, rales, ronchi anteriorly CV: tachycardic but regular Abdomen: Obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding GU: foley Ext: warm, well perfused, no edema, bandage on right foot with marker line on leg and inside marker line no erythema Pertinent Results: [**2128-7-21**] 08:05PM BLOOD WBC-18.1*# RBC-4.26* Hgb-11.0* Hct-33.0* MCV-78* MCH-25.9* MCHC-33.5 RDW-16.8* Plt Ct-269 [**2128-7-21**] 08:05PM BLOOD Neuts-88.5* Lymphs-4.4* Monos-6.4 Eos-0.2 Baso-0.5 [**2128-7-23**] 12:58AM BLOOD WBC-6.3 RBC-3.40* Hgb-8.8* Hct-25.8* MCV-76* MCH-25.8* MCHC-34.1 RDW-16.7* Plt Ct-219 [**2128-7-21**] 08:05PM BLOOD PT-16.4* PTT-29.3 INR(PT)-1.5* [**2128-7-22**] 12:54AM BLOOD Fibrino-640* [**2128-7-21**] 08:05PM BLOOD Glucose-434* UreaN-34* Creat-1.3* Na-127* K-4.6 Cl-92* HCO3-22 AnGap-18 [**2128-7-21**] 08:05PM BLOOD ALT-41* AST-49* LD(LDH)-332* AlkPhos-90 TotBili-0.8 [**2128-7-22**] 12:54AM BLOOD Albumin-2.4* Calcium-7.0* Phos-3.2 Mg-1.8 [**2128-7-22**] 12:54AM BLOOD Hapto-182 [**2128-7-21**] 08:05PM BLOOD Osmolal-296 [**2128-7-22**] 12:54AM BLOOD TSH-0.92 [**2128-7-23**] 12:58AM BLOOD Cortsol-13.5 [**2128-7-22**] 01:05AM BLOOD Type-[**Last Name (un) **] pO2-56* pCO2-50* pH-7.23* calTCO2-22 Base XS--6 [**2128-7-22**] 01:40AM BLOOD Type-ART pO2-96 pCO2-51* pH-7.23* calTCO2-22 Base XS--6 Intubat-NOT INTUBA [**2128-7-21**] 08:13PM BLOOD Glucose-386* Lactate-2.1* K-4.6 [**2128-7-22**] 09:37AM BLOOD freeCa-1.06* [**2128-7-21**] 09:45PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.023 [**2128-7-21**] 09:45PM URINE Blood-LG Nitrite-NEG Protein-75 Glucose-1000 Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2128-7-21**] 09:45PM URINE RBC-2 WBC-1 Bacteri-FEW Yeast-NONE Epi-0 . [**2128-7-22**] MRSA SCREEN MRSA SCREEN-PENDING INPATIENT [**2128-7-22**] SWAB GRAM STAIN-FINAL; WOUND CULTURE-PRELIMINARY; ANAEROBIC CULTURE-PRELIMINARY INPATIENT [**2128-7-22**] SWAB GRAM STAIN-FINAL; WOUND CULTURE-PRELIMINARY; ANAEROBIC CULTURE-PRELIMINARY INPATIENT [**2128-7-22**] URINE URINE CULTURE-FINAL INPATIENT [**2128-7-21**] SWAB GRAM STAIN-FINAL; WOUND CULTURE-PRELIMINARY; ANAEROBIC CULTURE-FINAL EMERGENCY [**Hospital1 **] [**2128-7-21**] BLOOD CULTURE Blood Culture, Routine-PENDING EMERGENCY [**Hospital1 **] [**2128-7-21**] BLOOD CULTURE Blood Culture, Routine-PENDING [**2128-7-21**] ECG: Narrow complex tachycardia which may be due to sinus tachycardia or an atrial flutter or atrial tachycardia with 2:1 conduction. Compared to the previous tracing of [**2124-5-20**] the rate has increased substantially and there may be an atrial arrhythmia present. . [**2128-7-21**] CT Head W/Out Contrast: 1. No acute intracranial pathology. 2. Parenchymal atrophy and small vessel microvascular disease. . [**2128-7-21**] R Foot AP,LAT & OBL X-Ray: : Soft tissue ulceration and swelling at the medial forefoot at the level of the great toe with soft tissue ulceration. Markedly limited study for evaluation for osteomyelitis and if clinically warranted, MRI may be obtained to further assess. . [**2128-7-21**] CXR: No evidence of pneumonia. Equivocal evidence of mild congestion. . [**2128-7-22**] TEE: 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 spontaneous echo contrast 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 with normal cavity size. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 40 cm from the incisors. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. . . [**7-24**]: xray HISTORY: Foot ulcer status post debridement. FINDINGS: In comparison with the study of earlier in this date, there has been extensive debridement about the first MTP joint with bony resection. Area of gas in soft tissues could merely be trapped under the bandage. Further information can be gathered from the operative report. Brief Hospital Course: 61yo M with DM2, vascular dementia found down at [**Hospital3 **] with infected foot ulcer s/p I+D in OR with hypotension likely from sepsis. . # Sepsis/ right foot osteomyletis: - Resolved following aggressive IVF. Lactate normalized and he had improved mentation and urination. Covered broadly for infected diabetic foot ulcer with Vanc/Ceftaz/Cipro/Flagyl initially. Cultures showed multiple organisms. Was followed by vascular and podiatry.On wound culture: UNABLE TO R/O OTHER PATHOGENS DUE TO OVERGROWTH OF SWARMING PROTEUS.STAPH AUREUS COAG +=RARE GROWTH. ANAEROBIC CULTURE (Preliminary):NO ANAEROBES ISOLATED. Blood pressures are currently stable. Status post podiatric surgery ([**7-24**])-Resection of first metatarsophalangeal joint. Radical debridement of skin, muscle and subcutaneous tissue, right foot. Delayed primary closure, right foot. Will be discharged on levofloxacin which will cover the MSSA which grew from his wound culture. . # Tachycardia: A flutter, s/p D/C cardioversion after amiodarone loading, and beta blocking. TEE did not show thrombus. Now in sinus with improved BP. Pt started on heparin gtt which was transitioned to lovenox and coumadin. Has remained in sinus rhythm. Currently being rate controlled with Metoprolol 75mg TID. Lovenox should be DC'd after INR therapeutic between [**12-31**]. Anticoagulation should be continued until [**8-24**]. At that time need for anticoagulation should be reassessed. . # Acid/Base disturbance: had respiratory acidosis and non gap met acidosis on admission to MICU. Thought to be secondary to sepsis with procedural sedation. This issue has resolved since and on the floor his acid/base status was stable. . # Hyponatremia: Hypovolemic hyponatremia likely [**12-30**] either tea and toast diet/poor po intake from being on floor for unknown number of days vs adrenal insufficiency vs insensible losses from fevers, infection etc. Improved with hydration (normal TSH, random cortisol was 13.2 ?????? equivocal).His sodium level on the floor were normal. . # Anemia: Hct were 25-26 which is low for his baseline of 30s-40s. guaiac negative, hemolysis labs were negative. Continued to trend Hct. Iron studies were obtained. Iron: 25 calTIBC: 176 Ferritn: 871 TRF: 135, suggestive of anemia with chronic disease. This should be followed by the patient's primary care physician. # Elevated INR: unclear etiology, patient not on coumadin, heparin. Possibly nutritional deficiency but with anemia concerning for hemolysis. INR is now coming down and has been stable at around 1.4. No evidence of hemolysis. Started on heparin gtt during stay which was transioned to lovenox and coumadin bridge. . # [**Last Name (un) **]: Likely [**12-30**] hypotension/pre-renal given sepsis. Now resolved. # conjunctivitis: Found to have conjunctivitis on [**7-22**]. Started on erythromycin drops. Resolving. Erythromycin stopped prior to discharge. # Dementia/MR: sedating meds were being held initially because of low BP. Otherwise issue stable during admission. # COPD: Standing atrovent and PRN albuterol nebs while in ICU and floor. Breathing status has been stable and he is tolerating room air well. Continued on home [**Month/Year (2) **] at discharge. . # DM: Standing insulin sliding scale. . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ -The patient will need at least 1 month of anticoagulation after having atrial flutter cardioversion. The potential continuation of anticoagulation will have to be assessed as an outpatient. Medications on Admission: HCTZ 25', metformin 1000', lisinopril 40', remeron 45'qhs, simvastatin 40', mertazipine 30'qhs, celexa 40', [**Last Name (LF) **], [**First Name3 (LF) 130**] Discharge Medications: 1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 10 days. Disp:*10 Tablet(s)* Refills:*0* 2. Warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 4. Lovenox 80 mg/0.8 mL Syringe Sig: One (1) Subcutaneous twice a day. 5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 7. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 8. [**First Name3 (LF) 4010**] Diskus 250-50 mcg/Dose Disk with Device Sig: One (1) Inhalation twice a day. 9. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 10. Acetaminophen 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for pain/fever. 11. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 12. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Discharge Disposition: Extended Care Facility: [**Hospital 4316**] Rehabilitation & [**Hospital **] Care Center - [**Location (un) **] Discharge Diagnosis: 1.Osteomyelitis, right first metatarsophalangeal joint. 2. Abscess and cellulitis, right foot. 3. Atrial flutter which was cardioverted Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: It was a pleasure to care for you as your doctor. . You were brought to the hospital because of a foot infection. You developed low blood pressure and spent a couple of days in the intensive care unit. After intravenous fluids, antibiotics, and surgery on your foot you improved and were transferred to the regular floor. Your admisison was complicated by a abnormal heart rhythm which required electrial conversion to a regular heart rhythm. . We made the following changes to your home medication list: -We added Coumadin which is a blood thinner you will need to take because of the irregular heart rhythm you experienced. Please take this medication as directed by your outpatient physician. -We added lovenox which is a blood thinner you must take for your irregular heart rhythm you experienced, please take this medication as directed by your physician at rehab. This will be stopped once your INR is between [**12-31**]. -We started levofloxacin which is an antiobiotic for your foot infection which you had surgery. - Lisinopril and HCTZ were stopped during admission. . Please follow up with the outpatient appointments below: Followup Instructions: Department: PODIATRY When: THURSDAY [**2128-8-5**] at 8:05 AM With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], 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 Department: HMFP When: THURSDAY [**2128-9-9**] at 2:10 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 1387**] Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 551**] Campus: EAST Best Parking: Main Garage Department: [**State **]When: MONDAY [**2128-9-27**] at 9:00 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8428**], MD [**Telephone/Fax (1) 2205**] Building: [**State **] ([**Location (un) **], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: On Street Parking [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**] ICD9 Codes: 5849, 2761
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Medical Text: Admission Date: [**2190-9-2**] Discharge Date: [**2190-9-7**] Date of Birth: [**2115-7-18**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 165**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2190-9-2**] Minimally Invasive Off-Pump Coronary Artery Bypass Graft x 1 (LIMA to LAD) History of Present Illness: 75 y/o male c/o dyspnea on exertion who had a cardiac CT that revealed plaque on his LAD. Underwent cardiac cath which revealed a totally occluded LAD. Past Medical History: Coronary Artery Disease, Hypertension, Hyperlipidemia, Aortic Insufficiency, s/p Appendectomy, s/p Hernia Repair x 2, Benign Prostatic Hypertrophy Social History: Retired. Quit smoking 50 years ago. Drink [**12-1**] glasses whiskey/night. Family History: Non-contributory Physical Exam: Admission: VS: 81 16 148/76 5'[**93**]" 170# Gen: WD/WN male in NAD Skin: Unremarkable HEENT: EOMI, PERRL, NCAT Neck: Supple, FROM , -JVD Chest: CTAB Heart: RRR Abd: Soft, NT/ND Ext: -c/c/e, -varicosities Neuro: A&O x 3, MAE, non-focal Discharge: VS: T98.4 HR81 BP126/68 RR18 O2sat93%RA Gen: NAD Neuro: A&Ox3, nonfocal exam Pulm: CTA-bilat CV: Irreg-Irreg, left thoracotomy incision w/steri's CDI Abdm: soft, NT/ND/NABS Ext: warm, well perfused. [**12-1**]+pedal edema Pertinent Results: [**9-2**] Echo: 1, The left atrium is moderately dilated. No spontaneous echo contrast is seen in the body of the left atrium. No thrombus is seen in the left atrial appendage. No atrial septal defect is seen by 2D or color Doppler. 2, Right ventricular chamber size and free wall motion are normal. Right ventricular chamber size is normal. 3. There are simple atheroma in the ascending aorta. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are mildly thickened. No masses or vegetations are seen on the aortic valve. There is no aortic valve stenosis. Moderate (2+) aortic regurgitation is seen. The aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. There is no flow reversal in the descending aorta. 4. The mitral valve appears structurally normal with trivial mitral regurgitation. Trivial mitral regurgitation is seen. 5, There is a trivial/physiologic pericardial effusion. 6. LV systolic function is normal . LVEF= 55%. During occlusion of LAD, there was akinesis of mid and distal anterior wall with preserved ejection fraction. Upon release of LAD occlusion, there is improvement of anterior wall, but some residual anterior hypokinesis. [**9-5**] CXR: PA and lateral views of the chest are obtained on [**2190-9-5**] at 1553 hours and compared with the prior radiograph performed on [**2190-9-2**]. The patient is status post CABG. He has been extubated and the Swan-Ganz catheter and pleural tubes have been removed. Increased density is seen in the right base which is likely a combination of fluid and atelectasis in the right lower lobe. Patchy increased density is seen in the retrocardiac area on the left side consistent with a degree of atelectasis/airspace disease of the left base. Bilateral small pleural effusions are present. [**2190-9-2**] 03:05PM BLOOD WBC-14.6*# RBC-3.01* Hgb-10.1* Hct-28.6* MCV-95 MCH-33.6* MCHC-35.3* RDW-13.4 Plt Ct-141* [**2190-9-5**] 02:02AM BLOOD WBC-10.9 RBC-2.90* Hgb-10.1* Hct-28.1* MCV-97 MCH-34.7* MCHC-35.8* RDW-13.1 Plt Ct-148* [**2190-9-2**] 03:05PM BLOOD PT-14.5* PTT-31.4 INR(PT)-1.3* [**2190-9-5**] 02:02AM BLOOD PT-11.8 PTT-27.1 INR(PT)-1.0 [**2190-9-2**] 04:30PM BLOOD UreaN-10 Creat-0.7 Cl-115* HCO3-22 [**2190-9-5**] 02:02AM BLOOD Glucose-113* UreaN-11 Creat-0.8 Na-135 K-4.0 Cl-105 HCO3-24 AnGap-10 [**2190-9-5**] 02:02AM BLOOD Calcium-8.2* Phos-2.5* Mg-2.2 COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct 07 [**2190-9-5**] 02:02AM 148* Source: Line-art [**2190-9-5**] 02:02AM 11.8 27.1 1.0 [**2190-8-30**] 02:02AM 10.9 2.90* 10.1* 28.1* 97 34.7* 35.8* 13.1 148* RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2190-9-5**] 02:02AM 113* 11 0.8 135 4.0 105 24 10 Brief Hospital Course: Mr. [**Known lastname 73692**] was a same day admit after undergoing all pre-operative work-up as an outpatient. On day admission he was brought to the operating room where he underwent a minimally invasive off-pump coronary artery bypass graft x 1. Please see operative report for surgical details. Following surgery he was transferred to the CVIICU for invasive monitoring in stable condition. Later on op day he was weaned from sedation, awoke neurologically intact and extubated. He required Neo-Synephrine for hemodynamic support until early post-op day three when it was weaned off. Lasix and beta blockers were initiated and he was gently diuresed towards his pre-op weight. Chest tubes were removed on post-op day three and he was transferred to the SDU for further care. Also on this day his heart rhythm went into atrial fibrillation and he was started on Amiodarone and Coumadin. He continued to progress in his activity and on POD 5 it was decided he was ready for discharge home with visiting nurse visits Medications on Admission: Aspirin 81mg qd, Amlodipine 3.75mg qd, Finasteride 5mg qd, Flomax o.4mg qd, Lasix 20mg qd, Lisinopril 5mg qd, Plavix 75mg Discharge Medications: 1. Aspirin 81 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:*1* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*1* 3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 7. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*1* 8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*1* 9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours): [**Hospital1 **] x 10 days then QD x 14 days. Disp:*34 Tablet(s)* Refills:*0* 10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO Q12H (every 12 hours): [**Hospital1 **] x 10 days then QD x 14 days. Disp:*68 Capsule, Sustained Release(s)* Refills:*0* 11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): 400 mg [**Hospital1 **] x 7 days then 400 mg QD x 7 days then 200 mg QD. Disp:*60 Tablet(s)* Refills:*2* 12. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) for 3 weeks. Disp:*65 Tablet(s)* Refills:*0* 13. Warfarin 2 mg Tablet Sig: as directed Tablet PO once a day: Target INR 1.5-2.0. Disp:*75 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) **] Nursing Services Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 1 PMH: Hypertension, Hyperlipidemia, Aortic Insufficiency, s/p Appendectomy, s/p Hernia Repair x 2, Benign Prostatic Hypertrophy Discharge Condition: Good Discharge Instructions: 1)Please shower daily. No baths. Pat dry incisions, do not rub. 2)Avoid creams and lotions to surgical incisions. 3)Call cardiac surgeon if there is concern for wound infection. 4)No lifting more than 10 lbs for at least 10 weeks from surgical date. 5)No driving for at least one month. Followup Instructions: Dr. [**First Name (STitle) **] in 4 weeks Dr. [**Last Name (STitle) 11493**] in [**1-2**] weeks Dr. [**Last Name (STitle) 17029**] in [**12-1**] weeks [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2190-9-7**] ICD9 Codes: 4241, 2724, 4019
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Medical Text: Admission Date: [**2114-10-22**] Discharge Date: [**2114-11-16**] Date of Birth: [**2064-6-13**] Sex: F Service: MEDICINE Allergies: Penicillins / Sulfur / Demerol / Amphotericin B / Allopurinol / Vicodin / Percocet Attending:[**First Name3 (LF) 6169**] Chief Complaint: Scheduled admission for chemotherapy Major Surgical or Invasive Procedure: s/p antegrade nephrostogram s/p PICC line placement History of Present Illness: Ms. [**Known lastname **] is a 50 year old woman with history of AML, allogenic transplant in [**2110-8-4**], and recent admissions for right-sided hydronephrosis ([**Month (only) 116**]), donor lymphocyte infusion in (discharged [**8-24**]), and left-sided hydronephrosis (discharged [**10-4**]). She has been admitted for chemotherapy in preparation for donor lymphocyte infusion vs. second bone marrow transplant. . She reports feeling "lousy" for the past several weeks, with feelings of fatigue and lack of stamina. She has had increased bruising. Her steroids were increased last Friday to 40mg daily from 30mg daily. She reports a headache and fever to 100.5 last night which came down with Tylenol. Past Medical History: ONCOLOGY HX: - Acute myelogenous leukemia s/p allo transplant - [**2110-8-4**]: 5 of 6 matched family member allogenic BMT for AML. Father was her donor. She has remained in complete remission; no GVHD. Her performance status was 100%. - mid-[**7-10**] found to have peripheral blasts and host cells in marrow, suggestive of relapsed AML, planning for DLI . PMH: 1. AML- as above 2. Allergic rhinitis 3. Depression Social History: Married, lives with her husband and three children ages 13, 8, 6. Works as a controller. No tobacco or EtOH. Family History: Both parents living. Mother with HTN, MI, SLE; father with HTN. Father (donor) recently had MI. Siblings with hypertension. Physical Exam: Vitals: T 98.6 BP 107/67 P 98 RR 18 O2sat 98% Gen: Well-appearing, no acute distress HEENT: PERRL, EOMI, OP clear, MMM Neck: No LAD Card: RRR, normal S1/S2, no m/r/g Pulm: CTA bilaterally Back: No CVAT, mild tenderness around percutaneous nephrostomy insertion site, ecchymoses Abd: Soft, non-distended, RUQ and epigastric tenderness Ext: No clubbing or cyanosis, 1+ non-pitting edema bilaterally, 2+ pulses bilaterally Skin: Some ecchymoses, no rashes Neuro: A&Ox3, responds appropriately Pertinent Results: Urine cytology : NEGATIVE FOR MALIGNANT CELLS. . RUQ U/S [**10-23**]: Mildly distended gallbladder. Mildly distended common bile duct. Negative [**Doctor Last Name 515**] sign. HIDA can be performed for further evaluation if clinically warranted. . CT Abd/Pelvis [**10-23**]: 1. Ascites and edema of the small and large bowel. The appearances may be consistent with enteritis or a graft versus host disease. 2. No evidence of perforation. 3. Left nephrostomy tube. 4. Moderate dilation of right kidney. 5. Unchanged appearance of low attenuation lesions in pancreas and liver. . Abd X-Ray [**10-23**]: FINDINGS: Left nephrostomy tube is present. No dilated bowel loops are identified. Stool and air is present in the colon. The osseous structures are unremarkable. IMPRESSION: No obstruction. . [**2114-11-5**] BONE MARROW CORE BIOPSY: DIAGNOSIS: Markedly hypocellular bone marrow with extensive fibrosis and focal increased blasts, see note. Note: The aspirate material is aspicular. The core biopsy shows extensive areas of grade 3 reticulin fibrosis. An immunohistochemical stain for CD34 highlights a focal area with increased interstitial blasts within the extensively fibrotic background, which likely represents minimal residual disease. This was reviewed in consultation with Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] who concurs. Compared to the previous biopsy, the current biopsy shows a marked reduction in cellularity. MICROSCOPIC DESCRIPTION. Peripheral Blood Smears: Red blood cells show hypochromasia and anisopoikilocytosis with rare microcytes, red cell fragments and dacrocytes. The white blood cell count appears markedly decreased. Platelet count appears markedly decreased. Large/giant forms are not seen. A limited 25 cell differential shows 100% lymphocytes. Aspirate Smears: The aspirate material is inadequate for evaluation due to a lack of spicules, hemodilution, and clotted sample. Clot Section and Biopsy Slides: The biopsy material is fragmented, but adequate for evaluation. One bony piece is hypocellular with new bone formation and likely represents previous biopsy site. A second bony core fragment contains diffuse background fibrosis occupying more than half the length of this piece. In the remaining half, the cellularity is variable (overall 10%) and is comprised predominantly of plasma cells, lymphocytes, and hemosiderin-laden macrophages. A small lymphoid aggregate is seen. Maturing myeloid and erythroid precursors are extremely scant. A CD34 immunohistochemical stain is performed to better assess presence of blasts, given the architectural distortion by background fibrosis. The CD34 stain highlights scattered interstitial mononuclear cells within the fibrotic areas overall comprising ~10% of marrow cellularity (the remaining being lymphocytes and plasma cells). Special Stains: Iron stain is inadequate for evaluation due to lack of spicules. Reticulin stain shows extensive Grade 3 reticulin fibrosis. Trichrome stain does not show any collagen fibrosis. ADDENDUM: Additional immunohistochemical studies with antibodies against favor VIII-related antigen highlights endothelial cells. Definite staining amongst blasts is not seen, however, scant tissue remains on deeper sections used for immunohistochemical staining. . Renal U/S: IMPRESSION: No definite evidence of hydronephrosis. Left-sided nephrostomy tube is seen in place. Likely right-sided ureteral jet. No left ureteral jet identified. . [**2114-11-15**] Antegrade Nephrostogram:IMPRESSION: Persistent narrowing of the distal left ureter, probably from the extrinsic compression, unchanged from the study from one month ago Brief Hospital Course: #) AML. She was admitted for scheduled MEC with initial plans for either second DLI vs. second BMT. She tolerated MEC, but her course was complicated by severe mucositis. pain was controlled with Fentanyl PCA. She also developed diarrhea (C. diff and other stool cultures negative and symptomatically treated with immodium). Day 14 marrow revealed markedly hypocellular bone marrow with extensive fibrosis and focal increased blasts. On discharge, she is to follow-up with her outpatient oncologist for a repeat bone marrow bx and further discussion of additional chemotherapy/mini transplant. . #) Abdominal pain: Patient was admitted with complaints of mild abdominal discomfort. Then, on AM of [**10-23**], developed worsening abdominal pain, diffuse, worse in LLQ. KUB negative for free air and obstruction. She was given lorazepam 1g IV for anxiety and sent for CT abd/pelvis without contrast. After returning from CT, BP was found to be 70/40 with continued progression of her pain. She also had some associated nausea. She was mentating normally throughout. She was given a 1L NS bolus with transient improvement of her blood pressure to 95/50s. She was also given aztreonam 2g IV, vancomycin 1g IV, and metronidazole 500mg IV. She also received morphine 1mg IV for pain with little relief. Surgery was consulted and she was transferred to the ICU. Abd CT revealed ascites and edema of the small and large bowel. The appearances may be consistent with enteritis or a graft versus host disease with no evidence of perforation. Ultimately, this was felt not to be an acute surgical abdomen. Once her blood pressure stabilized and she was aggressively diuresed. Following diuresis, her abdominal pain also subsided. By the time of discharge, she was feeling well without abdominal discomfort. . #) Hypotension: In the setting of severe abdominal pain, she was found to have SBP in 80's, which responded well to fluid boluses. Initially, there was concern for sepsis, and she was started on stress dose steroids, which were ultimately tapered down. Afterwards, her BP remained stable. She was discharged on a tapered down dose of 5 mg prednisone QD. . #) Fevers: Beginning on [**11-7**], she developed fevers to 101. She was empirically covered with aztreonam, vancomycin and caspofungin. There was concern for a line infection from her left IJ, which waspulled. The tip was sent for culture, but no organisms grew. Blood cx subsequently grew out Lactobacillus X3. ID was consulted and suggested starting meropenam. Given she has a hx of hives to penicillins, she was premedicated and tolerated the meropenam without incident. She was discharged to complete a total of 14 day course of meropenam. Ertapenam as QD antibiotic was discussed, but as there was no literature to support its efficacy against lactobacillus, she was discharged with VNA services to help administer her IV meropenam. By dicharge, she had been afebrile for greater than 72 hours. . #) Hydronephrosis: Patient has a history of obstruction of her ureters. The etiology remains unclear as the ureters behave as if there is external compression, but there are no compressing masses seen on any imaging. She was s/p urgent placement of L nephrostomy tube, and had been responding well. On [**11-10**], she developed R flank pain (very mild and intermittent) as well as decreased urine output. There was concern for right ureteral obstruction as well, but Abd U/S revealed normal flow through R ureter. Urology was consulted regarding taking out her left nephrostomy tube prior to discharge. She had a antegrade nephrostogram, which revealed essentially unchanged partial obstruction of left ureter with only minimal and slow flow. the decision was made for her to follow-up with her urologist, Dr. [**Last Name (STitle) 770**], as an outpatient to further assess in 2 weeks. . #) F/E/N: IVF, bolus as needed, replete electrolytes as needed. She was started on TPN for nutrition given her abdominal pain and was gradually weaned off. By discharge, she was tolerating PO's. Medications on Admission: Ciprofloxacin 250mg [**Hospital1 **] Ritalin 20mg QD Citalopram 20mg QD Loratadine 20mg QD Beclonase [**Hospital1 **] Fluconazole 200mg QD Acyclovir 400mg [**Hospital1 **] Protonix 40mg [**Hospital1 **] Sudafed 30 mg QD Potassium 20mEq powder Fluconazole QD Prednisone 40mg (increased on Friday) Discharge Medications: 1. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Loratadine 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 3. Pseudoephedrine HCl 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Methylphenidate 10 mg Tablet Sig: One (1) Tablet PO once a day. 5. Beclomethasone Diprop Monohyd 42 mcg (0.042 %) Aerosol, Spray Sig: One (1) Nasal [**Hospital1 **] (2 times a day). Disp:*qs qs* 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. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Loperamide 2 mg Capsule Sig: One (1) Capsule PO Q4H (every 4 hours) as needed for diarrhea. Disp:*30 Capsule(s)* Refills:*1* 9. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 10. Meropenem 500 mg Recon Soln Sig: One (1) Recon Soln Intravenous Q8H (every 8 hours) for 7 days: Please premedicate with Tylenol. Disp:*21 Recon Soln(s)* Refills:*0* 11. Potassium Chloride 20 mEq Packet Sig: One (1) PO once a day. Disp:*30 packets* Refills:*2* 12. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 13. Line care Please flush and care for line as per IV network protocol Discharge Disposition: Home With Service Facility: VNS of [**Location (un) 7188**] and [**Location (un) 16221**] County Discharge Diagnosis: Primary: AML lactobacillus bacteremia ureteral stricture Discharge Condition: good Discharge Instructions: You have AML and received induction chemotherapy during this admission. During this hospital course, you have some narrowing of your left ureter requiring the nephrostomy tube to be in place. You will need to address this issue with your urologist, Dr. [**Last Name (STitle) 770**]. Also, you have a bacteria called Lactobacillus growing in your blood. To treat this bacteria, you will need to take an antibiotic called Meropenam IV every 8hours for one week. Please attend all follow-up appointments and take all medications as prescribed. Followup Instructions: Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**] at [**Hospital1 18**] [**2114-11-19**] at 12:30. . Also, please follow-up with your urologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 770**] to discuss when you can have your nephrostomy tube removed. Your appointment with him is on [**2114-11-29**] 2:50PM in [**Hospital Ward Name 23**] Building [**Location (un) 436**], [**Hospital1 18**] [**Hospital Ward Name **]. ICD9 Codes: 7907, 4589
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Medical Text: Admission Date: [**2135-2-27**] Discharge Date: [**2135-3-2**] Date of Birth: [**2079-12-3**] Sex: F Service: MEDICINE Allergies: Haldol Attending:[**First Name3 (LF) 3507**] Chief Complaint: SOB, hypoxia Major Surgical or Invasive Procedure: none History of Present Illness: 55F with COPD, paranoid schizophrenia, seizure disorder presents with episode of SOB at her group home with hypoxia to the 70s, increasing cough productive of yellow sputum. Patient reports that she got up to go to the bathroom and felt SOB. She has had a productive cough for months but has recently had more sputum production. Denies sick contacts (although she lives in a group home), hemoptysis, chills, fevers, unwanted weight loss. She has had some night sweats and has been having episodes of vertigo which have been controlled with anivert. She continues to smoke [**2-15**] PPD. . In the ED, T 97.3, HR 109, BP 101/69, RR 20 O2 98% on 6 L to 94 % on RA. She had 2 episodes of hypotension to SBP high 70s-80s which initialy responded to IVF, but given second episode, was tranferred to the ICU for close monitoring. She recieved combivent nebs x3, 5 L NS, levofloxacon 500 mg IV x 1 and solumedrol 125 mg IV x1. . Per discussion with PCP; baseline BP runs in the 90s-100s. . ROS: Denies diarrhea, constipation, headache, CP. She has had a 10 lb intentional weight loss over the past months. Slight sore throat 2 days ago which resolved. She continues to hear voices. Most recently last night when people were trying to "slay her." She also sees "faces" and feel people are talking to her from the TV. Denies HI, SI. Past Medical History: Paranoid Schizophrenia Seizure disorder-unclear history COPD - no PFTs in [**Hospital1 **] system, patient's Pulmonologist is Dr. [**Last Name (STitle) 3278**] at [**Hospital **] Hospital. CXRs at [**Hospital1 18**] however demonstrate interstitial changes c/w ILD Vertigo Hypercholesterolemia Foot pain - unclear etiology Urinary incontinence s/p "bladder surgery" 8 years ago Social History: Patient lives in a group home. Smokes [**2-15**] ppd. Before this smoked PPD since age 13. Denies illicit drug use. Has 2 duaghters. Family History: 2 daughter with "mental health problems." Did not want to speak about her parents. Denies any family history of CAD or stroke. Did have a grandfather with COPD. Physical Exam: Vitals:Tm 100.5 General: Middle aged female lying flat in bed breathing comfortably in NAD HEENT: MMM, OP clear, PERRL Neck: no cervical LAD, no JVD CV: RR, nl S1, S2 no m/g/r Pulm: diffusely rhonchorous with occasional wheezes Abd: NABS, soft, NT/ND Ext: + clubbing right>>left, no LE edema, no calf tenderness, 2 + DP pulses, right forearm with slight erythema at site of PPD but no induration Neuro:AAOx3, CN intact, strength in upper and LE [**6-18**] and equal b/l Psych: reports auditory and visual hallucinations as above. No HI/SI. Somewhat flattened affect Skin: No rashes Pertinent Results: EKG: Sinus tachy, rate 100, nl axis, nl interval, <1mm St depressions in II, II, avF . CXR: b/l lateral interstitial changes. Unchanged from [**2130**]. No evidence of PNA. . [**2135-2-27**] 12:09PM BLOOD Lactate-1.6 [**2135-2-27**] 06:03PM BLOOD Phenyto-9.8* [**2135-2-27**] 09:20AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2135-2-27**] 06:03PM BLOOD CK-MB-2 cTropnT-<0.01 [**2135-2-27**] 09:20AM BLOOD CK(CPK)-48 [**2135-2-27**] 06:03PM BLOOD CK(CPK)-61 [**2135-2-27**] 09:20AM BLOOD Glucose-135* UreaN-22* Creat-0.8 Na-141 K-4.0 Cl-102 HCO3-30 AnGap-13 [**2135-2-27**] 09:20AM BLOOD WBC-17.7* RBC-4.83 Hgb-14.4 Hct-43.7 MCV-91 MCH-29.9 MCHC-33.1 RDW-13.4 Plt Ct-290 [**2135-3-1**] 07:50AM BLOOD WBC-11.4* RBC-4.24 Hgb-12.3 Hct-36.6 MCV-86 MCH-29.0 MCHC-33.5 RDW-13.5 Plt Ct-228 Brief Hospital Course: 55 yo female with h/o COPD, paranoid schizophrenia, seizure disorder presenting with episode of increasing SOB and cough likely [**3-18**] bronchitis v COPD exacerbation v PNA. . # Dyspnea and hypoxia: The patient carries the dx of COPD, however, PA/Lat during this admission demonstrated unchanged interstitial pattern compared to [**2130**]. No PFTs in [**Hospital1 18**] system. She may have a component of both COPD and ILD. Nevertheless,there was a ? of a retrocardiac opacity on the lateral film. Pt to complete 7 day course of Levofloxacin for CAP. She should have her ECG monitored every few days as there is a theoretical interaction between Quinolones and her antipsychotics. She was started on Spiriva and advair for more agressive COPD regimen, and will complete a quick steroid taper. Should f/u with her Pulmonologist, Dr [**Last Name (STitle) 3278**]. . # Hypotension: Patient reports that he SBP run in high 80 to 110s usually. She may have been mildly dehydrated on admission as she says she has not been drinking much and felt dry. She receievd 5.5 L IVF. Was not truly orthostatic on the floor. Lasix held upon discharge. . # Schizophrenia: Has hallucinations at baseline. No current SI/HI. Continued abilify, clozaril, lexapro, diazepam . # Seizure disorder: Unclear history. No recent seizures. Dilantin level at goal corrected for albumin . # ST depressions: Patient had no CP, no increasing DOE and no cardiac history and is not diabetic. Very slight <1mm ST depression in the inferior leads. 2 sets CE's negative. . # Vertigo: Patient says that she has been having feeling that the "room is spinning" for the past couple of weeks. Improved with antivert. Medications on Admission: Clozaril 600 mg PO QHS Abilify 30 mg PO QAM Lexapro 15 mg PO QAM Diazepam 5 mg PO TID Vitamin E 400 mg PO BID Prednisone 10 mg PO BID x 7 days (day 2) Azmacort 4 puffs Po BID Claritin 10 mg Po QD Colace 100 mg PO BID Dilantin 200 mg Po BID Lasix 40 mg Po QAM Antivert 25 mg PO BID:PRN vertigo Lipitor 10 mg PO QD MVI PO QAM DDAVP 0.4 mg PO QHS PPD placed (needs to be read [**2-28**]) C-Pap with 1.2 liters O2 overnight Relafen 500 mg QD PRN Albuterol nebs PRN Albuterol MDI PRN Robitussion 100 cc PO Q4H PRN Tylenol PRN Ibuprofen PRN MOM PRN Nicotine gum PRN Trazadone 50 mg Po QHS PRN sleep Lidomantle cream [**Hospital1 **] for foot pain Ditropan XL 15 daily Discharge Medications: 1. Clozapine 100 mg Tablet Sig: Six (6) Tablet PO HS (at bedtime). 2. Aripiprazole 10 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 3. Escitalopram 10 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 4. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 5. Vitamin E 400 unit Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 8. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 10. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day). 11. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 13. Desmopressin 0.1 mg Tablet Sig: Four (4) Tablet PO QHS (once a day (at bedtime)). 14. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) as needed. 15. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 6 days. 16. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR Transdermal DAILY (Daily). 17. Albuterol Sulfate 0.083 % Solution Sig: One (1) inhl Inhalation Q4H (every 4 hours) as needed. 18. Prednisone 10 mg Tablet Sig: as directed Tablet PO once a day for 2 days: Please take 20 mg on [**3-2**] and 10 mg on [**3-3**] then stop. Discharge Disposition: Extended Care Discharge Diagnosis: Primary Diagnoses: 1. COPD vs ILD exascerbation 2. ?Community Acquired PNA Secondary Diagnoses: Paranoid Schizophrenia Seizure disorder-unclear history Vertigo Hypercholesterolemia Urinary incontinence s/p "bladder surgery" 8 years ago Discharge Condition: stable Discharge Instructions: Please come back to the emergency room should you develop any worsening shortness of breath, fevers, chills, worsening cough, or any other serious concerns. Followup Instructions: Please call to make appiontments for the patient with the following providers. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 42596**], M.D. Specialty: Pulmonary Medicine Address 1: [**Hospital 42597**] Medical Building [**Apartment Address(1) 42598**] [**Hospital1 **], [**Telephone/Fax (1) 42599**] Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 42600**], M.D. Specialty: Family Practice Address 1: Family Medicine Associates, PC 38R [**Hospital1 42601**], [**Telephone/Fax (1) 42602**] ICD9 Codes: 486, 2720, 3051
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6728 }
Medical Text: Admission Date: [**2138-4-10**] Discharge Date: [**2138-5-4**] Date of Birth: [**2091-2-17**] Sex: M Service: [**Last Name (un) **] HISTORY OF PRESENT ILLNESS: The patient is a 47 year old male, with end stage liver disease secondary to hepatitis C cirrhosis diagnosed about 5 years prior to admission. The patient had undergone treatment with interferon and Ribavirin. He had been admitted to the [**Hospital1 18**] multiple times early in [**2137**] for management of encephalopathy and ascites. The patient had been discharged from the [**Hospital1 18**] on [**2138-4-7**], but was readmitted on [**2138-4-10**] when noted to have worsening renal function. The patient's serum creatinine on the day of discharge, on [**2138-4-7**], was 1.9, but was noted to increase to 3.2 on [**2138-4-9**], and was further elevated to 3.6 on [**2138-4-10**]. The patient was admitted with concern for hepatorenal syndrome. PAST MEDICAL HISTORY: 1. Hepatitis C cirrhosis for which the patient was on the liver transplant list. 2. Hypertension. 3. Nephrolithiasis. 4. Hemorrhoids. 5. Knee surgeries. 6. Back surgery. MEDICATIONS: 1. Miconazole nitrate powder tid prn for groin rash. 2. Protonix 40 mg po bid. 3. Lactulose 30 ml tid (titrated to 4 to 5 bowel movements qd). 4. Vancomycin 1 gm IV bid. SOCIAL HISTORY: The patient is married with no children. He works as a counselor at an alcohol and drug treatment facility for teenagers. The patient was previously a heavy alcohol user, but had been sober since [**2120**]. The patient had also used cocaine in the past, but had also stopped in [**2120**]. HOSPITAL COURSE: (Part of the patient's chart from the period [**2138-4-10**] to [**2138-4-24**] is currently unavailable, and this dictation will mainly cover the period from [**2138-4-24**] to [**2138-5-4**]) As previously mentioned, the patient's creatinine at the time of admission was up to 3.6 from 1.9 at the time of his discharge 3 days prior. Over the following 5 days, the patient's creatinine improved marginally to 2.7. Optimization of his fluid balance was managed by the medical service in consultation with hepatology and renal. The patient's INR on admission was 2.4, with his PT level being 18.9. The patient periodically required transfusions of fresh frozen plasma, as well as platelets and red cells. The patient was thrombocytopenic with a platelet count of 49 on the 23. The patient was continued on vancomycin therapy for his previously diagnosed Methicillin resistant, coagulase negative Staph bacteremia. The patient's nutrition was suboptimal, and the patient was started on tube feeding. The patient underwent diagnostic and therapeutic paracentesis on [**2138-4-17**], [**2138-4-22**], and [**2138-4-25**]. He had no evidence of spontaneous bacterial peritonitis. On [**2138-4-26**], a liver became available for transplant to the patient. The patient was taken to the operating room and underwent an orthotopic liver transplant. In order to aid in optimization of the patient's fluid status, the patient was on continuous [**Last Name (un) **] [**Last Name (un) **] dialysis during the procedure. His estimated blood loss was 2 liters. The patient received 5 liters of crystalloid, 9 units of fresh frozen plasma, 9 units of red cells, 6 units of platelets, as well as 1 liter of Cell [**Doctor Last Name **]. The procedure proceeded without complications, and the patient was transferred to the intensive care unit while still intubated following the procedure. The patient underwent an uncomplicated recovery in the intensive care unit. By postop day 1, the patient was awake, in no distress, and appeared lucid prior to extubation. The patient was extubated on postop day 1 without any problems. The patient was on a Lasix drip to aid in diuresis, and was ultimately converted to oral Lasix on postop day 1. The patient's pain control was with morphine. The patient required 2 units of fresh frozen plasma on the night following surgery, and 1 unit of platelets on postop day 1, but otherwise required no blood products following the liver transplant. The patient was started on sips on postop day 2, and advanced to clear liquids on postop day 3. He was advanced to a regular house diet later on postop day 3. The patient was advanced per protocol to an immunosuppressive regimen of prednisone, Neoral, and CellCept. The patient's mental status remained essentially clear throughout the entire postoperative period. The patient started ambulating with the assistance of physical therapy following transfer to the surgical floor. At the time of discharge, the patient was independent, ambulating, and functioning well. The patient's appetite improved significantly, and at the time of discharge the patient was on a regular diet with no tube feed supplements deemed necessary. The patient's liver function tests all improved appropriately by the time of discharge. The patient's surgical incision was also healing well by the time of discharge with no evidence of infection. The patient was ultimately deemed ready for discharge on postoperative day 8. DISCHARGE CONDITION: Stable. DISCHARGE MEDICATIONS: 1. Bactrim single strength 1 tablet po qd. 2. Protonix 40 mg po qd. 3. Metoprolol 25 mg po bid. 4. Fluconazole 200 mg po qd. 5. CellCept 1 gm po bid. 6. Prednisone 20 mg po qd. 7. Dilaudid prn. 8. Neoral 500 mg po bid. 9. Valcyte 450 mg po qod. 10.Lasix 40 mg [**Hospital1 **] x 21 days. 11.Colace 100 mg po bid. FOLLOW UP: 1. The patient was to follow-up with Dr. [**First Name (STitle) **] in the Transplant Center 3 days following discharge. 2. The patient was to follow-up with Dr. [**Last Name (STitle) 497**] of hepatology following discharge. MAJOR SURGICAL PROCEDURES: Liver transplant on [**2138-4-26**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 25452**] Dictated By:[**Last Name (NamePattern1) 17694**] MEDQUIST36 D: [**2138-5-7**] 08:29:54 T: [**2138-5-8**] 10:40:21 Job#: [**Job Number 25453**] ICD9 Codes: 5849, 5715, 2875
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Medical Text: Admission Date: [**2121-10-15**] Discharge Date: [**2121-10-19**] Date of Birth: [**2048-10-26**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: DOE Major Surgical or Invasive Procedure: PROCEDURE: 1. Aortic valve replacement with a 27-mm [**Company 1543**] Ultra Mosaic aortic valve bioprosthesis, serial number [**Serial Number 99679**]. 2. Coronary bypass grafting x1 with a reverse saphenous vein graft from the aorta to the posterior left ventricular coronary artery. 3. Endoscopic left greater saphenous vein harvesting. History of Present Illness: 72 yo M with h/o CAD s/p BMS in LAD and PTCA of D2 ostium, MR [**First Name (Titles) **] [**Last Name (Titles) **] presented today for pre-admission testing. Patient reports feeling well overall with occasional SOB with exertion (walking). He reports occasional palpitation. However, there has not been any chest pain, orthopnea, PND, swelling in the LE, syncope or pre-syncope. He is pre-op for AVR/CABG. Past Medical History: Aortic Insufficiency Coronary Artery Disease s/p AVR, CABG this admission PMH: aortic insufficiency mitral insufficiency NSTEMI [**2113**] coronary artery disease ( S/p BMS to LAD, PTCA to Diag) mild normocytic anemia chronic renal insufficiency ( baseline Cr 1.5) hypertension hyperlipidemia pacemaker [**4-2**] ( first degree and type-1 second degree AVB) Raynaud's syndrome benign prostatic hypertrophy RLL PNA [**2118**] gastroesophageal reflux left gynecomastia right LE varicosities Social History: Lives with:wife Occupation:investment manager Tobacco:quit 50 yrs ago ETOH:[**1-25**] glasses wine/day Family History: There is no family history of premature coronary artery disease, unexplained heart failure, or sudden death. Physical Exam: Pulse: 60 Resp: O2 sat: 96% RA B/P Right: 137/64 Left: 140/67 Height: 69" Weight: 140# General:thin gentleman Skin: Dry [x] intact [x]2 tiny bites at xyphoid area HEENT: PERRLA [x] EOMI [x]anicteric sclera;OP unremarkable Neck: Supple [x] Full ROM []-no JVD noted Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur- [**3-29**] diastolic Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] no HSM/CVA tenderness Extremities: Warm [x], well-perfused [x] Edema-none Varicosities: RLE Neuro: Grossly intact;nonfocal exam 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: [**2121-10-18**] 04:30AM BLOOD Hct-25.8* [**2121-10-17**] 05:55AM BLOOD WBC-9.9 RBC-2.90* Hgb-9.5* Hct-27.6* MCV-95 MCH-32.7* MCHC-34.3 RDW-13.3 Plt Ct-120* [**2121-10-18**] 04:30AM BLOOD UreaN-21* Creat-1.1 Na-134 K-4.2 Cl-98 Intra-Op TEE [**2121-10-15**] Conclusions Pre CBP: No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. Overall left ventricular systolic function is mildly depressed (LVEF= 50 %). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The ascending aorta is mildly dilated. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. There is no aortic valve stenosis. Severe (4+) aortic regurgitation is seen. Flow reversal was observed in the thoracic descending aorta. Mild (1+) mitral regurgitation is seen. Dr. [**Last Name (STitle) 914**] was notified in person of the results. Post CPB: The cardiac output is 4.8L/min, the patient is being AV paced. There is mild MR. There is a well seated bioprosthetic valve in the aortic position, with a peak gradient of 10mmHg and a mean gradient of 6mmHg. The thoracic aortic contours are intact. The LVEF is 40% with mild hypokinesis in the inferior wall, although it is difficult to assess wall motion abnormalities accurately while pacing. Brief Hospital Course: The patient was brought to the operating room on [**2121-10-15**] where the patient underwent CABG and AVR (27-mm [**Company 1543**] Ultra Mosaic aortic valve bioprosthesis, serial number [**Serial Number 99679**]) with Dr. [**Last Name (STitle) 914**]. See operative report for full details. Overall the patient tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. Cefazolin was used for surgical antibiotic prophylaxis. 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. His permanent pacemaker was interrogated and pacing wires discontinued. 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 were discontinued without complication. The patient was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on POD 4 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. The patient was discharged to home in good condition with appropriate follow up instructions. Medications on Admission: atenolol 12.5 mg daily ASA 162 mg daily lipitor 20 mg daily lisinopril 20 mg daily MVI daily Vit D2 1000 units daily omeprazole 20 mg daily flomax 0.4 mg daily fish oil 1200 mg/144 mg daily SL NTG prn 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. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. 4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 8. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day). Disp:*45 Tablet(s)* Refills:*2* 9. Omega-3 Fatty Acids Capsule Sig: One (1) Capsule PO DAILY (Daily). 10. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: 2.5 Tablets PO DAILY (Daily). Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Aortic Insufficiency Coronary Artery Disease s/p AVR, CABG this admission PMH: aortic insufficiency mitral insufficiency NSTEMI [**2113**] coronary artery disease ( S/p BMS to LAD, PTCA to Diag) mild normocytic anemia chronic renal insufficiency ( baseline Cr 1.5) hypertension hyperlipidemia pacemaker [**4-2**] ( first degree and type-1 second degree AVB) Raynaud's syndrome benign prostatic hypertrophy RLL PNA [**2118**] gastroesophageal reflux left gynecomastia right LE varicosities Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage No 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** Followup Instructions: Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2121-10-24**] 11:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8708**], M.D. Phone:[**Telephone/Fax (1) 719**] Date/Time:[**2121-11-13**] 4:00 [**Name6 (MD) **] [**Last Name (NamePattern4) 6559**], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2121-11-4**] 4:00 Please call to make an appointment with Dr. [**Last Name (STitle) 914**] in [**2-26**] weeks [**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** Completed by:[**2121-10-19**] ICD9 Codes: 412
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Medical Text: Admission Date: [**2162-5-18**] Discharge Date: [**2162-5-27**] Date of Birth: [**2087-5-9**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest pain/Dyspnea on exertion Major Surgical or Invasive Procedure: [**2162-5-21**] - Off pump CABG X 2 (Internal mammary to left anterior descending artery, vein graft to obtuse marginal). [**2162-5-18**] - Cardiac Catheterization History of Present Illness: This 75 year old female with a history of hypertension, smoking and hyperlipidemia was recently referred to Dr. [**Last Name (STitle) **] for evaluation of new onset chest pain. Two weeks ago, she awoke from sleep with chest pain that lasted for an hour. Since then, she has had one further episode of chest pain, occuring at rest. She took Mylanta at that time with relief of her symptoms. She has also been experiencing new onset dyspnea with exertion. She has dyspnea after walking about 2 blocks. She denies claudication, orthopnea, PND, and lightheadedness. She has left ankle edema. She was referred for a stress test, done at the [**Hospital1 882**] on [**2162-5-10**]. She exercised for 6?????? [**First Name8 (NamePattern2) **] [**Doctor First Name **] protocol. Negative for chest pain. Positive for 3mm downsloping ST segment depressions in leads II, III, AVF and V4-V6. Nuclear imaging was significant for a severe reversible anterior defect involving the mid and apical segments of the anterior wall, mid and apical segments of the upper septum and apical segment of the apex. EF 87%. Past Medical History: Hypertension Hyperlipidemia Glaucoma hysterectomy cyst removed from ovary D&C Cataract surgery to the right eye with a lens implant Social History: Social: Lives alone, works for the mass highway dept as an administrative assistant. She has no children. Has a 40-80 pack year history of smoking quitting 9 days Ago. Occassional alcohol consumption. Family History: Father died of MI at age 56 Physical Exam: 57 SB 16 145/77 62" 148lbs GEN: NAD HEENT: NCAT, PERRL, Anicteric sclera, OP benign NECK: supple, FROM LUNGS: Mildly diminished breath sounds at left base HEART: RRR, , No M/R/G ABD: Soft, NT, ND, NABS EXT: Warm, well perfused without edema. No varicosities noted on standing NEURO: Nonfocal Pertinent Results: [**2162-5-18**] 09:00AM PT-11.9 PTT-29.9 INR(PT)-1.0 [**2162-5-18**] 09:00AM WBC-8.8 RBC-4.24 HGB-12.0 HCT-35.4* MCV-84 MCH-28.2 MCHC-33.8 RDW-13.6 [**2162-5-18**] 09:00AM %HbA1c-6.3* [Hgb]-DONE [A1c]-DONE [**2162-5-18**] 09:00AM ALT(SGPT)-27 AST(SGOT)-23 CK(CPK)-86 ALK PHOS-54 AMYLASE-30 TOT BILI-0.2 DIR BILI-0.1 INDIR BIL-0.1 [**2162-5-18**] 09:00AM GLUCOSE-217* UREA N-18 CREAT-0.9 SODIUM-135 POTASSIUM-3.3 CHLORIDE-97 TOTAL CO2-31 ANION GAP-10 [**2162-5-18**] 11:27AM URINE BLOOD-TR NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-9.0* LEUK-NEG [**2162-5-18**] Cardiac Catheterization 1. Coronary angiography of this right dominant system demonstrated 3 vessel coronary artery disease. The LMCA had no angiographically apparent flow-limiting disease. The LAD had a 90% proximal stenosis and a 70% mid-vessel stenosis. The diagonal-1 branch was small and had a 40% distal stenosis. The LCx had a 70% mid-vessel stenosis. The OM1 had diffuse disease with a 40% stenosis. The OM2 was occluded. The RCA had a proximal total occlusion. There were left to right collaterals. 2. Limited resting hemodynamics revealed elevated left sided filling pressure with a LVEDP of 16 mmHg. The systemic arterial pressure was normal with a BP of 136/65 mmHg. There was no transaortic valve gradient on pullback of the catheter from the LV to the aorta. 3. Left ventriculography demonstrated no mitral regurgitation. The calculated LVEF was 67%. There was normal LV systolic wall motion. [**2162-5-19**] ECHO The left atrium is elongated. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is 11-15mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. There is no ventricular septal defect. The right ventricular cavity is mildly dilated. Right ventricular systolic function is normal. The ascending aorta is mildly dilated. 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. There is no mitral valve prolapse. Trace to mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. [**2162-5-19**] Carotid Ultrasound Less than 40% stenosis of the proximal internal carotid arteries bilaterally. This is a baseline examination at the [**Hospital1 18**]. Brief Hospital Course: Ms. [**Known lastname 72388**] was admitted to the [**Hospital1 18**] on [**2162-5-18**] for a cardiac catheterization. This revealed three vessel coronary artery disease and given the severity of it, the cardiac surgical service was consulted. Ms. [**Known lastname 72388**] was worked-up in the usual preoperative manner including a carotid duplex ultrasound which showed less then a 40% stenosis of the bilateral internal carotid arteries. Given that her preoperative chest x-ray and echocardiogram showed an atherosclerotic aorta, it was planned to do her surgery off pump. On [**2162-5-21**], Ms. [**Known lastname 72388**] was taken to the operating room where she underwent off pump coronary artery bypass grafting to vessels. Postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. By postoperative day one, Ms. [**Known lastname 72388**] had awoke neurologically intact and was extubated. Gentle diuresis was initiated. The physical therapy service was consulted for assistance with her postoperative strength and mobility. On postoperative day four, she was transferred to the step down unit for further recovery. She developed atrial fibrillation which converted to normal sinus rhythm with an increase in her beta blockade. As she continued to have paroxysmal rate controlled atrial fibrillation, coumadin was started for anticoagulation. Her white blood cell count was mildly elevated however slowly trended back towards normal. No evidence of infection was found and a repeat white cell count will be checked [**2162-5-31**]. She continued to make steady progress and was discharged to [**Hospital **] Rehab on [**2162-5-27**]. She will follow-up with Dr. [**Last Name (STitle) **], her cardiologist and her primary care physician as an outpatient. Her coumadin will be managed by Dr. [**Last Name (STitle) **] or Dr. [**Last Name (STitle) 53443**] upon discharge from rehab for a goal INR of 2.0-2.5 for atrial fibrillation. Medications on Admission: HCTZ 25mg daily Atenolol 25mg daily Simvastatin 20mg daily Timolol eye gtts one drop both eyes [**Hospital1 **] Aspirin 325mg daily 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: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 4. Zocor 20 mg Tablet Sig: One (1) Tablet PO at bedtime. 5. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 6. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 7. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 1 months. 8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 1 months. 9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 10. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**2-9**] Puffs Inhalation Q6H (every 6 hours) for 1 months. 11. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 5 days: Take for five days with potassium and then stop. 12. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 5 days: Take with lasix and stop when lasix stopped. . 13. Coumadin 1 mg Tablet Sig: Dose for goal INR of 2.0-2.5 Tablets PO once a day: Dose for goal INR of 2.0-2.5 for Atrial fibrillation. Monitor daily PT/INR and dose accordingly. . Discharge Disposition: Extended Care Facility: [**Hospital 66**] Rehab & Nursing Center - [**Hospital1 392**] Discharge Diagnosis: CAD HTN Glaucoma AF Discharge Condition: Stable Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. 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. No bathing or swimming for 1 month. Use sunscreen on incision if exposed to sun. 5)No lifting greater then 10 pounds for 10 weeksfroom date of surgery. 6)No driving for 1 month. 7)Take lasix 40mg once daily with potassium 20mEq once daily for five days and then stop. Please monitor electrolytes and replete as needed. 8)Take coumadin daily for goal INR of 2.0-2.5 for atrial fibrillation. Please monitor daily PT/INR for appropriate dosing. Dr. [**Last Name (STitle) 72389**] (PCP) [**Telephone/Fax (1) 6803**] or Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (Cardiologist) ([**Telephone/Fax (1) 72390**] will manage her coumadin as an outpatient. Please call to arrange follow-up appointment prior to discharge from rehab. She received her coumadin dose (4mg) for [**2162-5-27**]. 9)Please check white blood cell count on Monday [**2162-5-31**]. 10)Please call wih any questions or concerns. Followup Instructions: with Dr. [**Last Name (STitle) 53443**] (PCP) in [**3-13**] weeks [**Telephone/Fax (1) 6803**] with Dr. [**Last Name (STitle) **] (Cardiologist) in [**3-13**] weeks [**Telephone/Fax (1) 57005**] with Dr. [**Last Name (STitle) **] in [**5-13**] weeks (Cardiac Surgeon) ([**Telephone/Fax (1) 1504**] Please call all providers for appointments. Needs coumadin follow-up upon discharge from rehab. Likely Dr. [**Last Name (STitle) 53443**] (PCP) [**Telephone/Fax (1) 6803**] or if patient prefers Dr. [**Last Name (STitle) **] cardiologist [**Telephone/Fax (1) 57005**]. Please call to arrange when patient discharged from rehab. Goal INR is 2.0-2.5 for AF. Completed by:[**2162-5-27**] ICD9 Codes: 4111, 2724, 4019, 3051
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Medical Text: Admission Date: [**2169-7-7**] Discharge Date: [**2169-7-15**] Date of Birth: [**2126-7-19**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1854**] Chief Complaint: headaches Major Surgical or Invasive Procedure: LEFT SUB-OCCIPITAL CRANIOTOMY History of Present Illness: 41M with headaches x 1 month that are persistent and not relieved by Advil. The patient reports blurred vision with the "waves" of headache. He also was woken up 3 times this week in the middle of the night with vomiting. Currently he does not have nausea. He does not report gait disturbances. The patient works full time as a dentist and has not taken any time off since the onset of symptoms. He went to his PCP today who ordered a head CT. It showed a new large left cerebellar brain mass with ring enhancement. The patient does not take coumadin, aspirin, or plavix and has no history of cancer. Past Medical History: none Social History: works as a dentist; lives with his female partner and their 17 year old son Family History: non-contributory Physical Exam: Exam upon admission: T:97.8 BP:140/92 HR:63 RR:16 O2Sats:99% RA Gen: WD/WN, comfortable, NAD. HEENT: Pupils: PERRL EOMs-intact Neck: Supple. 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. 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, 4 to 3 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 [**6-20**] throughout. No pronator drift. Sensation: Intact to light touch bilaterally. Toes downgoing bilaterally Coordination: normal on finger-nose-finger, rapid alternating movements, heel to shin. No dysmetria noted. Pertinent Results: CT Head [**7-14**] prior to EVD removal: FINDINGS: Again left-sided posterior fossa craniotomy is identified with small amount of blood products in the region. The previously noted air within the area has decreased. A small hypodensity is seen in the region to the surgery with small areas of blood products from surgery. No large hematoma or interval new blood products are seen. There remains some mass effect on the left side of the fourth ventricle, which is unchanged. A right frontal ventricular drain extends to the third ventricle which is unchanged and minimal prominence of temporal horns is also unchanged. The air seen previously within the right lateral ventricle and in the frontal region has resolved. IMPRESSION: 1. Overall no significant change in the mass effect on the fourth ventricle without evidence of new hemorrhage. 2. Ventricular size is unchanged 3. Interval resorption of pneumocephalus. MRI [**2169-7-11**]: FINDINGS: The patient is post left occipital craniectomy with mesh in place overlying the left cerebellum. The previously seen left cerebellar enhancing lesion has been resected. Small amount of blood products are seen in the surgical bed. There is persistent cerebellar edema and mass effect on the left ambient cistern with evidence of upward transtentorial herniation. There is a thin left subgaleal fluid collection, measuring up to 6 mm in thickness, containing fluid and air. Again seen is a right transfrontal ventriculostomy catheter with its tip in the region of the foramen of [**Last Name (un) 2044**]. The ventricles are not dilated. There is no shift of normally midline structures. Major flow voids are unremarkable. There is susceptibility artifact within the right lateral ventricle, consistent with air. Following contrast administration, there is faint enhancement at the edge of the resection cavity, which could be seen in the postoperative setting, however continued followup to rule out recurrence is recommended. IMPRESSION: 1. Status post resection of left cerebellar lesion with small amount of blood products in the surgical bed and faint enhancement at the edge of the cavity, which may be related to post-surgical/inflammatory changes, however continued followup is recommended to rule out residual tumor. 2. Small subgaleal postoperative fluid collection. 3. Persistent edema in the left cerebellum with a mass effect on the ambient cistern. Head CT [**7-10**]: FINDINGS" There has been an interval left occipital craniectomy with mesh in place overlying the left cerebellum. There is expected pneumocephalus and high attenuation material within the resection cavity consistent with blood products. There is a right frontal approach ventriculostomy catheter with tip in the region of the foramen of [**Last Name (un) 2044**]. There is expected pneumocephalus and air within the right lateral ventricle. The ventricles appear nondilated and basal cisterns are preserved. There is no major midline shift. Outside of the resection site, there is a now new hemorrhage. [**Doctor Last Name **]-white matter junction differentiation is preserved. There is no edema outside the resection site. Air is seen in the subcutaneous tissues overlying the right frontal bone towards the vertex and in the operative site of the left occipital region. Mastoid air cells are clear. Visualized paranasal sinuses are unremarkable. IMPRESSION: Expected postoperative changes with no significant shift of midline structures or abnormal dilatation of ventricles. Brief Hospital Course: Mr [**Known lastname **] was admitted to Neurosurgery service started on Decadron for a new brain mass he underwent a torso CT to assess for any sign of malignancy which was negative. He underwent a sub occipital craniotomy for mass removal with EVD placement. He was monitored in the ICU for three days, treated with antihypertensives and slow EVD wean. He complained of neck pain, from the incision fo which he was started on Valium. Post operative MRI showed complete resection. Neur-Onc was consulted and they recommended follow in one month. Differential diagnosis included: hemangioblastoma, and pilocytic astrocytoma pathology is pending. He was transferred to the regular floor on [**7-14**] his drain was removed. Overnight he had no difficulties only neck incision pain, he ambulated without difficulty and was tolerating a regular diet. Medications on Admission: Advil Discharge Medications: 1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for headache: No driving while on this medication. Disp:*50 Tablet(s)* Refills:*0* 4. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for neck pain/spasm. Disp:*15 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: LEFT CEREBELLAR MASS Discharge Condition: NEUROLOGICALLY STABLE 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. If your wound closure uses dissolvable sutures, you must keep that area dry for 10 days. ?????? 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. 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: increasing redness, increased swelling, increased tenderness, or drainage. ?????? Fever greater than or equal to 101?????? F. Followup Instructions: PLEASE SEE YOUR PCP REGARDING CT OF CHEST/ABD/PELVIS, IT REQUIRES A REPEAT STUDY IN 3 MONTHS You have both sutures and staples in the front of your head as well as the back you will need those removed around [**7-20**] call [**Telephone/Fax (1) 1669**] for an appointment with [**Name8 (MD) **] NP You have a Brain [**Hospital 341**] Clinic appointment with [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD Phone:[**Telephone/Fax (1) 1844**]. It is on [**2169-8-7**] at 3:00pm on [**Hospital Ward Name 23**] 8 on the [**Hospital Ward Name 516**]. Completed by:[**2169-7-15**] ICD9 Codes: 4019
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Medical Text: Admission Date: [**2199-5-3**] Discharge Date: [**2199-5-5**] Date of Birth: [**2166-10-3**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Female First Name (un) 82171**] Chief Complaint: Tylenol PM overdose Major Surgical or Invasive Procedure: None History of Present Illness: 38 year old male with unknown past medical history (presumed depression as of [**1-/2199**]) found unresponsive with three wine bottles, suicide note and empty bottle of Tylenol PM (40 tablets) found next to him this evening. Receipt for the Tylenol PM was for 9:21 pm, [**5-2**]. A third party called EMS who brought him to [**Hospital1 18**] ED. No other drugs found at the scene. No signs of trauma. Per report, patient was found wearing multiple T-shirts from his bachelors party, with wife's wedding garter belt around his neck. Had recently told a friend he wished to be cremated. . In the [**Hospital1 18**] ED, initial VS: T98.1, HR123, BP133/81, RR30, O2 sat 100% on RA. The patient was initially minimally verbally responsive but protecting his airway, ABG 7.42/34/81. EKG showed sinus tachycardia with QTc 438 and QRS 92. Urinalysis negative for UTI and UTox negative for other substances. Labs were generally unremarkable except for Creatinine 1.3, INR 1.2 and serum alcohol level 56. LFTs currently normal. Serum tylenol still pending upon arrival to MICU. The patient became very agitated with Foley catheter placement, requiring Lorazepam 2mg IV. Haldol was avoided to prevent QTc prolongation. The patient also received Zofran 4mg for nausea and 3L IVF. Toxicology was consulted and recommended empiric NAC, which was started (first dose). They recommended against using activated charcoal since the patient likely ingested hours earlier and would be at risk for aspiration with his mental status. It was estimated that the patient consumed ~20 grams of tylenol and 1 gram of benadryl within the last 4.5 hours. . ROS: Patient arousable but garbled speech, does not endorse any complaints. Past Medical History: - L thumb tip avulsion (kitchen knife, [**3-/2198**]) - Depression Social History: Denies tobacco, illicit drug use. Reports 1-2 drinks per week. Of note, lived at home with wife until she recently moved out after being threatened repeatedly by patient. Family History: Schizophrenia Physical Exam: ADMISSION VS: Temp: 97.1 BP: 140/88 HR: 99 RR: 16 O2sat 99% on RA GEN: Sleeping soundly but responsive to verbal stimuli, follows commands, comfortable, NAD, garbled speech but appropriate HEENT: PERRL - dilated, EOMI, anicteric, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd RESP: CTA b/l with good air movement throughout, no wheezing/rhonchi/rales anteriorly CV: RR, S1 and S2 wnl, no murmurs/gallops/rubs ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: no rashes/no jaundice/no splinters NEURO: AAO. CN 2-12 intact. Moving all extremities. DISCHARGE VS: 97.9 80 125/80 15 99%RA GEN: Well appearing, NAD HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd RESP: CTA b/l with good air movement throughout, no wheezing/rhonchi/rales anteriorly CV: RR, S1 and S2 wnl, no murmurs/gallops/rubs ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: no rashes/no jaundice/no splinters NEURO: AAO. CN 2-12 intact. Moving all extremities. Pertinent Results: Blood Counts [**2199-5-3**] 01:10AM BLOOD WBC-7.0 RBC-4.49* Hgb-14.5 Hct-40.8 MCV-91 MCH-32.2* MCHC-35.4* RDW-12.9 Plt Ct-240 Coags [**2199-5-3**] 01:10AM BLOOD PT-13.8* PTT-23.1 INR(PT)-1.2* [**2199-5-3**] 10:06AM BLOOD PT-15.6* PTT-26.4 INR(PT)-1.4* [**2199-5-5**] 07:25AM BLOOD PT-12.6 PTT-23.5 INR(PT)-1.1 Chemistry [**2199-5-3**] 01:10AM BLOOD Glucose-97 UreaN-13 Creat-1.3* Na-143 K-3.8 Cl-104 HCO3-23 AnGap-20 [**2199-5-5**] 07:25AM BLOOD Glucose-98 UreaN-14 Creat-1.1 Na-139 K-4.0 Cl-99 HCO3-31 AnGap-13 LFTs [**2199-5-3**] 01:10AM BLOOD ALT-23 AST-22 AlkPhos-56 TotBili-0.6 [**2199-5-3**] 05:35PM BLOOD ALT-18 AST-15 LD(LDH)-157 AlkPhos-51 TotBili-1.0 [**2199-5-5**] 07:25AM BLOOD ALT-16 AST-13 LD(LDH)-158 AlkPhos-58 TotBili-0.7 Tox [**2199-5-3**] 01:10AM BLOOD ASA-NEG Ethanol-56* Acetmnp-210* Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2199-5-3**] 10:06AM BLOOD Acetmnp-52* [**2199-5-3**] 05:35PM BLOOD Acetmnp-6* [**2199-5-4**] 12:40AM BLOOD Acetmnp-NEG EKG [**2199-5-3**] Sinus tachycardia. There are non-diagnostic Q waves in the inferior leads. Non-specific ST-T wave changes. Brief Hospital Course: HOSPITAL COURSE This is a 38yo M who presented with a tylenol and benadryl overdose w/o significant signs of toxicity, stable over 48hrs, medically cleared, now being discharged to [**Hospital1 **] 4 Psychiatric Service. . ACTIVE # s/p suicide attempt: Pt found unresponsive with a suicide note, admitted to medical ICU for management of tylenol/benadryl overdose as below, now stable and medically cleared. He was monitored by 1:1 sitter, with social work and psychiatry following patient regarding ongoing mental health and social issues, including reports from wife of patient being increasingly paranoid and "emotionally abusive". Patient expressed regret re: suicide attempt. After evaluation by Psychiatry service, patient is now being discharged to [**Hospital1 **] 4 Psychiatric Service. . # Tylenol overdose: Patient admitted with tylenol overdose, estimated at 20g by toxicology service. Admission acetaminophen level of 210 at (~4hrs post ingestion). Patient received NAC and was monitored without major abnormality of LFTs, INR. Patient without any signs of significant toxicity at 48hrs post ingestion. . # Benadryl overdose: Patient admitted w delirium and agitation thought to be [**1-2**] to bendryl overdose, but was without significant QTc prolongation, hyperthermia, urinary retention. His mental status cleared and was without any prolonged toxicity at 48hrs post ingestion. . TRANSITIONAL 1. Code status - Patient remained full code 2. Pending - No labs/studies were pending at discharge 3. Transition of Care - Patient was medically cleared; after evaluation by psychiatry service, patient was accepted to [**Hospital1 **] 4 Psychiatric Service. Medications on Admission: -Vitamin D2 Discharge Medications: None Discharge Disposition: Extended Care Facility: [**Hospital1 69**] - [**Location (un) 86**] Discharge Diagnosis: PRIMARY Tylenol Overdose Benadryl Overdose Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Last Name (Titles) 82172**], It was a pleasure taking care of you at [**Hospital1 827**]. You were admitted for treatment of a tylenol and benadryl overdose. You were monitored and did not demonstrate any signs of lasting toxicity. You were medically cleared and are now being discharged to the [**Hospital1 18**] Psychiatric Service Followup Instructions: Please follow-up with the pschiatrists on the [**Hospital1 18**] Psychiatric Service [**Month (only) 6436**] ([**Month (only) **]) [**Name8 (MD) **] MD [**MD Number(2) 82173**] ICD9 Codes: 5849, 2930
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Medical Text: Admission Date: [**2138-4-6**] Discharge Date: [**2138-4-10**] Date of Birth: [**2062-9-5**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 45**] Chief Complaint: dyspnea, chest pressure on exertion Major Surgical or Invasive Procedure: Cardiac catheterization; cardiac electrophysiology study w/ ablation History of Present Illness: Mr. [**Known lastname 96278**] is a very pleasant 75 yo M w/ PMHx of HTN, moderately dilated aorta, moderate aortic regurgitation, AV conduction delay, who presnted to the ED after experiencing new onset anginal symptoms this AM. According to the Pt he has been in his usual state of health and this morning noted a sensation of chest pressure and dyspnea while putting the dishes away after eating breakfast. The episode resolved after rest and deep breathing. The Pt then decided that he would climb the stairs in his home so that he could check his BP and pulse on monitor he has at home. When climbing the stairs, again he felt a sensation of chest pressure and dyspnea. He noted that his BP was 150s/80s and heart rate 97 which is very fast for him. The pressure sensation again resolved spontaneously after rest and deep breathing. The sensation felt the same on both occasions and was not associated with any nausea, vomiting, diaphoresis, or radiation. Each time the episode lasted approximately 2 minutes. The Pt then called his PCP who recommended that he present to the ED for further evaluation. According to the Pt, this discomfort is new. Approximately 2-3 weeks ago, he resumed working out regularly after not working out for a number of weeks. He has been able to do regular exercise including weight lifting and cardiovascular exercise without experiencing any chest discomfort. . In the ER, vitals were 98.5 92 138/90 18 98 . Exam with 1+ LLE>RLE pitting edema (old), guiac negative. EKG showed LBBB (old). He was given ASA 324mg and started on IV heparin. . On evaluation on the floor, he reported no discomfort and specifically denied any chest discomfort or dyspnea. He was without any complaints. Past Medical History: 1. Hypertension. 2. Dyslipidemia. 3. S/p bilateral total knee replacement. 4. H/o prostate cancer. 5. Colonic adenoma [**2129**]. . Cardiac Risk Factors:- Diabetes, +Dyslipidemia, +Hypertension . Cardiac History: No CABG . Percutaneous coronary intervention: none . Pacemaker/ICD: none Social History: Pt is married real estate investor who lives in [**Location 1887**], Ma with his wife. [**Name (NI) **] has 3 daughters and 11 grandchildren and is a former weightlifter who reports that he holds multiple weightlifting records. He denied any hx of steroid use or performance enhancing drugs. He denies tobacco or illicit drugs and admits to social ETOH 3-4 times per week. Family History: There is no family history of premature coronary artery disease or sudden death. Physical Exam: VS - T 98 BP 118/64 P 100 rr 20 O2 sat 97% 2L Gen: Pleasant middle aged 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 JVP of 4 cm. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. 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, no crackles, wheezes or rhonchi. Abd: Soft, NTND. 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: On admission: [**2138-4-6**] 01:30PM BLOOD WBC-7.8# RBC-5.19 Hgb-16.0 Hct-46.3 MCV-89 MCH-30.9 MCHC-34.6 RDW-13.9 Plt Ct-158 [**2138-4-6**] 01:30PM BLOOD PT-12.5 PTT-24.0 INR(PT)-1.0 [**2138-4-6**] 01:30PM BLOOD Glucose-96 UreaN-32* Creat-1.0 Na-140 K-3.5 Cl-101 HCO3-32 AnGap-11 [**2138-4-6**] 01:30PM BLOOD CK(CPK)-142 [**2138-4-6**] 01:30PM BLOOD Calcium-9.0 Phos-3.5 Mg-1.9 . On discharge: [**2138-4-10**] 06:00AM BLOOD WBC-8.1 RBC-4.80 Hgb-14.4 Hct-42.7 MCV-89 MCH-29.9 MCHC-33.7 RDW-13.9 Plt Ct-136* [**2138-4-9**] 06:05AM BLOOD Neuts-78.8* Lymphs-13.5* Monos-6.0 Eos-1.2 Baso-0.5 [**2138-4-10**] 06:00AM BLOOD PT-13.3 PTT-34.6 INR(PT)-1.1 [**2138-4-10**] 06:00AM BLOOD Plt Ct-136* [**2138-4-10**] 06:00AM BLOOD Glucose-94 UreaN-26* Creat-1.0 Na-141 K-4.5 Cl-104 HCO3-30 AnGap-12 [**2138-4-7**] 05:10AM BLOOD CK(CPK)-119 [**2138-4-10**] 06:00AM BLOOD Mg-2.0 . Cardiac catheterization ([**2138-4-8**]): 1. Selective coronary angiography of this right dominant system demonstrated no significant coronary artery disease. The LMCA, LAD, and LCx were free of disease. The RCA had mild, non flow limiting disease. . FINAL DIAGNOSIS: 1. Coronary arteries are normal. 2. Normal ventricular function. . Brief Hospital Course: Mr [**Known lastname 96278**] is a pleasant 75 yo M with hx of HTN, moderately dilated aorta, moderate aortic regurgitation, AV conduction delay, who presented to the [**Hospital1 18**] ED after experiencing new onset anginal symptoms on the morning of admission. He was subsequently admitted to the cardiology service on [**2138-4-6**] where his anginal symptoms were evaluated. He underwent cardiac catheterization on [**2138-4-7**] and cardiac electrophysiology study with ablation on [**2138-4-8**]. He was discharged to home on [**2138-4-10**] his brief hospital course was notable for: . #. CAD/angina: Pt did not have hx of known CAD but has multiple risk factors including hypertension, hyperlipidemia, age, sex. TIMI risk score is [**3-19**]. Pt history of new onset dyspnea on exertion on morning of admission was conerning for unstable angina. He did not have EKG changes or cardiac enzymes leak to suggest NSTEMI. He was ruled out for myocardial infarction with three sets of negative cardiac enzymes, and no EKG changes. He underwent cardiac catheterization on [**2138-4-7**] to evaluate unstable angina. The catheterization was tolerated well, and demonstrated clean coronaries, with a normal ejection fraction, and no intervention was performed. . Of note, during the cardiac cath the Pt was noted to have a somewhat dilated and tortuous aorta. Prior to this hospitalization he had a previously known history of aortic dilation, presumed to be related to his history as a weightlifter. Further imaging of the aorta such as CTA or MRI could be considered as an outpatient. . # Wide complex tacchycardia: On the evening of admission, on two separate occasions the Pt was noted to go into a wide complex tacchycardia with a rate to 180-190s. Although there was initial concern for ventricular tachycardia, after thorough review of telemetry and 12-lead EKGs, it was thought that this arrhythmia most likely represented a supraventricular tachycardia with aberrancy. During both these episodes, the Pt was asymptomatic, and maintained a blood pressure within normal limits. The first episode lasted approximately 20 minutes and resolved after vagal maneuvers and 5 mg IV metoprolol. The second episode lasted approximately 5 minutes and resolved spontaneously. The Pt was monitored on telemetry and had no other such events. . He underwent consultation by the cardiac electrophysiology service and subsequent EP study, during which he was found to have Right side atrial flutter with aberrancy of Left Bundle Branch Block. The atrial flutter was pace terminated, but after ablation, he had an 8 second pause and remained in a junctional rhythm with HR in the 50s. He was briefly on isoproteronol, which was weaned off, and a temporary pacing wire was placed through a Right femoral line into the right atrium for backup pacing. The patient was transferred to the CCU overnight for monitoring on telemetery. He had no complaints of chest pain, shortness of breath, or palpitations overnight. He was noted to be in sinus bradycardia with rate in 40s-50s, intermittently paced with frequent PACs and PVCs on presentation to the CCU; in the morning, his sinus node appeared to have recovered, and he was noted to be in sinus bradycardia with rate in 50s, not being paced. The pacing wire and femoral line were removed, and he was transferred back to the floor in stable condition. He was discharged with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts Event Monitor and with outpatient follow-up arranged. . #Anticoagulation: Pt [**Name (NI) 96278**] was initiated on Warfarin at the time of discharge. He was also given a prescription for Lovenox 120 mcg qD to be taken [**Hospital1 **] until his INR is therapeutic. He was set up with follow-up at the [**Hospital 191**] [**Hospital 197**] clinic, where he was scheduled to visit on the day after discharge. After that time they will assume responsibility for his anticoagulation. . All other chronic medical issues for this Pt were stable. No further changes were made to this Pt's outpatient medication regimen than those noted above. He was discharged to home in good condition, ambulatory, with stable vital signs, and with appropriate outpatient follow-up arranged. Medications on Admission: ASA 81 mg qD Cholecalciferol 2,000 units 1 tab qD Diovan 80 mg -12.5 qD Fish oil 1200-144 qD Lorazepam 1mg [**Hospital1 **] PRN anxiety MVI 1 tab qD Simvastatin 40 mg qD Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Five (5) Tablet PO DAILY (Daily). 5. Omega-3 Fatty Acids Capsule Sig: One (1) Capsule PO DAILY (Daily). 6. Enoxaparin 120 mg/0.8 mL Syringe Sig: One (1) Subcutaneous twice a day: Please take until advised to stop by [**Hospital 197**] clinic. Disp:*30 * Refills:*2* 7. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. Disp:*30 Tablet(s)* Refills:*2* 8. Warfarin 2 mg Tablet Sig: as dir Tablet PO once a day: Please take these tablets as directed by the [**Hospital 197**] clinic. *** Only fill this prescription if directed to do so by coumadin clinic. Disp:*30 Tablet(s)* Refills:*2* 9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. Outpatient Lab Work Please have INR drawn on Saturday [**2138-4-12**] at [**Hospital3 18648**] and have the result paged to the [**Hospital1 18**] [**Company 191**] physician on call. [**Hospital1 18**] main number [**Serial Number 20875**], Dr. [**First Name4 (NamePattern1) 1169**] [**Last Name (NamePattern1) **] will be on call. Discharge Disposition: Home Discharge Diagnosis: Primary: atrial flutter s/p ablation Secondary: hypertension, dyslipidemia Discharge Condition: Good, normotensive and in sinus rhythm, ambulatory, AOX3 Discharge Instructions: You came into the hospital after developing chest pressure and shortness of breath. We determined that your symptoms were not caused by a heart attack. During your hospital stay, on two occasions your heart was noted to go in a fast rhythm for a brief period of time. You underwent a cardiac catheterization; this test did not show any significant coronary disease. You also underwent an electrophysiology study which showed that you had an abnormal heart rhythm called atrial flutter, and you had an ablation procedure to try to prevent this rhythm from coming back. . You are being discharged with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor to evaluate your heart rhythm at home. You have received instructions on how to use this monitor. . You will also need to take a blood thinning medication (warfarin, sometimes known as Coumadin) to reduce your risk of stroke related to the atrial flutter. While taking warfarin, close monitoring is essential to prevent the blood from becoming too thin, increasing your risk of bleeding, or not thin enough. The anticoagulation nurses will coordinate the dose of the warfarin. You will need to get your first blood test (INR) on Saturday [**2138-4-12**] at [**Hospital6 4620**]. It is very important that the results of this test are paged to the [**Company 191**] physician on call, available at phone [**Numeric Identifier 20875**]. . The following changes have been made to your outpatient medication regimen: STARTED Warfarin 5 mg by mouth once daily. Please take this medication daily as instructed by the [**Hospital 197**] clinic. STARTED Enoxaparin 120mg injections twice daily. Please take this medication until instructed to stop by the [**Hospital 197**] clinic. . Please continue to take your other medications as directed and keep your followup appointments. Followup Instructions: Please follow up with your cardiologist Dr. [**Last Name (STitle) 171**] as scheduled: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2138-5-28**] 1:20 . Please call your primary care doctor, Dr.[**First Name (STitle) 216**], to schedule a follow-up appointment within the next month [**Numeric Identifier 20875**] . You have been set-up for follow-up at the [**Hospital1 18**] Coumadin (anti-coagulation) clinic. The clinic will call you tomorrow [**4-11**] and assume care of your anticoagulation. If you do not hear from them tomorrow, please call them at [**Telephone/Fax (1) 14650**]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**Doctor First Name 63**] ICD9 Codes: 2724, 4019, 4271
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Medical Text: Admission Date: [**2102-4-8**] Discharge Date: [**2102-4-12**] Date of Birth: [**2034-2-7**] Sex: F Service: MEDICINE Allergies: Iodine; Iodine Containing / Penicillins / Shellfish Attending:[**First Name3 (LF) 134**] Chief Complaint: STEMI Major Surgical or Invasive Procedure: Cardiac catheterization History of Present Illness: Pt is a 68 yo woman with PMH of tobacco use, RA presents to ED today with chest pain, found to have inferior/posterior STEMI with RV involvement. Patient was in her USOH until 2 week PTA when developed sub-sternal chest pressure w/ radiation down both arms while raking leaves. She rested after onset of pain, and pain resolved after 5 minutes. 1 week prior to presentation, patient again experienced these sxs after having "an emotional phone call". Again, pt rested and pain resolved after [**10-29**] minutes, but she was nervous about pain, so presented to [**Hospital 2538**] on [**2102-4-3**]. At that time she was r/o for MI with negative cardiac enzymes and underwent stress ECHO that was negative after going 7 minutes on [**Doctor First Name **] protocol, achieving 91% of maximum HR. Therefore patient was discharged. She then again had a similar episode of this pain last night, associated w/ N/V x 1, but then was able to fall asleep without sxs. Pt then reports this evening, developed same type of substernal chest pressure, but more severe. Patient states she was baking pies when had onset of [**9-24**] sub-sternal chest pressure, + radiation down arms b/l, associated with N/V x 1 and diaphoresis. Onset of sxs was 7:30pm. Therefore pt called ambulanace and presented to [**Hospital1 18**]. On presentation to [**Hospital1 18**], pt was initially given NTG gtt and morphine. Found to have EKG with ST elevations in inferior leads with reciprical ST depressions in aVL, V1-V2. R sided EKG demonstrated ST elevations in V4, indicating RV involvment. Therefore nitro gtt d/ced, started on IVF - received a total of 1 L fluid bolus in ED. Also started on heparin gtt, integrilin gtt, and given plavix load 300mg x 1 in ED. Also received benadryl, solumedrol, pepcid prior to cardiac cath given hx of dye allergy. Patient presented to cath lab at 10:06 PM (therefore time of onset of pain to cath lab was approximately 2.5 hours). In cath lab, patient found to have lesion in RCA extending into PDA and PL - patient had 1 x stent placed in RCA-to-PDA, jailing the PL, which was then rescued with balloon angioplasty (TIMI 3 flow demonstrated). Also noted to have 50% LAD lesion after D1, 70% L Cx lesion, 40% proximal RCA lesion. Hemodynamics were noted to be CO 3.48, CI 2.02, PCWP 20, RA mean 15, PAP 46/22, RV 46/8. Cath course c/b some bradycardia, thought [**2-16**] vagal response, responded to atropine. Also had hypotension with SBP = 90's intra-cath, given fluid boluses for total of 1.8L in cath (2.8L total with 1L fluid bolus in ED). Post cath pt noted to have small groin hematoma. Post cath EKG notable for resolution of ST elevations, q waves in leads III and aVF. Patient had resolution of pain in cath lab. Currently patient feels well. Denies any chest pain/pressure, SOB, diaphoresis, nausea, any other complaints. ROS also negative for orthopnea, PND, LE edema. Past Medical History: Rheumatoid arthritis Social History: smokes 1-1.5 ppd x 55 years (quit on thursday - got nicotine patch), rare EtOH, no drug use. Lives alone, 2 daughters live nearby, also has 2 sons. Family History: Mother alive and well, father died in his 60's in a car accident, has 6 brothers, no FH of CAD or DM Physical Exam: Vitals - Afebrile, HR 89, BP 101/85, RR 12, O2 90-92% on RA (not SOB) -> 96% 2L NC General - lying supine, awake, alert, pleasant, NAD HEENT - PERRL, EOMI, dry MM Neck - could not assess JVP as pt lying flat, no carotid bruit b/l CVS - RRR, nl S1, S2, no M/R/G Lungs - CTA anteriorly and laterally - could not assess posterior lung fields as pt lying supine Abd - soft, NT/ND, + BS Groin - R sided groin w/ some eccymoses, mildy tender to palpation, ?small hematoma although difficult to assess, no bruit ascultated Ext - no LE edema b/l, 2+ DP pulses b/l Neuro - A+O x 3, FROM x 4 ext . EKG on presentation: ST elevations in leads II, III, aVF with reciprical ST depressions in aVL, V1-V2. R sided EKG with ST elevation in V4. . Post cath EKG: Resolution of ST elevation, q waves noted in III, aVF Pertinent Results: [**2102-4-8**] 09:20PM WBC-12.4* RBC-4.75 HGB-14.7 HCT-42.6 MCV-90 MCH-31.0 MCHC-34.5 RDW-15.1 [**2102-4-8**] 09:20PM NEUTS-50.9 LYMPHS-41.1 MONOS-5.5 EOS-2.2 BASOS-0.4 [**2102-4-8**] 09:20PM PLT COUNT-279 [**2102-4-8**] 09:20PM PT-11.6 PTT-19.2* INR(PT)-1.0 [**2102-4-8**] 09:20PM GLUCOSE-156* UREA N-24* CREAT-1.0 SODIUM-135 POTASSIUM-3.0* CHLORIDE-95* TOTAL CO2-25 ANION GAP-18 [**2102-4-8**] 09:20PM LD(LDH)-224 CK(CPK)-87 [**2102-4-8**] 09:20PM cTropnT-0.01 [**2102-4-8**] 09:20PM CK-MB-NotDone . CXR ([**4-8**]): Prominence of bilateral vasculature, which may represent early volume overload versus mild CHF. . C.cath ([**4-8**]): 1. Selective coronary angiography of this right dominant system revealed two vessel coronary artery disease. The LMCA was patent. The LAD had 50% stenosis after D1. The LCX had 70% OM2 stenosis. The RCA had proximal 40% and 100% stenoses distally at the crux. 2. Resting hemodynamics demonstrated elevated right and left sided pressures (mean RA pressure was 15mmHg, mean PCWP 20mmHg). There was evidence of moderate pulmonary hypertension. The cardiac index was normal at 2.02 L/min/m2. 3. Successful PTCA/stenting of the distal RCA with a 3.0x18mm Cypher DES posted to 3.5mm in the proximal portion with excellent results (see PTCA comments). . TTE ([**4-10**]): 1.The left atrium is normal in size. 2. 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%). 3. Right ventricular chamber size is normal. Right ventricular systolic function is normal. 4.The aortic valve leaflets are mildly thickened. No aortic regurgitation is seen. 5.The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. 6.There is borderline pulmonary artery systolic hypertension. 7.There is no pericardial effusion. Brief Hospital Course: Assessment/Plan: Patient is a 68 yo woman with PMH tobacco use, presents with inferior/posterior STEMI with RV involvement. . # Cardiac: A. Ischemia: Patient presents with inferior/posterior STEMI with RV involvement. Course complicated by some hypotension noted in cath lab, responsive to IVF boluses. PCWP noted to be 20 intra-cath. Initially monitored with Swan-Ganz catheter. Received integrilin gtt x 18 hours. Cardiac enzymes trended down. Continued on ASA 325mg QD, Plavix 75mg QD, Lipitor 80mg QD. Started on a beta blocker and discharged on Toprol XL. Started on ACE-i and discharged on lisinopril. Further lipid management deferred to outpatient setting. Discharged to follow up with Cardiology, may need ETT-MIBI in the future. Encouraged smoking cessation. . B. Pump: Patient with EF=65%, no wall motion abnormalities noted on stress ECHO done at [**Hospital3 **] on [**2102-4-4**]. Intra cath hemodynamics consistent with mild fluid overload, with PCWP=20, RA=15, PAP=46/22. TTE on [**4-10**] with EF 70-75%, no wall montion abnormality, 1+ MR, and borderline PA systolic hypertension. Euvolemic on exam upon discharge. Discharged on beta blocker and ACE-inhibitor as above. . C. Rhythm: Patient was in NSR. Given RV involvement, was felt to be high risk for arrythmia. No signs of nodal block on EKG. Had asymptomatic run of NSVT with stable vital signs. Maintained and discharged on beta blocker. . # Hematoma: Small hematoma noted in groin site post-cath. Remained hemodynamically stable, improved to just ecchymosis by discharge. Hct stable. . # Rheumatoid Arthritis: Patient on prednisone as outpatient. Continued on prednisone with prn Tylenol for pain. . # Code status: Full . Medications on Admission: Prednisone 5mg [**Hospital1 **] HCTZ 50mg QD Advil 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. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Prednisone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Inferoposterior ST elevation MI Right groin hematoma Discharge Condition: good Discharge Instructions: Please take all of your medications as prescribed. If you experience chest pain, shortness of breath, or other concerning symptoms, please call your doctor or go to the ER. Followup Instructions: 1) PCP: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3142**], [**2102-4-17**] at 2:30pm, ([**Telephone/Fax (1) 35385**]. 2) Cardiology: Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **], [**2102-5-4**] at 10:00am, ([**Telephone/Fax (1) 11814**]. Completed by:[**2102-9-13**] ICD9 Codes: 4280
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6735 }
Medical Text: Admission Date: [**2189-9-14**] Discharge Date: [**2189-10-3**] Date of Birth: [**2133-7-21**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1253**] Chief Complaint: Leg pain Major Surgical or Invasive Procedure: I/O line placement x 2 in right leg [**2189-9-14**] which was removed on [**2189-9-15**] Right femoral central line [**2189-9-15**] which was removed on [**2189-9-17**] Right IJ dialysis line placed by IR on [**2189-9-17**] Right Tunneled Catheter placed by IR on [**2189-9-25**] History of Present Illness: 56 obese M h/o gout, a-fib (INR 7.7) p/w multiple joint pain x 3 days. Pt was in USOH until 3 days ago when he developed b/l knee and ankle pain, R>L (both). This has gradually worsened and was accd by fever/chills over the weekend, resolving the morning prior to admission. Pt states that this is similar to past gout attacks, but more severe. The right knee has swollen and the right ankle has been warm. In the ED, initial VS were 98.6, 86, 148/98, 16, 98% RA. Labs notable for WBC 16.1, INR 7.7 (given 2.5mg Vit K). RLE LENI neg for DVT. X-ray R knee showed a large effusion and osteoarthritis. Arthrocentesis was performed which showed hemarthrosis (369k RBC), leukocytosis (26k) with both negative and positively birefringent crystals. On arrival to the floor, patient reports pain right knee and ankle > left knee, ankle. He denies any systemic symptoms of fever, chills, chest pain, dyspnea, light-headedness or syncope. At baseline poor mobility. REVIEW OF SYSTEMS: Denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria. Past Medical History: - Diabetes Mellitus (last Alc 7.3 [**4-19**]) - Dyslipidemia - Hypertension - Chronic Kidney Disease Stage IV - Morbid obesity - Chronic systolic congestive heart failure, EF 25-30% ([**9-/2187**]) - Coronary Artery Disease - Atrial fibrillation: on coumadin - Gout - Sleep apnea - Moderate Pulmonary Hypertension, secondary - Cardiac Cath [**5-/2187**]: 1. Selective coronary angiography in this left dominant system demonstrated no obstructive coronary disease. The LMCA was large and normal. The LAD was large and ectatic with slightly delayed flow into the distal vessel without luminal irregularities. The LCx was large and ectatic with delayed flow into the left PDA. The RCA had no significant disease. Social History: -On disability. Had been living with his brother and his sister-in-law in [**Name (NI) 2268**], prior to rehab stay -Tobacco history: Denies -ETOH: Admits to prior heavy drinking, unable to quantify. last drink 8 months ago -Illicit drugs: Denies Family History: Hypertension, mother with heart disease. Physical Exam: Admission Exam VS: T 98.5, HR 70, BP 168/100, RR 16, SO2 98%@RA GEN: pleasant, morbidly obese, NT/ND, NAD HEENT: NCAT, MMM, sclera anicteric NECK: supple, trachea midline PULM: CTAB, no r/r/w CV: faint heart sounds; irregular rhythm, normal rate, no m/r/g, EXT: R knee swollen, R>L knee pain on active and passive ROM; R ankle tenderness with active and passive ROM; no L ankle tenderness with active or passive ROM; no erythema or obvious swelling (difficult to assess due to adiposity) ABD: soft, morbidly obese, non-tender, no r/g NEURO: fluent, linear, prompt, moving all 4 spontaneously. Discharge Exam: VS - 97.9 122-133/79-80 81 16 97 ra GEN Morbidly obese, oriented, NAD, laying in bed HEENT: NCAT, MMM, EOMI, sclera anicteric, OP clear. NECK: supple, no LAD, tunnelled IJ HD cath in place, C/D/I, no oozing, mild pain to palpation around site of placement. No erythema or edema around site. PULM: Good aeration anteriorally, CTAB no wheezes, rales. Less rhonci and crackles heard in lower lobes this AM. Venti mask on 4L. CV: Irregular rhythm with normal rate, normal S1/S2, no m/r/g, distant heart sounds ABD Obese, soft, diffusely tender on soft and deep palpation, ND, hypoactive bowel sounds, no r/g EXT: WWP 2+ pulses palpable bilaterally. Trace edema under knees bilaterally. Tender to palpation in bilateral LE below the knee. Knees are mildly warmer than rest of legs bilaterally. NEURO: CNs2-12 intact, motor function grossly normal SKIN: Small (~2 cm) scratch to buttock, covered with Mepilux. No other rashes or lesions noted. GU: no foley Pertinent Results: Admission Labs [**2189-9-14**] 03:40PM BLOOD WBC-16.1* RBC-5.02 Hgb-13.4* Hct-42.6 MCV-85 MCH-26.7* MCHC-31.4 RDW-14.5 Plt Ct-158 Relevent Labs: [**2189-9-15**] 05:00AM BLOOD WBC-33.0*# RBC-3.85* Hgb-10.4* Hct-34.7* MCV-90 MCH-26.9* MCHC-29.8* RDW-14.3 Plt Ct-204 [**2189-9-15**] 09:54AM BLOOD WBC-43.0* RBC-3.20* Hgb-8.5* Hct-28.2* MCV-88 MCH-26.6* MCHC-30.3* RDW-14.8 Plt Ct-202 [**2189-9-15**] 07:06PM BLOOD Hct-23.7* [**2189-9-16**] 02:04AM BLOOD WBC-37.5* RBC-2.80* Hgb-8.1* Hct-24.0* MCV-86 MCH-28.8 MCHC-33.7# RDW-15.3 Plt Ct-148* [**2189-9-16**] 08:41AM BLOOD Hct-28.1* [**2189-9-16**] 03:59PM BLOOD WBC-34.9* RBC-3.43* Hgb-10.2*# Hct-29.7* MCV-87 MCH-29.7 MCHC-34.3 RDW-15.1 Plt Ct-119* [**2189-9-16**] 10:11PM BLOOD WBC-35.3* RBC-3.24* Hgb-9.6* Hct-28.2* MCV-87 MCH-29.6 MCHC-34.1 RDW-15.4 Plt Ct-106* [**2189-9-17**] 04:39PM BLOOD Hct-25.9* [**2189-9-18**] 03:58AM BLOOD WBC-24.1* RBC-2.94* Hgb-8.7* Hct-25.9* MCV-88 MCH-29.5 MCHC-33.5 RDW-15.8* Plt Ct-84* [**2189-9-18**] 03:44PM BLOOD Hct-25.1* [**2189-9-14**] 03:40PM BLOOD PT-75.7* PTT-75.8* INR(PT)-7.7* [**2189-9-15**] 09:54AM BLOOD PT-101.3* PTT-65.7* INR(PT)-10.4* [**2189-9-15**] 03:52PM BLOOD PT-28.7* PTT-36.2 INR(PT)-2.8* [**2189-9-15**] 09:04PM BLOOD PT-22.3* PTT-34.2 INR(PT)-2.1* [**2189-9-16**] 02:04AM BLOOD PT-20.3* PTT-29.4 INR(PT)-1.9* [**2189-9-17**] 02:54AM BLOOD PT-23.2* PTT-30.9 INR(PT)-2.2* [**2189-9-18**] 03:44PM BLOOD PT-34.5* PTT-37.5* INR(PT)-3.4* [**2189-9-15**] 05:00AM BLOOD Glucose-220* UreaN-37* Creat-2.7* Na-133 K-3.6 Cl-93* HCO3-13* AnGap-31* [**2189-9-15**] 03:52PM BLOOD Glucose-265* UreaN-42* Creat-3.3* Na-131* K-4.5 Cl-97 HCO3-12* AnGap-27* Discharge Labs: COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2189-10-3**] 07:25 13.0* 3.27* 9.4* 30.1* 92 28.7 31.2 17.3* [**2078**] DIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas Myelos [**2189-10-3**] 07:25 83.5* 9.7* 4.5 1.7 0.4 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct INR(PT) [**2189-10-3**] 07:25 NORMAL1 [**2079**] [**2189-10-3**] 07:25 12.7* 31.5 1.2* RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2189-10-3**] 07:25 125*1 63* 5.6* 133 3.9 96 27 14 Relevant Imaging: CT Abdomen ([**2189-9-15**]) 1. Large retroperitoneal hemorrhage involving the perirenal and both anterior and posterior pararenal spaces. The right kidney is also markedly enlarged. Suspect right renal subcapsular hematoma which ruptured into the retroperitoneum. Evaluation with contrast-enhanced CT would be helpful as permitted by patient's renal function. 2. No evidence of bowel wall thickening to suggest ischemia. 3. Spontaneous reflux of contrast into the esophagus is documented. CTU Abdomen ([**2189-9-18**]) 1. Expanded right renal contour with retroperitoneal fluid, similar in size and extent to [**2189-9-15**], and compatible with extension of a right renal subcapsular hemtoma into the retroperitoneum. No new region of hemorrhage is identified. 2. Right renal hilum appears swollen and obliterated, which is non-specific but may be seen with obstruction. Potential etiologies include thrombosis within the collecting system or obstruction of the collecting system by the retroperitoneal hematoma. Neither etiology is well-evaluated on this non-contrast exam. 3. Non-specific mild stranding adjacent to the left ureter in the pelvis. Slight interval increase in bilateral pleural effusions with adjacent compressive atelectasis. 4. Right adrenal adenoma, similar to [**2187-9-27**]. TTE: Suboptimal image quality. Left ventricular cavity dilation with low normal global systoilc function (the apical half of the left ventricle is not visualized). Pulmonary artery hypertension. Mild mitral regurgitation. Compared with the prior study (images reviewed) of [**2188-7-1**], the left ventricular cavity is now dilated and global systolic function is slightly improved. The severity of mitral regurgitation may be similar (better visualized on the prior study). The heart rate is much faster. Knee XR [**2189-9-24**]: 1. Moderate to large suprapatellar effusion, stable. 2. Mild-to-moderate tricompartmental osteoarthritis. Tunneled w/o Port [**2189-9-25**]: Conversion of a temporary to a tunneled double-lumen hemodialysis catheter through the existing right internal jugular vein approach. The catheter tip is located in the upper right atrium. The catheter is ready for use. CT Chest w/o Contrast [**2189-9-29**]: Limited assessment of the examination. Bilateral left more than right areas of atelectasis in the lower lobes. No evidence of pneumonia. Mucus in the trachea, potentially reflecting poor airway clearance. No evidence of infectious lung disease, no lung nodules or masses. Microbiology: [**2189-9-14**] 3:55 pm JOINT FLUID JOINT FLUID. **FINAL REPORT [**2189-9-17**]** GRAM STAIN (Final [**2189-9-14**]): 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2189-9-17**]): NO GROWTH. Blood culture [**2189-9-14**]: negative C. diff, stool culture [**9-20**], [**9-24**] negative [**9-24**] Ucx [**2189-9-24**] 6:46 pm URINE Source: CVS. URINE CULTURE (Final [**2189-9-27**]): PSEUDOMONAS AERUGINOSA. 10,000-100,000 ORGANISMS/ML.. Piperacillin/Tazobactam sensitivity testing performed by [**First Name8 (NamePattern2) 3077**] [**Last Name (NamePattern1) 3060**]. YEAST. 10,000-100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PSEUDOMONAS AERUGINOSA | CEFEPIME-------------- 8 S CEFTAZIDIME----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM------------- 0.5 S PIPERACILLIN/TAZO----- S TOBRAMYCIN------------ <=1 S Discharge Labs: [**2189-10-3**] 07:25AM BLOOD WBC-13.0* RBC-3.27* Hgb-9.4* Hct-30.1* MCV-92 MCH-28.7 MCHC-31.2 RDW-17.3* Plt Ct-190 [**2189-10-3**] 07:25AM BLOOD Neuts-83.5* Lymphs-9.7* Monos-4.5 Eos-1.7 Baso-0.4 [**2189-10-3**] 07:25AM BLOOD Glucose-125* UreaN-63* Creat-5.6*# Na-133 K-3.9 Cl-96 HCO3-27 AnGap-14 [**2189-10-3**] 07:25AM BLOOD Calcium-8.1* Phos-3.8 Mg-2.2 Brief Hospital Course: Mr. [**Known lastname 11950**] is an obese 56 year old male with gout, a-fib on coumadin, who was admitted for joint pain, gout/pseudogout/hemarthrosis. Course complicated by subcapsular right renal hemmorhage, RP bleed in the setting of INR 7.7, [**Last Name (un) **] on CKD with initiation of dialysis, and Pseudomonas UTI. Active Issues: # Hypotension due to subcapsular right renal hemmorhage complicated by retroperitoneal bleed in the setting of INR of 7.7. S/p volume and blood product resuscitation along with reversal of coagulopathy. IR and Urology following and managed conservatively. Hct remained stable at 25-30 s/p 8 units of blood, and 4 units of FFP over 2 weeks on the floor. # Gout/Pseudogout/Hemarthrosis. Cause of patient's bilateral knee pain, L>R. Also, contractures and critical care myopathy are possibilities at this point. Completed a course of prednisone taper per Rheumatology. Changed allopurinol and colchicine regimen to based on HD. Rheumatology considered IA steroid injection but opted not to due to recent hemarthrosis. Knee XR on [**9-24**] showed a slight decrease in joint effusion and a stable joint. Patient continues to complain of leg pain at discharge. # ARF on CKD, now HD dependent: Baseline stage IV CKD due to DM, HTN. R kidney likely damaged due to subcapsular bleed. Left kidney likely damaged from extended hypotension. Pt was on renal diet, all medications were renally dosed, and chemistries were followed daily. We continued calcitriol and nephrocaps while inpatient. Calcitriol was eventually switched to Doxerfericol. Renal diet initially was receiving 2g K daily, but later reduced 1.0g per day. K has since been in stable range. Transplant also would like to put in dialysis fistula for long-term access. Cardiology consulted to make sure pt is at cardiac optimization for such placement. Pt will continue outpatient with long-term dialysis for the forseeable future per Nephrology. # Atrial fibrillation in setting of supratherapeutic INR. Held coumadin since hospital day 1. Tele was placed during duration of hospital stay, with multiple episodes of VTach in the 150's overnight. INR was re-assesed daily, trending to 1.6 by discharge. Albumin level was 2.5 on [**9-28**]. Labetolol was continued, but changed to 100mg TID to support ultrafiltration and hemodialysis. Patient CHADS=3, however, in light of recent supratherapeutic INR and major bleed, coumadin was not reinitiated. Patient started on ASA 325mg. Will have Cardiology follow up to determine further anticoagulation. # Insomnia: pt reports not sleeping well for much of hospital stay. Questioning pinpoints problem to sleep maintanence. Experiences more lethargy as the day goes on. Doubled trazadone dosage helped when he was not in pain. # Elevated white count: Most likely due to steroids & Pseudomonal UTI. Possible multifactorial since it was present, but not as high, before steroid use. Unclear why WCB increased so much in MICU (above 40). Trend of WBC 18.2 -> 18.2 -> 16.3 at discharge while on cefepime for UTI. Plan complete a 10d course, last day on [**10-8**]. # Chronic systolic CHF. Some rales in lower lobes early on morning physical exams. Pt would report SOB that would resolve after dialysis. Pt was grossly fluid overloaded. CT showed no evidence of pneumonia. # Diabetes mellitus: HbA1C was 6.9% on [**2189-5-18**]. Complicated by neuropathic pain and gastroparesis. Increased sliding scale insulin when steroids began. Monitored glucose levels during the day. Continued gabapentin and metaclopramide. Continue prescribed sliding scale of insulin and standing doses in rehab and adjust based on blood glucose. Would consider transition to 70/30 on discharge home for better compliance. # Heartburn: Likely stress ulcer from ICU stay. Unlikely to be cardiac pain as pt was worked up in ICU after hypotension with no signs of ACS at that time and afterwards. Continued sucralfate and omeprazole. Was given GI cocktail containing maalox and lidocaine if persistant with positive results. # Hyperparathyroidism: most likely [**3-12**] CKD and inc. phosphate. Guidelines for pts on dialysis include Ca of 8.4-9.5, Ph of 3.5-5.5, and PTH of 150-300. Pt's values are 7.6, 5.5, and 589, respectfully. Renal recommended Vit D analog during dialysis rather than Sevelamer. # Diarrhea: C. diff results negative. Has resolved. No intervention needed. Chronic Issues: # Dyslipidemia: Stable. Continued simvastatin. # Hypertension: Pt with history of hypertension, but not an issue since major bleed. Continued on labetolol for rate control. Transitional Issues: Pt will be discharged to rehab where he will continue dialysis, physical therapy, and maintanence of care. Status: Full Code UTI: Cefepime 500mg IV q24h on [**2189-10-8**] Medication Changes: Stopped Calcitriol, Metoclopramide, Simvistatin, Torsemide, Insulin NPH 70/30, Colace, Vit D, Ferrous Sulfate, Tramadol. Started on Atorvastatin, Calcium Carbonate, Cepacol (Menthol), Colchicine, Digoxin, Doxerfericol, Guaifenesin, HYDROmorphone (Dilaudid), Ipratropium Brommide, Insulin SC Sliding Scale and Fixed Dose, Labetolol, Nephrocaps, Ondansetron, Sucralfate, Trazadone Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from Pharmacy. 1. Allopurinol 100 mg PO EVERY OTHER DAY 2. Calcitriol 0.25 mcg PO DAILY 3. Digoxin 0.25 mg PO MWF 4. Vitamin D 50,000 UNIT PO 1X/WEEK ([**Doctor First Name **]) 5. Gabapentin 300 mg PO BID 6. Metoclopramide 5 mg PO QIDACHS 7. Metoprolol Succinate XL 100 mg PO DAILY 8. Omeprazole 40 mg PO DAILY 9. Simvastatin 40 mg PO DAILY18 10. Torsemide 100 mg PO DAILY 11. TraMADOL (Ultram) 50 mg PO TID:PRN pain 12. [**Doctor First Name 7096**] 3 mg PO DAILY 13. [**Doctor First Name 7096**] 1 mg PO ASDIR 1-2 tablets daily as directed 14. Ferrous Sulfate 325 mg PO BID 15. 70/30 12 Units Breakfast 70/30 10 Units Dinner 16. Aspirin 81 mg PO DAILY 17. Albuterol Inhaler [**2-9**] PUFF IH Q6H:PRN shortness of breath or wheezing Discharge Medications: 1. Allopurinol 100 mg PO DAILY 2. Aspirin 325 mg PO DAILY 3. Digoxin 0.125 mg PO MWF Please start Monday [**9-28**]. 4. Gabapentin 100 mg PO DAILY give after HD on HD days 5. 70/30 12 Units Breakfast 70/30 10 Units Dinner Insulin SC Sliding Scale using HUM Insulin 6. Omeprazole 40 mg PO BID 7. Acetaminophen 325-650 mg PO Q6H:PRN pain 8. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing 9. Atorvastatin 80 mg PO DAILY 10. Calcium Carbonate 500 mg PO TID W/MEALS 11. CefePIME 500 mg IV Q24H day 1= [**9-28**] 12. Cepacol (Menthol) 1 LOZ PO PRN cough, sore throat 13. Colchicine 0.6 mg PO EVERY OTHER DAY 14. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 15. Docusate Sodium 100 mg PO BID hold for diarrhea 16. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 17. Guaifenesin [**6-18**] mL PO Q6H:PRN cough 18. Heparin 5000 UNIT SC TID 19. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN pain Please try prior to IV RX *hydromorphone [Dilaudid] 4 mg [**2-9**] tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*1 20. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezing 21. Labetalol 100 mg PO TID hold for SBP<100 or HR<60 22. Maalox/Diphenhydramine/Lidocaine 30 mL PO TID:PRN heartburn 23. Miconazole Powder 2% 1 Appl TP [**Hospital1 **] rash 24. Nephrocaps 1 CAP PO DAILY 25. Ondansetron 4 mg IV Q8H:PRN nausea 26. Senna 1 TAB PO BID:PRN constipation 27. Sucralfate 1 gm PO QID 28. traZODONE 100 mg PO HS insomnia 29. HYDROmorphone (Dilaudid) 1-2 mg IV Q4H:PRN pain hold for sedation or RR<10 RX *hydromorphone 2 mg/mL 1-2mg every four (4) hours Disp #*20 Unit Refills:*0 Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Retroperitoneal hematoma Acute Renal Failure on Stage 4 Chronic Kidney Disease, on Hemodialysis Type II Diabetes Mellitus Atrial Fibrillation Gastroesophageal Reflux Disease Urinary Tract Infection 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 11950**], As you know, you were initially admitted to the hospital for you knee pain and elevated coumadin levels. However, on your first night here you became very sick and had to go to the ICU. There they found that you were bleeding very heavily into your right kidney. You lost a lot of blood and required many transfusions to keep your blood pressure up. However, you blood pressure was very low for a long time. Your kidneys were already damaged from your diabetes and high blood pressure, and this low blood pressure very severely damaged this kidneys and you had to start dialysis, which is likely permanent. While you were very sick with did many other tests to keep you healthy. We found that you had a urinary tract infection and treated that first with a drug called ciprofloxacin and then with a drug called Cefepime. We gave you steroids to try to help the pain in your legs. We did chest xrays and a CT scan of your chest to make sure you did not have pneumonia. We looked at many EKGs of your heart and some blood tests to make sure that you did not have a heart attack. You were on [**Known lastname 7096**] before you came to the hospital, but your blood levels were very high and likely contributed to your large bleed. You were on this for your atrial fibrillation, but we think that it is no longer safe to continue this medicine as you may have a big bleed again. This is a risk, however, because as long as you have a-fib (an irregular heart rhythm) you are at risk of a stroke. We will give you aspirin, but this is not as effective as the coumadine would be. You should discuss this more with your primary care doctor and your cardiologist when you are out of the hospital. We will continue your beta blocker medicine Labetalol to keep your heart rate from going too fast as is often a risk for people with irregular heart rhythms. We realize that your legs are still causing you a great deal of pain. We were hoping that getting a lot of the extra fluid off your legs with dialysis would help. We also gave you steroids. You have an appointment with the rheumatology doctors in a [**Name5 (PTitle) 15935**] weeks to help treat your leg pain better. We made the following changes to your medicines: Stopped: Calcitriol Colace Ferrous Sulfate Metoclopramide Simvistatin Insulin NPH 70/30 Torsemide Tramadol Vit D [**Name5 (PTitle) 7096**] (also known as Coumadin) Started: Atorvastatin Calcium Carbonate Cepacol (Menthol) Colchicine Doxerfericol Guaifenesin HYDROmorphone (Dilaudid) Ipratropium Brommide Insulin SC Sliding Scale and Fixed Dose Labetolol Nephrocaps Ondansetron Sucralfate Trazadone Changed Dose/Dosing: (medication and dose listed is NEW dose) Allopurinol 100mg PO DAILY Aspirin 325 mg PO/NG DAILY Digoxin 0.125 mcg, PO, every MON, WED, and FRI Gabapentin 100 mg, PO, DAILY Followup Instructions: Please discuss with the staff at the facility a follow up appointment with your PCP below when you are ready for discharge. Name:Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Location: [**Hospital1 **] Address: [**Hospital1 **], [**Location (un) **],[**Numeric Identifier 1265**] Phone: [**Telephone/Fax (1) 7976**] Department: RHEUMATOLOGY When: WEDNESDAY [**2189-10-21**] at 11:00 AM With: [**Doctor First Name 21204**] (RHEUM LMOB) [**Last Name (un) **] [**Telephone/Fax (1) 2226**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 861**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: CARDIAC SERVICES When: MONDAY [**2189-10-26**] at 1 PM With: DR. [**First Name8 (NamePattern2) **] [**Doctor Last Name **] [**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: 5845, 0389, 5856, 5990, 2851, 2761, 2724, 4280, 4168, 2875
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Medical Text: Admission Date: [**2104-11-12**] Discharge Date: [**2104-12-1**] Date of Birth: [**2034-9-18**] Sex: F Service: MEDICINE Allergies: Lisinopril Attending:[**First Name3 (LF) 5893**] Chief Complaint: Hypoxia Major Surgical or Invasive Procedure: ABG History of Present Illness: 70 year old female with chief complaint of sob, weakness. Started to feel ill on Thankgiving while she was in [**State 2690**] visiting family and noted chills. Continues to have intermittent sweats and chills, also devloped progressive fatigue and SOB. By the time she arrived home [**11-7**], she could only take a few steps without feeling short of breath. Minimal cough, but does feel chest "tightness." Tm 100 at home. Other than "sitting still" Ms. [**Known lastname 13751**] did not find anything that made her symptoms better. Presented to OSH ED on Friday night (5 days ago) with these complaints. CXR there showed a pneumonia, and she was d/c home with a Z-pack which she finished last night. She had a scheduled follow up at her PCP's office today where she was found to be sating 83% on RA and was sent to the ED. In the [**Hospital1 18**] ED, initial VS T 96.5, HR 80, BP 98/66, RR 21, O2 97% 4L NC. The patient had a CXR that demonstrated a right lung consolidation, received levofloxacin, and was admitted to the ICU for further management. Labs in the ED were notable for a bicarb of 20 and WBC count of 13.7 with 81% PMNs. Pt has no Hx of chronic lung disease, but has had episodes of "bronchitis" in the past. No previous ICU admissions. VS upon transfer to [**Hospital Unit Name 153**] were T 98, HR 74, BP 104/60, RR 19, O2 97%5L NC. In the ICU, the patient felt much better since being placed on nasal canula. Minimal cough. Denies drenching night seats or high fevers. She has had a poor appetite, but no nausea or vomiting. . REVIEW OF SYSTEMS: CONSTITUTIONAL: [] All Normal [ X] Fever [ ] Chills [ ] Sweats [ X] Fatigue [ ] Malaise [ ]Anorexia [ ]Night sweats [ ] weight loss HEENT: [X] All Normal [ ] Blurred vision [ ] Blindness [ ] Photophobia [ ] Decreased acuity [ ] Dry mouth [ ] Bleeding gums [ ] Oral ulcers [ ] Sore throat [ ] Epistaxis [ ] Tinnitus [ ] Decreased hearing [ ]Tinnitus [ ] Other: RESPIRATORY: [] All Normal [ X] SOB [X] DOE [ X] Cough [ ] Wheeze [ ] Purulent sputum [ ] Hemoptysis [ ]Pleuritic pain [] no PND: CARDIAC: [X] All Normal [ ] Angina [ ] Palpitations [ ] Edema [ ] PND [ ] Orthopnea [] Chest Pain [ ] Other: GI: [X] All Normal [ ] Blood in stool [ ] Hematemesis [ ] Odynophagia [ ] Dysphagia: [ ] Solids [ ] Liquids [ ] Anorexia [] Nausea [] Vomiting [ ] Reflux [ ] Diarrhea [ ] Constipation [ ] Abd pain [ ] Other: GU: [X] All Normal [ ] Dysuria [ ] Frequency [ ] Hematuria []Discharge []Menorrhagia []unable to urinate SKIN: [X] All Normal [] SKs + ecchymoses MS: [X] All Normal [ ] Joint pain [ ] Jt swelling [ ] Back pain [ ] Bony pain NEURO: [X] All Normal [ ] Headache [ ] Visual changes [ ] Sensory change [ ]Confusion [ ]Numbness of extremities [ ] Seizures [] Weakness [ ] Dizziness/Lightheaded [ ]Vertigo [ ] Headache ENDOCRINE: [X] All Normal [ ] Skin changes [ ] Hair changes [ ] Temp subjectivity HEME/LYMPH: [X] All Normal [ ] Easy bruising [ ] Easy bleeding [ ] Adenopathy PSYCH: [X] All Normal [ ] Mood change []Suicidal Ideation [ ] Other: . [+]all other systems negative except as noted above Past Medical History: Hypertension Hyperlipidemia Depression Obesity 60-69% left ICA stenosis Osteopenia Cholecystectomy [**2089**] Social History: Her social history is positive for one to two glasses of wine a day and she did have a significant smoking history of two packs per day for 30 years. She quit 20 years ago. Lives alone. Retired. Family History: Her mother passed away last year. Mom had a MI and a TIA as well as a CHF. Physical Exam: VS: T = 100.4 P = 88 BP = 116/64 RR = 24 O2Sat = 94% on 4L NC GENERAL: NAD (on O2) Mentation: Alert, speaks in full sentences. Eyes:NC/AT, no scleral icterus noted Ears/Nose/Mouth/Throat: MMM, Neck: supple Respiratory: Diffuse rhonchi R lung Cardiovascular: RRR, nl. S1S2 Gastrointestinal: soft, NT/ND, normoactive bowel sounds Skin: no rashes or lesions noted. No pressure ulcer Extremities: No edema. Lymphatics/Heme/Immun: No cervical lymphadenopathy noted. Neurologic: -mental status: Alert, oriented x 3. Able to relate history without difficulty. -motor: normal bulk, strength and tone throughout. No abnormal movements noted. -sensory: No deficits to light touch throughout. Psychiatric: WNL Pertinent Results: [**2104-11-12**] 09:45AM WBC-13.7*# RBC-3.66* HGB-10.1* HCT-30.2* MCV-83# MCH-27.5 MCHC-33.3 RDW-13.4 [**2104-11-12**] 09:45AM GLUCOSE-106* UREA N-16 CREAT-1.0 SODIUM-138 POTASSIUM-4.7 CHLORIDE-103 TOTAL CO2-20* ANION GAP-20 [**2104-11-12**] 05:24PM TYPE-ART PO2-74* PCO2-32* PH-7.48* TOTAL CO2-25 BASE XS-0 Brief Hospital Course: 70yo F with HTN and dyslipidemia who was sent to ED from PCP's office for hypoxia in the setting of community aquired PNA x 2 weeks, refractory to outpatient azithromycin and was admitted to the ICU for severe pneumonia and sepsis which were complicated by multisystem failure including respiratory and renal failure. . She Presented to the ICU with a Pneumonia like picture. Stabalized on 4 L 02, but continued to have tachypnea. Due to difficulty maintaining respiratory rate, patient was electively intubated. Had imaging consistent with severe right pulmonary pneumonia as well as progressing rounded left lower lobe opacities, likely infectious in nature. CT scan complimented CXR, but was negative for pulmonary effusions. Started on broad antibiotics including vancomycin, zosyn, and levofloxacin. As pt had history of traveling to [**State 2690**] within the previous several weeks multiple tests for fungus, EBV, legionella, AFB, cryptococcus, sputum, blood, and urine cultures all were negative. The patient had a BAL after intubation which was negative for microorganisms including PCP. [**Name10 (NameIs) **] became progressivley more hypoxic requriing increased PEEP and FiO2. ARDSnet protocol was instituted as CXR was concerning for possible ARDS. Trathoracic pressure monitoring was performed via esophageal balloon manometry. Despite these efforts patient showed no clinical or radiological improvement and continued to have difficulty on the vent requiring increased FiO2 and PEEP to maintain her oxygen saturation. She also developed oliguric renal failure and CVVH was started. She was gradually weaned of sedation but did not regain consciousness. Throughout her hospital stay the ICU team worked closely with the patient's family and HCP who were aware of the worsening prognosis in the setting of multi-organ failure and lack of improvement. On hospital day 20 in accordance with the family's wishes she was terminally extubated. She expired shortly thereafter with the family at the bedside. . Medications on Admission: Simvistatin 40 mg Daily FUROSEMIDE 20mg Daily Metoprolol XL 25mg daily OXYBUTYNIN CHLORIDE Extended Release 5mg Daily RANITIDINE HCL 150 mg Daily ASPIRIN 325 mg Tablet Daily CALCIUM CARBONATE-VITAMIN D3 500 mg -400 unit Daily CLARITIN-D 24 HOUR 240 mg-10 mg MULTIVITAMIN once daily Discharge Medications: NA Discharge Disposition: Expired Discharge Diagnosis: NA Discharge Condition: NA Discharge Instructions: NA Followup Instructions: NA Completed by:[**2105-4-2**] ICD9 Codes: 0389, 486, 5845, 5856, 5070, 2724, 311
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Medical Text: Admission Date: [**2138-4-28**] Discharge Date: [**2138-5-3**] Date of Birth: [**2080-1-29**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 348**] Chief Complaint: hypercarbic respiratory failure Major Surgical or Invasive Procedure: Endotracheal intubation History of Present Illness: 58 y/o M with severe COPD with h/o mulitple intubations, obesity, DM, h/o DVTs s/p IVC filter, who had respiratory distress this morning. Wife called EMS for respiratory distress. Pt intubated in the field. VS at OSH ED Temp 33.1, HR 76, RR 22, BP 122/39, O2 Sat 98% intubated. Pt opened eyes to verbal stimuli, foley placed; pt opened eyes to name. Pt became hypotensive with SBP 68 so dopamine gtt started with improvement to 137 mmHg. CXR confimred tube placement. Pt's urine output noted to be 300-500cc, dopamine was weaned, IVF 1 L NS given. Central line placed for access. Given plavix 300 mg, heparin gtt, and protonix. Another 1 LS NS given. On transfer, pt given vecuronium, fentanyl, and versed for sedation. Vent set at TV 450 cc, RR 12, FiO2 40%, PEEP 5. Transferred to [**Hospital1 18**] for cardiac cath given STE in inferior leads. Cath showed 50% mid LAD otherwise no flow limiting disease. . In the CCU, history obtained from wife. Pt was recently discharge for PNA and COPD flare on [**4-15**]. Prednisone taper was stopped last week. He had not been sleeping much, probably off home BiPAP. Denied cough, chest pain, N/V or other symptoms. His only c/o was poor sleep; no indicaiton that there was worsening SOB or DOE. He uses oxygen and auto-BiPAP at baseline. He did c/o some postural sxs with standing but no syncope. . Admitted to MICU service for hypercarbic resp distress. Past Medical History: severe COPD -FEV1/FVC 29%, FEV1 0.69 (26%) -h/o multiple intubations -baseline co2 80's -home home oxygen 3-5 L RLL pulm nodule 4mm ([**2137-7-6**] at [**Hospital1 2025**]) s/p right facial burn sleep apnea -AHI 26.7, 79.8% sats, 6 L supplemental oxygen at night, BIPAP [**11-20**] allergic rhinitis h/o DVT s/p IVC filter -[**8-5**], then large RP bleed in [**12-7**] [**1-3**] coumadin -RLE/RUE DVT at [**Hospital1 2025**] -IVC [**2137-7-12**] Chest pain with neg stress in [**11-5**] PAF during resp distress GERD with h/o PUD h/o GIB in [**2137-7-14**] hyperlipidemia DM2 ventral hernia obesity chronic back pain psoriasis eczema anemia PTSD s/p facial burn in Summer [**2136**] (care at [**Hospital1 2025**]) PVD c/b right foot ulcer h/o [**Doctor Last Name 360**] [**Location (un) 2452**] exposure Social History: lived with wife, current [**Name2 (NI) 1818**] ([**2-3**] cigs/day), 1-1.5 ppd x several years, no EtOH, no drugs, former auto mechanic, large exposure to paint Physical Exam: 97.0, HR 98-101, BP 109/64 on 2.5 mcg dopamine FiO2 50%, PCV, 450 x 24, PEEP 5, compliance 13, 89-91% intubated, not repsonisve to verbal stimuli, does not follow commands R pupil < L pupil, both sluggishly reactive, no blink to threat RRR, distant heart sounds mechanical BS large obese abd, +BS, large reducible ventral hernia R a-line in groin, L femoral line in place 2+ LE edema bilateral with chronic venous stasis changes, flaking of skin Pertinent Results: [**2138-5-1**] 06:00AM BLOOD WBC-6.9 RBC-3.49* Hgb-10.6* Hct-34.2* MCV-98 MCH-30.3 MCHC-30.9* RDW-15.8* Plt Ct-314 [**2138-5-1**] 06:00AM BLOOD PT-11.8 PTT-31.0 INR(PT)-1.0 [**2138-5-1**] 06:00AM BLOOD Glucose-273* UreaN-24* Creat-0.9 Na-142 K-4.2 Cl-94* HCO3-VERIFIED B [**2138-5-1**] 06:00AM BLOOD Calcium-8.7 Phos-4.5 Mg-2.5 [**2138-4-30**] 03:32AM BLOOD CK(CPK)-18* [**2138-4-28**] 10:36PM BLOOD CK(CPK)-24* [**2138-4-30**] 03:32AM BLOOD CK-MB-NotDone cTropnT-0.02* [**2138-4-28**] 10:36PM BLOOD CK-MB-NotDone cTropnT-0.03* [**2138-4-29**] 05:54AM BLOOD Type-ART Temp-36.7 pO2-75* pCO2-85* pH-7.39 calTCO2-53* Base XS-21 Brief Hospital Course: Mr. [**Known lastname **] is a 58 year old man with severe COPD, DM, chronic low back pain, admitted for cath, which demonstrated one vessel disease, and with hypercarbic respiratory failure, s/p extubation on [**2138-4-30**]. Brief ICU course: #) Hypercarbic resp failure. Thought to be likely secondary to severe COPD exacerbation and residual community or hospital-acquired pneumonia, with recent rapid steroid taper. Pt. was intially intubated in the field and transferred to CCU in stable condition on [**2138-4-28**]. CXR showed hyperinflated lungs and mild generalized interstitial abnormality in lower lungs of indeterminate chronicity. ABGs revealed pH 7.21, pCO2 128, pO2 58, HCO3 54. PCV was started w/ PEEP 10 due to auto-PEEP in setting of COPD. Treatment was started w/ methylprednisolone IV 125mg IV q8h, ipratropium inh, albuterol inh, and fluticasone-salmeterol inh. Levofloxacin 750mg IV daily was also started for presumed pneumonia given CXR findings. A L subclavian line was attempted, but found to be folded over in L brachiocephalic vein, and subsequently removed. On [**2138-4-29**], mechanical ventilation was switched from PCV to AC, and ABGs revealed pH 7.39, pCO2 85. Vancomycin 1g IV q12 was initiated later due to concerns for GPC in blood cx from OSH. On [**2138-4-30**], ventilation was weaned from AC to PSV 16/10, which was tolerated well by the patient. Sputum gram stain showed 1+ GPCs, and blood/sputum cultures were drawn. Since pt did not show signs of infection (Tmax 99.4, WBC 5.3) at this time, abx regimen was continued. Pt was then weaned to PSV 5/5, and subsequently extubated. By [**2138-5-1**], pt has tolerated 4L NC and BiPAP at night, w/ O2Sat in the low 90's. Pt was subsequently transferred from the MICU in stable condition. . #) ST elevations: Although pt reported no prodrome of chest pain, EKG at OSH revealed STE in leads II, III, and AVF. On transfer to [**Hospital1 18**], cardiac catheterization revealed only 50% mid-lesion in LAD, but EF 63% and no wall motion abnormalities. Cardiac enzymes were negative x2 (CK 25 cTnT 0.03 on [**2138-4-29**] and CK 18 cTnT 0.02). No anti-coagulation was given, and pt never reported any CP, SOB, or palpitations . #) Hypotension: Pt's low SBP unlikely related to sepsis due to absence of fever, normal WBC and lactate. His BP stabilized quickly with 2L NS bolus on [**2138-4-28**]. Pt was taken off dopamine gtt, and SBPs have ranged from 100-150 for the remaining duration of his MICU stay. . #) Mental status change: Pt initally very poorly responsive, possibly secondary to paralytics and sedation en route on [**2138-4-28**]. Pupils were unequal and sluggishly reactive to light. On [**2138-4-29**], pt began to respond to verbal stimuli though not following commands, pupils were less unequal. On [**2138-4-30**], pt could follow commands, and pupils were equal and reactive. On [**2138-5-1**], pt was awake, appropriately interactive, and began asking for food. . #) Anemia: Pt's Hct initially dropped from 37.8 ([**2138-4-28**]) to 32.4 ([**2138-4-29**]) to 31.1 ([**2138-4-30**]), but stabilized to 34.4 ([**2138-5-1**]). . #) Chronic back pain: Pt continued on home narcotics regimen. . #) DM: Pt on ISS especially while on steroids. Once on the floor, he continued to receive his COPD medications and nebulizers. His home glyburide was restarted on [**5-2**]. His respiratory status continued to be stable, and he was discharged home on [**5-3**] on a slow steroid taper and instructed to follow up with his PCP. Medications on Admission: prednisone taper recently stopped flovent IH 220 mcg/[**Hospital1 **] combivent 14.7 gm 2 puffs q6 hrs lasix 20 mg qam MVI Fe sulfate 325 mg qam oscal + vit D 1 tab tid w/ meals advair 1 puff [**Hospital1 **] micronase 5 mg qd colace 100 mg [**Hospital1 **] MS contin 30 mg qid, morphine IR 30 mg q 6 prn protonix 40 mg qd diltiazem 90 mg (unclear [**Name2 (NI) **]) ASA 81 mg qd lisinopril 2.5 mg (unclear [**Name2 (NI) **]) foradil 1 puff [**Hospital1 **] Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 2. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q6H (every 6 hours). 3. Morphine 15 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed. 4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 5. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q24H (every 24 hours) for 4 days. Disp:*12 Tablet(s)* Refills:*0* 7. Omeprazole 20 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. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 11. Diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 12. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed. 13. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1) neb Inhalation Q6H (every 6 hours). 14. PredniSONE 50 mg Tablet Sig: One (1) Tablet PO daily () for 3 doses. Disp:*3 Tablet(s)* Refills:*0* 15. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day for 20 days: DIRECTIONS: [**Date range (1) 28125**]: 5 tablets [**Date range (1) 72937**]: 4 tablets [**Date range (1) 63629**]: 3 tablets [**Date range (1) 39587**]: 2 tablets [**Date range (1) 17333**]: 1 tablet [**Date range (1) **]: 0.5 tablet. Disp:*50 Tablet(s)* Refills:*0* Discharge Disposition: Home with Service Discharge Diagnosis: Primary Diagnosis Respiratory Failure requiring intubation Severe COPD (home oxygen 3-5L) Community acquired pneumonia Sleep Apnea on BiPap at night Chronic Back Pain Anemia Type II Diabetes Mellitus Secondary Diagnosis h/o DVT s/p IVC filter h/o PAF during resp distress GERD Hyperlipidemia Ventral Hernia Discharge Condition: Good Discharge Instructions: You were admitted to the hosptial with respiratory failure. After discharge, you should continue to take all your medications and follow up with your appointments as below. If you notice that your oxygen saturation is low, have difficulty breathing, cough, fevers, chills or chest pain please go to the nearest emergency room. Followup Instructions: Please follow up with your PCP [**Last Name (NamePattern4) **] 1 week after discharge. ICD9 Codes: 486, 2724, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6738 }
Medical Text: Admission Date: [**2156-1-8**] Discharge Date: [**2156-1-10**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2704**] Chief Complaint: claudication Major Surgical or Invasive Procedure: peripheral angiography and stent placement in Left Superficial Femoral Artery History of Present Illness: Pt is a [**Age over 90 **] yo man with htn, hyperlipidemia, PVD, experienced as pain in both calves when walking one block and resolving with rest, who presented for stenting of his femoral artery. He had ABIs which were also diminished bilaterally (0.82 right ankle, 0.66 left ankle). Lower extremity doppler evaluation showed triphasic waveforms in bilateral common femoral arteries and evidence of a left SFA occlusion. Past Medical History: 1. PVD-s/p atherectomy and stenting of left SFA 2. Bilateral Renal Artery Stenosis 3. Hyperlipidemia 4. Hypertension 5. Knee and hip replacement surgeries 6. s/p PPM Social History: Lives alone in [**Location 8391**] in [**Hospital3 **]. One son. 50 pack year history of smoking quit 50 yrs ago. Drinks accasional highball. Retired from construction work. Family History: Mother with MI in 40's. Physical Exam: Afebrile 145/60 64 12 99% on RA NAD. Alert. OP clear with MMM. L carotid upstroke diminished with bilateral bruits. RRR soft S1, normal S2. Soft systolic murmurs at RUSB and LLSB. No rubs or gallops Lungs clear to auscultation Abd is soft NTND. Normal BS. No bruits R groin without minimal ecchymoses no hematoma. No bruit and 1+ pulse. No peripheral edema. Bilateral LE warm. Pertinent Results: Catheterization: BRIEF HISTORY: [**Age over 90 **] yo man with hypertension and dyslipidemia referred for peripheral arteriography to evaluate significant bilateral leg claudication (L>R). He had ABIs which were also diminished bilaterally (0.82 right ankle, 0.66 left ankle). Lower extremity doppler evaluation showed triphasic waveforms in bilateral common femoral arteries and evidence of a left SFA occlusion. INDICATIONS FOR CATHETERIZATION: Peripheral vascular disease, claudication, positive noninvasive ischemia evaluation PROCEDURE: Peripheral Catheter placement was performed via the RFA. Peripheral Imaging was performed of the AA and bilateral LE. Peripheral PTA was performed of the R SFA. Peripheral Stenting was performed of the R SFA. Peripheral Atherectomy was performed of the R SFA. **PTCA RESULTS LSFA **BASELINE STENOSIS PRE-PTCA 100 **TECHNIQUE PTCA SEQUENCE 1 GUIDING CATH [**Last Name (un) **] GUIDEWIRES SPATRACO INITIAL BALLOON (mm) 3.0 FINAL BALLOON (mm) 6.0 # INFLATIONS 7 MAX PRESSURE (PSI) 120 **RESULT STENOSIS POST-PTCA 0 SUCCESS? (Y/N) Y PTCA COMMENTS: Initial angiography revealed a 70% lesion at the origin of the SFA and a mid-segment occlusion of the SFA in the left lower extremity. Heparin was started prophylactically. A 7 French [**Last Name (un) 12297**] sheath was advanced into the left CFA. The total occlusion of the left SFA was crossed with moderate difficuly using a Shinobi wire followed by an angled stiff Glidewire. Atherectomy was performed on th eproximal SFA using a Silverhawk LS device with good result. We were unable to deliver the Silverhawk device distal to the total occlusion, so the occlusion was dilated with a 3.0 x 20 mm Saavy balloon using 3 inflations of 6 ATM. We were still unable to deliver the atherectomy device so the diecsion was made to proceed with stenting of the left SFA. A 7.0 x 56 mm Dynalink stent was deployed across the lesion and a 4.0 x 60 mm Saavy balloon was used to dilate the stent at 120 ATM. Angiography demonstrated a filling defect at the proximal edge of the stent so a 7.0 x 100 mm Dynalink stent was deployed proximal to the first stent in overlapping fashion and both stents were dilated with the 4.0 x 60 mm balloon using 3 inflations of 6 ATM. Final angiography revealed no residual stenosis, no apparent dissection, and normal flow. TECHNICAL FACTORS: Total time (Lidocaine to test complete) = 1 hour 13 minutes. Arterial time = 1 hour 13 minutes. Fluoro time = 29 minutes. Contrast: Non-ionic low osmolar (isovue, optiray...), vol 214 ml Premedications: ASA 325 mg P.O. Anesthesia: 1% Lidocaine subq. Anticoagulation: Heparin 5000 units IV Other medication: Fentanyl 50 mcg iv Cardiac Cath Supplies Used: - [**Company **], ANGLED GLIDEWIRE, 180 .014 GUIDANT, [**Location (un) **]/CORE, 130CM .014 CORDIS, SHINOBI, 300CM 7F COOK, [**Last Name (un) 28712**], 55 7F FOXHOLLOW, SILVERHAWK ES 7 GUIDANT, DYNALINK 56, 80 7 GUIDANT, DYNALINK .018, 100 COMMENTS: 1. Access was obtained in retrograde fashion via the RFA using a 6 French short sheath. 2. Resting hemodynamics revealed no significant pressure gradient between AO and either common femoral artery. 3. Abdominal aortography revealed nild diffuse athersclerotic disease. 4. The renal arteries were single bilaterally. The left renal artery had a 70% proximal stenosis and minimal blush was noted in the left kidney. The right renal artery had a proximal 70% stenosis. 5. Selective angiography of the right lower extremity revealed no significant disease in the CIA or EIA. The SFA was subtotally occluded at the adductor. The popliteal had no significant disease. The AT and PT were occluded with the PA filling the foot. 6. Selective angiography of the left lower extremity revealed no significant disease in the CIA or EIA. There were mild luminal irreguarities in the CFA. The SFA was totally occluded in its mid segment and reconstituted just above the popliteal artery. The popliteal artery was not obstructed. 7. Successful atherectomy of the proximal left SFA (see PTA comments). 8. Successful PTA and stenting of the mid SFA with overlapping 7.0 x 100 mm and 7.0 x 56 mm Dynalink stents which were postdilated with a 6.0 mm balloon. Final angiography revealed no residual stenosis, no apparent dissection and normal flow (see PTA comments). FINAL DIAGNOSIS: 1. Bilateral SFA and infrapopliteal disease. 2. Bilateral renal artery stenosis. 3. Successful atherectomy, PTA, and stenting of the left SFA. . . Right femoral vascular ultrasound: Right common femoral artery and common femoral vein are widely patent, without pseudoaneurysm or AV fistula. No large hematoma is identified within the soft tissues of the right groin. IMPRESSION: No evidence of pseudoaneurysm, AV fistula or hematoma within the right groin. Brief Hospital Course: Pt was taken to the catheterization lab and a stent was placed in the left superficial femoral artery. At the end of the procedure it was very difficult to attain hemostasis at the right groin access site. As there was concern for development of hematoma or pseudoaneurysm, pt was admitted to the CCU where he was monitored closely and had multiple stable hematocrit checks. A femoral vascular ultrasound was performed at the right groins site and showed neither pseudoaneurysm or hematoma. Pt was stable and was discharged to home with plan to return at a later date for stenting of the right femoral artery. Medications on Admission: 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual Q5MIN () as needed for chest pain. 2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Medications: 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual Q5MIN () as needed for chest pain. 2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 30 days. 10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Outpatient Lab Work please check potassium, BUN, creatinine and call into nurse practitioner [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] at [**Hospital1 336**] ([**State 59677**]) - [**Telephone/Fax (1) 59678**]. 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual Q5MIN () as needed for chest pain. 2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 30 days. Disp:*30 Tablet(s)* Refills:*3* 10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Outpatient Lab Work please check potassium, BUN, creatinine and call into nurse practitioner [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] at [**Hospital1 336**] ([**State 59677**]) - [**Telephone/Fax (1) 59678**]. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Peripheral Vascular Disease Hyperlipidemia Hypertension Discharge Condition: Good, stable. Discharge Instructions: Continue your medications as directed. We have started one new medication called Plavix (clopidogrel) that you should take everyday from now on. You will have the other leg fixed on [**2156-1-22**]. You do not need to see Dr. [**First Name (STitle) **] prior to this. You will see [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] at your primary care doctor's office this Tuesday for a blood check. Drink plenty of fluids at home. Followup Instructions: You have an appointment with [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] (Nurse Practitioner) on Tuesday, [**1-13**], at 10:40 a.m. at your Primary Care Doctor's office at [**Hospital1 336**] ([**State 59677**]). You should have your blood drawn at that time to check on your kidney. You will also need to see Dr. [**First Name (STitle) **] as directed. You are scheduled to have the same procedure on your other leg on [**2156-1-22**]. Completed by:[**2156-1-28**] ICD9 Codes: 4280, 4439, 2720, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6739 }
Medical Text: Admission Date: [**2191-7-24**] Discharge Date: [**2191-7-26**] Date of Birth: [**2116-10-8**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2485**] Chief Complaint: resp failure Major Surgical or Invasive Procedure: none History of Present Illness: 74 yr old male with hx of metastatic lung cancer, prostate cancer, transitional cell ca of the bladder, recent MRSA pneumonia (completed Vanco course [**7-12**]), recent pseudomonas pneumonia (on Zosyn since [**7-8**]) noted to be lethargic at his nursing home with a RR 10. Per nursing home staff no recent worsening in cough, fevers, complaints of chest pain or shortness of breath. After several failed attempts at intubation, an ABG was checked and pCO2 was found to be 115. Pt was then brought to [**Hospital1 18**] ED with a laryngeal mask airway and then successfully intubated by anesthesia. An ABG on the ventilator was 7.32/57/241. In the ED, T 97, HR 86, bp 117/68, resp 18, 100%. CXR showed new patchy right-sided infiltrates and he received vancomycin 1 g IV X 1 and ceftazidime 1 g IV X 1 and 1.7 L of fluid. Patient then dropped his sbp to 60s and HR to the 40s, for which he received 1 mg of atropine and was started on a lephed gtt with recovery of his HR to 80s and sbp 130s. Currently unable to obtain further information from patient as he is intubated and sedated. Past Medical History: PUD squamous cell lung cancer s/p XRT and left pneumonectomy (15 years prior to arrival) TCCA bladder, diagnosed [**2190**] and not undergoing treatment prostate CA T2bNxMx, grade [**8-24**] s/p XRT and hormone therapy with biscalutamide GERD anemia of chronic disease Left knee trauma [**2156**] s/p fusion with rod in left leg and now left leg shorter than right HTN Social History: Per daughter.. patient's pre-morbid situation included: - living with girlfriend (67yo and an alcoholic) in home in [**Location (un) 686**] - home health aid once per week - His girlfriends friends have been stealing his percocets so PCP switched him to fentanyl patch Family History: NC Physical Exam: T97 HR 65, bp 143/66, resp 20 100% AC 400/18 FiO2 100% PEEP 5 Gen cachectic, elderly African American male, intubated, sedated HEENT: Pupils equal and minimally reactive to light, anicteric, pale conjunctiva, OMMM, intubated, neck supple Cardiac: irregularly irregular, II/VI SM at apex Pulm: Decreased BS throughout left lung, crackles at right lung base with diffuse ronchi. Occasional wheezes Abd: concave, hypoactive BS, soft, NT Ext: trace LE edema, warm with 1+ DP bilaterally. 2+ edema LUE. Significant shortening of LLE Neuro: Moves all 4 extremities in response to noxious stimuli, 2+ DTR throughout. Access: L SC portocath, Right EJ Pertinent Results: [**2191-7-24**] 08:26PM URINE BLOOD-LG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG [**2191-7-24**] 08:26PM URINE RBC->50 WBC-[**3-19**] BACTERIA-MOD YEAST-NONE EPI-[**3-19**] TRANS EPI-0-2 [**2191-7-24**] 08:26PM URINE GRANULAR-0-2 HYALINE-0-2 . [**2191-7-24**] 06:18PM TYPE-ART TEMP-36.7 PO2-241* PCO2-57* PH-7.32* TOTAL CO2-31* BASE XS-1 INTUBATED-INTUBATED VENT-CONTROLLED\ . [**2191-7-24**] 05:49PM GLUCOSE-107* UREA N-18 CREAT-0.6 SODIUM-147* POTASSIUM-VERIFIED B CHLORIDE-111* TOTAL CO2-31 [**2191-7-24**] 05:49PM ALT(SGPT)-20 AST(SGOT)-32 LD(LDH)-241 CK(CPK)-30* ALK PHOS-114 AMYLASE-17 TOT BILI-0.3 [**2191-7-24**] 05:49PM LIPASE-9 [**2191-7-24**] 05:49PM cTropnT-0.03* [**2191-7-24**] 05:49PM CK-MB-NotDone [**2191-7-24**] 05:49PM ALBUMIN-2.1* CALCIUM-11.2* PHOSPHATE-3.3 MAGNESIUM-1.9 . [**2191-7-24**] 05:49PM WBC-14.2* RBC-3.49* HGB-9.8* HCT-30.3* MCV-87 MCH-27.9 MCHC-32.2 RDW-15.1 [**2191-7-24**] 05:49PM PLT SMR-NORMAL PLT COUNT-164 [**2191-7-24**] 05:49PM NEUTS-93.3* BANDS-0 LYMPHS-3.8* MONOS-2.0 EOS-0.7 BASOS-0.2 [**2191-7-24**] 05:49PM PT-14.4* PTT-26.0 INR(PT)-1.4 . CTA: 1. No evidence for pulmonary embolism. 2. Interval opacification of the lung parenchyma within the left hemithorax with minimal aeration of the left upper lung lobe consistent with pneumonia. Interval worsening of the patchy airspace opacities within the right lower, middle, and upper lung lobes also consistent with pneumonia. Interval increase in size of large right pleural effusion. 3. Unchanged bony lesions. . CT Head: No evidence of hemorrhage, mass effect, or major vascular territorial infarction. . CXR: Persistent near complete opacification of the left lung. New, multifocal patchy opacities within the right lung which may represent infiltrate or CHF. . Upper ext doppler: New non-occlusive thrombus within the left subclavian vein. Brief Hospital Course: Pt was intubated for hypercarbic respiratory failure. After a meeting with the pt's daughter, his health care proxy, the decision was made, by both the pt and his daughter, to extubate the pt and make him CMO. The pt was extubated one day after admission and he expired the following day. His daughter was at his bedside. The following is a description of his brief hospital course. . 1) Hypercarbic respiratory failure: Pt intubated on arrival to ED. Respiratory failure likely [**2-16**] COPD exacerbation superimposed on persistent/recurrent pneumonia, possibly post-obstructive. CTA in ED was negative for PE. CXR showed near complete opacification of the left lung along with new opacities in the right lung. He was given Vancomycin, cefepime and flagyl for post-obstructive/aspiration pneumonia and solumedrol with nebs for COPD. Sputum cx grew pseudomonas. As above, pt was extubated after a family meeting and made CMO. . 2) Hypotension: Briefly, around time of intubation, due to propofol. Resolved. . 3) Hypernatremia: Likely [**2-16**] decreased access to free water so pt was given free water boluses down NGT. . 4) Coagulopathy: INR 1.4, likely represents nutritional deficiency so pt was given Vitamin K. . 5) h/o CAD: recent NSTEMI with current nonspecific ST-T wave changes. Pt was continued on cardiac meds. . 6) LUE edema: Left upper ext ultrasound showed new subclavian clot. Medications on Admission: 1. Aspirin 325 mg qd 2. Lipitor 40mg qd 3. Thiamine HCl 100 mg qd 4. Folic Acid 1 mg qd 5. Ferrous Sulfate 325 qd 6. MS Contin 30 mg Tablet qd 7. Finasteride 5 mg qd 8. Acetaminophen 325-650mg q4 prn 9. Prochlorperazine 10 prn 10. Multivitamin Capsule qd 11. Atrovent 12. Fentanyl patch 100 mcg/hr 13. Lidocaine 5 % patch 14. Megestrol Acetate 40 mg [**Hospital1 **] 15. Morphine 15mg q4-6hrs prn pain 16. Piperacillin-Tazobactam 4.5 gm q8hrs (To complete a 21 day course. Should end on [**2191-7-28**]) 17. Senna 18. Albuterol Sulfate 19. Pantoprazole Sodium 40 mg qd 20. Metoprolol Tartrate 25 mg [**Hospital1 **] Discharge Medications: none Discharge Disposition: Expired Discharge Diagnosis: hypercarbic respiratory failure Discharge Condition: expired Discharge Instructions: none Followup Instructions: none ICD9 Codes: 0389, 486, 2760, 4019
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Medical Text: Unit No: [**Numeric Identifier 77715**] Admission Date: [**2116-3-17**] Discharge Date: [**2116-5-6**] Date of Birth: [**2116-3-17**] Sex: M Service: NB HISTORY: Baby boy [**Known lastname 77716**] was born at 28-5/7 weeks with a birth weight of 1245 grams to a 39-year-old mom, [**Name (NI) **] P1-2. Mom's prenatal labs include the following: Blood type O positive, hepatitis B surface antigen negative, RPR nonreactive, GBS unknown at the time of delivery and rubella immune. Mom had spontaneous rupture of membranes on [**3-6**] for approximately 12 hours. She was treated with betamethasone and antibiotics. However, on the day of delivery, mom developed a low grade temperature and the infant was born via spontaneous vaginal delivery after induction for presumed chorioamnionitis in the mother. The patient emerged vigorous and had Apgars of 7 and 8. The patient did require oxygen and stimulation for poor respiratory effort and was transitioned to the NICU on CPAP. The weight on admission was 1245 grams which was equal to the 50-75 percentile. The length on admission was 39 cm which was equal to the 50-75 percentile. The head circumference on admission was 27.5 cm which was equal to the 50-75th percentile. Of note, this family is from [**Country 77717**] and mom has lived in the United States since [**2106**]. PHYSICAL EXAMINATION: On discharge, the weight was 2.685 kilograms which is equal to the 50-75 percentile. The head circumference at that time was 34 cm which is equal to the 75-90 percentile. The length upon discharge was 40 cms. Generally, this patient was well appearing and alert on physical exam. HEENT exam was significant for an anterior fontanel that was open, soft and flat. Extraocular movements intact with red reflex present bilaterally. Ears were normal set and rotation. Palate was intact. No dysmorphic facies were noted to the face. The neck was supple. Respiratory exam was consistent with clear and equal breath sounds bilaterally with no significant retractions or work of breathing. The cardiovascular exam is consistent for a normal S1, S2, regular rate and rhythm with no appreciable murmurs during the exam. Femoral pulses were equal bilaterally. Abdominal exam was consistent with a nontender, nondistended abdomen and no masses were palpable. GU exam was consistent with normal male genitalia. This patient, [**Last Name (un) **], did have a circumcision. There is a small blood clot around the circumference of the glans consistent with a normal healing circumcision. The testicles are palpable bilaterally in the mid inguinal canal. The testes can be pulled down into the scrotal sac. There is a min or bulge in the proximal portion of the inguinal canal area bilaterally. This bulge is thought to be most consistent with the testicles in the mid canal. There were no exam findings to suggest that there were bowel loops in this area (hernia evaluation negative). The anus is patent. The extremities are warm and well perfused and moving symmetrically. The neurological exam is consistent with normal tone and suck with a normal Moro reflex. HOSPITAL COURSE: Respiratory: This patient was initially brought from the delivery room on nasal CPAP. The patient remained on CPAP until day of life 5. The patient was then in room air until day of life 22 when he was placed on nasal cannula of 25 cc. The patient was then taken off of nasal cannula on day of life 26 and remained in room air for the duration of the hospitalization. This patient did have apnea of prematurity and was placed on caffeine. Caffeine was discontinued on [**2116-3-30**]. The patient was observed for 6-7 days prior to discharge with no significant apnea or bradycardia events. Cardiovascular: This patient had no significant appreciable murmur during this hospitalization. This patient did not have an echocardiogram to evaluate for a patent ductus arteriosis during the hospitalization. It was noted that this patient was often tachycardic with heart rates in the 170's-190's or even low 200's at times. Caffeine was discontinued because it was thought to exacerbate the tachycardia. The feedings were also reduced in length because it was thought that possibly the patient became more tachycardic near the end of the feedings. Regardless of these possibilities, this patient's heart rate remained stable in the 140's-170's for the last 2- 3 weeks of the hospitalization. An EKG was done that showed normal sinus tachycardia during the hospitalization. Fluids, electrolytes and nutrition: This patient was started on enteral feedings on day of life 3 and the patient reached full enteric feeds by day of life 10. The patient's maximum caloric intake was PE 28 kcal per ounce. Upon discharge, this patient was sent home with Enfamil 24 kcal per ounce feeding ad lib. This patient was supplemented with iron for anemia of prematurity during this hospitalization. Hematology: As mentioned above, the patient did have anemia of prematurity and was supplemented with iron. The most recent hematocrit was done on [**4-29**] which was equal to day of life 43 and the hematocrit value was 26.4. The reticulocyte value was 4.2%. The patient was supplemented 4 mg of elemental iron per kilo per day. This patient also had hyperbilirubinemia and the maximum bilirubin level was 6.5 on [**2116-3-29**] which was equal to day of life 2. The patient did receive phototherapy for this. Infectious disease: This patient was placed on an ampicillin and gentamicin for a sepsis workup for the first 48 hours of life. These antibiotics were discontinued and the patient had no other evaluations for sepsis during hospitalization. Neurology: This patient had an initial head ultrasound on day of life 8 that showed no intraventricular hemorrhage and results were within normal limits. Followup head ultrasound on day of life 30 or [**2116-4-21**] revealed bilateral germinal matrix bleeding. A followup on [**5-5**] revealed resolving bilateral germinal matrix hemorrhage. The film on [**5-5**] also showed no evidence of periventricular leukomalacia. This patient also had a retinopathy of prematurity screening during the hospitalization. The initial exam was on [**2116-4-21**] which showed immature retina in zone 2 bilaterally. A followup exam will performed on [**2116-5-6**] revealed the same -- immature retina in zone 2 bilaterally. Follow-up is recommended in 2 weeks. Psychosocial: The [**Hospital1 69**] social worker was involved with the care of this patient as they do for all the patients in the neonatal intensive care unit. As mentioned previously, this family is from [**Country 77717**] and mom has lived in the United States since [**2106**]. Mom speaks [**Name2 (NI) 483**] fluently. CONDITION ON DISCHARGE: Stable. DISPOSITION: Home. PRIMARY CARE PEDIATRICIAN: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 47710**] in [**Location (un) 55**] Pediatrics. The address of the pediatrician is [**Apartment Address(1) **], [**Location (un) 55**], [**Numeric Identifier **]. Phone number is [**Telephone/Fax (1) 47712**]. CARE/RECOMMENDATIONS: Feedings on discharge are Enfamil 24 kcal per ounce ad lib. Medications on discharge: Ferrous sulfate 4 mg of elemental iron per kilo per day which is equal to 0.5 ml p.o. daily with a concentration of 25 mg/mL. Car seat position screening was performed prior to discharge and the patient passed. State newborn screening was performed on [**2116-3-20**] which revealed an elevated phenylalanine level. Followup testing on [**2116-3-31**] revealed a normal newborn screen. The last screen was sent on [**2116-4-28**] and no abnormal results have been reported. Immunizations received during this hospitalization were hepatitis B vaccine on [**2116-4-17**]. Immunizations recommended: Synagis RSV prophylaxis should be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following four criteria: 1: Born at less than or equal to 32 weeks. 2: Born between 32-35 and 0/7 weeks with two of the following: Daycare during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities or school age siblings. 3: Chronic lung disease. 4: Hemodynamically significant congenital heart disease. 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. This infant has not received rotavirus vaccine. The American Academy of Pediatrics recommends initial vaccination of preterm infants at or following discharge from the hospital if they are clinically stable and at least 6 weeks but fewer than 12 weeks of age. We recommend that the GU exam be followed clinically as an outpatient. Due to his prematurity, [**Last Name (un) **] is at risk for inguinal hernias. It is difficult to assess now if he has inguinal hernias. We feel that [**Last Name (un) 40781**] physical exam is consistent with descending testicles. FOLLOWUP: Primary care pediatric appointment on Thursday, [**2116-5-7**] at 11:45 a.m. Visiting nurse service on [**Last Name (LF) 2974**], [**2116-5-8**]. Followup referrals have been placed with early intervention and infant followup clinic. Family needs to schedule a follow-up appointment with ophthlmology to follow the development of his retina. DISCHARGE DIAGNOSES: 1. Preterm newborn 2. Respiratory distress syndrome 3. Apnea of prematurity 4. Sepsis evaluation 5. Hyperbilirubinemia 6. Anemia of prematurity 7. Bilateral germinal matrix hemorrhages 8. Immature retinal development [**Name6 (MD) **] [**Last Name (NamePattern4) **], [**MD Number(1) 55472**] Dictated By:[**Last Name (NamePattern4) 76810**] MEDQUIST36 D: [**2116-5-5**] 15:03:08 T: [**2116-5-5**] 16:02:42 Job#: [**Job Number 77718**] ICD9 Codes: 7742, 769, V290, V053
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Medical Text: Admission Date: [**2148-11-21**] Discharge Date: [**2148-11-25**] Date of Birth: [**2091-2-25**] Sex: M Service: MEDICINE Allergies: Erythromycin Base / Biaxin / Ciprofloxacin Attending:[**First Name3 (LF) 1943**] Chief Complaint: Fever Major Surgical or Invasive Procedure: Central line placement History of Present Illness: 57-year old man with a history of HIV CD4 373 in [**2148-6-14**], history of asplenia, history of strep viridans septic shock in [**2148-6-14**] presents with fevers and rigors, lightheadedness, and elevated WBC who is admitted to the ICU for hypotension and fever. He was well until he woke up this morning with rigors and feeling of lightheadedness without syncope. He took a hot shower that did not warm him up and decided to present to the ED given that these symptoms were similar to his prior Strep viridans septic shock. He denies any other localizing symptoms including cough, rhinorrhea, nausea, vomiting, diarrhea, myalgias, chest pain/pressure, SOB, calf pain, or rash. He recently travelled to [**Country 12649**] and to [**Location (un) **] where he engaged in protected anal and oral sex, ate mussels, but no other changes in diet or habits. No animal exposures other than his pet chihuahua. No known sick contacts. [**Name (NI) **] had pneumovax and flu vaccines. In the ED, initial vital signs were: T 98.1 P 122 BP 145/59 R 16 O2 sat 100%. His blood pressure dropped to 80's systolic and had a temperature up to 103F. Vanco and zosyn were given in the ED. Initial lactate was 2.2, elevated to 2.5 after 2nd liter of NS. WBC was 21.3 with 88% neutrophils. CXR showed L retrocardiac density concerning for pneumonia but later read as subsegmental atelectasis. Received total 6L NS, central line was placed. Upon leaving the ED, vitals were HR 111 BP: 114/52 O2: 98%2L RR 21 In the [**Hospital Unit Name 153**], T: 101.5 HR: 108 BP: 117/77 100% RA. Review of sytems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. 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: HIV, CD4 379 [**6-22**], undetectable viral load and CD4 > 600 2 weeks ago by report, never below 350 since diagnosis per patient. Treated initially with Trisovir, now on Atripla (efavirenz-an NNRTI, emtricitabine--a nucleoside RTI, and tenofavir--a nucleoside RTI). Hep B Diagnosed [**2117**]. ([**6-22**]: negative Hep B viral load; had been on Atripla which includes emtricitabine and tenofovir, both w anti-Hep B activity) S/P Septic Shock with Xigris (activated protein C) administration [**3-18**] strep viridans bacteremia c/b Acute Renal Failure and CVVH, respiratory failure and thrombocytopenia in [**6-22**] History of splenic abscess s/p splenectomy in [**2135**] DM type 2, on metformin Obesity Hypercholesterolemia, on lipitor Asthma R medial meniscal tear History of severe bronchitis [**2146**] Social History: In long term relationship w/ partner x 30 years. Works in software quality assurance for [**Location (un) 12650**]. No smoking. Very occasional alcohol. No drugs. Recently travelled to Barcelona [**Country 12649**] with + oral/anal sex, all protected. Recent travel also to [**Location (un) **]. Ate mussels x 2 in [**Country 12649**], no unpasteurized cheeses, no animal contacts other than pet chihuahua, no bites, no travel to SW US or tropics, no significant tick exposure. Family History: Aunt with rheumatic fever, died [**2119**] Mother with arrhythmia requiring pacemaker Father died of lung ca, 60 year smoking history Physical Exam: Vitals: T: 101.5 HR: 108 BP: 117/77 100% RA General: Alert, oriented, no acute distress. Interactive and pleasantly conversant. HEENT: Sclerae anicteric, MMM, oropharynx clear without thrush Neck: Supple, JVP not appreciated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi. CV: Tachycardic, regular, normal S1 + S2, grade 2/6 systolic murmur at LUSB, no detectable radiation, no rubs or gallops Abdomen: Obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. well-healed laparotomy scar noted GU: foley in place Ext: +erythema, swelling, and tenderness in left anterior lower leg. there are skin abrasions on dorsal surface of both halluxes as well as onychomycosis of some toe nails. Pertinent Results: ADMISSION LABS: [**2148-11-21**] 05:56PM LACTATE-1.8 [**2148-11-21**] 06:29PM URINE HOURS-RANDOM UREA N-681 CREAT-60 SODIUM-126 [**2148-11-21**] 05:56PM TYPE-[**Last Name (un) **] PH-7.36 [**2148-11-21**] 05:22PM GLUCOSE-125* UREA N-29* CREAT-1.4* SODIUM-140 POTASSIUM-4.3 CHLORIDE-111* TOTAL CO2-19* ANION GAP-14 [**2148-11-21**] 05:22PM CALCIUM-8.9 PHOSPHATE-2.4*# MAGNESIUM-1.7 [**2148-11-21**] 05:22PM WBC-28.1* RBC-3.63* HGB-11.2* HCT-34.6* MCV-95 MCH-30.9 MCHC-32.4 RDW-15.1 [**2148-11-21**] 12:32PM LACTATE-2.5* MICROBIOLOGY: [**2148-11-21**] Blood Cx pending as of day of discharge [**2148-11-21**] Urine Cx negative [**2148-11-21**] GC / Chlamydia negative [**2148-11-22**] Cdiff negative [**2148-11-22**] Stool Cx negative STUDIES: [**2148-11-21**] CXR - Mild cardiomegaly with sub-segmental atelectasis in the left lower lobe. Brief Hospital Course: 57 year old asplenic male with HIV (per pt. most recent CD4=600), h/o strep viridans sepsis in [**Month (only) 547**]/[**2148-6-14**], was admitted with sepsis, most likely secondary to left leg cellulitis. 1. Sepsis Patient presented with fevers, tachycardia, elevated WBC, and hypotension responsive to fluids. Of note, the patient is asplenic, so encapsulated organisms were of concern. There was concern for another episode of Strep Viridans sepsis as with his previous hospitalization in [**2148-6-14**], but his blood cultures have been negative so far. Initial interpretation of CXR was possible PNA, but the patient did not have any respiratory symptoms to support it. A left lower extremity cellulitis was the likely source of sepsis. The cellulitis had no induration, but the erythema and swelling appeared to increase slowly in size for a full 24 hours on the intravenous antibiotic regimen before it stabilized. Vancomycin and Zosyn were continued for treatment of his cellulitis because of his history of MRSA and to cover for encapsulated organisms. GC/Chlamydia swaps were negative. ID consult recommended transition to PO Bactrim and Augmentin as outpatient therapy. Will defer to PCP as to whether or not patient should have penicillin prophylaxis because of his asplenia. 2. Acute vs Chronic Renal Insufficiency: Mr. [**Known lastname 12651**] creatinine was 1.3-1.4 on presentation. His baseline creatinine is unclear. [**Name2 (NI) **] had acute renal failure during his last hospitalization in [**Month (only) 116**], and it is unclear whether his creatinine ever returned to his baseline. 3. HIV Per patient, his last CD4 count was greater than 600, and his viral load undetectable. During his hospitalization, he was continued on Atripla. 4. Type 2 Diabetes Mellitus He was initially maintained on insulin sliding scale but was then transitioned to his home regimen of metformin. 5. Hypertension His lisinopril was initially held during this admission and then restarted once his blood pressure improved. Medications on Admission: Metformin 250mg PO BID Atripla 1 tab PO daily Lisinopril 15mg PO daily Lipitor 10mg PO daily ASA 81mg PO daily Ibuprofen 3 tabs TID Prilosec 20 mg daily (?) supplements including fish oil, L carnitine, glucosamine Discharge Medications: 1. Metformin 500 mg Tablet [**Month (only) **]: 0.5 Tablet PO BID (2 times a day). 2. ATRIPLA [**Telephone/Fax (3) 567**] mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO once a day. 3. Lisinopril 5 mg Tablet [**Telephone/Fax (3) **]: Three (3) Tablet PO DAILY (Daily). 4. Atorvastatin 10 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO DAILY (Daily). 5. Aspirin 81 mg Tablet, Chewable [**Telephone/Fax (3) **]: One (1) Tablet, Chewable PO DAILY (Daily). 6. Bactrim DS 160-800 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO twice a day for 10 days. Disp:*20 Tablet(s)* Refills:*0* 7. Augmentin 875-125 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO twice a day for 10 days. Disp:*20 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Cellulitis of the left lower leg. SECONDARY DIAGNOSIS: 1. HIV 2. Asplenia 3. Type 2 Diabetes Mellitus 4. Hypertension Discharge Condition: Stable. Patient is ambulating, tolerating oral intake, and has returned to his baseline condition. Discharge Instructions: You were admitted to the hospital with sepsis thought likely related to your left lower leg cellulitis. You were started on IV antibiotics with improvement in your blood pressure. We have adding the following medications for treatment of your cellulitis: 1. Bactrim DS one tablet twice daily for 10 days total 2. Augmentin 875mg one tablet twice daily for 10 days total Please seek immediate medical attention if you develop fevers, shaking chills, night sweats, light-headedness, dizziness, passing out, worsened swelling in your left leg, shortness of breath, abdominal pain, diarrhea, or cough. Followup Instructions: Provider: [**Name10 (NameIs) 6131**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2148-11-27**] 3:15 Please follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 6164**], within the next 10 days. ICD9 Codes: 0389, 5849, 4019
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Medical Text: Admission Date: [**2196-11-30**] Discharge Date: [**2196-12-3**] Date of Birth: [**2146-5-1**] Sex: F Service: SURGERY Allergies: Baclofen Attending:[**First Name3 (LF) 668**] Chief Complaint: The patient was initially admitted for diarrhea and jaundice. Major Surgical or Invasive Procedure: Emergent exploratory laparotomy for control of life-threatening intraperitoneal variceal hemmorhage [**2196-12-3**] Transfusion of 35 units of packed red blood cells, 20 units of FFP, 6 units of platelets, 2 units of cryoprecipitate, and one dose of recombinant Factor VIIa over [**Date range (1) 71513**]/09 History of Present Illness: This 50 year old lady with hepatitis C cirrhosis was initially admitted for diarrhea and jaundice. The diarrhea had resolved and jaundice with ARF secondary to volume depletion was correcting early in her hospital course. During the night of [**2196-12-2**], she transferred to the ICU for abdominal pain, hemodynamically stable and repeat hematocrit drops consistent with a bleed. Prior to transfer the patient received 9 units of pRBCs, 4 units FFP, 3 units platelets and 1 Unit cryoprecipitate with appropriate hematocrit increase, but without platelent increase or resolution of coagulopathy. Diagnostic paracentesis revealed sanguinous fluid with a hematocrit of 13. Tagged RBC scan was non-revealing. CT scan suggested no retroperitoneal bleed (full report below). The patient remained hemodynamically stable with systolic blood pressures 90-100 and heart rate 70-80 while on Nadolol. Past Medical History: 1.Cirrhosis [**12-26**] HCV (genotype 1) and EtOH - h/o ascites, SBP, and encephalopathy - currently listed for liver [**Month/Day (2) **] - Abdominal CT [**5-/2196**] showed stable cirrhosis, portal hypertension, and extensive variceal formation, patent portal vein, cholelithiasis, splenomegaly, anterior pelvic midline hernia containing a small bowel loop without obstruction, ascites, and mild cecal thickening. - Abdominal U/S [**5-/2196**] showed no liver mass, splenomegaly, and patent main portal vein with hepatopetal flow and large patent umbilical vein shunting portal venous flow (no flow detected in right portal vein) - EGD [**5-/2196**] showed grade 1 esophageal varices, grade 1 esophagitis, a small hiatal hernia, portal hypertensive gastropathy, and an ulcer in the duodenal bulb 2.Asthma 3.mildly dilated left atrium, trace AR, trivial MR, EF>55%, no [**Last Name (un) 6879**] on TTE [**12-1**] 4.No h/o diabetes, cancer, stroke, MI, epilepsy, seizures, high cholesterol or hypertension 5.s/p fractured jaw repair [**2185**] 6.s/p ankle surgery [**2177**] 7.Endometriosis and right simple ovarian cyst s/p BSO [**3-/2195**] Social History: Lived with her sister, has a very supportive family. Formerly employed in social work but currently unemployed [**12-26**] fatigue and poor memory. Smokes 2 packs/week, used to smoke 1 PPD. Drank heavily for 20 years, but no EtOH use since [**2194-2-22**]. +Prior marijuana and intranasal cocaine use, but no h/o IVDU. Family History: Significant for the absence of any colon cancer or breast cancer. No liver disease. Her mother is healthy. Her dad has prostate cancer. She has three sisters and two brothers who are all healthy. Physical Exam: Wt 90.6 kilograms, up from 86 kilograms. 02 sat is 100%. HEENT -does reveal marked sclera icterus. Heart normal rate and rhythm, no murmurs Lungs clear to auscultation bilaterally,no wheezes. Abdomen soft, distended, obvious ascites on exam. Extremities reveal 1+ edema pitting edema bilaterally and there is increased swelling in the left lower extremity with some bruises and cuts. Neurologic exam: postivie for asterixis but she is alert and oriented x3. Pertinent Results: [**2196-11-30**] 09:20PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2196-11-30**] 05:12PM GLUCOSE-123* UREA N-28* CREAT-1.6* SODIUM-132* POTASSIUM-4.5 CHLORIDE-99 TOTAL CO2-28 ANION GAP-10 [**2196-11-30**] 05:12PM ALT(SGPT)-12 AST(SGOT)-68* LD(LDH)-413* ALK PHOS-93 TOT BILI-10.7* [**2196-11-30**] 05:12PM ALBUMIN-2.4* CALCIUM-8.4 PHOSPHATE-3.9 MAGNESIUM-2.2 [**2196-11-30**] 05:12PM WBC-3.8* RBC-1.96* HGB-7.0* HCT-20.4* MCV-104* MCH-35.9* MCHC-34.5 RDW-17.8* [**2196-11-30**] 05:12PM PLT COUNT-31* [**2196-11-30**] 05:12PM PT-24.0* PTT-40.0* INR(PT)-2.3* [**2196-11-30**] Abdominal ultrasound: IMPRESSION: 1. Coarsening of the hepatic parenchyma, consistent with known history of cirrhosis. Portal hypertension is evidenced by massive splenomegaly, moderate ascites, and recanalization of the paraumbilical vein. 2. Unchanged cholelithiasis without son[**Name (NI) 493**] evidence for cholecystitis. There is no intra- or extra-hepatic biliary ductal dilatation. Mild gallbladder wall thickening and edema is nonspecific, and can be seen in cirrhosis. 3. No focal liver lesions identified. 4. There is normal antegrade flow in the main portal vein, dilation of the left portal vein, and continuation into a recanalized paraumbilical vein. The intrahepatic portal veins are difficult to identify as discribed above but show likely flow reversal in right anterior and posterior portal veins, an unchanged finding. [**2196-12-1**] CT without contrast: 1. Moderate-to-large amount of ascites. Shrunken nodular liver with numerous varices notably in the distal esophagus consistent with cirrhosis and decompensated liver disease. 2. No retroperitoneal bleed. 3. Largely distended gallbladder with layering stones within the lumen. Evaluation is otherwise limited given surrounding ascities and non-constrast enhanced evaluation. HIDA may be pursued as indicated. 4. Tiny 3 mm non-obstructing renal calculus within the right kidney. 5. 3.8 cm venous varix within the subcutaneous tissues of the anterior abdominal wall without change. [**2196-12-2**] CT with contrast: 1. New layering high-density within large ascites concerning for interval bleeding into the ascitic fluid. While source of bleeding is not identified on non-contrast study, note is made of slight higher density material in the pelvis and near the gallbladder. No retroperitoneal hematoma seen. 2. Fat-containing umbilical hernia, unchanged. Multiple fluid- containing ventral wall hernias, also containing fluid-fluid levels. 3. Cirrhotic liver with large ascites and extensive variceal formation. 4. Anasarca, enlarged ascites, small left and tiny right pleural effusions. 5. Largely distended gallbladder with layering gallstones as seen one day prior on CT. If clinically concerning for acute cholecystitis, again HIDA may be performed. 6. Nonobstructing 2-mm right renal calculus Brief Hospital Course: Patient was transferred from [**Doctor Last Name 3271**]-[**Doctor Last Name 679**] to MICU for increasing abdominal pain and repeated hematocrit drop in the face of multiple units of blood. The patient was transfused with 4 additional units as well as fresh frozen plasma and platelets to achieve hemostasis. She remained hemodynamically stable and pain controlled on morphine. At approximately 10am, the patient experienced an acute drop in blood pressure to the 70s with severe abdominal pain. At this time she had evidence of an acute abdomen. Surgery and anesthesia were called immediately and transfusions started. The patient was intubated, sedated and central access was obtained. With multiple units of PRBCs transfusing the patient was taken to the OR by [**Doctor Last Name **] surgery. Operative Course Upon entering the abdomen, there was a tremendous amount of bloody ascites. The liver was obviously cirrhotic and she had extensive abdominal and subcutaneous varices measuring greater than 1-2 cm in diameter. Uponentering the peritoneal cavity, there was a very large amount of bleeding with massive exsanguinating hemorrhage coming from the hilum of the liver, which was ultimately found to come from a recanalized umbilical vein. The vein itself measured about 3 cm in diameter and there was a hole in the side of the umbilical vein that measured about 1.5 cm. There was a significant hemorrhage coming from this likely 500-600 mL a minute. Control of this vein was achieved by ligating the umbilical vein proximally and distally to the venotomy and this essentially caused the hemorrhage to cease. At this time, the abdominal closure was aborted due to furthing variceal bleeding encounted upon attempted fascial closure. A [**Location (un) 5701**] bag was placed into the abdomen as a temporary closure followed by two 19 [**Doctor Last Name 406**] drains above the [**Location (un) 5701**] bag and [**Last Name (un) 71514**] laparotomy pads, blue sterile towel, and then an Ioban. The patient was then returned to the surgical intensive care unit in critical condition. Hours after return from the OR, the patient experienced a pulseless electrical activity cardiac arrest in the SICU. Chest compressions were immediately initiated, resulting in a return of heart rhythm. Discussions were held with the patient's family regarding the patient's overwhelmingly poor prognosis in light of the events which had occured. The family elected to make patient no compressions no shocks initally. Later on [**12-3**], the family changed the patient's status to comfort measures only and life-sustaining measures and treatments were discontinued. The patient expired on [**2196-12-3**]. Medications on Admission: Ciprofloxacin 250mg daily Folate 1mg daily Furosemide 40mg daily Lactulose 30cc QID Omeprazole 20mg daily Rifaximin 600mg [**Hospital1 **] Spironolactone 200mg daily Multivitamin daily Thiamine 250mg daily Discharge Medications: Not applicable Discharge Disposition: Expired Discharge Diagnosis: Death due to exsanguination and subsequent hypovolemic shock from intraperitoneal variceal bleeding secondary to end stage liver disease Discharge Condition: Expired Discharge Instructions: Not applicable Followup Instructions: Not applicable ICD9 Codes: 5849, 2851, 9971, 5715, 4275
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Medical Text: Unit No: [**Numeric Identifier 56046**] Admission Date: [**2129-7-10**] Discharge Date: [**2129-8-30**] Date of Birth: [**2129-7-10**] Sex: F Service: NB HISTORY OF PRESENT ILLNESS: [**Known lastname **] was delivered on [**2129-7-10**] by cesarean section at 30 weeks gestation to a 36 year old, Gravida I, now Para 0 mother. This was a twin gestation, resulting from in-[**Last Name (un) 5153**] fertilization. Mother's prental screens include blood type is A positive, antibody negative, RPR nonreactive, Rubella immune, hepatitis B surface antigen negative, GBS unknown. Pregnancy was complicated by twin gestation and HELLP syndrome. Mother was treated with magnesium sulfate and was treated with betamethasone on [**7-5**] and [**7-6**]. Baby was delivered by cesarean section for worsening HELLP. Her weight was 990 grams. Initially, she was blue with a weak cry. Heart rate greater than 100. She was dried, suctioned and provided positive pressure ventilation for one minute for ineffective respiratory effort and this resulted in improvement in color. She continued with facial C-Pap and was noted to be centrally pink and crying. She was shown to her parents briefly in the delivery room and transferred to the Neonatal Intensive Care Unit for further management. PHYSICAL EXAMINATION: Weight 990 grams, less than 10th percentile. Length 36 cm. Head circumference 26.5 cm. She had an anterior fontanel which was open, flat and soft; non dysmorphic facial features. Nares were patent. Her palate was intact. Her mucous membranes were moist and pink. Chest was clear with decreased breath sounds. Heart rate was regular rate and rhythm with no murmur, no rub, no gallop. Pulses were plus 2 and equal. Abdomen was soft with active bowel sounds. Her cord was clamped. She had spontaneous range of motion of all extremities. Her neurologic examination was nonfocal. HOSPITAL COURSE: Respiratory: Infant was intubated upon admission to the Neonatal Intensive Care Unit. She received one dose of Surfactant with maximum pressures of 22 over 5 and a rate of 25. She was weaned after her dose of Surfactant and was extubated on day of life one, at which time caffeine was started. She remained on caffeine for the next several weeks. Caffeine was discontinued on [**8-8**] on day of life number 29, for apnea of prematurity and [**Known lastname **] has remained free from spells for the last several days prior to discharge. After being extubated on day of life one to CPAP, [**Known lastname **] was placed in room air on day of life three which she has subsequently remained. Her breathing is comfortable and has noted occasional desaturations with feedings but no true apnea for the last several days. [**Known lastname **] also received a 12 dose course of Vitamin A for lung disease. Cardiovascular: [**Known lastname **] remained cardiovascularly stable, with mean blood pressures on admission between 36 and 50. She required no volume or pressor support. Vigilance for a patent ductus arteriosus was maintained but there was no clinical evidence of such. She had a PICC line placed which was deemed to be non central and she received PN and intra lipids through this. This line was discontinued on day of life nine when feedings were advanced to full enteral volume. She also had an initial UVC placed which was pulled on day of life five, the time that the PICC line was placed. She was noted to have some elevate blood pressure in the NIUC. She had a renal ultrasound [**2129-8-29**] which was normal as part of the work-up. Fluids, electrolytes and nutrition: [**Known lastname 56047**] initial dextrose stick was 54. She remained euglycemic on parenteral nutrition and transitioning to enteral feeds. She was maintained n.p.o. until day of life three, receiving intravenous fluids and PN during that time. Enteral feeds were introduced and gradually advanced to full enteral feeds on day of life nine, at which time calories were advanced to a maximum of breast milk 30 with ProMod. She demonstrated good weight gain at this caloric density and subsequently, calories were weaned. At the time of discharge, [**Known lastname **] is taking breast milk 24 calories made with Similac powder for average intake of 180 cc per kg per day all p.o. or breast feeding. [**Known lastname **] had an episode of abdominal distention on day of life 47, [**8-26**], following administration of eye drops for an ophthalmic evaluation. She had a KUB at that time which noted some dilation of her bowel loops. She had a CBC and a blood culture done concurrently which the blood culture remained sterile and the CBC was benign. There was no further treatment and her distention has resolved spontaneously. She has a normal voiding and stooling pattern otherwise. Her weight on the day of discharge was 2.37 kg, length 44 cm, head circumference 32.5 cm. Electrolytes were monitored throughout administration of PN and remained in the normal range. Gastrointestinal: [**Known lastname **] underwent phototherapy for physiologic jaundice, with a peak bilirubin noted on day of life four at 4.7 over 0.4. Phototherapy was discontinued on day of life nine and rebound bilirubin was 3.8. The problem was resolved at that time. Hematology: Initial CBC was notable for white count of 5.5 with 25 polys and 1 band. Hematocrit of 59.4 percent. Platelets of 281,000. [**Known lastname **] was started on iron and vitamin E on day of life 11. She continues on iron at the time of discharge. Vitamin E was discontinued. Her last hematocrit was on [**8-26**] and was 37.1. She had a reticulocyte count of 9.2 percent a week prior to that. There were no blood products received during this hospitalization. Her state screens were notable for having FAS hemaglobin. She has sickle cell trait. This was discussed with the parents. The mother who has never had any hematological problems is being screened for sickle cell. Hematology was consulted. There was no furher work-up required. Infectious disease: As part of her initial sepsis evaluation at the time of admission, blood culture was obtained which remained negative. [**Known lastname **] received 48 hours of Ampicillin and Gentamycin during this time. She has remained clinically well off antibiotics. Neurologic: Head ultrasounds were performed for screening purposes for intraventricular hemorrhage on day of life seven and again at a month of age and both were noted to be within normal limits. Sensory: Audiology: Hearing screening was performed with automated auditory brain stem responses. Hearing screen was passed bilaterally. Ophthalmology: Eyes were most recently examined on [**8-26**], revealing ROP stage one, zone three bilaterally, four clock hours on the left and seven clock hours on the right. It is recommended that she have a follow-up examination two weeks from [**8-26**] which would be the week of [**9-12**] as an outpatient. Psychosocial: [**Hospital1 69**] social work was involved with this family. She may be reached at [**Telephone/Fax (1) 56048**]. CONDITION ON DISCHARGE: Good. DISCHARGE DISPOSITION: Home with parents. PRIMARY CARE PHYSICIAN: [**First Name8 (NamePattern2) 5279**] [**Last Name (NamePattern1) 43699**], [**Name Initial (NameIs) **].D. CARE AND RECOMMENDATIONS: Feedings: Breast feeding or breast milk 24 calorie made with Similac powder, ad lib demand. MEDICATIONS: Iron. Car seat positioning screening was passed on day prior to discharge. State newborn screening status: State newborn screens included. IMMUNIZATIONS: Received: Initial hepatitis B vaccine was given on [**7-13**] and the second hepatitis B vaccine was administered on [**2129-8-11**]. Recommended: Synagis RSV prophylaxis should be considered from [**Month (only) 359**] to [**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 the following: Day care during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities or school age siblings. Or, 3.) With chronic lung disease. Influenza immunization is recommended annually in the Fall for all infants once they reach six 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: Follow-up with pediatrician is scheduled for Thursday of this week on [**9-1**]. [**Hospital6 407**] will visit the family at home as well this week. She need opthomlogy follow-up the week of [**9-9**]-27. DISCHARGE DIAGNOSES: Prematurity at 30 weeks, twin gestation. Surfactant deficiency. Sepsis suspect. Physiologic jaundice. Apnea of prematurity. Anemia of prematurity. Retinopathy of prematurity. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 48738**], MD [**MD Number(2) 55708**] Dictated By:[**Last Name (NamePattern1) 54678**] MEDQUIST36 D: [**2129-8-30**] 19:28:20 T: [**2129-8-30**] 20:15:29 Job#: [**Job Number **] ICD9 Codes: 7742, V290
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6744 }
Medical Text: Admission Date: [**2184-5-31**] Discharge Date: [**2184-6-28**] Date of Birth: [**2114-11-23**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2184-5-31**] Aortic valve replacement(23mm CE Magma), two vessel coronary artery bypass grafting(vein grafts to obtuse marginal and PDA), and Aortic endarterectomy [**2184-6-14**] Sternal re-exploration, Evacuation of mediastinal blood and Sternal debridement. [**2184-6-14**] Repair of sternal dehiscence and bilateral pectoralis major musculocutaneous advancement flap. [**2184-6-22**] Dobhoff tube placement History of Present Illness: Mr. [**Known lastname 1007**] is a 69 year-old male with a long history of aortic stenosis followed by serial echocardiograms, recently found to have coronary artery disease as well. He recently had been complaining of dyspnea on exertion along with chest pain and worsening fatigue. Therefore, he was referred for surgical evaluation. Preoperative evaluation was notable for a cirrhotic liver on CT scan. Workup was otherwise unremarkable and he was admitted for aortic valve replacement and coronary artery bypass grafting surgery. Past Medical History: - Aortic Stenosis/Coronary Artery Disease - Type II Diabetes Mellitus - Hypertension - Cirrhosis, Portal Hypertension, with Splenomegaly, Varices and Ascites - Psoriasis - Cataract Surgery Social History: Mr. [**Known lastname 1007**] is a custodian at a retail store. He reports smoking cigars in the past. He denies drinking alcohol. He lives with his wife. Family History: Noncontributory Physical Exam: At the time of admission, Mr. [**Known lastname 1007**] was found to be in no acute distress. 65" 185# Multiple psoriatic plaques were noted on his skin. His lungs were clear to auscultation bilaterally. His heart was of regular rate and rhythm and a III/VI murmur was noted. His abdomen was soft, non-tender, and non-distended with bowel sounds. His extremities were warm and well perfused. Superficial varicosities were noted in his left lower extremity. Neuro was grossly intact. There were 2+ bil. fem/DP/PT/radial pulses. Murmur radiated to both carotids. Pertinent Results: [**2184-6-27**] 04:38AM BLOOD WBC-8.9 RBC-3.27* Hgb-10.4* Hct-32.7* MCV-100* MCH-31.7 MCHC-31.7 RDW-16.7* Plt Ct-181 [**2184-6-28**] 03:04AM BLOOD PT-18.4* PTT-35.0 INR(PT)-1.7* [**2184-6-27**] 04:38AM BLOOD PT-19.4* INR(PT)-1.8* [**2184-6-26**] 06:13AM BLOOD PT-17.6* INR(PT)-1.6* [**2184-6-28**] 03:04AM BLOOD Glucose-108* UreaN-34* Creat-1.7* Na-147* K-4.2 Cl-113* HCO3-25 AnGap-13 [**2184-6-27**] 04:38AM BLOOD Glucose-114* UreaN-33* Creat-1.5* Na-149* K-3.9 Cl-116* HCO3-24 AnGap-13 [**2184-5-31**] Intraop TEE PRE-CPB: 1. The left atrium is normal in size. No spontaneous echo contrast is seen in the body of the left atrium. No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. 2. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with inferior hypokinesis. Overall left ventricular systolic function is mildly depressed (LVEF= 40-50 %). 3. There are complex (>4mm) atheroma in the aortic root. There are simple atheroma in the ascending aorta. There are complex (>4mm) atheroma in the aortic arch. There are focal calcifications in the aortic arch. There are complex (>4mm) atheroma in the descending thoracic aorta. An epiaortic scan was performed and stored on a different machine. A single plaque was visualized in the ascending aorta adjacent to the pulmonary artery. 4. There are three aortic valve leaflets. The aortic valve leaflets are severely thickened/deformed. No masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. There is severe aortic valve stenosis (valve area 0.8-1.0cm2). Trace aortic regurgitation is seen. 5. The mitral valve leaflets are moderately thickened. There is mild valvular mitral stenosis (area 1.5-2.0cm2). Trivial mitral regurgitation is seen. POST-CPB: On infusion of phenylephrine. AV pacing. There is a well-seated bioprosthetic valve in the aortic position with no regurgitation seen. A transvalvular gradient was not able to be obtained but there was no evidence of residual stenosis by color flow doppler. Biventricular systolic function is preserved. The aortic contour is normal post decannulation with no alteration seen of the plaque in the proximal aorta. [**2184-6-4**] Abd/Chest CT Scan: CT ABDOMEN: The lung bases demonstrate small bilateral pleural effusions and associated relaxation atelectasis. Heart size is normal. There is no pericardial effusion. The liver contour is nodular consistent with history of cirrhosis. Ill defined approximately 8 x 3 cm lesion in segment V demonstrates patchy peripheral enhancement. The portal vein, SMV, and splenic vein are patent. The gallbladder is unremarkable without evidence of gallstones. There is no intra- or extra- hepatic biliary dilatation. The spleen, pancreas, adrenals, kidneys are unremarkable. The SMV, splenic and portal veins are patent. Severe atherosclerotic calcifications at the origin of the celiac artery and SMA are noted . A replaced right hepatic artery arises from the SMA. Moderate splenic varices are noted. The abdominal loops of small bowel are dilated to 3.4 cm without evidence of pneumatosis, wall thickening or transition point to suggest acute obstruction. Stool is seen to the level of the rectum and there is mild colonic dilation to 5.5 cm. Scattered mesenteric and retroperitoneal nodes do not meet CT size criteria for enlargement. Stranding in the subcutaneous tissues diffusely likely represents anasarca. The kidneys enhance and excrete contrast symmetrically. CT PELVIS: The rectum, sigmoid, and prostate are unremarkable. Air within the bladder is likely secondary to foley catheterization. [**2184-6-14**] Transesophogeal ECHO: No atrial septal defect is seen by 2D or color Doppler. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. No thoracic aortic dissection is seen. A bioprosthetic aortic valve prosthesis is present. The aortic valve prosthesis leaflets appear to move normally. There is severe mitral annular calcification. Physiologic mitral regurgitation is seen (within normal limits). There is a large pericardial effusion. The effusion appears circumferential. No right atrial diastolic collapse is seen. No right ventricular diastolic collapse is seen. Brief Hospital Course: In [**2184-5-31**], Mr. [**Known lastname 1007**] was admitted and underwent a coronary artery bypass grafting times two (SVG to OM and SVG to PDA), aortic valve replacement (23mm CE magna pericardial), aortic endartarectomy. Please see the operative note for details. He tolerated this procedure well and was transferred in critical but stable condition. On the following day the hepatology service was consulted secondary to a pre-operative CT suggesting a cirrhotic liver. This consultation revealed cryptogenic cirrhosis and portal hypertension with no liver failure. By post operative day two he was extubated and weaned from pressors. He was found to be lethargic and disoriented, but with a non-focal exam. He had atrial fibrillation which was initially treated with amiodarone but it then was stopped secondary to his poor liver function. He was transfered to the step down floor on the following day. A nasal-gastric tube was placed for a distended abdomen and a CT scan revealed an ileus. On post-operative day six, sips were initiated and a PICC was placed for access. While his mental status and ileus improved initiatially, both worsened on the 26th and he was returned to the intensive care unit and the [**Last Name (un) **]-gastric tube was replaced. With time his liver function tests improved and he passed his bowels. By post-operative day ten he was transfered back to the step down floor and TPN was begun to boost his nutrition. He had two episodes of atrial fibrillation which resolved with betablockers. His [**Last Name (un) **]-gastric tube was removed on the following day and his diet was advanced. On post-operative day 14 he was noted to have bloody drainage from his mediastinal incision, hypotension, and decrease oxygen saturation. A bedside echocardiogram revealed a circumferential pericardial effusion, so he was taken to the operating room for tamponade. The plastic surgery service joined the cardiac surgery team in the operating room and plated his sternum, performing bilateral myocutaneous advancement flaps. Please see operative note for details. He was brought to the surgical intensive care unit in critical but stable condition. ID consult done for abx management as bone culture grew coag neg. staph. Extubated again on [**6-16**]. Transferred back to the floor on POD #18/13 to begin increasing his activity level. Jaundice noted with elevated bilirubins. Serial C. Diff. cultures were negative. A bedside swallowing evaluation was done on [**6-21**] and he was cleared for ground solids and nectar thick liquids with a chin tuck and strict supervision, but it was recommended that ENT evaluate him first for his dysphonia. Since he was still too drowsy to increase his intake adequately he was fed with TPN and tube feeds for a couple of days. ENT felt on exam that Mr. [**Known lastname **] vocal cords were inflammed but not compromised. He removed his own Dobhoff tube and he began to take in food with supervision. He was diuresed and given albumin for third spacing. He was started on scheduled haldol and his mental status improved markedly. The patient was found suitable for transfer to rehab on POD 28/14. Vancomycin and rifampin are continued for a total of 6 weeks per ID recommendations. The patient was advised of appropriate follow-up. Medications on Admission: Aspirin 162, multivitamin, calcium 1200, B12 1000, omeprazole 20, lisinopril 5, zocor 40, metformin 500, lopressor 25, glipizide 2.5, iron 325, humira pen 40, clobetasol propionate Discharge Medications: 1. Metoprolol Tartrate 25 mg Tablet [**Known lastname **]: One (1) Tablet PO BID (2 times a day). 2. Haloperidol 1 mg Tablet [**Known lastname **]: One (1) Tablet PO BID (2 times a day). Tablet(s) 3. Aspirin 81 mg Tablet, Chewable [**Known lastname **]: One (1) Tablet, Chewable PO DAILY (Daily). 4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization [**Known lastname **]: One (1) Inhalation Q6H (every 6 hours). 5. Rifampin 300 mg Capsule [**Known lastname **]: One (1) Capsule PO Q12H (every 12 hours) for 4 weeks. 6. Glipizide 5 mg Tablet [**Known lastname **]: 0.5 Tablet PO BID (2 times a day). 7. 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. 8. Furosemide 40 mg IV BID Start: In am 9. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush PICC, non-heparin dependent: Flush with 10 mL Normal Saline daily and PRN per lumen. 10. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR PO BID (2 times a day). 11. Acetaminophen 325 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. 12. Metoclopramide 10 mg IV Q8H:PRN nausea 13. Vancomycin 500 mg Recon Soln [**Last Name (STitle) **]: 2.5 Intravenous Q 24H (Every 24 Hours) for 4 weeks: trough goal 15-20, vancomycin 1250mg IV q24h. 14. Insulin Regular Human 100 unit/mL Solution [**Last Name (STitle) **]: One (1) Injection ASDIR (AS DIRECTED): see attached sliding scale. 15. Outpatient Lab Work weekly LFTs, CBC w diff, chem 7, ESR, CRP results to Dr. [**Last Name (STitle) **] ([**Hospital **] clinic) fax: ([**Telephone/Fax (1) 1353**] Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Aortic stenosis coronary artery disease s/p aortic valve replacement,aortic endarterectomy & coronary artery bypass graft X 2 sternal dehiscence and wound infection atrial fibrillation tamponade hypertension psoriasis noninsulin dependent diabetes mellitus hypercholesterolemia prior IMI 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**] (cardiac surgery)in 4 weeks ([**Telephone/Fax (1) 170**]) Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] (PCP) in [**1-16**] weeks ([**Telephone/Fax (1) 3183**]) Dr. [**First Name (STitle) **] (plastic surgery) in 1 week [**Telephone/Fax (1) 1416**] weekly labs to [**Hospital **] clinic Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13447**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2184-9-22**] 11:00 Provider: [**Name10 (NameIs) 12082**] CARE ID Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2184-7-19**] 1:30 Completed by:[**2184-6-28**] ICD9 Codes: 5849, 2761, 2760, 4241, 5715
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Medical Text: Admission Date: [**2200-10-21**] Discharge Date: [**2200-10-27**] Date of Birth: [**2138-11-16**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: new onset chest pain with exertion Major Surgical or Invasive Procedure: s/p emergent CABG for 70% prox LAD occlusion [**10-21**] History of Present Illness: 61 yo M p/w new onset chest pain . Cath showed clot in distal LM, LAD and circ disease. Transferred for CABG. Past Medical History: Gout, HTN, Obesity, IBS, HZV (past) Hyperchol, Sq Cell CA, Bas Cell CA, Skull frx, R knee Social History: works in real estate quit tobacco 20 years ago 6 etoh/week Family History: NC Physical Exam: HR 78 Pertinent Results: [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 75282**] (Complete) Done [**2200-10-21**] at 3:35:27 PM PRELIMINARY Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) **] R. Division of Cardiothoracic [**Doctor First Name **] [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2138-11-16**] Age (years): 61 M Hgt (in): 66 BP (mm Hg): 180/801 Wgt (lb): 219 HR (bpm): 75 BSA (m2): 2.08 m2 Indication: Intraoperative TEE for CABG ICD-9 Codes: 786.05, 440.0 Test Information Date/Time: [**2200-10-21**] at 15:35 Interpret MD: [**Name6 (MD) 928**] [**Name8 (MD) 929**], MD, MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5740**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2007AW2-: Machine: 2 Echocardiographic Measurements Results Measurements Normal Range Aorta - Annulus: 2.2 cm <= 3.0 cm Aorta - Sinus Level: 3.2 cm <= 3.6 cm Aorta - Sinotubular Ridge: 2.4 cm <= 3.0 cm Aorta - Ascending: 3.1 cm <= 3.4 cm Aorta - Descending Thoracic: 2.5 cm <= 2.5 cm Findings LEFT ATRIUM: Good (>20 cm/s) LAA ejection velocity. RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is seen in the RA and extending into the RV. Normal interatrial septum. No ASD by 2D or color Doppler. LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Normal ascending aorta diameter. Normal aortic arch diameter. Simple atheroma in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. No AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. Mild (1+) MR. TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Physiologic TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets with physiologic PR. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. The patient appears to be in sinus rhythm. Results were personally reviewed with the MD caring for the patient. Results were reviewed with the Cardiology Fellow involved with the patient's care. See Conclusions for post-bypass data The post-bypass study was performed while the patient was receiving vasoactive infusions (see Conclusions for listing of medications). Conclusions PRE-BYPASS: 1. No atrial septal defect is seen by 2D or color Doppler. 2. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). 3. Right ventricular chamber size and free wall motion are normal. 4. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. 5. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. 6. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 7. The tricuspid valve leaflets are mildly thickened. POST-BYPASS: For the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine. 1. Biventricular systolic function is preserved. 2. MR [**First Name (Titles) **] [**Last Name (Titles) 1506**]. 3. Aorta is intact post decannulation 4. Other findings are [**Last Name (Titles) 1506**] Brief Hospital Course: He was taken to the operating room where he underwent a CABG x 3. He was transferred to the ICU in stable condition. He was extubated later that same day. He was transferred to the floor on POD #1. He did well postoperatively. His Chest tubes were removed. Post cxr showed no sequele. POD 3 # Pacing wires were removed. PT worked with pt. Pt stable for DC. To note pt did fail voiding trial. He is urinating on DC Medications on Admission: Miralax 17mg PRN, Levmid 0.375, Diovan 160, Amytiptyline 75 QHS, Cochicine Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. Aspirin 81 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:*0* 5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*0* 6. 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* 7. Amitriptyline 25 mg Tablet Sig: Three (3) Tablet PO HS (at bedtime). 8. Hyoscyamine Sulfate 0.375 mg Capsule, Sust. Release 12 hr Sig: One (1) Capsule, Sust. Release 12 hr PO BID (2 times a day). 9. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 10. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 4 days. Disp:*8 Tablet(s)* Refills:*0* 11. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours) for 4 days. Disp:*8 Packet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: CAD now s/p CABG Gout, HTN, Obesity, IBS, HZV (past) Hyperchol, Sq Cell CA, Bas Cell CA, Skull frx, R knee 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: Dr. [**Last Name (STitle) 1968**] 2 weeks Dr. [**Last Name (STitle) **] 4 weeks Dr. [**Last Name (STitle) 13175**] 2 weeks Completed by:[**2200-10-26**] ICD9 Codes: 4111, 2720, 4019, 2749
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Medical Text: Admission Date: [**2124-1-19**] Discharge Date: [**2124-1-27**] Date of Birth: [**2065-3-9**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 165**] Chief Complaint: coronary arttery disease Major Surgical or Invasive Procedure: [**2124-1-21**] - Coronary artery bypass graft x5 (left internal mammary artery to the ramus artery and saphenous vein grafts to left anterior descending artery, diagonal, obtuse marginal, posterior descending) History of Present Illness: This58 year old spanish speaking gentleman was found in atrial fibrillation fibrillation following a colonoscopy. He was admitted to [**Hospital3 **] and was found to have an elevated troponin. A cardiac catheterization was perfomed which showed severe three vessel disease. Given the severity of his disease, he was transferred to the [**Hospital1 18**] for surgical management. Past Medical History: insulin dependent diabetes mellitus Hypercholesterolemia Diabetic retinopathy Social History: Occupation:unemployed Cigarettes: Smoked no [n] yes [] last cigarette _____ Hx: Other Tobacco use:denies ETOH: < 1 drink/week [] [**12-28**] drinks/week [X] >8 drinks/week [] Illicit drug use Family History: Father MI < 55 [n]died resp illness. Mother < 65 [n]MI age 82 Physical Exam: Pulse: Resp:16 O2 sat: B/P Right:122/60 Left:122/64 Height: Weight:145 General:WDWN in NAD Skin: Dry [] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [] Irregular [x] Murmur [n] grade ______ Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema [n] _____ Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral Right:2 Left:2 DP Right: 2 Left:2 PT [**Name (NI) 167**]:2 Left:2 Radial Right:2 Left:2 Carotid Bruit Right: N Left:N Pertinent Results: [**2124-1-21**] - ECHO 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. 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 aortic arch. There are simple atheroma in the descending thoracic aorta. 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 no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the study. POST BYPASS The patient is atrially paced. There is normal biventricular systolic function. The mitral regurgitation is worsened - now moderate, central regurgitation. The thoracic aorta is intact after decannulation [**2124-1-26**] 04:20AM BLOOD WBC-9.1 RBC-2.99* Hgb-9.1* Hct-26.1* MCV-87 MCH-30.5 MCHC-35.0 RDW-13.5 Plt Ct-244 [**2124-1-19**] 07:30PM BLOOD WBC-8.4 RBC-4.58* Hgb-14.0 Hct-39.5* MCV-86 MCH-30.4 MCHC-35.3* RDW-12.2 Plt Ct-230 [**2124-1-27**] 05:39AM BLOOD PT-30.8* INR(PT)-3.0* [**2124-1-26**] 04:20AM BLOOD PT-52.3* INR(PT)-5.2* [**2124-1-25**] 05:22AM BLOOD PT-33.6* INR(PT)-3.3* [**2124-1-24**] 05:25AM BLOOD PT-15.7* INR(PT)-1.5* [**2124-1-23**] 01:48AM BLOOD PT-12.1 PTT-26.0 INR(PT)-1.1 [**2124-1-22**] 02:53AM BLOOD PT-12.5 PTT-27.1 INR(PT)-1.2* [**2124-1-21**] 12:40PM BLOOD PT-16.7* PTT-26.6 INR(PT)-1.6* [**2124-1-27**] 05:39AM BLOOD Na-132* K-4.3 Cl-98 [**2124-1-25**] 05:22AM BLOOD Glucose-59* UreaN-26* Creat-1.0 Na-139 K-3.9 Cl-103 HCO3-33* AnGap-7* [**2124-1-19**] 07:30PM BLOOD Glucose-225* UreaN-14 Creat-0.9 Na-138 K-4.0 Cl-104 HCO3-24 AnGap-14 [**2124-1-19**] 07:30PM BLOOD ALT-23 AST-24 LD(LDH)-199 AlkPhos-85 TotBili-0.3 Brief Hospital Course: Mr. [**Known lastname 1004**] was admitted to the [**Hospital1 18**] on [**2124-1-19**] for surgical management of his coronary artery disease. He was worked-up in the usual preoperative manner. A radial duplex ultrasound was obtained as a radial artery graft was desired given his younger age. This revealed significant califications of the bilateral radial arteries and thus the decision was made not to use a radial artery for conduit. On [**2124-1-21**], Mr. [**Known lastname 1004**] was taken to the Operating Room where he underwent coronary artery bypass grafting to five vessels. As the greater saphenous vein was very small in the left leg, an extra length was harvested from his right thigh. Please see operative note for details. Postoperatively he was taken to the Intensive Care Unit for monitoring. Over the next several hours, he awoke neurologically intact and was extubated. He was transfused a unit of red blood cells for postoperative anemia. He remained in atrial fibrillation which was treated with Amiodarone. On postoperative day two, he was transferred to the step down unit for further recovery. He was gently diuresed towards his preoperative weight. The Physical Therapy service was consulted for assistance with his postoperative strength and mobility. Anti-coagulation was initiated with Coumadin for atrial fibrillation. He was extremely sensitive to dosing and his INR rose to 5.2, nec3essitating an extra hospital day as the Coumadin was held and the INR fell to 3. Arrangements were made for his anticoagulation to be managed by his primary care physician. [**Name10 (NameIs) 92592**] appointments were given and medications and restrictions discussed. He had converted to sinus rhythm at discharge and Amiodarone will be tapered over the next 4 weeks. Medications on Admission: Lantus 15units daily,metformin 850mg [**Hospital1 **],Glipizide 20mg daily,ASA 325mg daily,Lipitor 40mg daily, prn Naproxen Discharge Medications: 1. Outpatient Lab Work serial PT/INR Coumadin for AFib Goal INR [**12-24**] First draw day after discharge Then please do INR checks Monday, Wednesday, and Friday for 2 weeks then decrease as directed by Dr. [**Last Name (STitle) 73614**] Results to phone [**Telephone/Fax (1) 82128**] fax [**Telephone/Fax (1) 92593**] 2. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain for 4 weeks. Disp:*50 Tablet(s)* Refills:*0* 3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 4. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 5. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). Disp:*30 Capsule, Ext Release 24 hr(s)* Refills:*2* 7. isosorbide dinitrate 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 8. amiodarone 200 mg Tablet Sig: as directed Tablet PO BID (2 times a day): 400mg (2 tablets) twice daily for two weeks, then 200mg (one tablet) twiced daily for two weeks , then 200mg(one tablet) daily until instructed to discontinue. Disp:*100 Tablet(s)* Refills:*2* 9. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 10. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever, pain. 11. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Discharge Disposition: Home With Service Facility: VNA of Greater [**Hospital1 189**] Discharge Diagnosis: Coronary artery disease IDDM Hypercholesterolemia Diabetic retinopathy Discharge Condition: Alert and oriented x3, nonfocal Ambulating with steady gait Incisional pain managed with oral analgesics Incisions: Sternal - healing well, no erythema or drainage Leg Left - healing well, no erythema or drainage. Edema: trace Discharge Instructions: 1) 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. 2) Please NO lotions, cream, powder, or ointments to incisions. 3) Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) No driving for approximately one month and while taking narcotics. Driving will be discussed at follow up appointment with surgeon when you will likely be cleared to drive. 5) No lifting more than 10 pounds for 10 weeks 6) 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 Surgeon: Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 170**] on [**2124-2-22**] at 1:15pm Cardiologist: Dr. [**Last Name (STitle) 4922**] on [**2124-2-17**] at 1:30pm Please call to schedule appointments with your Primary Care Dr. [**Last Name (STitle) 73614**] ([**Telephone/Fax (1) 82128**]) in [**2-24**] 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 atrial fibrillation Goal INR 2-2.5 First draw [**1-28**] go to primary care clinic for blood draw with presciption attached Then please do INR checks Monday, Wednesday, and Friday for 2 weeks then decrease as directed by Dr. [**Last Name (STitle) 73614**] Results to phone [**Telephone/Fax (1) 82128**] fax [**Telephone/Fax (1) 92593**] [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2124-1-27**] ICD9 Codes: 2859, 2724
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Medical Text: Admission Date: [**2170-4-14**] Discharge Date: [**2170-4-15**] Date of Birth: [**2091-7-29**] Sex: F Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 106**] Chief Complaint: post operative ST elevation myocardial infarction Major Surgical or Invasive Procedure: intubation History of Present Illness: 78 year old female with history of hypertension, hypercholesterolemia, coronary artery disease with past angioplasty x2, congestive heart failure, paroxysmal atrial fibrillation, s/p aortic valve replacement and mitral valve repair for rheumatic disease, who presented initially to [**Hospital1 **] on [**4-11**] for infected artificial knee hardware and sepsis. After undergoing resection arthroplasty [**4-14**] the patient was transferred to the ICU, where she became hypotensive (SBP 48) with 3mm ST elevations seen in inferoseptal leads on ECG. CK was elevated >1600 and Troponin T was >50. Patient was transferred to [**Hospital1 18**] for urgent cardiac catheterization. Levophed and dopamine infusions were started and the patient was intubated upon arrival. In catheterization, one drug eluting stent was applied to a 80% occluding right coronary artery lesion without residual flow defect. The patient became hypotensive and developed ventricular tachycardia during the procedure requiring addition of a lidocaine infusion, maximal levophed and dopamine delivery, and balloon pump placement. She was transferred to the CCU for further management since her cardiac output was low at 1.8 (CI 1.2 PCWP 18) and she continued to be hypotensive. Of note, echocardiogram on [**2170-4-3**] showed dilated LV, severe pulm HTN 70mmHg, moderate MR, mild TR, LVH, and normally functioning porcine AV. Ejection fraction was normal and no wall motion abnormalities were seen. Past Medical History: coronary artery disease with past angioplasty x2, congestive heart failure, paroxysmal atrial fibrillation, s/p aortic valve replacement and mitral valve repair for rheumatic disease, chronic renal insufficiency and acute renal failure, paroxysmal atrial fibrillation (retroperitoneal bleed on coumadin [**10-2**]), chronic anemia, COPD, rheumatoid arthritis, lacunar infarct, cortical atrophy, facial droop, peptic ulcer disease [**1-31**] NSAIDS, diverticulosis, short bowel syndrome, neuropathy, recurrent UTI/pyelonephritis caused by Serratia and Klebsiella, s/p colectomy [**2167**] for bowel ischemia, s/p ileostomy for recurrent lower GI bleeding, s/p bilateral total knee replacement c/b recurrent infection of the right knee (s/p incision and drainage [**5-2**] for infection with klebsiella, proteus, e.coli), degenerative disc diasease, s/p appendectomy, s/p cholecystectomy, s/p hysterectomy, s/p tracheostomy Social History: home health services living with daughter [**Name (NI) **] Family History: father and brother died of MI Physical Exam: The patient was unresponsive and found to be breathless, pulseless, and without heart tones, blood pressure, and corneal reflexes. The patient was pronounced dead at 0515 on [**2170-4-15**]. The patient's private physician and family were notified. They refused anatomic gifts and autopsy. Pertinent Results: [**2170-4-14**] 10:50PM TYPE-ART O2 FLOW-100 PO2-404* PCO2-31* PH-7.18* TOTAL CO2-12* BASE XS--15 INTUBATED-INTUBATED [**2170-4-14**] 10:50PM GLUCOSE-100 K+-3.5 [**2170-4-14**] 10:50PM HGB-12.2 calcHCT-37 O2 SAT-96 [**2170-4-15**] 12:56AM BLOOD WBC-26.7* RBC-3.09* Hgb-9.5* Hct-28.2* MCV-92 MCH-30.7 MCHC-33.5 RDW-15.1 Plt Ct-237 [**2170-4-15**] 12:56AM BLOOD PT-18.7* PTT->150* INR(PT)-2.2 [**2170-4-15**] 12:56AM BLOOD CK(CPK)-1416* [**2170-4-15**] 12:56AM BLOOD CK-MB-242* MB Indx-17.1* cTropnT-20.53* [**2170-4-15**] 12:56AM BLOOD Calcium-7.0* Phos-4.1 Mg-1.7 [**2170-4-15**] 03:02AM BLOOD Type-ART pO2-180* pCO2-38 pH-7.29* calHCO3-19* Base XS--7 [**2170-4-15**] 01:03AM BLOOD Type-ART pO2-305* pCO2-25* pH-7.08* calHCO3-8* Base XS--21 [**2170-4-14**] 10:50PM BLOOD Type-ART O2 Flow-100 pO2-404* pCO2-31* pH-7.18* calHCO3-12* Base XS--15 Intubat-INTUBATED [**2170-4-15**] 01:03AM BLOOD Glucose-110* Lactate-7.9* Na-134* K-3.8 Cl-112 [**2170-4-15**] 03:02AM BLOOD Lactate-7.6* [**2170-4-15**] 01:03AM BLOOD freeCa-1.09* Brief Hospital Course: 78 year old female with multiple medical problems who developed an acute myocardial infarction after orthopedic surgery at [**Hospital1 **]. . Cardiovascular-She had known coronary disease with prior angioplasties as well as atrial fibrillation and valvular disease. At the OSH, the patient became hypotensive with signs of inferoseptal myocardial infarction on ECG. At [**Hospital1 18**], the patient received one stent that fully opened an 80% lesion in the proximal right coronary artery. No flow limiting disease was seen in in the LCX or LAD. However, the patient developed hypotension and required intubation plus pressure support with monitoring in the ICU. In spite of aggressive care on levophed, dobutamine, vasopressin, and lidocaine; the patient became increasingly bradycardic and expired approximately 6 hours after admission to [**Hospital1 18**]. She was given plavix and aggrastat. Calcium and electrolytes were repleted. . Pulmonary-Intubated for airway protection. Fentanyl and versed infusions for sedation. She developed lactic acidosis (lactate 7.9) with respiratory compensation. Bicarbonate supplementation was given without significant improvement. . Renal- At baseline Cr 1.4. Medications were renally dosed. . Musculoskeletal- The patient was status post right knee resection arthroplasty with drain in place for recurrent right knee prosthetic infections. Fluid analysis identified many PMNs but no organism on gram stain. Preliminary cultures grew gram negative rods resembling Serratia. It was sensitive to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, gentamicin, imipenem, levoquin, bactrim, and augmentin. Resistant to ampicillin, piperacilliin, tetracycline, and cefazolin. Infectious disease consultation at the OSH had started ceftriaxone 2g IV and vancomycin 650mg IV daily, which was continued at [**Hospital1 18**]. The patient did not have fever but developed a post MI leukocytosis. . GI-Iliostomy care. . FEN: NPO, albumin at OSH 2.9, hypocalcemia cCa 7.9/free Ca 1.08(Ca 9.6->7), hypomagnesemia. Repleted Ca and Mg. Supplemented sodium bicarbonate for acidosis. . MRSA and aspiration precautions. . Access: Femoral line and left portacath in place. Left radial arterial line placed at [**Hospital1 18**]. . Code: Full . HCP is her daughter, [**Name (NI) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 39202**] W[**Telephone/Fax (1) 39203**], who was present at the time of death. Medications on Admission: Home Meds: protonix 40', neurontin 300''', lasix 40', lomotil 2.5'''', plavix 75', verapamil 40''', ultram OSH added calan, tylenol, vicodin, tigan, phenergan, compazine, senna, MVI, MOM, dulcolax, [**Name2 (NI) 13426**], magnesium All: PCN (swelling), aspirin (PUD), egg and swordfish(swelling) Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: expired due to hypotension and shock in spite of aggressive care. Thought due to acute anteroseptal myocardial infarction after orthopedic surgery at an outside hosptial. Secondary: coronary artery disease with past angioplasty x2, congestive heart failure, paroxysmal atrial fibrillation, s/p aortic valve replacement and mitral valve repair for rheumatic disease, chronic renal insufficiency and acute renal failure, paroxysmal atrial fibrillation (retroperitoneal bleed on coumadin [**10-2**]), chronic anemia, COPD, rheumatoid arthritis, lacunar infarct, cortical atrophy, facial droop, peptic ulcer disease [**1-31**] NSAIDS, diverticulosis, short bowel syndrome, neuropathy, recurrent UTI/pyelonephritis caused by Serratia and Klebsiella, s/p colectomy [**2167**] for bowel ischemia, s/p ileostomy for recurrent lower GI bleeding, s/p bilateral total knee replacement c/b recurrent infection of the right knee (s/p incision and drainage [**5-2**] for infection with klebsiella, proteus, e.coli), degenerative disc diasease, s/p appendectomy, s/p cholecystectomy, s/p hysterectomy, s/p tracheostomy Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired ICD9 Codes: 9971, 496, 4271, 4280, 4019, 2720
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Medical Text: Admission Date: [**2148-10-20**] Discharge Date: [**2148-10-28**] Date of Birth: [**2098-6-19**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1974**] Chief Complaint: headache Major Surgical or Invasive Procedure: none History of Present Illness: Patient has h/o chronic headche but complains of acute worsening today. She describes constant [**11-5**] right sided throbbing headahce that does not radiate. Denies photophobia but did complain of some mild blurry vision. She took excedrin as usual but did not help. Of note, patient is from DC and is here for visiting her family. She had not been taking her anti-hypertensive for 2 weeks. She never had such severe headache before. Patient had not seen her PCP [**Name Initial (PRE) **] 2 years. . On arrival to ED, her initial VS T98.3 P110 BP 246/116 R17 99%on RA. She received 20mg labetalol x1, 20mg hydralazine x1, labetolol infusion, aspirin. She is currently on labetalol 1.5mg/min with BP in 160s/110s on transfer. She continues to complain of HA, vomited x2 and received anzemet, phenergan 25mg IVP, morphine 4mg and dilaudid 2mg. EKG show TWI V3-V6 and inferior leads, ST depression inferior leads, repeat show resolution of ST depression in inf leads. . Currently, patient denies chest pain, palpitation, shortness of breath, abdominal pain. She does complain of nausea from narcotic. She still complains of right sided headahce albeit less. . Past Medical History: diabetes on insulin hypertension chronic headahce s/p head injury [**12-1**] s/p hysterectomy Social History: denies smoking/alcohol/drugs . Family History: noncontributory Physical Exam: T 97 BP153/80 P73 R8 100% on 2L Gen- sleepy, otherwise no apparent distress, African American obese female HEENT- anciteric, pin point pupils 1-2mm, reactive bilaterally, EOMI, fundoscopic exam impossible because of pinpoint pupils, no sinus tenderness, dry mucus membrane, no JVD at 45 degrees, neck supple CV- regular, no murmurs/gallop, PMI not displaced RESP- clear bilaterally, no crackles ABDOMEN- soft, nontender, nondistended, obese abdomen, hypoactive bowel sounds EXT- trace pedal edema, pedal pulses equal bilaterally NEURO- A+O x3, CNII-XII intact, muscles strength 5/5 grossly, sensation grossly intact, reflexes deferred. SKin- no rashes/bruises Pertinent Results: [**2148-10-20**] 02:30PM WBC-8.6 RBC-3.86* HGB-10.5* HCT-30.8* MCV-80* MCH-27.1 MCHC-33.9 RDW-14.5 [**2148-10-20**] 02:30PM PLT COUNT-324 [**2148-10-20**] 04:38PM GLUCOSE-170* UREA N-30* CREAT-2.5* SODIUM-139 POTASSIUM-4.5 CHLORIDE-107 TOTAL CO2-22 ANION GAP-15 [**2148-10-20**] 02:30PM URINE BLOOD-TR NITRITE-NEG PROTEIN-500 GLUCOSE-250 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2148-10-20**] 02:30PM URINE RBC-0-2 WBC-[**3-31**] BACTERIA-MOD YEAST-NONE EPI-0-2 [**2148-10-20**] 11:15PM CK-MB-2 cTropnT-<0.01 [**2148-10-20**] 02:30PM CK-MB-2 cTropnT-<0.01 [**2148-10-21**]: serum/urine tox: [**2148-10-21**]: serum erythopoietin: . [**2148-10-20**]: CT head: There is no evidence of hemorrhage, mass effect, shift of normally midline structures, hydrocephalus, or acute major vascular territorial infarction. The ventricles and sulci are normal in size. The [**Doctor Last Name 352**]-white matter differentiation is preserved. The visualized paranasal sinuses show opacification of the right mastoid air cells and a small mucus retention cyst in the right sphenoid sinus. Otherwise, the surrounding osseous and soft tissue structures are unremarkable. There is a nasopharyngeal mass on the right, perhaps crossing the midline. The opacification of the mastoid air cells suggests that this has been present for an extended period of time- i.e. unlikely to be inflammatory nodal enlargement. These findings are most concerning for nasopharyngeal carcinoma or other malignancy. .. MRI HEAD: Lobulated right-sided nasopharyngeal soft tissue mass lesion, which is highly suspicious for an underlying neoplastic process or carcinoma as indicated on the patient's prior CT from [**10-20**] and 25, [**2148**]. No acute territorial infarct seen within the brain. Right-sided mastoiditis. Brief Hospital Course: 1) HYPERTENSIVE EMERGENCY: Pt was admitted to ICU. She was tried on multiple BP regimens. At discharge, she is on lopressor, ACEI, amlodipine, and HCTZ. On this regimen, her BP is within her short term goal though not ideally controlled. There was also one measurement of BP in her 2 arms that was different. This was concerning for aortic dissection, but CXR showed no widening of mediastinum. Repeat simultaneous b/l UE BP measurements were equal so no further imaging was pursued. . 2) RENAL FAILURE: Creatinine ranged from 2.6-3.0 while in hospital but did not change significantly. Baseline is unknown but is possible she has CKD from DM and HTN. She did have proteinuria. Renal US was suboptimal quality but did not show definitive RAS or other pathology. Pt will require outpt renal f/u. . 3) DM: Seen by [**Last Name (un) **]. Regimen adjusted and now on NPH with SSI. . 4) NASOPHARYNGEAL MASS: Incidental finding on head CT and MRI. ENT consulted who stated these are usually benign but should have outpt biopsy in next few months once acute issues resolved. Biopsy not practical as inpatient given issues with hypertension. . 5) ANEMIA: Hct ranged widely but settled in low 20s. Baseline unknown. [**Month (only) 116**] be due to chronic kidney failure. Should have outpt w/u including colonoscopy given age. Medications on Admission: insulin 70/30 actos lipitor aspirin blood pressure medicines (2) excedrin migraine 3x/day Discharge Medications: 1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*7 Tablet(s)* Refills:*2* 2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*7 Tablet(s)* Refills:*2* 3. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*7 Tablet(s)* Refills:*2* 4. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*21 Tablet(s)* Refills:*2* 5. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*7 Tablet(s)* Refills:*2* 7. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*7 Tablet(s)* Refills:*2* 8. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Sixteen (16) units Subcutaneous daily at breakfast. Disp:*10 mL* Refills:*2* 9. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: per SLIDING SCALE units Subcutaneous QACHS. Disp:*3 ML* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary: Malignant Hypertension . Secondary: Chronic renal failure Diabetes mellitus type 2 Nasopharyngeal mass Obesity Hyperlipidemia Urinary Tract infection Anemia Discharge Condition: Good. blood pressure at short term goal. ambulating without assist. tolerating oral medications and nutrition. Discharge Instructions: You have been evaluated and treated for very high blood pressure, headaches, and acute kidney disease. While in the hospital your blood pressure was controlled with a combination of multiple medications. Your headaches improved with better control of the headaches. Also, the kidney disease improved as well but remains abnormal and needs to followed closely. . While you were in the hospital, we found that there is an abnormal mass inside your sinuses. We did not complete all the necessary testing as these should be done as an outpatient. The mass could be something unimportant, but it also could be very serious like a cancer. You should see the Ear-Nose-Throat doctors as described below. . Also, while you were in the hospital, we found that you had a urinary tract infection. You completed a 3 days cours of antibiotics . The most important next step is for you to get regular medical care. You must go see your primary doctor as soon as possible in [**State 12000**]. I have given you enough prescriptions to last you for about one week and we have arrange money for you to pay for that, but beyond the one week you should discuss with Dr. [**Last Name (STitle) 22650**] on how to obtain medications and care. . It is absolutely essential that you take your blood pressure pills as prescribed. . When you meet with the doctors at the community health center please give them this list of medical problems which is below. . After you meet with your new doctor, ask them to help arrange for a follow-up appointment with the Ear-Nose-Throat doctors here at [**Hospital3 **] Deaconness, to discuss the nasal mass. If you have any trouble obtaining your medications, experience recurrent HA, neurological symptoms, chest pain or any other symptoms of concern to you, call Dr. [**Last Name (STitle) 22650**] or go to the nearest ER. Followup Instructions: You need to follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 22650**] in [**State **] within one week. Call [**Telephone/Fax (1) 68544**] to make an appointment. He should be able to help you get access to your medications, monitor your medical issues and make you the appropriate referrals (see below). . You should have an appointment with the Ear-Nose-Throat doctors [**Last Name (NamePattern4) **] [**3-1**] weeks to evaluate the mass inside your nose. The appointment can be with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital3 **] Deaconness the telephone number is [**Telephone/Fax (1) 41**]. If you return to [**State 12000**], please ask Dr. [**Last Name (STitle) 22650**] to refer you to ENT. You also need to see a kidney doctor. Ask Dr. [**Last Name (STitle) 22650**] to refer you. ICD9 Codes: 5849, 5859, 5990, 2859
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Medical Text: Admission Date: [**2119-11-23**] Discharge Date: [**2118-12-7**] Date of Birth: [**2119-11-23**] Sex: F Service: NB HISTORY: Baby girl [**Known lastname 68473**] was the [**2063**] gram product of a 37 and 2/7 weeks gestation born to a 31-year-old G1, P0 mother. Prenatal screens - O positive, antibody negative, hepatitis surface antigen negative, rubella immune, RPR nonreactive, GBS negative. This pregnancy was notable for intrauterine growth restriction and spontaneous onset of labor. The infant delivered vaginally with Apgars of 8 and 9. She was noted to have dysmorphic features and developed stridor soon after birth. On arrival to the newborn intensive care unit, the infant with audible stridor and moderate subcostal retractions. PHYSICAL EXAMINATION: Weight [**2063**] grams, less than 10th percentile; length 42 cm, less than 10th percentile; head circumference 28 cm, less than 10th percentile. IUGR infant with obvious dysmorphic features, large long filtrum, depressed nasal bridge, small chin, short stubby hands and feet, bilateral single palmar crease and two phalanx each finger. Anterior fontanel at level, sutures normal, intact palate, neck supple. Eyes with bilateral red reflex present. Continues audible stridor even at rest, bilateral moderate subcostal retractions with conducted sounds. CARDIOVASCULAR: Pink, well perfused, S1, S2 normal. No murmurs. Femorals 2+. ABDOMEN: Soft, nondistended. No hepatosplenomegaly. GENITOURINARY: Normal female genitalia. Anus patent but anteriorly displaced. NEUROLOGIC: Tone normal. Moving all 4 extremities. Spine with sacral dimple. The remainder is normal. Hips stable. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: RESPIRATORY: The baby was admitted to the newborn intensive care unit for observation, and management of her IUGR status and her respiratory stridor. She has remained stable in room air throughout her hospital course and has not required any methylxanthine therapy for apnea bradycardia. ORL evaluated the infant and discovered severe laryngomalacia. Plan is to have surgery to correct this issue at [**Hospital3 **] on [**2119-12-7**]. CARDIOVASCULAR: The infant has an audible murmur. An echocardiogram was obtained revealing patent foramen ovale, small anterior muscular ventricular septal defect, small patent ductus arteriosus. Cardiology was consulted and recommended continued care. FLUIDS, ELECTROLYTES AND NUTRITION: Birth weight was [**2063**] grams. She is currently [**2033**] grams. She was initially started on 80 cc per kg per day of D10W. Enteral feedings were initiated on day of life 1. The infant is on full enteral feedings, requiring PG feeding. She was evaluated by the feeding team at [**Hospital3 **] this week and it was recommended to continue offering PO feeds every other feed knowing that the infant is at high risk for aspiration at this time. Plan is to reevaluate the infant following her surgery on Thursday. She is currently receiving 150 cc per kg per day of breast milk 28 calorie with Beneprotein again an average 10 to 30 grams per day. GASTROINTESTINAL: Peak bilirubin was on day of life 3 of 9.1/0.4. HEMATOLOGY: Hematocrit on admission was 42.6. She has not required any blood transfusions. INFECTIOUS DISEASE: CBC and blood culture obtained on admission. CBC was benign and blood cultures remained negative at 48 hours at which time ampicillin and gentamycin were discontinued. NEUROLOGIC: The infant has been appropriate for gestational age. GENETICS: Genetics was consulted to evaluate this infant for dysmorphism. A chromosome analysis was performed revealing normal 46 XX. FISH was performed for chromosome 22 and chromosome 18 and those were normal. Genetics has seen the infant most recently on [**12-5**] recommending a signature CHIP being sent off which has not yet been done. AUDIOLOGY: Hearing screen has not yet been performed but should be done prior to discharge. OPHTHALMOLOGY: The infant was seen by ophthalmology to rule out ophthalmologic malformations. She was seen by Dr.[**First Name9 (NamePattern2) **] [**Name (STitle) **] on [**11-27**] to reveal no colobomas, normal optic nerves and retina. PSYCHOSOCIAL: The family lives on [**Known lastname 6687**] and are experiencing some financial strains due to housing in [**Location (un) 86**] area. They are interested and involved and loved their daughter. CONDITION ON DISCHARGE: Stable. DISCHARGE DISPOSITION: To [**Hospital3 **]. NAME OF PRIMARY PEDIATRICIAN: Dr. [**Last Name (STitle) **]. Telephone No.: [**0-0-**]. CARE RECOMMENDATIONS: 1. Feeds at discharge: She will be NPO at the time of transfer to [**Hospital3 **], 130 cc per kg per day of D10W with 2 of sodium chloride and 1 mEq of potassium chloride. 2. Medications: Not applicable at the time of transfer but prior to transfer she was on no medications. 3. State newborn screens have been sent per protocol and have been within normal limits. 4. Immunizations received: The infant has not received any immunizations to date. DISCHARGE DIAGNOSES: 1. A 37 week infant, small for gestational age. 2. Laryngomalacia. 3. Dysmorphism. 4. Patent ductus arteriosus. 5. Muscular ventricular septal defect. [**Doctor First Name **] [**Name6 (MD) **] [**Name8 (MD) **], [**MD Number(1) 62348**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2119-12-6**] 21:43:57 T: [**2119-12-6**] 22:48:45 Job#: [**Job Number 68474**] ICD9 Codes: V290
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Medical Text: Admission Date: [**2192-5-4**] Discharge Date: [**2192-6-12**] Date of Birth: Sex: M This Dictation Summary will discuss the patient's course in hospital. There will be an addendum detailing his initial presentation. 1. Operative: The patient was taken to the Operating Room hemicolectomy. Following his operation, his postoperative course was complicated by a prolonged ileus which prohibited the patient from taking p.o. Additionally, he was delirious. He was started on TPN for nutrition on [**2192-5-14**]. from probable aspiration. He required intubation and displayed septic physiology with hypotension, abnormal cultures ultimately grew E. coli and Klebsiella. The source was felt to be urinary, however, the patient also had Methicillin sensitive Staphylococcus aureus in his sputum along with copious thick secretion. He was treated initially with Vancomycin, Ceftazidime and Levofloxacin and later switched to Oxacillin and Levofloxacin when sensitivities revealed that his organisms were sensitive to these medications. He was extubated on [**2192-5-21**]. Following this, he had been slow to interact with others and displayed continued inability to take oral feedings and medications due to his sedation. This was initially attributed to morphine and Propofol infusion received while in the Surgical Intensive Care Unit. However, on [**2192-5-29**], the patient continued to exhibit poor interaction with others and an inability to tolerate p.o. and at this point the Geriatrics Team was consulted. On [**2192-6-1**], the patient was transferred to the Medical Service for further management. 2. Renal: At the time of transfer to the Medical Service, the patient's creatinine had markedly increased. Concern was raised for another septic episode given hypernatremia as well as rising creatinine and hypotension and mild fevers. As discussed initially, a septic picture was considered and the patient was started on broad-spectrum antibiotics, however, a Foley catheter was placed and the patient exhibited a large post obstructive diuresis. He was diagnosed with post-obstructive uropathy and was followed closely. He had no further rises in creatinine throughout the remainder of his hospital course. 3. Infectious Disease: As discussed, it was initially felt that the patient was septic at the time of the rise in creatinine. He was covered with Vancomycin, Ceftazidine, and Clindamycin. When cultures remained negative over 48 hours, those antibiotics were discontinued. However, on [**6-4**], the patient spiked a temperature to 102.0 F. Cultures were sent by Venipuncture and off of his central line. An Infectious Disease consultation was obtained. They recommended that Clindamycin and Vancomycin be discontinued. Liver functions were checked and these were mildly elevated. An abdominal ultrasound was obtained which was mainly negative. Please see separate report for full details. The patient also had yeast growing in his urine, which they recommended not to be treated by the Infectious Disease Service. Throughout the remainder of the hospitalization, the patient remained afebrile. Surveillance cultures were checked and remained mainly negative with the exception of one set of blood cultures taken off of the patient's central line which grew Staphylococcus aureus, coagulase negative, felt to be a contaminant, given no other blood cultures grew this. This was not treated with any antibiotics. The patient remained afebrile throughout the remainder of the course of the hospitalization. Access: His central line was changed and replaced with a PICC line. 4. Cardiovascular: The patient had tachycardia which was treated off and on with Lopressor. This was occasionally held given concerns for hypotension and at this time is off Lopressor. 5. Pulmonary: The patient had worsening O2 needs and developed tachypnea on [**2192-6-5**]. An arterial blood gas was consistent with respiratory alkalosis and chest x-ray was negative. A VQ scan was obtained which revealed a pulmonary embolism. Although the study was poor, the patient was felt to be high probability for pulmonary embolism and he was treated with heparin. It was also known that he had a thrombus in the right internal jugular from an old central line which could also be the source of his embolus. Hypoxia resolved, and at the time of this dictation, he is on room air with no oxygen needs. He was ultimately changes to Lovenox 60 mg subcutaneously q. 12. Coumadin was not started because of fluctuating nutritional status. 6. Endocrine: Although he had no prior history of diabetes mellitus, the patient was noted to be hyperglycemic while on TPN and was managed with a regular insulin sliding scale, and insulin in his TPN. 7. Gastrointestinal: On rounds on [**2192-6-6**], the patient was found to be distended and tympanitic. An abdominal x-ray was obtained which revealed a partial small bowel obstruction versus ileus. An NG tube was placed and over the course of the next several days, the patient's distention resolved slowly. His NG tube was removed on [**6-9**], and the patient remained stable since. Repeat abdominal x-ray showed resolution of his small bowel obstruction/ileus. Given his past history, it was felt that the most likely cause of this was ileus as opposed to obstruction. 8. Fluids, Electrolytes and Nutrition: When initially transferred to the Medical Service, the patient was hypernatremic. This was repleted with free water and adjustments in his TPN. Ultimately, the patient became hyponatremic and required further TPN adjustments. At the time of this dictation, his hyponatremia and hypernatremia are both controlled and he has normal natremic and continues to receive TPN. The patient was not started on enteral feedings given his profound delirium and ileus problems. Since he had not yet "woken up" and continued to be somnolent much of the time, even after about a month after surgery, the prognosis was quite guarded, so the decision for a PEG tube in this elderly confused gentleman was deferred. At this time, he continued on TPN. 9. Prophylaxis: The patient received Zantac in his TPN on [**2192-6-11**]. This was changed to Protonix as Zantac can interfere with mental status in the elderly. ADDITIONAL STUDIES: During the course of this hospitalization: 1. Abdominal ultrasound: Which revealed a simple cyst in the liver and a small amount of pleural effusion on the right (please see full report). 2. CT scan of the neck on [**2192-6-5**]: Revealed a filling defect in the right internal jugular vein consistent with non-occlusive thrombus and a left subclavian line which was felt to be coiled upon itself. Following discovery of this, his line was discontinued and changed to a PICC line. 3. CT scan of the abdomen and pelvis on [**2192-5-19**]: Full transit of oral contrast through the GI tract; not unchanged from the [**5-18**] CT scan of the abdomen which revealed no evidence for pulmonary embolism in the main pulmonary arteries and intussusception and small bowel obstruction. 4. Echocardiogram on [**2192-5-18**], ejection fraction greater than 55%, left atrium moderately dilated; left ventricular wall thickness, cavity size, and systolic function normal; an left ventricular ejection fraction of greater than 55%; right ventricular cavity dilated, right ventricular systolic function appears depressed; aortic root moderately dilated. Aortic leaflets three and mildly thickened, or at least mild aortic regurgitation, mitral leaflets mildly thickened. Presence/absence of mitral valve prolapse cannot be determined. There is at last mild mitral regurgitation. There is moderate pulmonary hypertension and no pericardial effusion. DISCHARGE STATUS: Stable for discharge to rehabilitation facility. DISCHARGE INSTRUCTIONS: 1. He should follow-up with his primary care physician upon discharge. 2. Routine PICC line care with heparin and saline flushes. 3. Continue total parenteral nutrition. DISCHARGE MEDICATIONS: 1. Lovenox 60 mg subcutaneously q. 12. 2. Regular insulin sliding scale. 3. Protonix 40 mg p.o. q. day. 4. Total parenteral nutrition as directed. FINAL DIAGNOSES: 1. Colon cancer status post right hemicolectomy. 2. Sepsis. 3. Urosepsis. 4. Pulmonary embolus. 5. Obstructive uropathy. 6. Diabetes mellitus. 7. Ileus. 8. Small bowel obstruction. 9. Hypernatremia. 10. Hyponatremia. 11. Delirium. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 45008**] Dictated By:[**Name8 (MD) 2665**] MEDQUIST36 D: [**2192-6-12**] 09:57 T: [**2192-6-12**] 10:03 JOB#: [**Job Number 37508**] ICD9 Codes: 2930
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Medical Text: Admission Date: [**2180-12-2**] Discharge Date: [**2180-12-11**] Date of Birth: [**2105-9-2**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 689**] Chief Complaint: L ankle pain Major Surgical or Invasive Procedure: ORIF for left distal fib/tib fx History of Present Illness: 75 year old female with history of COPD on home O2 (2L)who presents with left ankle pain. Patient had fallen asleep on the sofa. When she awoke, she tried to get up to go to the kitchen. When she stood on her feet and turned to walk, she felt a sharp pain in her left ankle. She felt as if her foot were "caught on something." She felt as if her ankle "popped" and then she fell to the ground. She denies LOC, trauma to head, syncope. Past Medical History: -COPD on home O2 (pulmonologist at [**Hospital1 112**]- Fanta) -h/o Syncope 3 years ago (negative w/u) --Echo [**3-4**]: EF 60%, mild pulm HTN (28), E/A 0.78, no WMA, no LVH, trace MR [**Name13 (STitle) **] Knee Cyst -Anxiety -osteoporosis Social History: Widowed x 5 years. Has 2 children. Lives alone in a studio apartment in [**Location (un) **]. Has person to help clean 2x week. Son lives one block away. Formerly worked in newspaper advertising. ~120 pack year smoking history (quit [**2145**]), per patient 2 glasses of EtOH with evening meal. Per son, mother drinks quite a bit more. Family History: Mother c anxiety d/o, fa was alcoholic. Sister and 2 children all in psychiatric tx (details unknown). Physical Exam: VS: Tc & max: 98.3, HR: 105 (80-105), BP: 125/71 (124-155/53-78) HEENT: EOMI, anticteric, dry MM, neck supple, JVP not elevated Lungs: Decreased breath sounds, no audible wheezes or rhonchi Heart: Soft heart sounds, tachycardic, s1, s2, no m/g/r auscultated abd: Soft NT, ND, +BS ext: -edema, left ankle in bandage, good distal cap refill neuro: alert and oriented to hospital, but not to floor. Year=[**2179**] Pertinent Results: [**2180-12-2**] 02:30PM GLUCOSE-90 UREA N-31* CREAT-0.7 SODIUM-142 POTASSIUM-3.9 CHLORIDE-106 TOTAL CO2-27 ANION GAP-13 [**2180-12-2**] 02:30PM WBC-11.5*# RBC-3.76* HGB-11.4* HCT-33.0* MCV-88 MCH-30.5 MCHC-34.7 RDW-14.0 [**2180-12-2**] 02:30PM NEUTS-84.6* BANDS-0 LYMPHS-9.7* MONOS-3.4 EOS-2.2 BASOS-0.2 [**2180-12-2**] 02:30PM PLT COUNT-321 [**2180-12-2**] 02:30PM PT-12.2 PTT-23.7 INR(PT)-1.0 [**2180-12-2**] EKG: Baseline artifact. Sinus rhythm. Modest non-specific ST-T wave changes. Poor R wave progression - cannot rule out old anteroseptal myocardial infarction. Compared to the previous tracing of [**2180-7-20**] no significant diagnostic change. [**2180-12-2**] Ankle/tib/fib films: horizontally oriented fracture through medial malleolus. Associated obliquely oriented fracture through the anterior corner of the tibia. Obliquely oriented fracture through the distal fibula with slight posterior angulation of the distal fracture fragment. Disruption of the ankle mortise with slight lateral subluxation of the distal tibia. [**2180-12-5**] CTA chest: Multiple small, nonocclusive pulmary emboli in the subsegmental branches of the left lung. Emphysematous changes. Several small, ill-defined nodular pulmonary opacities, nonspecific in appearance; followup in several months could be obtained to ensure resolution. Brief Hospital Course: 75 year old female with history of COPD presents with left tib/fib fracture and COPD exacerbation, subsequently found to have multiple pulmonary embolisms. 1) Left Ankle Tib/Fib Fracture: When patient came to the ED, her x-ray noted fractures through tibula, fibula and medial malleolus. She was admitted to the ortho service and medically cleared for surgical repair. However, overnight she had MS changes (discussed below)and adamantly refused surgery recommended the next morning. Several days later, the patient consented to surgery, and underwent an ORIF without complications. She was fitted for a bivalve cast and cleared for rehab. She will follow-up with orthopedics in 2 weeks following discharge . 2) Mental Status Changes: After the patient's admission to the ortho service, she was noted to be agitated and tremulous, and, according to the staff, appeared to be having auditory hallucinations. The patient refused surgery the AM after admission. Psychiatry service was called to assess capacity. She was found to be in a confusional state and to lack capacity to make a decision. They recommended waiting until the delirium cleared to proceed with the therapy. Because of the patient's reported EtOH abuse and elevated CIWA scores, she was placed on a CIWA protocol. Prn benzos (other than CIWA protocol) and morphine were d/c'd. The patient was given a 1:1 sitter for safety. Patient was ordered for Haldol prn. Imipramine was briefly discontinued, to be replaced by nortriptyline (due to its lack of anti-cholinergic side effects), however, the patient became upset about the change and was returned to her original medication. Over the next days, the patient's mental status improved. She consented to the surgery, and was treated with tramadol and morphine for pain relief. After the operation, her mental status was mostly at baseline, except for a few reports of increased agitation and nervousness, usually correlated to larger doses of morphine. . 3) Pulmonary: Patient has a long standing history of COPD is on constant home 02 2L n/c and is treated with nebs. Upon admission, she was noted to be 87% on RA and up to 98% on 2L. Lung exam revealed rhonchi and expiratory wheezes. The patient did not have a fever or observed cough. While on the ortho service, the patient had episodes of dropping O2 sat to 76 and 80 on RA when nasal cannula was partially or fully removed by patient while delirius. When nasal cannula was repositioned, SpO2 recovered. Later, the patient became progressively tachypneic and had worsening hypoxia with ABG 7.42/45/56 on 2L of room air. Chest XR was negative for infiltrate or pleural effusions. Chest CT revealed bilateral non-obstructive thrombi of unclear age. The patient was begun on heparin gtt for PE, which was later switched to coumadin and lovenox after her surgery. She is currently on coumadin with a lovenox bridge; she will need to continue lovenox until she is therapeutic on coumadin (INR [**1-5**]) for 48 hrs. Next INR check is due [**2180-12-12**]. She was also felt to have a COPD exacerbation and was started on solumedrol, subsequently transitioned to a prednisone taper. Discussion with her PCP suggested that she had not been taking prednisone daily prior to admission, as originally thought. Albuterol/atrovent nebulizer treatments and advair were continued throughout her hospital stay. At time of discharge, her oxygen saturation was stable 94% on 2L nasal cannula. . 4) Hypertension: Over the course of her hospital stay, the patient's home dose of Lisinopril was increased and a B1 selective BB was added. Good control was achieved (120-130's systolic)on this regimen. Patient was also placed on a low salt diet. . 5) Anemia: Over the first several days of her admission, the patient's hematocrit dropped significantly from baseline. She was transfused with 2 units of blood and her hematocrit stabilized in the low 30s. . 6) Hyperglycemia. Patient has no known history of DM. Her high sugars throughout her hospital stay were most likely secondary to steriod use. Patient was placed on a SSI. Medications on Admission: Albuterol, Advair, Atrovent, Excedrin 325 mg Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 2. Albuterol Sulfate 0.083 % Solution Sig: One (1) newb Inhalation Q2H (every 2 hours) as needed for shortness of breath or wheezing. 3. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Enoxaparin 60 mg/0.6mL Syringe Sig: Sixty (60) mg Subcutaneous Q12H (every 12 hours): continue until patient has been therapeutic on coumadin (INR [**1-5**]) for 48 hours. 6. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Haloperidol 1 mg Tablet Sig: 1-2 mg PO TID (3 times a day) as needed for severe agitation or confusion. 9. Imipramine HCl 25 mg Tablet Sig: Four (4) Tablet PO BID (2 times a day). 10. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours). 11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 13. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain: Please hold if sedated. 14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 15. Prednisone 20 mg Tablet Sig: Forty (40) Tablet PO DAILY (Daily): for 2 days, then 30 mg PO daily for 2 days, then 20 mg PO daily for 2 days, then 10 mg PO daily for 2 days, then 10 mg PO every other day for 3 days. 16. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 18. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Primary: chronic obstructive pulmonary disease exacerbation Secondary: left tibial/fibular fracture, pulmonary embolism, ansiety, osteoporosis, delirium, steroid-induced hyperglycemia Discharge Condition: Stable. Discharge Instructions: Please follow-up with chest pain, shortness of breath, or other symptoms that concern you. Followup Instructions: 1) Orthopedics - please call [**Telephone/Fax (1) 1228**] to schedule an appointment to see Dr. [**Last Name (STitle) 1005**] within 10-14 days following discharge 2) Primary care - please call to schedule an appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1313**] ([**Telephone/Fax (1) 355**]) within 1-2 weeks following discharge from rehab Completed by:[**2180-12-11**] ICD9 Codes: 4019, 2930, 2859
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Medical Text: Admission Date: [**2193-2-14**] Discharge Date: [**2193-2-16**] Date of Birth: Sex: M Service: MICU HISTORY OF PRESENT ILLNESS: The patient is a 70 year-old male admitted to the MICU with sepsis, hypertension, status post episode of ventricular tachycardia now on pressors. The patient was admitted to the Vascular Service between [**12-30**] and [**2193-1-17**]. He has an extensive history of peripheral vascular disease and status post left femoral popliteal bypass with a jump graft and a left second toe amputation and revision. The patient was found to have a gangrenous wound with involvement of the left third toe with purulent discharge and breakdown of the incision site and underwent further debridement and revision. He was evaluated by his vascular surgeon Dr. [**Last Name (STitle) **] and thought to be stable for rehab and that the wound was viable and without need for further surgical intervention. The patient was at rehab when he started complaining of difficulty swallowing and coughing up dried blood on [**2193-2-13**] and neck pain. Rehab doctor was called to evaluate the patient for same complaints and blood pressure was noted to be 70/40 with a heart rate of 92, white count 33.6. Blood cultures from [**2193-2-12**] had four out of four bottles growing gram positive cocci while on Vancomycin and Levaquin and the patient was febrile to 102. The patient was transferred to [**Hospital1 346**], but on route developed ventricular tachycardia while on Dopamine and was diverted to [**Hospital3 11531**]. Apparently ventricular tachycardia spontaneously resolved and the patient was stable in their Emergency Department and he was sent to [**Hospital1 188**] Emergency Department while awaiting MICU bed. In the Emergency Department here his blood pressure was 60/palp. The patient was started on neo-synephrine, fluid boluses and Flagyl was added to his antibiotic regimen. PAST MEDICAL HISTORY: Coronary artery disease status post myocardial infarction in [**2169**], status post coronary artery bypass graft in [**2183**], status post catheterization in [**11-8**] with patent left internal mammary coronary artery to left anterior descending coronary artery, patent supraventricular tachycardia to obtuse marginal two and occluded saphenous vein graft to right coronary artery. Exercise MIBI on [**2192-11-22**] showed fixed apical defects, severe fixed distal anterior wall defect with minimal reversible defect in distal inferior wall, global left ventricular hypokinesis and apical akinesis, EF of 22%. Paroxysmal atrial fibrillation, type 2 diabetes, end stage renal disease on hemodialysis since [**11-8**], hypercholesterolemia, renal cell carcinoma status post right nephrectomy in [**2182**] with metastasis to bone treated with radiation therapy in [**10/2192**] with metastasis to gallbladder status post cholecystectomy and status post abdominal wall dissection. Hypothyroidism, peripheral vascular disease status post above surgeries. MEDICATIONS: Colace, Nephrocaps, Lopressor 12.5 b.i.d., Amiodarone 200 q day, Synthroid 100 micrograms q day, Pepcid 20 mg q day, Senna, vitamin C, Levaquin 250 mg po after hemodialysis. Zocor 40 q.d., NPH 16 units in the a.m. and 3 units in the p.m. Calcitriol, Reglan, zinc, aspirin, Coumadin 1 mg po q day, Vancomycin dose with hemodialysis. ALLERGIES: Ativan makes the patient "go crazy." SOCIAL HISTORY: No tobacco. Rare alcohol. PHYSICAL EXAMINATION: Vital signs 60/palp increased to 97/36 on neo-synephrine. Pulse 97. Respiratory rate 22. Sating 98% on 2 liters nasal cannula. In general the patient is in bed in no acute distress. HEENT oropharynx clear. Sclera anicteric. Neck mildly swollen and full, nontender, no lymphadenopathy. No JVD. Lungs with decreased breath sounds at the bases. Cardiovascular irregular irregular rhythm. Normal S1 and S2. Abdomen was soft, nontender, nondistended with normoactive bowel sounds. Extremities left lower extremity with TMA frankly necrotic, but no purulence. INITIAL DATA: White blood cell count 27.6 with 97% neutrophils, 3 lymphocytes, 3 monocytes, hematocrit 29.5, platelets 537, INR 3.1, liver function tests within normal limits. Chem 7 143, 4.8, 106, 23, 29, 4.2, glucose 73. Initial CK negative. Rhythm strip with sustained ventricular tachycardia. Electrocardiogram subsequently showed atrial fibrillation rate of 97, Q waves in 3 and V1, poor R wave progression, no ST or T wave changes, unchanged from [**2193-1-30**]. Chest x-ray showed possible right lower lobe infiltrate with obscured right hemidiaphragm. CT of the neck showed degenerative changes of the cervical spine, but no pharyngeal fluid collections. HOSPITAL COURSE: 1. Vascular surgery evaluated the patient and they determined when the patient was medically stable that he would require bilateral below the knee amputations. In the interim the patient's left TMA wound received bedside debridement. 2. The patient was also complaining of new onset right sided blindness. Ophthalmology evaluated the patient in the Emergency Department. There is no evidence of septic emboli. The patient's blindness was consistent with AION. 3. The patient was also seen by the Infectious Disease Service for his staph aureus bacteremia, which is likely secondary to his gangrenous foot. Other sources of infection could hve included his dialysis catheter. The patient was continued on Vancomycin and Ciprofloxacin as well as Flagyl. 4. Cardiovascular, the patient continued to be persistently hypotensive. He was started on neo-synephrine to which Levophed was also added. The patient also started to become dyspneic for which he was intubated. Immediately after his intubation the patient became increasingly hypotensive and also had an episode of ventricular tachycardia and also had several episodes of supraventricular tachycardia. Both of his arrhythmias resolved spontaneously. The patient also had a metabolic acidosis, which was being poorly compensated. At that time a family meeting was held and the gravity of his situation was explained. On [**2193-2-16**] the patient's family decided to withdraw care. The patient was extubated and started on a morphine drip and the patient expired shortly thereafter. The time of death was 7:30 p.m. on [**2193-2-16**]. CAUSE OF DEATH: Respiratory failure secondary to sepsis. No postmortem was performed. [**Name6 (MD) 2467**] [**Last Name (NamePattern4) 10404**], M.D. [**MD Number(1) 10405**] Dictated By:[**Doctor Last Name 10735**] MEDQUIST36 D: [**2193-7-15**] 14:59 T: [**2193-7-17**] 08:15 JOB#: [**Job Number **] ICD9 Codes: 4271, 486
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Medical Text: Admission Date: [**2113-3-20**] Discharge Date: [**2113-3-26**] Date of Birth: [**2045-4-27**] Sex: M Service: CARDIOTHORACIC Allergies: Lisinopril / Diltiazem Attending:[**First Name3 (LF) 922**] Chief Complaint: shortness of breath, dyspnea on exertion Major Surgical or Invasive Procedure: [**2113-3-20**]: 1. Bentall procedure with a 29-mm [**Company 1543**] Freestyle valve graft, serial #[**Serial Number 59432**], with coronary button reimplantation. 2. Hemi-arch replacement and replacement of ascending aorta with a 28-mm Vascutek Gelweave single side-arm graft, catalog #[**Numeric Identifier 31950**], lot #[**Serial Number 59433**], serial number [**Serial Number 59434**]. History of Present Illness: Mr. [**Known lastname **] is a 67 year male with known aortic aneurysm involving the root and ascending portion. His PMH is notable for COPD and hypertension. His aneurysm has been followed with yearly echocardiograms and CT scans. Given current size of 5.7 centimeters, he was referred by Dr. [**Last Name (STitle) **] for cardiac surgical intervention. Patient denies chest and back pain. He has longstanding shortness of breath and dyspnea on exertion secondary to his COPD. He does experience palpitations with exertion. Past Medical History: ascending aortic aneurysm, s/p Bentall Procedure [**2113-3-20**] PMH: chronic obstructive pulmonary disease Hypertension Hypercholesterolemia supra-ventricular tachycardia [**2103**] Intention Tremor, mostly right hand Chronic Back Pain Renal Cyst peptic ulcer disease [**2073**] Arthritis gastroesophageal reflux disease Social History: Retired machinist. Recently seperated, lives alone. Active smoker - about 3 cigs/day. Admits to 45 pack year history of tobacco. Rare ETOH. Family History: Non-contributory Physical Exam: Height: 6'3" Weight: 196 lbs General: Appears well, lying flat post cath, in NAD Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Clear with some ronchi bilaterally Heart: RRR [x] Irregular [] - distant heart sounds Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Trace edema LLE Varicosities: None [x] Neuro: Alert and oriented, CN 2-12 grossly intact, no focal deficits 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: Pre-bypass: 1. The left atrium and right atrium are normal in cavity size. No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. 2. No atrial septal defect is seen by 2D or color Doppler. 3. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). 4. Right ventricular chamber size and free wall motion are normal. 5. The aortic root is moderately dilated at the sinus level. The ascending aorta is moderately dilated. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. There is no aortic valve stenosis. Moderate (2+) aortic regurgitation is seen. 6. The mitral valve appears structurally normal with trivial mitral regurgitation. 7. There is no pericardial effusion. Post-bypass: AV paciong. On infusion of phenylephrine. Well-seated bioprosthetic valve in the aortic position. No AI; systolic gradient is trivial. Ascending graft visible in the aortic positoion. No dissection seen. Aortic contour is normal in the descending aorta. Biventricular systolic function is preserved. [**2113-3-25**] 06:00AM BLOOD WBC-7.6 RBC-2.65* Hgb-7.8* Hct-24.5* MCV-93 MCH-29.6 MCHC-32.0 RDW-13.4 Plt Ct-146* [**2113-3-20**] 12:09PM BLOOD WBC-12.0* RBC-2.85*# Hgb-9.2*# Hct-26.6*# MCV-93 MCH-32.4* MCHC-34.7 RDW-12.9 Plt Ct-139* [**Known lastname 8034**],[**Known firstname **] [**Medical Record Number 59435**] M 67 [**2045-4-27**] Radiology Report CHEST (PA & LAT) Study Date of [**2113-3-23**] 1:36 PM [**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2113-3-23**] 1:36 PM CHEST (PA & LAT) Clip # [**Clip Number (Radiology) 59436**] Reason: pl.eff [**Hospital 93**] MEDICAL CONDITION: 67 year old man s/p Bentall/hemiarch REASON FOR THIS EXAMINATION: pl.eff Final Report TWO-VIEW CHEST OF [**2113-3-23**] COMPARISON: [**2113-3-21**]. INDICATION: Evaluate pleural effusion in postoperative patient. FINDINGS: Cardiomediastinal contours are stable in appearance compared to previous postoperative radiographs. Small pleural effusions, right greater than left, are unchanged from the two most recent radiographs. Minor atelectatic changes persist at the bases. On the lateral view, retrosternal gas and fluid is likely related to the recent sternotomy. Due to patient obliquity, it is difficult to exclude small loculated anterior hydropneumothorax, but no visible apical pleural line is evident on the corresponding frontal view. High-grade compression deformity in the mid thoracic spine is unchanged since the preoperative study. IMPRESSION: Small pleural effusions, right greater than left with adjacent basilar atelectasis. DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**] Approved: [**Doctor First Name **] [**2113-3-23**] 2:18 PM Imaging Lab [**2113-3-20**] 01:30PM BLOOD PT-15.0* PTT-45.7* INR(PT)-1.3* [**2113-3-20**] 12:09PM BLOOD PT-16.0* PTT-43.2* INR(PT)-1.4* [**2113-3-25**] 06:00AM BLOOD Glucose-97 UreaN-11 Creat-0.7 Na-133 K-4.1 Cl-93* HCO3-32 AnGap-12 [**2113-3-21**] 03:31AM BLOOD Glucose-111* UreaN-12 Creat-0.7 Na-135 K-4.8 Cl-104 HCO3-25 AnGap-11 Brief Hospital Course: The patient was admitted to the hospital and brought to the operating room on [**2113-3-20**] where he underwent Bentall procedure as well as ascending aorta and hemi-arch replacement. See operative note for further details. Overall the patient tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. He awoke neurologically intact and was extubated without difficulty. Weaned off Nitroglycerin. Beta-Blocker/Aspirin/Statin/diuresis was initiated. Preoperative meds were resumed. All lines and drains were discontinued in a timely fashion. POD#1 he was transferred to the step down unit for further monitoring. Physical therapy was consulted to evaluate mobility and strength. He continued to progress although he was not able to be weaned off of supplemental oxygen completely. As discussed with his pulmonologist, Mr.[**Known lastname **] continued his inhalers and diuresis, and would require O2 arranged for discharge to home. Postoperatively he had transient hyponatremia requiring free water restriction and diuresis to correct his electrolytes. On POD# 6 he was cleared by Dr.[**Last Name (STitle) 914**] for discharge to home. All follow up appointments were advised. Medications on Admission: HCTZ 25 qd, Atenolol 100 qd, Amiodarone 200 qd, Nifedipine 30 qd, Pravastatin 40 qd, Advair prn, Trazadone 150 qd, Oxycontin 20-60 TID, Alendronate 70 qweek, Spiriva 18mcg daily, ASA 81mg po daily, Fluticasone 50mcg 2 sprays each nostril daily, Albuterol PRN Discharge Medications: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at bedtime) as needed for insomnia. 5. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: Three (3) Tablet Sustained Release 12 hr PO Q8H (every 8 hours) as needed for pain. Disp:*90 Tablet Sustained Release 12 hr(s)* Refills:*0* 6. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 7. Pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 9. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 10. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2) Spray Nasal DAILY (Daily). 11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 12. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). Disp:*60 Disk with Device(s)* Refills:*2* 13. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**1-28**] Puffs Inhalation Q6H (every 6 hours) as needed for dyspnea. Disp:*qs * Refills:*0* 14. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 15. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. 16. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 17. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 18. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 19. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 20. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 21; Home oxygen arranged for nasal cannula Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: ascending aortic aneurysm, s/p Bentall Procedure [**2113-3-20**] PMH: chronic obstructive pulmonary disease Hypertension Hypercholesterolemia supra-ventricular tachycardia [**2103**] Intention Tremor, mostly right hand Chronic Back Pain Renal Cyst peptic ulcer disease [**2073**] Arthritis gastroesophageal reflux disease Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with ** prn 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 until follow up with surgeon No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Home oxygen arranged for nasal cannula Followup Instructions: Surgeon Dr. [**Last Name (STitle) 914**] #[**Telephone/Fax (1) 170**], appointment arranged for [**2113-4-25**] at 1:30pm Primary Care Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 58937**] in [**1-28**] weeks Cardiologist Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 16005**] in [**1-28**] weeks Pulmonologist Dr [**Last Name (STitle) 26225**] in [**3-2**] weeks Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse will schedule Completed by:[**2113-3-26**] ICD9 Codes: 4241, 2761, 5180, 496, 4019, 2724, 3051
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Medical Text: Admission Date: [**2193-12-30**] Discharge Date: [**2194-1-8**] Date of Birth: [**2167-11-21**] Sex: F Service: CCU HISTORY OF PRESENT ILLNESS: The patient is a 26-year-old female with a new diagnosis of dilated cardiomyopathy with an ejection fraction of 10%. The patient was admitted to the Coronary Care Unit for management of her congestive heart failure and cardiomyopathy. The shortness of breath started approximately two to three years. At that time, she was diagnosed with asthma by pulmonary function tests. Six months ago, the patient noted new shortness of breath with exertion and pleuritic chest pain that was nonexertional and accompanied by nausea, vomiting, and nonbloody diarrhea. Approximately one month ago the patient noted she was waking up from sleep gasping for air. The patient went to her primary care physician and was then admitted to [**Hospital 1474**] Hospital. In early [**2193-12-7**], an echocardiogram there showed an ejection fraction of 10%. She was seen by Cardiology and started on medications for cardiomyopathy. She was discharged on [**2193-12-13**]. The patient's symptoms worsened at home, and she was getting more short of breath with exertion. She could only go a few steps prior to becoming short of breath. She was returned to [**Hospital 1474**] Hospital and was transferred to the [**Hospital1 346**] for further management. PAST MEDICAL HISTORY: 1. Idiopathic cardiomyopathy. 2. Asthma. 3. Hypertension. 4. Cesarean section four years ago; postpartum hemorrhage. MEDICATIONS ON ADMISSION: 1. Digoxin 0.25 mg by mouth once per day. 2. Lasix 40 mg by mouth once per day. 3. Lisinopril 2.5 mg by mouth once per day. 4. Toprol-XL 12.5 mg by mouth once per day. 5. Potassium chloride 10 mEq by mouth once per day. ALLERGIES: SOCIAL HISTORY: The patient works as a bus driver. She lives with her son and sister. She has one child. She quit smoking one month ago; however, she had smoked half a pack per day for eight years. She denies alcohol and intravenous drug use. FAMILY HISTORY: Her family history is significant for a brother with asthma. Her mother has hypertension and diabetes. Her son has an "arrhythmia" and asthma. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination with vital signs which revealed the patient's temperature was 95.9 degrees Fahrenheit, her heart rate was 103, her blood pressure was 144/81, her respiratory rate was 22, and her oxygen saturation was 100% on 2 liters via nasal cannula. In general, the patient was pleasant and in no acute distress. Head, eyes, ears, nose, and throat examination revealed the pupils were equal, round, and reactive to light. The extraocular movements were intact. There was bilateral tonsilar enlargement. The mucous membranes were moist. Jugular venous pressure at the angle of jaw. There was no lymphadenopathy. Chest examination revealed the lungs were clear to auscultation bilaterally. There were no crackles. Cardiovascular examination revealed tachycardia with a regular rhythm. There were no murmurs. Positive third heart sound and fourth heart sound. The abdominal examination revealed the abdomen was obese, nontender, and nondistended. there were positive bowel sounds. Extremity examination revealed no clubbing, cyanosis, or edema. Dorsalis pedis and posterior tibialis pulses were 2+ bilaterally. Neurologic examination revealed the patient was alert and oriented times three. Grossly intact. PERTINENT LABORATORY VALUES ON PRESENTATION: Laboratories revealed the patient's hematocrit was 39.6, and her platelets were 261. The patient's sodium was 142, potassium was 3.6, chloride was 104, bicarbonate was 28, blood urea nitrogen was 10, creatinine was 0.9, and her blood glucose was 114. Her creatine kinase was 59. Troponin was 0.06. Urinalysis at the outside hospital was negative. Digoxin level was less than 0.2. Her INR was 1.3, her prothrombin time was 14, and her partial thromboplastin time was 26.1. Cardiac transplant workup laboratories revealed the patient's total iron-binding capacity was 361, her ferritin was 58, TRF was 278, her hemoglobin A1c was 6.1. Her low-density lipoprotein was 80, cholesterol/HD was 3.3, her high-density lipoprotein was 42, her triglycerides were 90. Her thyroid-stimulating hormone was 2.5. Her free T4 was 1.3. Hepatitis B surface antigen was negative. Hepatitis B surface antibody was positive. Hepatitis B core antibody was negative. Hepatitis A virus antibody was negative. Antinuclear antibody was negative. Hepatitis C virus antibody was negative. Human immunodeficiency virus antibody was negative. Toxo IgG was negative. IgM was negative. [**Doctor Last Name 3271**]-[**Doctor Last Name **] virus viral capsid antigen IgG antibody positive. [**Doctor Last Name 3271**]-[**Doctor Last Name **] virus viral capsid antigen IgG antibody positive. [**Doctor Last Name 3271**]-[**Doctor Last Name **] virus [**Doctor Last Name 3271**]-[**Doctor Last Name **] nuclear antigen IgG antibody positive. [**Doctor Last Name 3271**]-[**Doctor Last Name **] virus viral capsid antigen IgM antibody negative. Cytomegalovirus IgG positive. Cytomegalovirus IgM negative. Varicella zoster negative. Herpes simplex virus II IgG negative. Herpes simplex virus I IgG negative. The patient's aspartate aminotransferase was 16, her alanine-aminotransferase was 20, and her bilirubin was 1.6, her alkaline phosphatase was 63. Her magnesium was 2.3, her calcium was 8.9, and her phosphorous was 4.3. Her albumin was 3.2. Her amylase was 47. Her lactate dehydrogenase was 317. Purified protein derivative was negative. Guaiac-negative. PERTINENT RADIOLOGY/IMAGING: A posterior/anterior and lateral chest x-ray revealed no cardiomegaly but no evidence of cardiac failure or pneumonia. Impression from a computed tomography angiogram revealed the examination was greatly limited due to the patient's body habitus. There was no pulmonary embolus identified. There was bilateral dependent atelectasis. Findings were consistent with congestive heart failure. Impression from an ultrasound of the abdomen (complete study) revealed (1) gallstones and (2) normal liver Doppler, but right hepatic artery not visualized due to technical limitations. An electrocardiogram revealed a normal sinus rhythm at 98 beats per minute, normal axis, normal intervals, right atrial enlargement, and left atrial enlargement. There were Q waves in V5 and V6. No changes. Consistent with prior electrocardiogram. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: 1. CARDIOVASCULAR ISSUES: The patient was admitted to the hospital and taken directly to cardiac catheterization. During the procedure, the patient went into an atrioventricular nodal reentrant tachycardia arrhythmia and was given adenosine with good results. On the evening of night of [**1-2**] to [**1-3**], the patient went into a heart rate in the 190s. Electrocardiogram at that time was taken and showed atrioventricular nodal reentrant tachycardia arrhythmia. Vagal maneuvers were attempted without success. Blood pressure was stable in the 100s. The patient was asymptomatic; however, when the patient was woken up she complained of chest pain, right arm pain, diaphoresis, and lightheadedness. The symptoms resolved when the patient was given adenosine with good resolution of atrioventricular nodal reentrant tachycardia. On cardiac catheterization the patient was shown to have dilated cardiomyopathy and high cardiac pressures, elevated central venous pressure, pulmonary artery pressure (both systolic and diastolic), and elevated pulmonary capillary wedge pressure. Henceforth, the patient was started on a Lasix drip initially and then taken off for fear of pushing the patient into prerenal failure. She was then started on milrinone. An ACE inhibitor was then added in addition to a beta blocker with good pressure control. Despite medical management, the patient continued to be tachycardic since admission secondary to her heart failure. She was started on a workup for cardiac transplantation and without followed by Dr.[**Name (NI) 23312**] Congestive Heart Failure Service. Electrophysiology was consulted for ablation of the atrioventricular nodal reentrant tachycardia. The Electrophysiology team spoke with the patient and mother. They obtained consent and performed atrioventricular nodal reentrant tachycardia ablation without any complications. The team was unable to re-induce atrioventricular nodal reentrant tachycardia. The patient was then weaned off the milrinone drip. The central lines were pulled, and the patient was transferred to the floor for one and then discharged home. The patient was to have Heart Failure Service followup and further transplant evaluation. 2. PULMONARY ISSUES: The patient had desaturations to 88% on room air. The patient was tried on different levels of oxygen until finally placed on a nonrebreather face mask with saturations stabilizing to the 90s. At that time, the patient was tachycardic but was not complaining of any chest pain. Arterial blood gas showed a pH of 7.38, PCO2 was 49, and PO2 of 52 on a nonrebreather. Respiratory Therapy was consulted for suspected obstructive sleep apnea. The patient was placed on [**Hospital1 **]-level positive airway pressure with good results. The patient's oxygen saturation at that point were 98%. The following day, attempts to take off the [**Hospital1 **]-level positive airway pressure were unsuccessful. The next thought was that the patient might have had a pulmonary embolism. A computed tomography angiogram was performed, and the results were negative. Attempted to wean off the [**Hospital1 **]-level positive airway pressure slowly over the course of two days and were able to place the patient back on 2 liters nasal cannula with oxygen saturations stable at 98%. The patient subsequently did well off any oxygen requirements with oxygen saturations stable from 95% to 98%. 3. HYPERGLYCEMIA ISSUES: Likely due to apparent glucose intolerance secondary to obesity. Spoke at length regarding dietary modification and had Nutrition see the patient. 4. FLUIDS/ELECTROLYTES/NUTRITION ISSUES: The patient was placed on a low-sodium cardiac diet. 5. PROPHYLAXIS ISSUES: Subcutaneous heparin was administered throughout the entire hospitalization. CONDITION AT DISCHARGE: Condition on discharge was good. DISCHARGE STATUS: Discharge status was to home. DISCHARGE DIAGNOSES: 1. Acute-on-chronic congestive heart failure (systolic and diastolic). 2. Left congestive heart failure. 3. Dyspnea. 4. Hypertension. 5. Atrioventricular nodal reentrant tachycardia arrhythmia. 6. Status post atrioventricular nodal reentrant tachycardia radioablation. 7. Hyperglycemia. MEDICATIONS ON DISCHARGE: 1. Warfarin 5-mg tablets one tablet by mouth at hour of sleep. 2. Metoprolol succinate 50-mg tablets one tablet by mouth once per day. 3. Lisinopril 20-mg tablets two tablets by mouth every day. 4. Digoxin 350-mcg tablets one tablet by mouth every other day. 5. Digoxin ? 250-mg tablets 1.5 tablets by mouth every other day. DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The patient had an exercise stress test appointment on [**2194-1-15**] at 9:30 a.m. The patient was to call telephone number [**Telephone/Fax (1) 1566**] for any questions or concerns. 2. The patient was instructed to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at the [**Last Name (un) 469**] Center Cardiac Services on [**2194-1-21**] at 10 a.m. The patient was to call telephone number [**Telephone/Fax (1) 2550**] for questions or concerns. 3. The patient was instructed to follow up with her primary care physician at [**Name9 (PRE) 53941**]. She was to call her physician in one to two weeks to schedule an appointment at telephone number [**Telephone/Fax (1) 3183**]. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 2814**] Dictated By:[**Last Name (NamePattern1) 9622**] MEDQUIST36 D: [**2194-2-25**] 18:14 T: [**2194-2-26**] 11:04 JOB#: [**Job Number 53942**] ICD9 Codes: 4280, 4254, 4019
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Medical Text: Admission Date: [**2179-12-23**] Discharge Date: [**2179-12-28**] Date of Birth: [**2131-7-11**] Sex: M Service: CSU HISTORY OF PRESENT ILLNESS: This is a 48 year old male with the history of AIDS, coronary artery disease, status post cardiac catheterization on [**2179-12-7**] with percutaneous transluminal coronary angioplasty to his left anterior descending coronary artery and balloon angioplasty. He presents to the emergency room on [**2179-12-23**] with dyspnea on exertion since discharge. He reported he had initial symptoms on his previous presentation where bilateral upper extremity pain and substernal chest pain "like somewhat is sitting on my chest." Since then he has had severe dyspnea on exertion with minimal activity, occasionally with chest pain without upper extremity pain. He reported no weight loss, fever, vomiting, diarrhea. He does complain of night sweats, nausea and gas. He has no lower extremity edema, no paroxysmal nocturnal dyspnea and stable two to three pillow orthopnea. He reported that he did start smoking again after his last hospitalization and that he recently had some "bumps" popping up over his shoulder and back over ten days. They are nonpruritic. Currently on examination he is chest pain free with no shortness of breath. PAST MEDICAL HISTORY: 1. HIV positive requiring retroviral therapy. Last CD4 count 66 on [**8-4**]. 2. Hypercholesterolemia. 3. Coronary artery disease. 4. Depression. 5. Congestive heart failure with both diastolic and systolic dysfunction. 6. Right middle lobe 9 mm nodule noted on a CT angio of his chest [**2179-12-4**]. 7. Shingles. 8. Gastroesophageal reflux disease. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: 1. Lopinavir-Ritonavir 133.3-33.3 caps, dosing 3 caps by mouth twice a day. 2. Lamivudine-Zidovudine 150-300 mg tablets 1 tablet P.O. twice daily. 3. Abacavir 300 mg P.O. twice a day. 4. Plavix 75 mg P.O. once a day for 30 days starting [**2179-12-8**] status post stent placement. 5. Aspirin 325 mg P.O. once a day. 6. [**Month/Day/Year **] 20 mg P.O. once a day. 7. Atenolol 50 mg P.O. once a day. 8. Lisinopril 5 mg P.O. once a day. 9. Bactrim SS 1 tablet once a day. 10. Famotidine 20 mg P.O. twice a day. 11. Sublingual nitroglycerine. 12. Senna PRN 13. Colace. 14. Prozac 40 mg P.O. once a day and nicotine transdermal patch 14 mg, application every 24 hours. SOCIAL HISTORY: Admitted to smoking one pack a day, occasional alcohol, no current drug use at all. FAMILY HISTORY: Had a positive family history. His father died of myocardial infarction at age 47. PHYSICAL EXAMINATION: On admission temperature 98.9, blood pressure 143/64, heart rate 62, regular, saturating 99 percent on room air. Head, eyes, ears, nose and throat examination was unremarkable. He had jugular venous distension, no lymphadenopathy palpable. Heart was regular rate and rhythm with S1, S2, tones no murmur, rub or gallop. Lungs were clear bilaterally with distant breath sounds bilaterally. Abdomen had some mild epigastric tenderness, no distention, no masses, no hepatosplenomegaly. Extremities had no edema. He had some rare 1 mm scabbed over papules on his left shoulder and back, nontender, nonpruritic. Chest x-ray showed no infiltrate, no congestive heart failure or effusion. His electrocardiogram showed normal axis with sinus rhythm at 75 with 1 to [**Street Address(2) 37964**] elevations in V1 through V3. Biphasic T waves in V2 through V3 consistent with his prior electrocardiogram on [**2179-12-8**]. Only the T wave changes were new. Please refer to his electrocardiogram done on [**2179-12-23**] for official report. Cardiac catheterization on [**2179-12-7**] did show three vessel disease. He received three stents to his left anterior descending coronary artery and balloon angioplasty to his third obtuse marginal, AV groove circumflex and left posterior descending coronary artery. His ejection fraction at that time was 46 percent with an left ventricular ejection fraction of 13. He was admitted through the emergency room. Laboratories prior to the catheterization were as follows; troponin T 0.02, saturation of 35, potassium of 5.6. Chloride 99, bicarb 21, BUN 24, creatinine 1.0, blood sugar 101, anion gap 21, CK 135 with MB of 3. White count of 5.9, hematocrit 31.6, platelet count 357,000. PT 12.2, PTT 24.4, INR 0.9. Urinalysis was negative. Given his current symptoms the patient went to the cardiac catheterization laboratory on the cardiology service which showed a clot in the left anterior descending coronary artery, restenosis in the circumflex and he was referred to Dr. [**Last Name (STitle) 70**] for emergent coronary artery bypass graft. On the 23rd he went to the operating room for emergent coronary artery bypass grafting times two with a left internal mammary artery to the left anterior descending coronary artery, a vein graft to the obtuse marginal and a vein graft sequentially to the posterior descending coronary artery. He was transferred to the cardiothoracic Intensive Care Unit in stable condition on a Neo-Synephrine drip at 0.8 mcg per kilogram per minute and titrated propofol drip. On postoperative day one he was hemodynamically stable on a Neo-Synephrine drip at 2.5 mcg per kilograms per minute. He was restarted on his aspirin and Plavix and continued with his perioperative vancomycin. His white count was 8.3, hematocrit 31.8, platelet count 286,000, potassium 4.5, BUN 17, creatinine 0.9. He remained intubated. He was stable and remained in the cardiothoracic Intensive Care Unit. He was seen by his [**Hospital6 **] Center physician who made suggestions for his antiretroviral therapy protocol and his HIV medications were restarted. On postoperative day two he had no events overnight. He was extubated. His maximum temperature was 100. He was hemodynamically stable in sinus rhythm, saturating 94 percent on 2 liters nasal cannula. His creatinine and white count were stable. He was doing well. His Swan was discontinued. His Neo-Synephrine continued to be weaned. Chest tubes were discontinued and his Foley was pulled and he was encouraged to ambulate. On the 26th his Cordis was discontinued. Peripheral intravenous was placed. He was transferred out to the floor. His examination was unremarkable. His incisions were clean, dry and intact. He continued to be seen every day by Dr. [**Last Name (STitle) 37965**], his [**Hospital1 778**] staff physician. [**Name10 (NameIs) **] was encouraged to continue using the incentive spirometer and work on pulmonary toilet as well as ambulation with physical therapy and the nursing staff. On postoperative day four he had a blood pressure of 124/76 with sinus rhythm at 78. His beta blockage with Lopressor continued as well as Lasix diuresis. He continued on his triple antiviral therapy as well as his Plavix. His examination was relatively unremarkable. Incisions were clean, dry and intact. His epicardial pacing wires were to be removed during the day that day. He was saturating 95 percent on room air. He had somewhat of a flat affect but otherwise appeared to be alert and oriented with a nonfocal examination. Psychiatry consult was requested and done by Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) 16293**] for his history of depression and the assessment was based on his current examination and he appeared safe for discharge with outpatient follow up and they recommended that his Prozac be continued. He was also seen by case management and patient's desire was to be discharged to home and his roommate will be with him. Patient would be discharged with [**Hospital6 407**] services. On the day of discharge he was receiving Percocet PRN and ibuprofen for P.O. pain control. He had good bowel sounds. Discharge planning was done. His examination was unremarkable. Incisions were clean, dry and intact. He was performing all of his activities of daily living and his last laboratories were hematocrit of 27.3. The patient was deemed well enough to be discharged to home with Visiting Nurse Associates services and was discharged with the following diagnoses. FINAL DIAGNOSES: 1. Status post emergent coronary artery bypass grafting times three. 2. Coronary artery disease, status post triple vessel stenting [**12-4**]. 3. HIV positive on retroviral therapy. 4. Hypercholesterolemia. 5. Depression. 6. Congestive heart failure. 7. Right middle lobe nodule. 8. Gastroesophageal reflux disease. DISCHARGE FOLLOW UP APPOINTMENTS: Were scheduled. Patient was requested to make an appointment with Dr. [**Last Name (STitle) 2392**] for approximately one to two weeks post discharge, to make appointment for a psychiatric referral at [**Hospital 778**] Health Center one week after discharge and make appointment to see Dr. [**Last Name (STitle) 70**], his surgeon in the office for postoperative surgical visit in approximately six weeks. He also has an appointment scheduled with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**] from cardiology for [**2180-1-14**] at 11:30. DISCHARGE MEDICATIONS: 1. Percocet 5/325 one to two tablets P.O. PRN q 4 hours for pain. 2. Plavix 75 mg P.O. once daily. 3. Aspirin 81 mg enteric coated P.O. once daily. 4. Abacavir Sulfate 300 mg P.O. twice daily. 5. Lamivudine - zidovudine 150-350 mg tablet, 1 tablet P.O. twice daily. 6. Lopinavir-ritonavir 133.3 - 33.3 mg capsule, 3 capsules twice a day. 7. Flexitime 40 mg P.O. daily. 8. Metoprolol 25 mg P.O. twice a day. 9. Lasix 20 mg P.O. twice a day for seven days. 10. Potassium chloride 20 mEq P.O. twice a day for seven days. 11. Pepcid 20 mg P.O. once a day. 12. Ibuprofen 600 mg P.O. q 6 hours PRN for pain. The patient was discharged home with [**Hospital6 1587**] services on [**2179-12-28**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2179-12-29**] 15:35:12 T: [**2179-12-29**] 18:06:34 Job#: [**Job Number 37966**] ICD9 Codes: 4111, 4019, 3051, 2724, 311
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Medical Text: Admission Date: [**2187-7-24**] Discharge Date: [**2187-8-2**] Date of Birth: [**2133-10-19**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3223**] Chief Complaint: GI Bleed Major Surgical or Invasive Procedure: EGD on [**2187-7-24**] 1. Hemigastrectomy with Billroth II reconstruction. 2. Feeding jejunostomy History of Present Illness: 53M with a PMHx of HTN, DMII, COPD, developed dizzyness with nausea, stomach pain, and vomitting 3-4 days prior to admission. Emesis was dark black. Melanotic stools began on saturday and continued for three days until admission. This morning dizzyness and weakness progressed, he called 911 and was brought to ED by EMS. In the ambulance, was noted to have inferior ST elevations (got ASA 325 by EMS). These resolved on the ED 12-lead and were attributed to machine calibration; he does not have a cardiac hx and had no chest pain. Trop on arrival 0.05, CK=28 (Cr at 1.6, baseline unknown). . In the ED, initial vs were: T=96.8 P=99 BP=90/29 R=20 O2 sat 95%. Patient was pale and diaphoretic at presentation c/o weakness. His initial Hct was 23.7 (unknown baseline) with WBC of 20, normal plts, normal coags. His pants were stained with melanotic stool. NG drainage was drak red and did not clear with lavage. He was given 4L NS (1 prior to Hct, 3 post) and erythromycin for motility prior to EGD. Pressure transiently as low as 81/28 in the ED, at time of transfer (POST 4L), HR=86, BP=105/60, R=20, 96%ra. One unit of blood given in transit and second unit given over one hour in MICU. . EGD in MICU showed clot in fundus with no active bleeding. Currently feels weak but significatly better than earlier today. Denies ever having had chest pain. Denies GIB hx, ulcer hx, etoh abuse, denies excess NSAID use. Never had stomach pain before 4 days PTA. Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. No dysuria. Denied arthralgias or myalgias. PCP informed of admission; has not seen him in one year. Past Medical History: Chronic pain on home opiates s/p MVA with femur fx 20+ years ago R knee OA HTN COPD/asthma Hypercholesterolemia Hospitalization for PTX s/p bleb rupture several years ago. Social History: The patient is married, has two children. Denies alcohol or drug use. He currently smokes 2 packs of cigarettes per day. He works and owns a pizza shop in [**Location (un) 745**]. Wife is travelling in [**Country 5881**] and has been updated. Family History: non-contributory, no CAD hX, NO ONCOLOGIC HX Physical Exam: Vitals: T:97.4 BP:109/58 P:95 R:22 O2:98ra General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, distant BS, no wheezes, rales, ronchi CV: Regular rate and rhythm, DISTANT 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 Brief Hospital Course: # Upper GI Bleed - In the emergency department, the patient received two peripheral 16 gauge IV's. Overall, he received 5 liters of normal saline and 3 units of blood. After receiving these fluids, his tachycardia resolved and his blood pressure returned to the low-normal range. After the patient was transferred to the emergency department, an EGD was performed. When he received sedation for his EGD, he did have an episode of hypotension that required a saline bolus. The EGD showing significant clot in stomach with no active bleeding. The patient had no additional melena or emesis. Hematocrits were followed throughout the night and remained stable around 25 (up from his initial hematocrit of 23.7). He was also maintained on an IV PPI. Overnight, he remained normotensive. The day after his admission, he was transferred out of the MICU to the floor with plans for a repeat EGD after 48 hours. Pt had repeat EGD on [**2187-7-26**] which showed a fungating, ulcerated and infiltrative 5-7cm mass with stigmata of recent bleeding of malignant appearance at the stomach body, with a ventral vessel. Surgery was consulted and the decision was made to go to the OR on [**2187-7-27**] with Dr. [**Last Name (STitle) 519**]. A hemigastrectomy with Billroth II reconstruction was performed along with a feeding jejunostomy. Metastatic gastric adenocarcinoma was diagnosed on biopsy. The patient recovered from his surgery in the unit before being transferred to the floor. He was discharged on post-operative day 5 and hospital day 9. Medications on Admission: HCTZ 25',lisinopril 20', atenolol 50', simvastatin 10', oxycontin 20", advair diskus 250/50, spiriva, fenofibrate cap 200mg (1 cap PO daily with meals), metformin 500" Discharge Medications: 1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Atenolol 50 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 3. Famotidine 20 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) as needed for constipation for 1 months: Take with pain meds. Disp:*60 Capsule(s)* Refills:*0* 5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain for 2 weeks: Maximum of 4gm of APAP daily. . Disp:*45 Tablet(s)* Refills:*0* 6. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 8. Advair Diskus 250-50 mcg/Dose Disk with Device Sig: One (1) Inhalation once a day. 9. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary: Upper gastrointestinal hemorrhage with gastric mass. Adenocarcinoma of the stomach Discharge Condition: Stable. Tolerating regular diet. Pain well controlled with oral medications. Discharge Instructions: Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *Avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *Avoid driving or operating heavy machinery while taking pain medications. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. * Continue to ambulate several times per day. . Incision Care: -Your staples will be removed at your follow up appointment. -Steri-strips will be applied and will fall off on their own. Please remove any remaining strips 7-10 days after application. -You may shower, and wash surgical incisions. -Avoid swimming and baths until your follow-up appointment. -Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. . J-TUBE: Please continue to flush J-TUBE with 30-60 cc of water daily. Please continue to change dressing daily and as needed. Please continue to assess site for s/s of infection. Followup Instructions: 1. Please call Dr.[**Name (NI) 1745**] office, [**Telephone/Fax (1) 6554**], to make a follow up appointment in 1 week. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**] ICD9 Codes: 5789, 5849, 2762, 486, 496, 2851, 4019, 2720, 4589, 3051
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Medical Text: Admission Date: [**2112-7-25**] Discharge Date: [**2112-8-13**] Date of Birth: [**2057-6-4**] Sex: F Service: Surgery CHIEF COMPLAINT: Recurrent sigmoid diverticulitis, postoperative anastomotic leak. MAJOR SURGICAL PROCEDURES: Sigmoid colon resection on [**2112-7-25**], exploratory laparotomy, and diverting ileostomy on [**2112-8-2**], and removal of retained drain on [**2112-8-11**]. HISTORY OF PRESENT ILLNESS: The patient is a 54-year-old woman with a history of recurrent diverticulitis. Since [**2110**], she had at least 3 documented episodes of acute diverticulitis. Patient was now admitted for elective sigmoid resection. Patient underwent a sigmoid colon resection on [**2112-7-25**]. Patient had a postoperative complication with an anastomotic leak which necessitated exploratory laparotomy and diverting ileostomy. Subsequently, 1 of the drains that was placed at the 2nd operation was retained and could not be removed at bedside. Therefore, patient required an additional procedure in the operating room with extraction of the drain. After that procedure, the patient was doing well, and she could be discharged home on [**2112-8-13**]. DISCHARGE STATUS: On discharge, the patient was in good general condition. She was afebrile. Her ileostomy was working well. DISCHARGE FOLLOWUP: Patient will follow up in Dr.[**Name (NI) 109160**] office in approximately 10 days. [**Name6 (MD) 5183**] [**Last Name (NamePattern4) 5184**], [**MD Number(1) 5185**] Dictated By:[**Last Name (NamePattern4) 95468**] MEDQUIST36 D: [**2112-11-10**] 11:18:39 T: [**2112-11-11**] 09:55:24 Job#: [**Job Number 109161**] ICD9 Codes: 4019, 3051
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Medical Text: Admission Date: [**2198-5-22**] Discharge Date: [**2198-6-15**] Service: MEDICINE Allergies: Bactrim Ds Attending:[**First Name3 (LF) 2297**] Chief Complaint: Hypotension, Unresponsiveness Major Surgical or Invasive Procedure: Endotracheal (through stoma) intubation History of Present Illness: 85 year old man with a hx of laryngeal CA s/p laryngectomy w/permanent tracheostomy p/w decreased responsiveness and hypotension. Pt. had been suffering through a cough and likely COPD exacerbation with pneumonia based on pervious pulmonary records. According to family, patient was being suctioned when suddenly became unresponsive, was found to be flaccid by EMS with cold extremities. Intubated through his stoma in ED with resultant return of color and In the ED, VS 99.6 115/46 59 100%RA 12, CXR demonstrated right sided consolidation, received Vancomycin, Zosyn, rectal ASA. EKG seen by cardiology with no plans for cath but would echo instead, trop's negative. Pt. was subsequently paralyzed with vecuronium (for an unknown reason) with resultant hypotension to 60's, ETT repositioned. Lactate initially at 4.0, down to 0.6 after fluids, initial ABG was 7.25/68/417/31 Fi02 100%. Was started on levophed with resultant increase in BP, given 1L NS and weaned off prior to arrival to MICU. IJ placed. Also received decadron 10mg IV x 1. . In MICU, pt. required boluses, though responsive initially to command, nodding head to questions. Started on vanc/zosyn, given MDI's. Placed patient again on levophed due to lower blood pressures. . Of note, was febrile to 102.7 the week before this admission, with green sputum and shortness of breath. Was placed on azithromycin and steroids by Dr. [**Last Name (STitle) 575**]. . Past Medical History: (1) Chronic obstructive pulmonary disease (COPD). (2) Status post laryngeal cancer with permanent tracheostomy placed in [**2180**]. (3) Status post right upper lobectomy for lung cancer in [**2186**]. (4) Left ventricular dysfunction with inferior akinesis on echo. (5) Monoclonal gammopathy of unknown significance. (6) Prior polio with right lower extremity weakness. (7) Kyphoscoliosis. (8) Hypertension. Social History: Pt. lives with wife and daughter. Extensive smoking history, social drinking, no IVDU. Family History: Non contributory Physical Exam: VS: T 36, BP 115/52 (on levophed), 52, 100%, 24 (on vent) Gen: Occasionally responsive to commands HEENT: PERRLA, EOMI, clear OP, MMM Neck: supple CV: RRR, -m/r/g, nl S1/S2 Lungs: Decreased BS on R side, slightly wheezing, coarse breath sounds from mechanical ventilation. Abd: S/NT/ND/nabs, -HSM Ext: -c/c/e, slightly cool extremities Pertinent Results: [**2198-5-22**] 04:00PM BLOOD WBC-12.9* RBC-3.97* Hgb-12.1* Hct-39.7* MCV-100* MCH-30.6 MCHC-30.6* RDW-15.9* Plt Ct-340 [**2198-5-22**] 08:43PM BLOOD WBC-8.0 RBC-3.25* Hgb-10.1* Hct-32.6* MCV-100* MCH-30.9 MCHC-30.9* RDW-15.8* Plt Ct-224 [**2198-5-24**] 02:22AM BLOOD WBC-5.7 RBC-3.12* Hgb-9.5* Hct-29.7* MCV-95 MCH-30.5 MCHC-32.0 RDW-15.6* Plt Ct-220 [**2198-5-29**] 03:00AM BLOOD WBC-9.4 RBC-3.38* Hgb-10.2* Hct-31.3* MCV-93 MCH-30.1 MCHC-32.5 RDW-15.5 Plt Ct-305 [**2198-5-29**] 03:00AM BLOOD PT-14.0* PTT-69.4* INR(PT)-1.2* [**2198-5-22**] 08:43PM BLOOD Glucose-174* UreaN-35* Creat-0.6 Na-145 K-4.5 Cl-115* HCO3-27 AnGap-8 [**2198-5-25**] 03:58PM BLOOD Glucose-151* UreaN-29* Creat-0.7 Na-145 K-3.7 Cl-104 HCO3-33* AnGap-12 [**2198-5-29**] 03:00AM BLOOD Glucose-119* UreaN-18 Creat-0.6 Na-141 K-3.7 Cl-98 HCO3-39* AnGap-8 [**2198-5-22**] 04:00PM BLOOD ALT-40 AST-51* CK(CPK)-74 AlkPhos-64 TotBili-0.3 [**2198-5-22**] 08:43PM BLOOD ALT-157* AST-263* LD(LDH)-386* AlkPhos-140* TotBili-0.3 [**2198-5-23**] 01:00AM BLOOD ALT-266* AST-370* LD(LDH)-389* CK(CPK)-33* AlkPhos-222* TotBili-0.3 [**2198-5-23**] 04:38PM BLOOD ALT-204* AST-178* LD(LDH)-177 AlkPhos-184* TotBili-0.3 [**2198-5-24**] 02:22AM BLOOD ALT-161* AST-116* LD(LDH)-143 AlkPhos-154* TotBili-0.3 [**2198-5-25**] 02:42AM BLOOD ALT-132* AST-63* LD(LDH)-187 AlkPhos-148* TotBili-0.4 [**2198-5-27**] 01:48PM BLOOD CK(CPK)-65 [**2198-5-27**] 08:17PM BLOOD CK(CPK)-77 [**2198-5-28**] 02:25PM BLOOD CK(CPK)-65 [**2198-5-22**] 04:00PM BLOOD Lipase-120* [**2198-5-23**] 04:38PM BLOOD Lipase-40 [**2198-5-22**] 04:00PM BLOOD cTropnT-<0.01 [**2198-5-23**] 01:00AM BLOOD cTropnT-<0.01 [**2198-5-23**] 10:09AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2198-5-27**] 06:48AM BLOOD CK-MB-3 cTropnT-<0.01 [**2198-5-27**] 01:48PM BLOOD CK-MB-NotDone cTropnT-0.08* [**2198-5-27**] 08:17PM BLOOD CK-MB-NotDone cTropnT-0.11* [**2198-5-28**] 02:25PM BLOOD CK-MB-NotDone cTropnT-0.03* [**2198-5-22**] 04:00PM BLOOD Calcium-8.9 Phos-5.4* Mg-2.4 [**2198-5-25**] 02:42AM BLOOD Calcium-8.3* Phos-2.1* Mg-2.2 [**2198-5-29**] 03:00AM BLOOD Calcium-7.9* Phos-2.9 Mg-1.9 [**2198-5-27**] 06:48AM BLOOD TSH-2.0 [**2198-5-22**] 04:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2198-5-22**] 05:39PM BLOOD Tidal V-450 FiO2-100 pO2-417* pCO2-68* pH-7.25* calTCO2-31* Base XS-0 AADO2-249 REQ O2-48 Intubat-INTUBATED Vent-IMV [**2198-5-23**] 02:53AM BLOOD Type-ART Temp-36 Rates-24/24 Tidal V-400 PEEP-5 FiO2-50 pO2-128* pCO2-55* pH-7.26* calTCO2-26 Base XS--2 Intubat-INTUBATED Vent-CONTROLLED [**2198-5-23**] 11:00AM BLOOD Type-ART Temp-36.6 Rates-24/ Tidal V-434 PEEP-5 FiO2-40 pO2-115* pCO2-46* pH-7.33* calTCO2-25 Base XS--1 -ASSIST/CON Intubat-INTUBATED [**2198-5-24**] 02:09PM BLOOD Type-ART Rates-/29 Tidal V-395 PEEP-5 FiO2-30 pO2-78* pCO2-48* pH-7.42 calTCO2-32* Base XS-5 Intubat-INTUBATED Vent-SPONTANEOU [**2198-5-25**] 03:49AM BLOOD Type-ART Temp-36.6 Rates-/24 Tidal V-250 PEEP-5 FiO2-30 pO2-62* pCO2-52* pH-7.39 calTCO2-33* Base XS-4 Intubat-INTUBATED Vent-SPONTANEOU [**2198-5-26**] 12:48AM BLOOD Type-ART Temp-35.4 O2 Flow-30 pO2-124* pCO2-78* pH-7.27* calTCO2-37* Base XS-6 Intubat-NOT INTUBA [**2198-5-22**] 04:15PM BLOOD Glucose-243* Lactate-4.5* Na-145 K-5.0 Cl-103 calHCO3-28 [**2198-5-22**] 04:21PM BLOOD Lactate-4.0* [**2198-5-22**] 06:53PM BLOOD Lactate-0.6 [**2198-5-24**] 02:44AM BLOOD Lactate-0.9 [**2198-5-22**] 04:00PM URINE Blood-MOD Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-SM [**2198-5-22**] 04:00PM URINE RBC-21-50* WBC-[**12-14**]* Bacteri-FEW Yeast-NONE Epi-0-2 [**5-22**] Urine culture negative. Blood cultures x2 negative. [**5-23**] Sputum [**2198-5-23**] 12:33 am SPUTUM Source: Endotracheal. **FINAL REPORT [**2198-5-26**]** GRAM STAIN (Final [**2198-5-23**]): >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM NEGATIVE ROD(S). SMEAR REVIEWED; RESULTS CONFIRMED. RESPIRATORY CULTURE (Final [**2198-5-26**]): SPARSE GROWTH OROPHARYNGEAL FLORA. STAPH AUREUS COAG +. SPARSE GROWTH. Staphylococcus species may develop resistance during prolonged therapy with quinolones. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. Testing of repeat isolates may be warranted. Please contact the Microbiology Laboratory ([**7-/2495**]) immediately if sensitivity to clindamycin is required on this patient's isolate. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN----------<=0.12 S OXACILLIN------------- 0.5 S TRIMETHOPRIM/SULFA---- <=0.5 S [**5-26**] Sputum culture: contaminated [**5-23**] Echo IMPRESSION: Suboptimal image quality. Moderate pulmonary artery systolic hypertension. Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Compared with the report of the prior study (images unavailable for review) of [**2191-5-26**], moderate pulmonary artery systolic hypertension with mild right ventricular enlargement is now identified. Regional left ventricular systolic function now appears preserved. This constellation of findings is suggestive of a primary pulmonary process. [**5-22**] CXR IMPRESSION: 1. Low positioned ET tube approximately 3 cm retraction for optimal positioning is recommended. 2. Fluffy left mid and lower lung opacity could reflect infectious/post- obstructive or aspiration pneumonitis. Given history of malignancy, lymphangitic carcinomatosis remains a differential consideration; however, no prior comparisons for accurate assessment are available. 3. Right hemithorax volume loss, but otherwise not evaluable due to rotation. [**5-24**] CXR IMPRESSION: Interval worsening of left basilar airspace disease and stable left upper lobe airspace disease concerning for infection. Interval placement of tracheostomy tube terminating 4.7 cm above the carina. Stable right-sided post-surgical changes. [**5-26**] CXR IMPRESSION: Background COPD. Superimposed infectious infiltrate or CHF cannot be excluded. However, no significant change is detected compared with one day earlier. [**5-27**] CXR [**Known lastname **],[**Known firstname **] [**Medical Record Number 24814**] M 85 [**2112-10-17**] Radiology Report CHEST (PORTABLE AP) Study Date of [**2198-5-27**] 3:53 AM [**Doctor Last Name **],[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] MED MICU [**2198-5-27**] 3:53 AM CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 24815**] Reason: eval for interval change [**Hospital 93**] MEDICAL CONDITION: 85 year old man with pneumonia, intubated, ?fluid overload REASON FOR THIS EXAMINATION: eval for interval change Final Report HISTORY: Pneumonia, intubated, question fluid overload interval change. CHEST, SINGLE AP VIEW Despite provided history, no ET tube is identified. The lungs are hyperinflated, consistent with COPD. There is considerable respiratory motion blurring detail. Allowing for this, the right lung appearance is grossly unchanged compared with 5/1 and [**5-26**]. However, even allowing for differences in technique, the degree of opacity along the lateral aspect of the left chest appears more pronounced and confluent, particularly at the left lung base. The appearance is more suggestive of parenchymal consolidation than of layering fluid and the opacity does not extendto directly abut the chest wall. Although much of the abnormal appearance could relate to the patient's background COPD, the possibility of an acute superimposed pneumonic infiltrate must be considered. Brief Hospital Course: Mr. [**Known lastname 10132**] is an 85 year old gentleman with a PMH significant for laryngeal CA s/p laryngectomy and trach, COPD, CAD admitted with unresponsiveness, dynamic ST-T wave abnormalities, shock, and respiratory failure. Patient remained vasopressor and vent dependent with BAL growing Pseudomonas. After family meeting, patient's code status was changed to Comfort Measures Only. All medications were stopped and the patient was started on morphine gtt for comfort. He expired shortly thereafter with family at bedside. . # Respiratory failure, requiring mechanical ventilation: The patient presented with respiratory distress that was intially thought to be secondary to pneumonia in conjuction with volume overload. He was managed with antibiotics, including vancomycin and zosyn as well as diuresis with furosemide, which was later limited by hypotension. He also had underlying COPD, an exacurbation of which was thought to contribute as well. This was managed with nebulizers and steroids, initially IV followed by [**Doctor Last Name 2949**] to a standing regimen of rednisone 5 mg daily. His overall respiratory status was tenous and effors to wean off the ventilation were unsucessfull. # Unresponsiveness: This was intially noted in the setting of desaturation to mid to high 70s, and EKG demonstrating ST elevations. Cardiology was consulted and [**Hospital 24816**] medical management for possible ACS. An EEG was performed showing nonspecific findings. Head CT was negative for bleeding. His prognosis for recovery remained poor. The family was updated throughout the patients course. Ultimately a family meeting was conducted to evaluated the goals of care. The family decided to focus towards comfort measures. # Troponin leak and ST elevations: These were most likely consistent with ACS. This was managed medically with ASA, BB, statin and ACEi. Initially he received heparin IV but this was held given concern for active bleeding in the setting of HCT drop (requiring multiple transfusions) and skin echymosses. His BB and ACEi course was intermittent, given his hypotension. His cardiac status was also associated with intermittent bradycardia, also hindering management of his ACS. # Hypotension: This was attributed to ACS and likely cardiogenic shock. He required pressors (at times more than one, including dopamine, norepinephrine and phenylephrine) throughtout most of his ICU stay. His antihypertensive medications were held. CTA chest negative for PE. CT abd/pelvis showed some free fluid in abdomen but no blood. Also, bilateral renal cysts evident. Initially thought to be urine from bladder perforation, CT cystogram obtained which demonstrated no contrast extravasation into peritoneum. Medications on Admission: ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day ATORVASTATIN [LIPITOR] - 20 mg Tablet - 1 Tablet(s) by mouth at bedtime FINASTERIDE [PROSCAR] - 5 mg Tablet - 1 (One) Tablet(s) by mouth once a day FLUTICASONE [FLOVENT HFA] - 110 mcg/Actuation Aerosol - 2 (Two) puffs inhaled once or twice a day as needed for periods of mild exacerbation GABAPENTIN - (Prescribed by Other Provider) - 300 mg Capsule - 1 (One) Capsule(s) by mouth two times a day IPRATROPIUM-ALBUTEROL [COMBIVENT] - 18 mcg-103 mcg (90 mcg)/Actuation Aerosol - 3 puffs inhaled up to four times a day and as needed, up to 14 puffs daily LEVOTHYROXINE [SYNTHROID] - 100 mcg Tablet - 1 (One) Tablet(s) by mouth once a day brand name only, medically necessary. No substitutions - No Substitution LISINOPRIL - (Prescribed by Other Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) - 5 mg Tablet - 2 Tablet(s) by mouth daily OXYGEN - - 2 L/min at night SODIUM CHLORIDE - (Prescribed by Other Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) - 0.9 % Solution for Nebulization - 1 (One) 3ml(s) inhaled via nebulizaiton twice a day in this pt with COPD as needed . Medications - OTC ASPIRIN [ENTERIC COATED ASPIRIN] - (Dose adjustment - no new Rx) - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day HYDROCOLLOID DRESSING [DUODERM CGF DRESSING] - 4" X 4" Bandage - apply to area on buttock every 2-3 days apply to area on buttock and change every 2-3 days NEBULIZER & COMPRESSOR FOR NEB - Device - Use to aerosolize 3 ml of saline into permanent tracheostomy stoma twice a day in this pt with COPD Discharge Medications: Patient expired Discharge Disposition: Expired Facility: [**Hospital3 105**] - [**Location (un) 86**] Discharge Diagnosis: Patient expired Discharge Condition: Patient expired Discharge Instructions: Patient expired Followup Instructions: Patient expired Completed by:[**2199-3-26**] ICD9 Codes: 486, 5070, 5849, 0389, 2449, 2724
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Medical Text: Admission Date: [**2109-11-13**] Discharge Date: [**2109-11-28**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4052**] Chief Complaint: Hypoxia Major Surgical or Invasive Procedure: none History of Present Illness: Pt is a [**Age over 90 **] yo Asian male from NH with multiple medical problems who presents with shortness of breath and hypoxia. Per NH records and family patient had developed cold-like symptoms [**2-22**] days ago. He had a nasal/sinus congestion, cough with yellow sputum, and increasing lethargy. Today at NH he was noted to have PNA on CXR. He was started on Levo/Flagyl but had not received any dosages. He was then seen in the afternoon by his family who found him SOB, gurgling, and disoriented. At this time his O2 sats were noted to be in the 60-70 range. Therefore family asked that the patient be sent to the hospital. . Pt is currently pain free, denies any abd pain, chest pain, diarrhea, nausea, vomiting. . In the ED he was found to be hypoxic with O2 sat of 79% on RA. He was given combivent with minimal improvement and placed on NRB. His lactate was found to be 7.4 and after 3L of fluid came down to 2.4. He was given levofloxacin and clindamycin in the ED. Past Medical History: PMH: Hypothyroid Dementia A.fib h/o CVA BPH Depression Dysphagia CHF- EF 30% CRI- Baseline cr 1.7 Anemia h/o bilateral renal stones(uric acid) h/o GIB (duodenal/gastric ulcers) Social History: Currently lives in a NH. Per old records no ETOH/tobacco use. Family History: NC Physical Exam: PE T 97 BP 97/50 [**Last Name (un) **] 69 HR 88 RR 20 O2sats 96% 70% Shovel Gen: Awake, following commands, A&O times 2(did not know date) HEENT: Unequal pupils, both reactive to light Lt 5mm Rt 3mm, EOMI, dry mm, anicteric Neck: no JVD Lungs: Signficant upper airway sounds, gurgling, bilateral basilar crackles Heart: Irregularly, irregular Abd: Soft, NT, ND hypoactive BS, + abd scar Ext: No edema, cyanosis Neuro: A& O times 2, CN 2-12 intact, strength 5/5 bilaterally in UE/LE Pertinent Results: SPUTUM GRAM STAIN (Final [**2109-11-14**]): >25 PMNs and <10 epithelial cells/100X field. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE ROD(S). 2+ (1-5 per 1000X FIELD): GRAM NEGATIVE DIPLOCOCCI. RESPIRATORY CULTURE (Final [**2109-11-16**]): SPARSE GROWTH OROPHARYNGEAL FLORA. YEAST. SPARSE GROWTH. . CXR: [**2109-11-13**]: IMPRESSION: Development of bilateral pulmonary opacities. The differential includes multifocal pneumonia versus atypical pattern of CHF, given underlying emphysema. . ECG: Afib at 81, LAD, no ST/T wave changes . ECHO '[**06**]- Conclusions: The left atrium is moderately dilated. No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). The right atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is moderate global left ventricular hypokinesis. No masses or thrombi are seen in the left ventricle. The right ventricular cavity is dilated with moderate global free wall hypokinesis. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but not stenotic. Mild to moderate ([**12-23**]+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate to severe (3+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. There is no pericardial effusion. IMPRESSION: Biventricular hypokinesis. Moderate-severe mitral regurgitation. Pulmonary artery systolic hypertension. Moderate-severe tricuspid regurgitation. . [**2109-11-13**] 05:30PM CK-MB-4 cTropnT-0.04* proBNP-[**Numeric Identifier 14891**]* [**2109-11-13**] 11:39PM ART PO2-299* PCO2-40 PH-7.34* TOTAL CO2-23 BASE XS--3 [**2109-11-13**] 11:39PM LACTATE-4.7* [**2109-11-13**] 06:06PM LACTATE-7.4* [**2109-11-13**] 05:30PM GLUCOSE-94 UREA N-44* CREAT-2.3* SODIUM-145 POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-21* ANION GAP-23* [**2109-11-13**] 05:30PM WBC-10.5 RBC-4.60 HGB-12.7* HCT-40.5 MCV-88 MCH-27.6 . [**2109-11-18**] Video Swallowing Study: FINDINGS: Oral and pharyngeal swallowing videofluoroscopy was performed in collaboration with the speech therapist. Two teaspoons of nectar thick liquid barium were administered. The patient aspirated both times without spontaneous coughing. Cued cough was ineffective in clearing the aspirated material. [**Known lastname **] tuck position did not prevent aspiration. The exam was subsequently discontinued given the patient's tenuous respiratory status. Brief Hospital Course: In the ED the pt was found to be hypoxic with O2 sat of 79% on RA. He was given Combivent with minimal improvement and placed on NRB. CXR on admission showed bilateral lower lung field infiltrates, and he was given levofloxacin and clindamycin in the ED. On admission, his lactate was also found to be 7.4 and after 3L of fluid came down to 2.4. . The patient was admitted to the MICU, where Levo/Flagyl were started for tx of presumptive aspiration pneumonia; Vancomycin was also started for empiric coverage for MRSA as pt is a nursing home resident. The pt received aggressive chest physiotherapy, albuterol/atrovent nebulizers PRN, O2 by face tent (pt is a mouth breather). Sputum was sent for culture [**11-14**]. Speech and swallow consult was obtained, and pt was deemed to be at high risk for aspiration, and pt was made NPO with NGT recommended for nutrition/hydration. . The pt's hypoxia was also thought to be also due in part to CHF, as pt's EF 30% per [**9-23**] Echo, and BNP [**Numeric Identifier 14892**]. However, pt appeared intravascularly depleted, with reported poor PO's and thirst; diuresis was also held given h/o CRI, with increased Cr on admission thought to be secondary to pre-renal azotemia. Pt received gentle boluses of NS, then LR (given low bicarbonate) for intravascular fluid repletion as well as for tx of low UOP. . The patient was called out of the ICU to regular inpatient floor [**11-15**], as his O2 saturation had improved greatly to 95-96% with blow-by O2 (face tent not on face, lying on chest). . HOSPITALIZATION COURSE - REGULAR INPATIENT FLOOR: 1) ID/ PNA: Pt with initial hypoxia, has transitioned from face tent to O2 by NC, with improved O2 sats on NC to 99-100% on 2L, 93-95%RA; productive cough improved and ultimately resolved, pt appears much more comfortable with respiration. Pt was continued on Vancomycin, Levo, Flagyl until sputum culture came back; as no evidence of MRSA, Vancomycin was discontinued. He ultimately completed a 2 week total course of Levaquin and Flagyl, ending with doses given on [**11-28**]. The patient was never febrile; his WBC increased transiently to 18, but quickly decreased to WNL. He was maintained on aspiration precautions, daily chest physiotherapy for loosening of secretions, and daily albuterol/atrovent nebulizers. He had negative blood cultures, UCx negative [**11-18**], [**11-20**], C. diff negative [**11-17**] . 2) CHF: Pt has EF of 30%, BNP [**Numeric Identifier 14892**]. Pt had evidence of pulmonary edema on exam with lung crackles and LE edema. He was started on Lasix 10 mg IV given [**11-18**], pt responded with good diuresis; he was transitioned to 10 mg per G/J tube on [**11-27**]. His Cr was monitored cloesly and actually normalized while on diuresis, as he was simultaneously hydrated and given gentle free water repletion IV for dehydration and intravascular depletion and hypernatremia, then per G/J tube when placed. He is not on an ACEI, but one was not started at this time given ARF. . 3) ARF: Pt with baseline creatinine of 1.7 from [**2106**], increased up to 2.3 on admission. Likely pre-renal, as the patient had had poor PO intake prior to admission, and the pt consistently complained of thirst and requested water. Urine Na 19, also sign of sodium avidity. With gentle hydration, the pt's Cr gradually improved to 1.3 . 4) Afib: Rate controlled on metoprolol IV - then per G/J tube for rate control. Metoprolol given w/ holding parameters given low BP. Pt has not been on anti-coagulation, per NH. Had been on coumadin in the past, but discontinued [**1-23**] GI bleed . 5) FEN- NPO given aspiration risk. Pt failed both bedside and video speech and swallow, and was found to have no gag reflex and silent aspiration. The patient was NPO w/ aspiration precautions, then given PPN for a short course prior to receiving G/J tube placement by IR [**11-26**]. He was started on tube feeds, Probalance 15 cc-> 55 cc/hr, with 150 cc H20 boluses. This was increased to 200 cc boluses as UOP slightly decreased and concentrated on day of discharge. He tolerated tube feeds with low residuals and no leakage. **NOTE**: G/J tube held in place w/ T- fasteners sutured to skin - will need these d/c'd in [**6-30**] days, can be done by RN in NH, just need to cut sutures holding fasteners in place (NOT sutures holding PEG in place) The patient also required care for oral hygiene, slightly wet sponges for oral comfort given thirst. . 6) Coagulopathy: - The pt was found to have increased INR from baseline of 1.3-1.6, up to 2.0. The pt had not been on coumadin, per NH. LFT's normal, no evidence of DIC, normal platelets, possible nutritional deficiency. He received 3 day courses of Vitamin K x 2 during admission. INR on discharge was 1.6 . 7) Anemia: - Uncertain etiology, normal MCV so B12/Folate deficiency unlikely, pt has h/o GI bleeds, guaiac negative. Hcts were stable during admission, Hct on day of discharge 34.8. . 8) Lactate - Lactate initially elevated on admission, likely due to dehydration/hypoperfusion, hypoxia, subsequently improved w/ hydration. . 9) Hypothyroidism - Levothyroxine per home regimen . 10) BPH - Possible traumatic foley placement, with hematuria (now resolved). 11) Dementia: - Initially on Doxepin; Zyprexa PRN/HS, however, pt never demonstrated any agitation or confusion, and did not receive these medications, and they were discontinued. 12) Peripheral neuropathy: - Pt seen by neurology consult, initially for evaluation of limited speech. Found to be able to verbalize with no focal deficits and normal cranial nerve exam - and that pt does not like to speak secondary to oral dryness and discomfort. However, pt found to have a distal sensory polyneuropathy, for which he had a negative work-up, with negative ESR, A1C, RPR; only abnormal TSH given hypothyroidism. - Pt followed by PT during admission, and deemed to be safe to be discharged. Able to ambulate with assist. Only requires further PT for mobility. 13) Code- DNR/DNI; confirmed by Dr. [**Last Name (STitle) 1266**] and son [**Name (NI) **] [**Name (NI) **]. Medications on Admission: Meds: Furosemide 10mg qday, metoprolol 12.5mg [**Hospital1 **], MVI, synthroid 50 mcg qday, Vit C, zyrtec 10mg qday, colace, ranitidine 150mg [**Hospital1 **], doxepin 10mg qhs, tylenol prn, albuterol nebs, Urocit-K 5meQ qday . All: NKDA Discharge Medications: 1. NURSING ORDER To RN: PLEASE D/C FASTENER'S HOLDING G/J TUBE TO SKIN IN 7 DAYS - these are the barrel shaped pieces of cotton with protruding wires. Please cut wires, they will recede into abdomen and will be resorbed. Please do not cut sutures tied directly around G/J tube! Thank you 2. Albuterol Sulfate 0.083 % Solution [**Hospital1 **]: One (1) Inhalation Q6H (every 6 hours). 3. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) Inhalation Q6H (every 6 hours). 4. Furosemide 40 mg/5 mL Solution [**Hospital1 **]: Ten (10) mg PO DAILY (Daily). 5. Levothyroxine 25 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 7. Senna 8.8 mg/5 mL Syrup [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a day) as needed. 8. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO BID (2 times a day). 9. Therapeutic Multivitamin Liquid [**Last Name (STitle) **]: One (1) Cap PO DAILY (Daily). 10. Chlorhexidine Gluconate 0.12 % Mouthwash [**Last Name (STitle) **]: One (1) ML Mucous membrane [**Hospital1 **] (2 times a day). 11. Guaifenesin 100 mg/5 mL Syrup [**Hospital1 **]: 5-10 MLs PO Q6H (every 6 hours) as needed. 12. Acetaminophen 160 mg/5 mL Solution [**Hospital1 **]: One (1) PO Q4-6H (every 4 to 6 hours) as needed. 13. Docusate Sodium 150 mg/15 mL Liquid [**Hospital1 **]: One (1) PO BID (2 times a day) as needed. 14. Bisacodyl 10 mg Suppository [**Hospital1 **]: One (1) Suppository Rectal HS (at bedtime) as needed. Discharge Disposition: Extended Care Facility: [**Hospital1 2670**] - [**Location (un) **] Discharge Diagnosis: Presumed aspiration pneumonia, chronic renal insufficiency/acute renal failure, dehydration, anemia, atrial fibrillation, congestive heart failure Discharge Condition: Stable Discharge Instructions: Please take your medications as written. Call your primary care physician with worsening cough, chest pain, fever, shortness of breath, confusion, any other worrisome symptoms Followup Instructions: Please call for an appointment to follow up with Dr. [**Last Name (STitle) 1266**] in [**12-23**] weeks ([**Telephone/Fax (1) 8417**] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 4055**] Completed by:[**2109-11-28**] ICD9 Codes: 5070, 5849, 5859, 2760, 2449, 2859
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Medical Text: Admission Date: [**2167-5-14**] Discharge Date: [**2167-5-21**] Date of Birth: [**2107-6-10**] Sex: F Service: MEDICINE Allergies: Demerol / Propofol Analogues / Cefazolin Attending:[**Last Name (NamePattern1) 13129**] Chief Complaint: left knee pain Major Surgical or Invasive Procedure: left total knee replacement/cardiac catheterization History of Present Illness: Ms. [**Known lastname 6633**] is a 59 yo woman with PMH significant for asthma (FEV1 39% predicted, FVC 44% predicted) s/p multiple intubations after operations, presents after left total knee arthroplasty for DJD with hypoxia and tachypnea. . Initial exam notable for marked prolonged expiratory phase, limited air movt, and wheezing. She received [**3-27**] albuterol nebulizer and a racemic epi nebulizer in the PACU with some improvement of her symptoms. She initially described chest pressure and once her air movt improved described [**5-3**] SSCP worse with cough and expiration. OF note, she received 1800 cc in OR with minimal blood loss. . ABG s/p several nebulizer treatments was 7.3/60/108 with RR~25, HR 70, BP 127/63 and FiO2 60-70% by face mask. EKG notable for sinus rhythm with significant artifact and no ischemic changes compared to a prior two weeks old. After several nebulizer treatments, air movement improved and she was noted to have crackles to the mid lung fields bilaterally. She was given 40 IV lasix on arrival to the MICU. She has no documented hx of heart failure. She does have CAD s/p PTCI in [**2165**] and held her plavix preoperatively. . Of note, she had an almost identical episode after her last TKR in [**2162**] during which she was re-intubated post-op and also had SSCP which was evaluated with serial cardiac enzymes and ultimately a dobutamine stress test. Past Medical History: 1)Asthma/reactive airway disease for the past 15 years with a history of at least five intubations, with at least two this year after minor operations on her right lower extremity. 2)status post-right knee arthroscopy in [**Month (only) 547**] of this year, which is complicated by respriatory failure and two days intubation in the [**Hospital Unit Name 153**] at [**Hospital3 **]. 3) Status post-right toe bunionectomy, complicated by a respiratory failure at [**Hospital 487**] Hospital earlier this year. 4) s/p cardiac catheterization at [**Hospital3 **] with a question of coronary artery stenting at that time in approximately [**Month (only) 205**] of this year. 5)anemia 6)hyperlipidemia 7)hepatic steatosis noted on imaging 8)hypertension, with a history of hypertensive urgency in [**Month (only) 547**] of this year, an echo in [**Month (only) 547**] of this year showed an EF of 65% and 1 to 2+ MR. 9) status post-hysterectomy. 10)Status post- appendectomy 11)Status post-perforated colon? cancer, requiring ostomy in the past. Social History: per OMR: She lives in [**Hospital1 487**], alone. She is retired. She has a 30 pack year history of smoking, which she quit smoking five years ago. She had started smoking at the age of 15. She denies alcohol or elicit drug use. She has no history of asbestos exposure. Family History: per OMR: Non-significant for any pulmonary problems. [**Name (NI) **] father did have an MI at age 60. . Physical Exam: well appearing, well nourished 59 year old female alert and oriented no acute distress RLE: -dressing-c/d/i -incision-c/d/i -+AT, FHL, [**Last Name (un) 938**] -SILT -brisk cap refill -calf-soft, nontender -NVI distally Discharge Physical Exam: Temp: 99.4 BP: 80-110/40-80 HR 70-80's 18 96% RA. Gen: NAD, not-uncomfortable, able to lay on her side General: MMM, CVL site on R neck, C/D/I. Bandage in place non-tender to palpation Res: Decreased air movement bilaterally, but no wheezes, crackles or rhonchi CV: Normal S1, and S2, with II/VI systolic murmur at LSB, radiating to LUSB. ABD: Soft, NT, ND +BS, no rebound or guarding Ext: L knee, sutures in place, DP2+, PT 2+ bilaterally, with L pre-tibial edema, and L thigh ecchymosis and L thigh edema. No point tenderness over the knee. R leg without edema. Her LUE had a PICC line that was c/d/i without any erythema. Pertinent Results: Admission: [**2167-5-14**] 08:30PM BLOOD WBC-16.9*# RBC-3.95* Hgb-12.0 Hct-35.6* MCV-90 MCH-30.4 MCHC-33.7 RDW-11.9 Plt Ct-177 [**2167-5-15**] 01:41AM BLOOD Neuts-91.8* Lymphs-5.3* Monos-2.6 Eos-0.1 Baso-0.1 [**2167-5-14**] 08:30PM BLOOD Plt Ct-177 [**2167-5-14**] 08:30PM BLOOD Glucose-244* UreaN-19 Creat-1.0 Na-141 K-3.5 Cl-102 HCO3-29 AnGap-14 [**2167-5-14**] 08:30PM BLOOD CK(CPK)-66 [**2167-5-14**] 08:30PM BLOOD CK-MB-2 cTropnT-<0.01 [**2167-5-14**] 08:30PM BLOOD Calcium-8.7 Phos-4.0 Mg-2.0 [**2167-5-17**] 05:55AM BLOOD calTIBC-267 Ferritn-167* TRF-205 [**2167-5-15**] 01:41AM BLOOD %HbA1c-6.9* eAG-151* . Imaging: . ECHO showed: mildly dilated L atrium, with normal left ventricular wall thicknesses and size. Left ventricular systolic function is hyperdynamic (EF 80%). There is a mild resting left ventricular outflow tract obstruction. RV wnl. Study is inadequate to exclude significant aortic valve stenosis. Moderate pulmonary artery systolic hypertension. There is no pericardial effusion. . COMMENTS: 1. Selective coronary angiography in this right dominant system demonstrated single vessel coronary artery disease. The first diagonal contained a 60% lesion that appeared to be hazy on angiography. The right coronary, circumflex and left main were all free of angiographically apparent flow limiting disease. The circumflex arose from a separate origin in the right coronary cusp. 2. The patient had a hazy first diagonal lesion. Her pain was ongoing and was made worse during balloon inflation. It was better after stenting. FINAL DIAGNOSIS: 1. Successful BMS to diagonal lesion 2. Single vessel coronary artery disease 3. Normal systemic blood pressures. . CXR (ICU):FINDINGS: In comparison with the study of [**4-30**], there is ill-defined opacification at the left base silhouetting the hemidiaphragm and descending aorta. Although this could merely reflect atelectasis, in the appropriate clinical setting, an infectious process must be considered. . Right IJ catheter extends to the lower portion of the SVC. No evidence of vascular congestion. . CT Knee: Large left knee hemarthrosis. Additional focus of hyperdensity seen around the deep sutures may represent hematoma as well. Brief Hospital Course: The patient was admitted to the orthopaedic surgery service and was taken to the operating room for total knee replacement. Please see separately dictated operative report for details. The surgery was uncomplicated and the patient tolerated the procedure well. Patient received perioperative IV antibiotics. Postoperative course was remarkable for the following acute hypoxic respiratory failure with a Transfer to [**Hospital Unit Name 153**] for acute respiratory distress which was multifactorial: asthma exacerbation and possible flash pulmonary edema. [**Hospital Unit Name 13533**]: Patient was transferred to [**Hospital Unit Name 153**] given concern for increased work of breathing after extubation in PACU. Initial exam was notable for poor air movement and bilateral wheezing. Air movement improved with multiple nebulizer treatments and lung exam then revealed wheezing. Patient was treated with Albuterol and Ipratropium nebs in the [**Hospital Unit Name 153**] and was weaned to NC. She was also given IV Lasix for concern for volume overload contributing to her symptoms. Her respiratory distress was thought to be most likely due to bronchospasm from ETT, given hx of asthma and repeated history of respiratory distress after similar episodes. However, she was also given a short steroid taper for potential asthma exacerbation. . Interestingly, the patient had elevated lactate in post-operative setting, attributed to albuterol. This trended down without intervention. . Of note, the patient had chest pain on night of admission, as well as two episodes the following day. During all episodes, she had normal EKG and serial cardiac enzymes were negative. She was treated with sublingual nitro without response, but pain dissipated with morphine. Cardiology was consulted given past history and outpatient symptoms consistent with increasing anginal pain. Cardiology elected to cath her, and thus, at the time of discharge from the ICU, she was transferred to the medicine service. . Upon arrival to the medicine/cardiology service the patient was chest pain free. Her case was discussed with the interventional cardiologist who felt she should undergo cardiac catheterization for crescendo angina. The night before catheterization she was trasnsitioned from subcutaneous lovenox to heparin drip for anti-coagulation. At that time she did not report any knee pain. Subsequently she went to Catheterization which revealed CAD (see report for specific details, in brief: she had single vessel CAD and a BMS was placed to a diagonal lesion). Post Cath she began to complain of increasing knee pain and chest pain. A CT of her R knee showed a hematoma and her case was discussed with Orthopedics. The orthopaedics service recommended aggressive pain control, compression, ice, compression stockings, PCM, but did not recommend a surgical intervention. She was also restarted on lovenox daily for DVT prophylaxis. Her knee pain persisted despite escalating dose of short acting PO narcotics, until long acting narcotics were initiated. Additionally, her chest pain resolved, after administration of pain medication, and serial ECG's did not demonstrate in-stent thrombosis. She also had serial cardiac enzymes which remained normal. Of note, at the time of her chest pain she had a drop in her Hgb which was believed to be secondary to the development of her large knee hematoma. She was transfused 1 unit of PRBC, and her HgB remained stable. She also had a persistent leukocytosis that was attributed initially to her steroid taper, and then to a stress response after the development of the hematoma. Prior to discharge, and her pain was well controlled. She was kept on Lantus and an ISS for hyperglycemia which was secondary to DMII given her HgBAIC was 6.9%. Transitional Issues: - Patient was discharged on Post-Op day #7. - Follow up hemoglobin/hematocrit - Blood pressure: Her systolic pressure in the morning after administration of long acting nitrates was in the morning was in the mid 80's. She was asymptomatic. She may need titration of her blood pressure medications. Her beta blocker was not increased due to concern that she had a bronchospasm post cath. Her beta blocker may need to be titrated as an outpatient. - Anticoagulation: 1-3 weeks post discharge: ASA 325 daily, Plavix 75 daily, Lovenox 40 mg subq daily 4-6 weeks post discharge: ASA 325 [**Hospital1 **], Plavix 75 daily After 7 weeks post discharge: ASA 325 daily, Plavix daily - The patient has had a low grade fever 99 for several days prior to discharge. She has been cultured without evidence of infection. Her CXR does not show a PNA. If the patient spikes please re-culture. Outpatient Follow up: 1) PCP: [**Name10 (NameIs) **] need to help start oral medications for her new diagnosis of DMII, follow up blood cultures 2) Cardiologist: Will need to up-titrate her beta-blocker in the setting of her recent stent placement and progressive angina. 3) Orthopedics Patient was discharged to: Extended Care Facility: Wood Mill Care and Rehab Ctr Medications on Admission: albuterol, amlodipine, ASA, atrovent, claritin, colace, flovent, metoprolol, nitrostat, restasis, hydrocortisone cream, percocet, plavix, pravachol, serevent Discharge Medications: 1. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe Subcutaneous once a day for 3 weeks: Take until [**2167-6-11**]. Please take your ASA and plavix. Disp:*21 syringe* 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. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): hold for loose stools. Disp:*60 Tablet(s)* Refills:*2* 4. aspirin, buffered 325 mg Tablet Sig: One (1) Tablet PO twice a day for 3 weeks: AFTER completing all lovenox injections, please take as directed with food. once you have finished the 3 weeks of twice daily aspirin, you may resume your preoperative regimen of plavix 75mg and aspirin 81mg daily. Disp:*42 Tablet(s)* Refills:*0* 5. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day. 6. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 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. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig: 15-30 MLs PO Q6H (every 6 hours) as needed for Dyspepsia. 9. multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 10. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain. 11. pravastatin 20 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). 12. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Please take while taking your lovenox injections. Once you finish your lovenox injections, please take [**Hospital1 **] as intructed for 3 weeks and then resume once weekly dosing. 13. cyclosporine 0.05 % Dropperette Sig: One (1) Dropperette Ophthalmic [**Hospital1 **] (2 times a day). 14. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 15. insulin glargine 100 unit/mL Cartridge Sig: One (1) variable Subcutaneous at bedtime: Please see attached ISS. 16. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. 17. ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. 18. morphine 15 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO Q12H (every 12 hours). 19. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 20. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 21. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day). 22. lisinopril 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 23. ondansetron HCl (PF) 4 mg/2 mL Solution Sig: Two (2) Injection Q8H (every 8 hours) as needed for nausea/vomiting. 24. heparin, porcine (PF) 10 unit/mL Syringe Sig: Two (2) ML Intravenous PRN (as needed) as needed for line flush. 25. Flovent Diskus 250 mcg/Actuation Disk with Device Sig: Two (2) Inhalation twice a day. 26. salmeterol 50 mcg/dose Disk with Device Sig: One (1) Inhalation twice a day. 27. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) Inhalation twice a day. Discharge Disposition: Extended Care Facility: Wood Mill Care and Rehab Ctr Discharge Diagnosis: left knee osteoarthritis CAD s/p stent 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: 1. Please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. Please follow up with your primary physician regarding this admission and any new medications and refills. 3. Resume your home medications unless otherwise instructed (see below). Please take Lovenox as prescribed, plavix, and aspirin 4. You have been given medications for pain control. Please do not drive, operate heavy machinery, or drink alcohol while taking these medications. As your pain decreases, take fewer tablets and increase the time between doses. This medication can cause constipation, so you should drink plenty of water daily and take a stool softener (such as colace) as needed to prevent this side effect. Call your surgeons office 3 days before you are out of medication so that it can be refilled. These medications cannot be called into your pharmacy and must be picked up in the clinic or mailed to your house. Please allow an extra 2 days if you would like your medication mailed to your home. 5. You may not drive a car until cleared to do so by your surgeon or your primary physician. 6. Please keep your wounds clean. You may shower starting five (5) days after surgery, but no tub baths or swimming for at least four (4) weeks. No dressing is needed if wound continues to be non-draining. Any stitches or staples that need to be removed will be taken out by the visiting nurse (VNA) or rehab facility two weeks after your surgery. 7. Please call your surgeon's office to schedule or confirm your follow-up appointment in four (4) weeks. 8. Please DO NOT take any non-steroidal anti-inflammatory medications (NSAIDs such as celebrex, ibuprofen, advil, aleve, motrin, etc). 9. ANTICOAGULATION: Please continue your lovenox for three (3) weeks to help prevent deep vein thrombosis (blood clots). After completing the lovenox, please take Aspirin 325mg TWICE daily for an additional three weeks. Once you have completed the 3 weeks of aspirin therapy twice a day, you may resume your pre-operative regimen of plavix 75mg and aspirin 325 mg daily. [**Male First Name (un) **] STOCKINGS x 6 WEEKS. 10. WOUND CARE: Please keep your incision clean and dry. It is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four (4) week checkup. Please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. Check wound regularly for signs of infection such as redness or thick yellow drainage. Staples will be removed by the visiting nurse or rehab facility in two (2) weeks. 11. VNA (once at home): Home PT/OT, dressing changes as instructed, wound checks, and staple removal at two weeks after surgery. 12. ACTIVITY: Weight bearing as tolerated on the operative extremity. ROM as tolerated. No strenuous exercise or heavy lifting until follow up appointment. Mobilize. 13. You were given a new diagnosis of DM during your hospital stay, and you will be given insulin at rehab, but should be transitioned to metformin before you go home. 14. The pain in your R knee is from a hematoma that developed after you under went cardiac catheterization. This will resolved after a few weeks. The following medication changes where made: DO NOT STOP: Aspirin daily or [**Hospital1 **] (please see medication worksheet), Plavix, or Lovenox (only three weeks) ADDED: Imdur, senna, bisacodyl, morphine SR, dilaudid, alum-mag hydroxide-simeth, albuterol nebs PRN, ipratropium nebs PRN, lisinopril, insulin, acetaminophen, multivitamin, zofran CHANGED: Metoprolol, Aspirin STOPPED: percocet Followup Instructions: -Provider: [**First Name11 (Name Pattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3260**], [**MD Number(3) 3261**]:[**Telephone/Fax (1) 1228**] Date/Time:[**2167-6-12**] 11:00 -Please have the rehab facility call your PCP prior to discharge to set up an appointment regarding your new diagnosis of DM. -Please have the rehab facility call your cardiologist prior to discharge to arrange an appointment regarding your coronary artery disease. You had a bare metal stent placed in your heart to help with your symptoms of chest pain. Completed by:[**2167-5-27**] ICD9 Codes: 4111, 2762, 4280, 4019
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Medical Text: Admission Date: [**2195-10-19**] Discharge Date: [**2195-10-22**] Date of Birth: [**2152-8-22**] Sex: M Service: MEDICINE Allergies: Tegretol / Valproic Acid And Derivatives Attending:[**First Name3 (LF) 11040**] Chief Complaint: s/p fall Major Surgical or Invasive Procedure: endotrachial intubation suture of right brow laceration reduction of nasal fractures History of Present Illness: 43 yo man with h/o epilepsy, psychogenic polydipsia, mental retardation with multiple nasal fractures s/p fall who was electively intubated in the ED due to agitation. . Per ED notes, the patient was running to catch a bus, fell down and hit his face. Upon presentation to the ED, initial VS: 88 18 96%. He complained of severe facial pain and had multiple facial lacerations. CT scan sinus/head/spine revealed multiple communited nasal and maxillofacial fractures; no spine fx or acute intracranial event. . Throughout ED course, he was agitated and received in total 25mg halidol, 10mg ativan. He transiently desaturated to 88% on 100% NRB with concern for possible aspiration event. Due to continued agitation, he was electively intubated. Plastic surgery was consulted and repaired lacerations, reduced fractures. He also received levofloxacin 500mg x 1 for possible aspiration pneumonia Past Medical History: - Developmental delay / Mental Retardation - Seizure Disorder - Mood disorder (? type) - Hypertension - Chronic Hyponatremia - Left ventricular hypertrophy - History of pulmonary edema and ascites - Dyslipidemia - Obstructive sleep apnea, unable to tolerate CPAP Social History: Unable to live independently, non-smoker. No drug use. Independent in basic activities of daily living. Has a guardian responsible for health care decisions Attends a day program, but the program is not very active, patient probably sits most of the day Family History: unknown to staff, unable to obtain from patient Physical Exam: VS: Temp: afebrile BP: 129/84 HR: 93 RR: 12 O2sat: 100% GEN: intubated, responds to sternal rub HEENT: b/l orbital ecchymoses, nasal splint in place; right brow laceration with sutures c/d/i; midface stable to palpation; poor dentition with ET tube in place NECK: in c-spine collar RESP: CTA b/l with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: b/l knee abrasions, left elbow abrasion NEURO:PERRL, face symmetric; moves all extremities Pertinent Results: Labs: [**2195-10-19**] 10:00AM WBC-10.9 RBC-5.04 HGB-15.8 HCT-45.9 MCV-91 MCH-31.3 MCHC-34.4 RDW-14.0 [**2195-10-19**] 10:00AM NEUTS-81.9* LYMPHS-11.4* MONOS-5.1 EOS-0.6 BASOS-0.9 [**2195-10-19**] 10:00AM PLT COUNT-170 [**2195-10-19**] 10:00AM PT-12.6 PTT-26.0 INR(PT)-1.1 [**2195-10-19**] 10:00AM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007 [**2195-10-19**] 10:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2195-10-19**] 07:40PM TYPE-ART TEMP-39.0 O2-100 PO2-252* PCO2-48* PH-7.40 TOTAL CO2-31* BASE XS-4 AADO2-431 REQ O2-73 INTUBATED-INTUBATED [**2195-10-19**] 10:00AM GLUCOSE-135* UREA N-19 CREAT-0.9 SODIUM-141 POTASSIUM-4.2 CHLORIDE-101 TOTAL CO2-30 ANION GAP-14 Imaging: MRI cervical spine: Study is limited due to patient motion. Within this limitation, there is no definite abnormal cord signal identified. Specifically, there is no evidence of cord contusion or extra-axial fluid collection to suggest epidural hematoma. There is no abnormal STIR signal identified on sagittal imaging to suggest ligamentous injury or acute fracture. Small amount of increased fluid signal anterior to the vertebral bodies likely represents fluid within the nasal and oropharynx due to recent intubation rather than prevertebral or retropharyngeal edema. This exam was not tailored for degenerative changes, although there is no significant canal stenosis identified at any level. IMPRESSION: No evidence of ligamentous injury or cord injury identified CT maxillofacial/ mandible/ sinus: B/L Nasal bone fractures with postero-medial displacement of right sided distal fracture fragment. Comminuted fracture of the nasal septum with right sided displacement of fracture fragments. Significant sinus disease. CT spine: No cervical spine fractures. Endotrachial and OG tubes. B/L lung consolidations consistent with aspiration CT head w/o contrast: No hemorrhage, large territorial infarct, or mass effect. Nasal bone fractures as described in facial CT. CXR: Single AP supine portable view of the chest is obtained. Endotracheal tube is in place with its tip located approximately 3.4 cm above the carina. An NG tube is seen extending into the left upper quadrant. The lungs appear clear despite low lung volumes. Cardiomediastinal silhouette appears grossly unremarkable. IMPRESSION: Adequate position of the ET and NG tubes Brief Hospital Course: 43 yo man with h/o epilepsy, psychogenic polydipsia, mental retardation with multiple nasal fractures s/p fall who was electively intubated in the ED due to agitation Nasal and maxillofacial fractures: Presented with communited fractures of nasal septum that were reduced by plastic surgery in the emergency department. A nasal splint was alos placed and keept in place until [**10-22**]. Per plastic surgery recommendations, patient was placed on 7 day course of augmentin to end [**10-26**]. Maintained sinus precautions i.e. nothing by straw, avoidance of nose blowing, sneezing with open mouth, throughout hospitalization. Follow up arranged with plastic surgery as an outpatient. status post mechanical fall: Presented following a mechanical fall with multiple lacerations and nasal fractures (see above). Patient was placed in a cervical collar until c-spine was cleared by CT spine and MRI (performed due to inability to clinically clear given underlying mental retardation and sedating medication side effects). Intubated in emergency department due to agitation for laceration repair and reduction of fractures. Trauma team followed patient with secondary and tertiary survey and determined no further evidence of injury. status post intubation: As above, patient intubated in emergency department mostly due to agitation. Reportedly had episode of hypoxia to 88% on 100% NRB in the ED in the setting of agitation. Although there was initial concern that this may have represented aspiration of oropharyngeal secretions, no clear infiltrate was seen CXR and vent settings were able to be weaned quickly. Sputum cx did grow GPC in chains and clusters and patient was continued on augmentin per plastic surgery recommendations for laceration/ nasal fractures. Patient was extubated without difficulty and had no further oxygen requirements. Mood disorder: per ED, agitated and violent, requiring multiple sedatives and eventual intubation. Patient was restarted on all of his home medications (risperidol was substituted for home paliperidone while intubated due to inability to give down orogastric tube). Following extubation, patient required no further doses of ativan or halidol. Seizure d/o: stable, continued on home lamotrigine and gabapentin Medications on Admission: gabapentin 1600mg TID - dilantin 130mg qam, 160mg qpm - nadolol 240mg qam - lamotrigine 75mg [**Hospital1 **] - furosemide 40mg qam - MVI - docusate 100mg [**Hospital1 **] - senna 8.6mg qpm - calcium/ vitamin D - olanzipine 40mg QHS - cogentin .5mg [**Hospital1 **] - paliperidone 9mg qam chlorhexidine, sodium fluoride, debrox 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. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 3. docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 4. nadolol 80 mg Tablet Sig: Three (3) Tablet PO QAM (once a day (in the morning)). 5. benztropine 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. lamotrigine 25 mg Tablet Sig: Three (3) Tablet PO twice a day. 7. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day. 8. paliperidone 9 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO DAILY (Daily). 9. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 4 days. Disp:*9 Tablet(s)* Refills:*0* 10. gabapentin 400 mg Capsule Sig: Four (4) Capsule PO TID (3 times a day). 11. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every [**3-31**] hours as needed for pain: do not exceed 4 grams acetaminophen daily. Do not drink or drive with this medication . Disp:*15 Tablet(s)* Refills:*0* 12. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every [**3-31**] hours as needed for pain: do not exceed 4 grams daily. 13. multivitamin Tablet Sig: One (1) Tablet PO once a day. 14. Vitamin D 400 unit Capsule Sig: One (1) Capsule PO twice a day. 15. Calcium 500 500 mg (1,250 mg) Tablet Sig: One (1) Tablet PO three times a day. 16. phenytoin sodium extended 100 mg Capsule Sig: One (1) Capsule PO twice a day. 17. Dilantin 30 mg Capsule Sig: One (1) Capsule PO twice a day. 18. Dilantin 30 mg Capsule Sig: One (1) Capsule PO Qpm. Discharge Disposition: Home Discharge Diagnosis: Communited nasal fractures Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to the hospital following a mechanical fall with a broken nose and several cuts that needed to be sutured. In the emergency department you were very agitated, probably because you were in pain. To fix the fractured bones and repair the cuts, you were given sedation and intubated. Your cuts were sutured and your fractures reduced. You had a CT scan and MRI of your cervical spine to ensure that you had not injured your neck: these were normal. You were able to have the breathing tube removed. You will need to take antibiotics for a total of 7 days to protect your cuts from becoming infected. You will need to follow up with the plastic surgeons on Friday (see below). Prior to seeing the plastic surgeons make sure that you keep your wounds clean and dry, apply bacitracin ointment to your wounds and do NOT drink through a straw or blow your nose. Please make the following changes to your medications: - please take augmentin 875mg twice daily for a total of 7 days (last day [**2195-10-26**]) Please take your other medications as previously prescribed Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 22438**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2196-1-5**] 10:00 Please follow up with your primary care provider [**Last Name (NamePattern4) **] [**12-27**] weeks ICD9 Codes: 5070, 4019, 496
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Medical Text: Admission Date: [**2146-6-4**] Discharge Date: [**2146-7-11**] Date of Birth: [**2066-7-17**] Sex: M Service: SURGERY Allergies: Sulfa (Sulfonamide Antibiotics) Attending:[**First Name3 (LF) 2836**] Chief Complaint: Perforated duodenum s/p laparoscopic cholecystectomy in OSH Major Surgical or Invasive Procedure: [**2146-6-4**]: 1. Exploratory laparotomy with repair of enterotomy in the jejunum. 2. Placement of lateral duodenostomy tube for duodenal perforation. 3. Placement of feeding jejunostomy tube and drainage. . [**2146-6-10**]: Placement of a 10Fr internal-external biliary drain through the right posterior biliary tree. . [**2146-6-16**]: Replacement of 10 French internal-external biliary drainage catheter. History of Present Illness: 79yM s/p laparoscopic cholecystectomy [**2146-6-2**] @ [**Hospital3 **] with intraoperative drain placement for bleeding and mild bile spillage who developed bilious drainage on POD1. He was sent to [**Hospital1 18**] from [**Hospital1 392**] for ERCP and was found to have a duct of Luschka leak and is now s/p CBD stent. He returned to [**Hospital1 **] [**2146-6-3**] in the evening and began to develop some vague abdominal pain. He also became distended. He was tachycardic to HR: 130's overnight. A CXR this AM showed free air and a subsequent CTscan showed free extravasation of contrast into the gallbladder fossa likely from the duodenal stump as well as a large amount of free air, pneumomediastinum and subcutaneous emphysema. Upon transfer to the ICU, he continued to complain of diffuse abdominal pain. He was tachycardic upon presentation to the TSICU and his BP was stable from 107-110 systolic without vasopressors. He had an NGT in place with bilious output and a foley in place with 40cc over 2 hours. Past Medical History: Past Medical History: HTN, prostate CA, duodenal ulcer Past Surgical History: partial gastrectomy with BII reconstruction, prostatectomy with bilateral inguinal node dissection, laparoscopic cholecystectomy Social History: Lives at home with wife who has alzheimer's, and is retired. No EtOH, no tobacco x 20yrs Family History: non-contributory Physical Exam: At time of discharge: Vitals: T 98.2, HR 68, BP 112/55, RR 26, O2sat 96%RA General: Appears well, in no acute distress, alert and oriented to person and place but not to time. Obeys simple commands, awakens and responds to voice and touch. Cardiac: RRR, holosystolic murmur. Pulmonary: Diminished breath sounds in the bilateral lung bases, no rales or rhonchi appreciated. Otherwise, the rest of the lung fields were CTAB. Abdomen: 3 drains in place: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] tube connected to a JP bulb, a T-tube draining the duodenum connected to a JP bulb, and a PTBD drain. All three drains are putting out green, billous appearing discharge. Abdomen was soft, non-tender, non-distended. Drain sites appeared C/D/I, no erythema or discharge. Patient has a small wound open to air inferior to the umbilicus which is healing well. There is no erythema, discharge, or warmth surrounding the wound. Patient has +BS. Skin: Multiple areas of skin breakdown due to tape on abdomen and neck Ext: No lower extremity edema Pertinent Results: [**2146-6-13**] ABD CT: IMPRESSION: 1. Small 1.4 x 3.7 cm focus of peri-hepatic fluid along the course of the duodenostomy tube. 2. Small 2 x 2 x 3cm fluid collection interposed between colon and duodenal stump. 3. Small bilateral pleural effusions and atelectasis. 4. Mild wall thickening of pelvic loops of ileum, cannot exclude enteritis. 5. Subcentimeter left thyroid lobe hypodensities. Consider thyroid ultrasound if clinically appropriate. 6. Indeterminate left renal lesion [**2146-6-15**] PA/LAT: Interval resolution of pulmonary edema with mild persistent bibasilar atelectasis and small right pleural effusion. [**2146-6-15**] LENI: No evidence of deep vein thrombosis in either the right or left lower extremity. [**2146-6-15**] CTA CHEST: IMPRESSION: 1. Apart from an equivocal filling defect in the left lower lobe superior segmental branch there are no filling defects in the main, lobar or segmental branches concerning for pulmonary embolism. 2. Mild paraseptal emphysema. 3. Mild-to-moderate non-serous right pleural effusion accompanying adjacent atelectasis. 4. Bilateral pleural plaques with small nodular calcification suggest prior asbestos exposure. 5. Extensive esophagotracheal aspiration or retained tracheobronchial secretion. [**2146-6-20**] G/GJ/GI TUBE CHECK: 1. Contrast filling the [**Doctor Last Name 406**] drain is worrisome for a leak from the duodenum. 2. Duodenostomy tube appears to be in satisfactory position and unchanged from prior. [**2146-6-21**] ECHO: The left atrium is normal in size. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is small. Left ventricular systolic function is hyperdynamic (EF 80%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The right ventricular free wall is hypertrophied. The right ventricular cavity is dilated with depressed free wall contractility. The aortic valve is not well seen. There is no aortic valve stenosis. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. There is severe mitral annular calcification. Mitral stenosis is present, most likely secondary to severe annular calcification. Tricuspid regurgitation is present but cannot be quantified. There is no pericardial effusion. MICRO: [**2146-6-20**] PERITONEAL FLUID ENTEROBACTER CLOACAE COMPLEX - Resistent to Zosyn, sensitive to cipro STENOTROPHOMONAS (XANTHOMONAS) MALTOPHILIA - Sensitive to Zosyn ACINETOBACTER BAUMANNII - Sensitive to Zosyn, sensitive to cipro [**2146-6-25**] Sputum Cx GRAM NEGATIVE ROD(S). SPARSE GROWTH. GRAM NEGATIVE ROD #2. SPARSE GROWTH. GRAM NEGATIVE ROD #3. RARE GROWTH. YEAST. SPARSE GROWTH. Diagnostic: TTE [**6-21**]- LVEF 80%, mild symmetric LVH, PCWP>18mmHg, RV dilation with depressed free wall contractility, mitral stenosis present & is most likely secondary to severe annular calcification. [**2146-6-25**] CT Abdomen IMPRESSION: 1. Interval decrease in size of the right upper quadrant fluid loculation adjacent to the duodenostomy tube; no discrete wall seen surrounding this fluid. 2. Bilateral pleural effusions, slightly increased on the left. 3. Multiple small calculi in the right kidney, the largest measures 6 mm. 4. Extensive atherosclerotic calcification in the abdominal aorta and calcification of the mitral valve. 5. Bilateral pleural plaques consistent with prior asbestos exposure. [**2146-6-25**] CT Head FINDINGS: There is no evidence of acute intracranial hemorrhage, edema, large vessel territorial infarction, shift of normally midline structures. The ventricles and sulci are prominent, likely representing age-related cortical atrophy. Mild bilateral periventricular white matter hypodensities are identified and likely sequela of chronic small vessel ischemic disease. No acute fractures are identified. Mucosal thickening is noted in bilateral maxillary sinuses as well as the sphenoidal sinuses. Mucosal thickening is also noted in the right mastoid air cells. [**2146-7-6**] EEG IMPRESSION: This is an abnormal continuous ICU monitoring study because of moderate diffuse background slowing and frequent runs of frontal intermittent rhythmic delta activity. These findings are indicative of moderate diffuse cerebral dysfunction which is etiologically non-specific. There is focal slowing over the left hemisphere indicative of more prominent focal dysfunction in this region. No epileptiform discharges or electrographic seizures are present. Compared to the prior day's recording, there is no significant change. [**2146-7-8**] CXR As compared to the previous radiograph, there is no relevant change. Mild elevation of the right hemidiaphragm, borderline size of the cardiac silhouette without pulmonary edema. Unchanged left PICC line. No larger pleural effusions. No pneumothorax. No evidence of pneumonia. Brief Hospital Course: The patient was transferred emergently from [**Hospital3 5365**] on [**2146-6-4**] for duodenal perforation and bile leak s/p laparoscopic cholecystectomy. He was taken immediately to the OR where he underwent exploratory laparotomy with placement of lateral duodenostomy tube for duodenal perforation, repair of enterotomy in the jejunum, and placement of feeding J-tube. He also had an NG tube in place, as well as [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] drain placed intraoperatively and a JP drain from his cholecystectomy at the outside hospital. He was transferred back to the ICU intubated and sedated. In the morning he was weaned from the ventilator and extubated on [**2146-6-5**]. His pain was initially controlled with IV dilaudid, however he had confusion and agitation and all narcotics and benzos were stopped. He required restraints and intermittent haldol to protect his lines. He remained agitated the next night and pulled out his NG tube, which was replaced on [**2146-6-6**]. He remained in the ICU for close monitoring. Tube feeds were started through his J-tube and advanced to goal. Overnight he had an episode of tachypnea and respiratory distress for which he received IV lasix with appropriate diuresis. He also received nebulizer treatments and with improved respiration. During this time his creatinine increased to 1.3 and no further diuresis was performed at this time. He continued to be intermittently confused and on [**6-8**] the geriatric surgery service was consulted and felt he was having delirium. He was changed to seroquel as necessary for agitation given his history of possible Parkinson's disease. His respiratory status was stable and he was transferred to a regular floor bed. On [**6-9**] increased biliary drainage was noted from the [**Doctor Last Name **] drain near the duodenostomy tube, while decreased drainage was observed from the duodenostomy tube. It was felt there was a continued bile leak and on [**6-10**] he underwent placement of percutaneous transhepatic biliary drainage catheter by IR. This was performed under general anesthesia and the patient tolerated it well. He was returned to the floor. His foley catheter was removed and a condom cath was placed. on [**6-11**] the NG tube was removed and the patient was out of bed to chair with assistance. He continued to have intermittent confusion but was not agitated. His creatinine increased to 1.3 with an eventual maximum of 1.5 and his lisinopril was held due to concern for kidney injury. He was seen by PT who recommended rehab when ready for discharge. on [**6-13**] the patient was afebrile but had a rising WBC. He had a CT torso with IV and po contrast that showed several small fluid collections believed to be consistent with normal post-operative changes. on [**6-14**] he had a speech and swallow evaluation in which he was cleared for nectar thick liquids and pureed solids, although he was unable to take in much by mouth. His labs were checked and his WBC was noted to be increasing. on [**6-15**] he continued to be tachypneic with respiratory rate in the high 20s-30s. A blood gas showed respiratory alkalosis. He underwent lower extremity ultrasound studies which were negative for DVT, and a CTA was negative for pulmonary embolism. He remained hemodynamically stable. on [**6-16**] the patient's T-tube continued to have low output while the [**Doctor Last Name **] drain output had increased. The PTC drain output continued to be appropriate. He underwent a repeat cholangiogram which again showed a bile leak from an accessory bile duct. No leak was observed from the cystic duct stump. on [**6-17**] the patient had longer periods of clarity. His labs were checked and his WBC decreased. on [**6-18**] the bilious output from the PTC drain was returned to the patient via the J-tube feeds. He continued to have a weak voice which had not improved significantly over the past several days. ENT was consulted and reported that his vocal cords moved symmetrically, but were atrophic. It was felt that his difficulty with phonation could be due to deconditioning. [**6-19**] the patient was noticed to have dicreased urine output, and his Cre increased to 1.8 (1.3 day before). He received 500 cc LR boluses x 2 and his free H2O was increased via J-tube. Patient was started on 1 to 1 fluid repletions, and his PTBD output was given back via J-tube. [**6-20**] Cre up to 2.1, patient was given IV Bicarb. His respiratory rate remained within 30-36. The patient underwent T-tube study, which demonstrated leak around t-tube captured by [**Doctor Last Name 406**] drain. [**6-21**] Nephrology was consulted for climbing Cre (3.0) and metabolic acidosis, ATN most like s/t recent contrast administration. Nephrology recommendations were followed. The patient underwent cardiac echo, which revealed LVEF 80% and depressed RV function. [**6-22**] Pulmonary was consulted for persisent tachypnea, which thought to be compensatory for metabolic acidosis. The patient's urine output improved, Cre 3.5. The patient received one unit of RBC for HCT 22.6. [**Doctor Last Name 406**] fluid gram stain positive for GNRs, continued Zosyn, Vanc and Fluconazole (renal dose). [**6-24**] Neurology was consulted for altered mental status, tachypnea, and new onset acidosis. Patient was transferred to the ICU and intubated. CT scan of head without contrast revealed no acute process. CT scan of abdomen revealed interval decrease in RUQ fluid loculation, seen on previous CT scan. [**6-27**] His creatinine improved to 2.6, from peak value of 3.8. Patient was taken off of zosyn and cipro and switched to levofloxacin instead, as all three speciated organisms from [**Doctor Last Name **]-tube fluid were shown to be sensitive to levofloxacin. [**6-30**] Patient was extubated. [**7-1**] Patient's stool output remained high (~2L) a day, lomotil, tincture of opium, and imodium were initiated. [**7-2**] Patient received a PICC line. [**7-3**] Due to high stool output, rather than re-feed his bile output through his J-tube, he was replenished with 1cc LR per IV per cc bile output. The patient received [**Hospital1 **] BMP's to monitor his electrolyte status. His stool output responded to this change, resulting in a daily stool output of <300cc. [**7-4**] His CXR's suggested that he might be fluid overloaded, and he continued to be tachypneic. Thus, he was gently diuresed to decrease his net fluid balance. [**7-7**] Patient had a 48-hour EEG which revealed that he was not suffering from seizures. Patient remained on chest physical therapy, but nebulized saline and guaifenisin were added to his regimen in an attempt to improve his respiratory status. He had a bedside swallow evaluation performed by speech language pathology - patient failed to pass the swallow test. His creatinine plateaued at 1.4. [**7-8**] Patient was weaned off of supplemental oxygen. [**7-10**] Patient's stool output has decreased to 200cc/day. [**7-11**] Patient had a high potassium of 5.7 and was given a dose of kayexelate. The patient's potassium decreased to 5.4. His tubefeeds were changed to Nepro@55cc/hr due to concern regarding the high potassium. He was also given a second dose of kayexelate. Patient was deemed stable and ready for discharge to a long term care facility. Medications on Admission: lisinopril 20 mg Discharge Medications: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB., wheeze RX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 1 neb every six (6) hours Disp #*120 Unit Refills:*1 2. Aspirin 324 mg PO DAILY crush 4 81mg tablets administer through j tube RX *aspirin 81 mg 4 Tablet(s) Jtube once a day Disp #*120 Tablet Refills:*1 3. Culturelle *NF* (lactobacillus rham. GG-inulin;<br>lactobacillus rhamnosus GG) 10 billion cell Oral qd Reason for Ordering: increased stool output despite modifications of tube feeding, addition of opium, lomotil RX *Probiotic 10 billion cell 1 Capsule(s) Jtube once a day Disp #*30 Capsule Refills:*1 4. Guaifenesin 5 mL PO Q6H RX *guaifenesin 100 mg/5 mL 5 mL Jtube every six (6) hours Disp #*60 Milliliter Refills:*1 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. RX *heparin lock flush 10 unit/mL every six (6) hours Disp #*30 Syringe Refills:*1 6. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol RX *dextrose 50% in water (D50W) 50 % q15min Disp #*30 Syringe Refills:*1 7. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol RX *glucagon (human recombinant) 1 mg q15min Disp #*3 Syringe Refills:*1 8. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY RX *lansoprazole 30 mg 1 Capsule(s) Jtube once a day Disp #*30 Capsule Refills:*1 9. Metoprolol Tartrate 25 mg PO TID Hold for SBP < 95, HR < 55 RX *metoprolol tartrate 25 mg 1 Tablet(s) J tube three times a day Disp #*90 Tablet Refills:*1 10. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush Temporary Central Access-ICU: Flush with 10mL Normal Saline daily and PRN. 11. Heparin 5000 UNIT SC TID 12. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using HUM Insulin RX *Humalog KwikPen 100 unit/mL Up to 8 Units per sliding scale four times a day Disp #*80 Unit Refills:*2 RX *Humalog KwikPen 100 unit/mL Up to 8 Units per sliding scale four times a day Disp #*60 Unit Refills:*1 Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: 1. Perforated duodenum. 2. Bile leak after laparoscopic cholecystectomy 3. Acute renal failure 4. Persistent tachypena with respiratory alkalosis 5. Post op delirium Discharge Condition: -- Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: You were admitted to the surgery service at [**Hospital1 18**] for perforated duodenum and bile leak following a laparoscopic cholecystectomy at an outside hospital. You are now safe to complete your recovery at an extended care facility with the following instructions: . Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than [**5-12**] lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. Followup Instructions: Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. You have an appointment scheduled on [**2146-8-5**], 9:30 AM. Location: [**Hospital Ward Name 23**] building, [**Location (un) 470**], [**Hospital Ward Name 516**]. [**Location (un) **], [**Location (un) 86**], MA. Phone: [**Telephone/Fax (1) 2998**] ICD9 Codes: 5845, 2760, 2762, 9971, 2930, 2851, 5990, 4019, 4280
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Medical Text: Admission Date: [**2153-2-15**] Discharge Date: [**2153-2-19**] Date of Birth: [**2086-3-24**] Sex: F Service: MEDICINE Allergies: Flagyl / Iodine Attending:[**First Name3 (LF) 1973**] Chief Complaint: Acute Blood Loss Anemia due to Gastric Ulcers with Bleeding Major Surgical or Invasive Procedure: Upper Endoscopy History of Present Illness: 66 year old Female with ESRD on peritoneal dialysis due to hypertensive nephropathy, and h/o NSCLC on Tarceva and nephrolithiasis who presents with symptomatic anemia. The patient typically adjusts her weekly EPO injections between 4000-6000 units depending on her symptoms of fatigue and dyspnea. Two and a half weeks ago her dialysis nurse had her terminate EPO in the setting of an elevated hmg > 12 per her report. She has been waiting to hear back from her dialysis clinic regarding when to restart her EPO. She titrates her own EPO, given a similar episode of severe symptomatic anemia. In the interim she developed excruciating flank pain earlier this week for which she presented to the ED, a CT demonstrated bilateral stones. She was given toradol and vicodin and discharged home with total resolution of her pain. However, as the week progressed, she has become progressively constipated and fatigued with suprapubic abdominal pain. She reports her PD fluid has been clear. She had an episodic visit at [**Company 191**] on Thursday which prompted referral to the ED. Her blood pressure was 112/72 laying and 94/68 standing. Blood cultures were taken, but patient denied any fevers or chills. She got IVF (approximately 500 cc). Her labs were significant for a hematocrit of 27, down from 36 on [**2-13**]. She was guiac negative. Her potassium was elevated at 6, she was given kayexalate. She had an abdominal CT which showed nothing acute. A CXR was negative for acute processes. Repeat orthostatics were: lying HR 75 BP 135/63, standing HR 85 BP 127/61. On transfer to the floor her abdominal pain had completely resolved in the setting of a large dark brown bowel movement after receiving kayexalate. She did not receive PD o/n. ROS: Denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, vomiting, diarrhea, BRBPR, hematochezia. She makes trace amounts of urine. She notes acid reflux for the past 3 days that has been constant. She has only been eating peppermints do to her poor appetite. Past Medical History: MEDICAL & SURGICAL HISTORY: - NSCLC on erlotinib - ESRD on PD - recurrent nephrolithiasis - depression - insomnia - seasonal rhinitis - papillary thyroid CA s/p excision Social History: Divorced, lives in same house as 3 friends ([**Name (NI) 11894**], [**First Name3 (LF) **], [**Name (NI) **]). 2 adult sons. Remote tobacco (quit 20 years ago)denies EtOH or illicit drug use. Family History: Mother- diabetes Father with kidney disease Physical Exam: ADMISSION: VS: 98.7 143/69 85 18 100 RA GENERAL - in NAD, comfortable, appropriate, pale HEENT - NC/AT, MMM LUNGS - CTAB, no r/rh/wh, good air movement, resp unlabored HEART - RR, no MRG, nl S1-S2 ABDOMEN - soft/NT/slightly distended, no rebound/guarding, PD catheter in lower abdomen with clean bandage, skin without erythema, non-tender EXTREMITIES - trace LE edema, WWP, 1+ peripheral pulses NEURO - awake, A&Ox3, gait intact DISCHARGE: GENERAL: NAD, comfortable, upright in pain, returned color LUNGS: Decreased breath sounds and mild crackles at left lower lung base HEART - RR, no MRG, nl S1-S2 ABDOMEN - soft/NT/slightly distended, no rebound/guarding, PD catheter in lower abdomen with clean bandage, skin without erythema, non-tender EXTREMITIES - trace LE edema, WWP, 1+ peripheral pulses Pertinent Results: CHEST XRAY [**2153-2-15**] PA AND LATERAL VIEWS OF THE CHEST: The cardiac silhouette is normal in size. The mediastinal and hilar contours are stable. Chain sutures within the left lower lobe are again demonstrated. Pulmonary vascularity is not engorged. Left lower lobe mass is again noted, better seen on the prior CT, but similar compared to the prior study. Nodular opacity within the left upper lobe appears relatively unchanged from prior. Small left pleural effusion persists. The right lung is grossly clear. No pneumothorax is identified. Multiple clips are demonstrated within the thyroid bed. Left proximal humeral fracture appears chronic. IMPRESSION: No significant interval change in appearance of left lower lobe lung mass, and nodule in the left upper lobe. Persistent small left pleural effusion. CT ABDOMEN w/out contrast [**2153-2-15**] CT OF THE ABDOMEN: There is unchanged left lower lobe round nodule with associated surgical material and small left pleural effusion and mild bibasilar atelectasis. Unchanged multiple pulmonary nodules at the right lung base. Segment III liver hypodensity is stable and was previously characterized as a hemangioma. Adjacent sub-cm hypodensity in the left lobe is also unchanged. The gallbladder, spleen, bilateral adrenal glands and pancreas are normal. Unchanged splenic artery calcifications. The kidneys are atrophic with numerous calcifications, likely vascular, and cysts, unchanged from priors. The stomach, duodenum, small bowel are normal. A peritoneal dialysis (PD) cathether is visualized in the left lower quadrant with unchanged small 17 x 8 mm seroma in the subcutaneous soft tissues and moderate amount of ascites. Unchanged calcification of the aorta and its major branches. There is no retroperitoneal or mesenteric lymphadenopathy. CT OF THE PELVIS: The urinary bladder is normal. There is no pelvic lymphadenopathy, no pelvic hernias. BONES: There are moderate degenerative change at L5-S1 with intervertebral disc disease. . IMPRESSION: No acute process or interval change from 2 days prior, including no evidence of diverticulitis or appendicitis. . PORTABLE CHEST XRAY [**2153-2-18**] IMPRESSION: AP chest compared to [**3-15**]: Mild interstitial abnormality in the right lung is probably edema. Moderate left pleural effusion is increasing. Large left lung lesions also appear grown since [**2-15**], though this is probably mostly a function of projection between the PA and AP orientations. Heart size top normal. Mediastinal veins and upper lobe pulmonary vessels are slightly dilated. PERTINENT LABS [**2153-2-19**] 06:55AM BLOOD WBC-8.3 RBC-3.48* Hgb-10.9* Hct-31.1* MCV-90 MCH-31.5 MCHC-35.1* RDW-14.2 Plt Ct-227 [**2153-2-18**] 07:15AM BLOOD WBC-7.9 RBC-3.38* Hgb-10.6* Hct-29.5* MCV-87 MCH-31.3 MCHC-35.9* RDW-14.5 Plt Ct-211 [**2153-2-17**] 07:10AM BLOOD WBC-8.4# RBC-3.23* Hgb-10.0* Hct-28.5* MCV-88 MCH-31.1 MCHC-35.2* RDW-14.3 Plt Ct-231 [**2153-2-17**] 07:10AM BLOOD WBC-8.4# RBC-3.23* Hgb-10.0* Hct-28.5* MCV-88 MCH-31.1 MCHC-35.2* RDW-14.3 Plt Ct-231 [**2153-2-16**] 04:15PM BLOOD WBC-17.0*# RBC-3.02* Hgb-9.3* Hct-26.8* MCV-89 MCH-30.8 MCHC-34.8 RDW-14.1 Plt Ct-249 [**2153-2-16**] 09:00AM BLOOD WBC-8.4 RBC-2.59* Hgb-8.0* Hct-22.7* MCV-88 MCH-31.1 MCHC-35.5* RDW-14.0 Plt Ct-295 [**2153-2-16**] 02:40AM BLOOD Hct-22.8* [**2153-2-16**] 01:20AM BLOOD WBC-10.9 RBC-2.58* Hgb-7.9* Hct-22.5* MCV-87 MCH-30.6 MCHC-35.2* RDW-14.1 Plt Ct-308 [**2153-2-15**] 05:27PM BLOOD WBC-10.9 RBC-3.09* Hgb-9.5* Hct-27.2* MCV-88 MCH-30.8 MCHC-35.1* RDW-14.1 Plt Ct-347 [**2153-2-15**] 05:27PM BLOOD Neuts-83.7* Lymphs-12.1* Monos-1.3* Eos-2.2 Baso-0.7 [**2153-2-17**] 07:10AM BLOOD PT-12.7 INR(PT)-1.1 [**2153-2-19**] 06:55AM BLOOD Glucose-88 UreaN-81* Creat-12.2* Na-140 K-5.4* Cl-100 HCO3-26 AnGap-19 [**2153-2-17**] 07:10AM BLOOD Glucose-83 UreaN-95* Creat-10.7*# Na-138 K-4.8 Cl-101 HCO3-25 AnGap-17 [**2153-2-16**] 01:20AM BLOOD Glucose-92 UreaN-108* Creat-11.5* Na-141 K-4.6 Cl-102 HCO3-24 AnGap-20 [**2153-2-18**] 07:15AM BLOOD ALT-22 AST-27 LD(LDH)-174 AlkPhos-218* TotBili-0.4 [**2153-2-16**] 09:00AM BLOOD TotBili-0.2 DirBili-0.1 IndBili-0.1 [**2153-2-15**] 05:27PM BLOOD ALT-26 AST-23 AlkPhos-263* TotBili-0.2 [**2153-2-19**] 06:55AM BLOOD Calcium-7.8* Phos-5.2* Mg-2.1 [**2153-2-17**] 07:10AM BLOOD Calcium-7.9* Phos-5.2* Mg-2.1 [**2153-2-15**] 05:27PM BLOOD Albumin-3.3* Calcium-9.3 Phos-3.6# Mg-2.5 [**2153-2-16**] 09:00AM BLOOD Hapto-180 [**2153-2-16**] 02:40AM BLOOD Hapto-198 [**2153-2-18**] 03:17PM BLOOD IgA-122 [**2153-2-18**] 03:17PM BLOOD tTG-IgA-4 [**2153-2-15**] 07:45PM BLOOD Lactate-0.9 K-5.4* [**2153-2-15**] 05:29PM BLOOD Lactate-1.1 [**2153-2-16**] 05:48AM OTHER BODY FLUID WBC-34* RBC-1* Polys-4* Lymphs-16* Monos-0 Macro-79* Other-1* [**2153-2-16**] 5:48 am DIALYSIS FLUID IMPROPER SPECIMEN COLLECTION. INTERPRET RESULTS WITH CAUTION. **FINAL REPORT [**2153-2-19**]** GRAM STAIN (Final [**2153-2-16**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2153-2-19**]): NO GROWTH. [**2153-2-18**] 3:17 pm SEROLOGY/BLOOD **FINAL REPORT [**2153-2-19**]** HELICOBACTER PYLORI ANTIBODY TEST (Final [**2153-2-19**]): NEGATIVE BY EIA. (Reference Range-Negative). EGD: [**2153-2-16**] Impression: Multiple superficial ulcers in the stomach antrum Few cratered ulcers in the pre-pyloric region A single cratered ulcer with stigmata of recent bleeding in the pre-pyloric region (injection) Bulbar duodenitis Brunner's gland hyperplasia in the duodenal bulb Scalloping folds on the mucosa of the second and third parts of the duodenum Otherwise normal EGD to third part of the duodenum Recommendations: The findings account for the symptoms, and the distribution of the gastric ulcers suggests that they are NSAID-induced. Continue PPI, avoid all aspirin or NSAID products. Follow serial Hcts, transfuse PRBCs to Hct >30. Consider DDAVP and/or platelet transfusion for uremic platelets. Check H.pylori serology, treat if positive. Check TTG and IgA to exclude Celiac disease. If re-bleeds will need repeat EGD. Brief Hospital Course: HOSPITAL COURSE Ms. [**Known lastname 92380**] is a 66 year old woman with ESRD on PD, NSCLC, anemia, and thyroid cancer who presented with an upper GI bleed. She required multiple transfusions and transfer to the MICU where upper endoscopy revealed bleeding gastric ulcers secondary to recent NSAID use. ACTIVE ISSUES # Acute Blood Loss Anemia due to Gastric Ulcers with Bleeding, Duodenitis: Symptomatic anemia in the setting of a significant drop in Hct over a three day period. (36->27->22) Etiology initially concerning for discontinuation of weekly epogen in setting of elevated hmg on routine lab draw. The patient has past history of dramatic hct drop off epo. She received 1x dose of tordol during ED visit on Monday. No other NSAID use or history of GERD. Most recent colonscopy in [**2146**] demonstrated multiple polyps. Follow up colonoscopy deferred given NSCLC. Initially no evidence of acute bleed, guaic negative stool in the ED prior to transfer, however on the morning of admission the patient passed four melanolic stool, guaic positive. Her hct dropped to 22, she was transfused 1 unit of pRBC and given desmopressin. Two PIVs were placed, she was started on PPI gtt and 1 more unit pRBC and transferred to MICU for EDG and further management. EGD revealed multiple gastric ulcers in antrum, one of which had stigmata of recent bleed with overlying dark area. This area was injected. There was no evidence of active bleeding. The duodenal bulb was acutely inflammed and edematous w/o discrete ulcer or bleeding. Patient received additional 2 units pRBCS after procedure, with subsequent stabilization in HCT and hemodynamics. Her diet was advanced to clears, and she was stable to be transferred back to the general medicine floor. Her hematocrit continued to be stable. Pantoprazole was changed to PO BID dosing which she will continue on for 6 weeks. She will discuss further epoitin dosing with her outpatient nephrologist. Hpylori negative. IgA at normal levels. # Flank Pain: The patient has was admitted to the ED prior to admission for left sided plank pain for which she was prescribed vicodin for pain managment. An episode of this flank pain recurred on admission. Physical exam demonstrated left flank tenderness to palpation. CT abdomen on [**2-13**] demonstrated bilateral stones and CT abdomen two days later demonstrated calcified atrophic kidneys. Unclear if pain is secondary to stones as patient is PD dependant and almost anuric. Would consider outpatient MRI to investigate for nerve impingement. Her pain was treated with vicodin. # Abdominal Pain Diffuse: Completely resolved in setting of large bowel movement on night of admission. She was afebrile, but given her history of peritonitis and PD, fluid sent for culture and gram stain. Gram stain revealed 1+ polys and no microorganisms, culture was negative. Blood cultures were negative at the time of discharge. # ESRD: Renal fellow contact[**Name (NI) **] regarding admission. Peritoneal dialysis was started per home regimen. Epoetin dosing to be discussed with outpatient nephrologist. The patient became mildly fluid overloaded in setting of multiple transfusions and clear diet. CXR demonstrated small pleural effusion. Her PD dialsylate was adjusted as indicated. # Hyperkalemia: Hyperkalemic on admission. She received kayexalate with improvement in her potassium. No peaked T waves. # Hypothyroidism: Continued home levothyroxine dose. # NSCLC: On Tarceva every three days. Patient stated she will not take until appetite improved. Heme/onc was called, and placed orders for patient to continue on Tarceva as per home regimen. TRANSITIONAL ISSUES Medical Management: Pantoprazole 40mg [**Hospital1 **] for 6 weeks, Vicodin for 3 days Code Status: Full (Was DNR but do Intubate on admission.) Medications on Admission: CALCITRIOL - - 0.25 mcg Capsule - 1 Capsule(s) by mouth three times a week (MWF) EPOETIN ALFA [EPOGEN] - - 4,000 unit/mL Solution - 6000 weekly ERLOTINIB [TARCEVA] - 25 mg Tablet - 1 Tablet(s) by mouth Q3 days on an empty stomach LEVOTHYROXINE [LEVOXYL] - 150 mcg Tablet - 1 Tablet(s) by mouth once a day and extra [**12-17**] tablet once weekly. SEVELAMER CARBONATE [RENVELA] - 800 mg Tablet - 5 Tablet(s) by mouth TID w/ food ZOLPIDEM - 5 mg B COMPLEX-VITAMIN C-FOLIC ACID [[**Doctor First Name **]-VITE] - 0.8 mg Tablet - 1 Tablet(s) by mouth once a day CAMPHOR-MENTHOL [SARNA ANTI-ITCH] - 0.5 %-0.5 % Lotion - apply on the skin as needed for itch three to four times daily as needed Discharge Medications: 1. calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO QMOWEFR (Monday -Wednesday-Friday). 2. epoetin alfa 4,000 unit/mL Solution Sig: One (1) Injection once a week. 3. erlotinib 25 mg Tablet Sig: One (1) Tablet PO QMOWEFR (Monday -Wednesday-Friday). 4. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1) Nasal twice a day. 5. levothyroxine 150 mcg Capsule Sig: One (1) Capsule PO once a day. 6. sevelamer carbonate 800 mg Tablet Sig: Five (5) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 7. valsartan 80 mg Tablet Sig: One (1) Tablet PO once a day. 8. zolpidem 10 mg Tablet Sig: One (1) Tablet PO at bedtime. 9. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours): take for 6 weeks and then decreased to once daily. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 10. hydrocodone-acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain for 3 days. Disp:*qS Tablet(s)* Refills:*0* 11. hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for itching. Discharge Disposition: Home Discharge Diagnosis: NSAID induced Gastric Ulcers End Stage Renal Disease Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Discharge Instructions: You were admitted for management of an upper GI bleed. An upper endoscopy demonstrated multiple ulcers in your stomach. It is likely that the tordol you received during your prior ED visit precipitated the development of these ulcers. A small injection of epinephrine in one of the bleeding ulcers was made which stopped the bleeding. You required multiple blood transfusions. You were started on pantoprazole twice daily. You will need to continue this medication for six weeks and then may take it just once daily. You developed left sided flank pain that appears to be an intermittant chronic issue. Please discuss with your primary care physician, [**Name10 (NameIs) **] MRI to explore the cause of your intermittant spasms. Please discuss with your nephrologist how much epoetin you should be taking. Followup Instructions: Department: [**Hospital3 249**] When: WEDNESDAY [**2153-2-28**] at 10:10 AM With: [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 1520**], MD. [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage *This appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. [**Name10 (NameIs) 616**] this visit, you will see your regular primary care doctor in follow up. Nephrology Appointment: PENDING **We are working on a follow up appointmentt in the NEPHROLOGY DEPARTMENT with DR.[**Last Name (STitle) **] [**Doctor Last Name **] for you to be seen with in 2 weeks from your discharge. You will be called at home with the appointment. If you have not heard from [**Doctor First Name **] in his office by WED., [**2-21**] or have questions, please her at [**Telephone/Fax (1) 721**]. ICD9 Codes: 5856, 2851, 5119, 2767
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Medical Text: Admission Date: [**2104-1-6**] Discharge Date: [**2104-1-17**] Date of Birth: [**2046-10-17**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Male First Name (un) 5282**] Chief Complaint: Hematemesis Major Surgical or Invasive Procedure: EGD History of Present Illness: 57 yoM w/ HepC cirrhosis w/ known varices EGD [**7-/2103**] presented with one day of coffee-ground and then bright red emesis (<1L); + nausea; no melena/BRBPR. No prior episodes of GIB. Baseline Hct in the low to mid-30's. . Pt. reports not taking medications, including insulin, home BG of 411 last checked on day PTA. Pt. states that he has been non-adherent w/ diabetic diet on [**3-5**] days PTA. Denies SOB, CP, or worsening abdominal girth. States that this actually improved. Recently had Spironolactone dose increased to 100mg qD by PCP. [**Name10 (NameIs) 17613**] sadness, but no hopelessness, anhedonia or SI. . BP was 100/palp with EMS en route; was given 250 cc bolus with improvement. In the ED he was HD stable with VS 118/68, 82, 16, 98% RA. He was given protonix and ocreotide. . Was admitted to ICU, where he underwent an EGD, showing grade I and II non-bleeding ulcers and [**Doctor First Name **]-[**Doctor Last Name **] tear. Pt. received 2U PRBCs and 2U of FFPs. HCT stable. . ROS: Denies melena, BRBPR, previous hematemesis, CP, SOB, encephalopathy hx. Past Medical History: #. Multiple gallbladder stones w/o cholecystitis #. Hepatocellular Carcinoma - two bx lesions c (+) path - s/p RFA [**2103-8-29**] #. Hospitalization x2 over last 2-4 months for severe cellulitis of lower extremities #. Hep C Genotype 1 - Pegylated interferon, ribavirin ([**2096**]): Viral relapse - Liver bx ([**2099**]): Stage 3 fibrosis, grade 2 inflammation - EGD ([**7-/2101**]): Esophagitis, varices - AFP 9.8 #. Hypertension #. DMII: c/b neuropathy #. Psoriasis #. Anxiety #. GERD #. Chronic anemia #. s/p laminectomy ([**11/2095**]) #. Chronic pain [**2-4**] laminectomy managed by methadone #. s/p right ankle surgery ([**2089**]) Social History: Lives at home alone in [**Location (un) **], has girlfriend. has no social supports, most family lives far away and has no one to call in case of emergency. Currently on disability (formerly employed in communications/IT); no tobacco; no hx of recreational drug use; very occasional EtOH Family History: Both parents alive and in good health. Overweight/obesity, DM and HTN in multiple family members. Denies hx Ca, CAD, Liver Px. Physical Exam: VS on arrival to the ED: 118/68, 82, 16, 98% RA VS on arrival to the ICU: 80, 152/75, 13, 100% RA General: comfortable and well nurished appearing HEENT: non-icteric sclera; dry MM Lungs: CTA b/l Cardio: RRR, no m.r.g., no JVD Abd: + BS, soft, NTND Extremities: right leg external rotation > left at rest; Skin: no rashes; WWP Neuro: AA, OX3, no asterixis By [**2104-1-7**] patient developed loss of attention and prominent asterixis. Pertinent Results: Labs on admission: [**2104-1-6**] 02:15AM BLOOD WBC-11.7* RBC-2.77* Hgb-8.9* Hct-26.5* MCV-96 MCH-32.3* MCHC-33.8 RDW-14.5 Plt Ct-153 [**2104-1-6**] 11:19AM BLOOD WBC-10.5 RBC-2.61* Hgb-8.4* Hct-23.6* MCV-90 MCH-32.1* MCHC-35.6* RDW-15.8* Plt Ct-117* [**2104-1-7**] 02:54AM BLOOD WBC-13.2* RBC-3.11* Hgb-9.6* Hct-28.7* MCV-92 MCH-31.0 MCHC-33.6 RDW-15.9* Plt Ct-127* [**2104-1-6**] 02:56AM BLOOD PT-18.6* PTT-31.2 INR(PT)-1.7* [**2104-1-7**] 02:54AM BLOOD PT-16.8* PTT-30.2 INR(PT)-1.5* [**2104-1-6**] 02:15AM BLOOD Glucose-257* UreaN-70* Creat-4.3*# Na-124* K-7.1* Cl-89* HCO3-20* AnGap-22* [**2104-1-7**] 02:54AM BLOOD Glucose-61* UreaN-62* Creat-3.2* Na-131* K-4.5 Cl-102 HCO3-22 AnGap-12 [**2104-1-6**] 02:15AM BLOOD ALT-63* AST-151* CK(CPK)-853* AlkPhos-176* TotBili-1.6* [**2104-1-7**] 02:54AM BLOOD ALT-59* AST-120* AlkPhos-147* TotBili-2.2* [**2104-1-6**] 11:19AM BLOOD Calcium-7.4* Phos-4.6*# Mg-1.6 [**2104-1-7**] 02:54AM BLOOD Albumin-2.7* Calcium-8.1* Phos-4.0 Mg-1.6 [**2104-1-7**] 04:59PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.006 [**2104-1-7**] 04:59PM URINE Blood-SM Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-4* pH-7.0 Leuks-TR [**2104-1-6**] 02:56AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.011 [**2104-1-6**] 02:56AM URINE Blood-TR Nitrite-NEG Protein-NEG Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-4* pH-5.0 Leuks-NEG [**2104-1-6**] 02:56AM URINE RBC-[**6-11**]* WBC-[**3-6**] Bacteri-FEW Yeast-NONE Epi-[**3-6**] RenalEp-[**3-6**] . . Imaging/Studies: . CXR [**2104-1-6**] - PORTABLE UPRIGHT CHEST RADIOGRAPH: The heart size and mediastinal contours remain normal. The lungs are well inflated and remain clear. No pneumothorax or pleural effusion is seen. Degenerative changes of the thoracic spine as before. IMPRESSION: No evidence of acute intrathoracic process seen. . EGD [**2104-1-6**]: Summary: [**Doctor First Name **]-[**Doctor Last Name **] tear. Varices grade I/II at the gastroesophageal junction and lower third of the esophagus. Blood in the fundus . RUQ U/S: [**1-8**] . IMPRESSION: 1. Segment IV s/p RFA cystic and solid lesion with mural nodules concerning for tumor recurrence. 2. Segment III lesion also raises the possibility of recurrence. 3. Persistent ascites and gallstones. 4. Normal son[**Name (NI) 493**] exam of the portal venous system. 5. Mild left renal pelviectasis . Colonoscopy - see brief hospital course. . MRI of abdomen - Pending. . Microbiology: . URINE CULTURE (Final [**2104-1-11**]): ENTEROCOCCUS SP.. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ <=2 S NITROFURANTOIN-------- <=16 S TETRACYCLINE---------- =>16 R VANCOMYCIN------------ <=1 S . Peritoneal fluid, blood cultures negative. . Labs on discharge: . [**2104-1-17**] 05:35AM BLOOD WBC-8.9 RBC-2.92* Hgb-9.5* Hct-27.8* MCV-95 MCH-32.4* MCHC-34.1 RDW-15.4 Plt Ct-126* [**2104-1-17**] 05:35AM BLOOD PT-18.7* PTT-38.6* INR(PT)-1.7* [**2104-1-17**] 05:35AM BLOOD Glucose-126* UreaN-27* Creat-1.8* Na-129* K-4.0 Cl-99 HCO3-23 AnGap-11 [**2104-1-17**] 05:35AM BLOOD ALT-33 AST-73* LD(LDH)-232 AlkPhos-137* TotBili-1.0 [**2104-1-17**] 05:35AM BLOOD Albumin-2.6* Calcium-7.8* Phos-3.6 Mg-1.6 [**2104-1-10**] 08:45AM BLOOD calTIBC-294 VitB12-1338* Folate-9.0 Ferritn-219 TRF-226 Brief Hospital Course: 57 year old man w/ history of HCV and HCC s/p RFA in [**8-/2103**], w/ Grade I/II varices, not on nadolol was admitted w/ episode of hematemesis/UGIB [**2-4**] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear, diagnosed on emergent endoscopy. Patient received 2U of PRBCs and FFP and was transfered from ICU to the floor for further care. . #) GIB and anemia. Patient initially presented with a GIB due to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear diagnosed via EGD. Patient was also noted to have grade I/II non-bleeding varices. No banding was performed. Patient was started on protonix 40 mg [**Hospital1 **] and Nadolol 20mg QD. He received 2U of PRBCs and HCT nadired at 24, 26 on admission and was 30 after transfusions. No further frank upper GI bleeding was noted. Patient had intermittently guiac positive stools with HCT dropping to 26 on HD#7. This was felt to be due to possible dilutional effect (Pt had received 50g of albumin) vs. LGIB. He underwent a colonoscopy which showed three polyps, with one maximum size of 1cm. No polypectomy was performed due to agitation by the patient and INR of 1.6. No sites of bleeding were noted. Patient received 2 additional units of PRBCs. HCT increased to 30 and remained stable until discharge. He will require a repeat colonoscopy for polypectomy and pathology evaluation. He is currently scheduled for this with Dr. [**Last Name (STitle) **]. Chronic anemia could not be further characterized and patient had received transfusions. He will require outpatient evaluation including iron studies, reticulocyte count and vitamin studies. TSH was nl in [**2103**]. HCT on discharge was 28. . #) ESLD, HepC cirrhosis/HCC s/p RFA in [**8-9**]. Patient is currently being worked up for liver transplantation (seen [**11-9**] by Dr.[**Name (NI) 948**] office). HCV tx by Ribavarin, interferon in [**2096**], w/ relapse and VL of 465K [**11-9**]. His EGD showed Grade I/II varices. Prior to this admission, he had no hx of encephalopathy. Liver ultrasound showed coarsened liver echotexture, segment IV s/p RFA cystic and solid lesion with mural nodules concerning for tumor recurrence, segment III lesion also raises the possibility of recurrence, persistent small asictes, gallstones, normal portal venous system. On admission to the floor, patient was noted to have asterexis and impaired attention and memory. He was started on lactulose and rifaximin. WBC count was elevated and a diagnostic tap was performed which failed to show SBP, 200 PMNs. Other infectious work up was negative including CXR, BCx, C.difficile antigen and contaminated UA. Due to persistent ecephalopathy and elevated WBC, patient was started on ceftriaxone for possible SBP. On HD8 patient grew enterococcus in from urinary source. He was started on ampicillin IV on [**1-11**] and ceftriaxone was discontinued. With this treatment, encephalopathy improved significantly, including improved attention (days of the week and months of the year backwards, and nearly resolved asterixis). As part of liver [**Month/Day (4) **] work up, patient underwent an echocardiogram, which showed normal PAP and LVEF of 70%. Due to concern for recurrent bleeding, patient's nadolol was increased to 40mg daily. His lactulose was titrated to [**3-5**] BMs per day and Rifaximin was continued at 400mg TID. From social work perspective, patient has had difficulties getting to appointments due to transportation and financial issues. The day of discharge, patient underwent an MRI of abdomen to assess the recurrence of HCC. This study will require follow up by PCP and [**Hospital1 1388**] Dr. [**Last Name (STitle) 497**] and [**Doctor Last Name **]. . #) ARF on CKD. Baseline Cr reported as 1.5 to 2.0, was 4.3 on admission. CKD was felt to be likely due to DM and HTN. ARF on admission was likely pre-renal in setting of N/V and hemorrhage. Diuretics were held. Patient responded to IVF in ICU with Cr improving to 3.2. However, improvement ceased as WBC began to climb. Urine lytes were intially consistent with intrinsic disease, Na of 105, FeNA > 1%, however eventually showed pre-renal state w/ Na 18, FeNA <1%. UA did not show casts, eosinophils were negative. Cr. improved after albmuin administration and PRBC transfusions. Given this and lack of hypotension, hepatorenal syndrome was felt unlikely and cause was felt to be pre-renal. Renal team was consulted who agreed with above assessment. At time of discharge Cr improved to 1.8. With this treatment, patient's LE edema re-accumulated, approximately 1+ at time of discharge with 5kg wt gain over last 4 days of hospitalization. Reported as baseline by patient. Patient was restarted on Lasix 40 QD and Spironolactone of 50mg qd at time of discharge. . #) Chronic RLE pain and back pain. This was unchanged during admission. Pt. on methadone 40 mg QAM and 30 mg QPM as outpatient. These were continued. Pain was reported as [**2105-2-5**]. Patient was evaluated by physical therapy was deemed to require rehabilitation for further gait and strength training. . #) Liver nodule. see above for ultrasound results and further work up performed with MRI on day of discharge. This will require follow up. . #) T2DM, Hyperglycmeia. Improved, still not consistently < 150. Has had some hypoglycemia in AM, [**2-4**] NPO. Likely presented in DKA w/ trace ketones in urine, and elevated BG at home and N/V. A1C 5.9 in [**10-9**], thus relatively well controlled. Pt. on 85 lantus as OP. This scale was restared with BG ranging between 110-220s, w/ occasional 60s during periods of NPO. Pt. was discharged w/ HISS and Lantus 85U QHS. . #) Hypertension. Blood pressures ranging 130-150 systolic throughout hospital stay. he was restarted on home Diltiazem CR at 120 QD on HD#5 and Spironolactone at discharge. Goal SBP 130/80 or less. 0 #) PPX: PO protonix; pneumoboots . #) COMMUNICATION: with patient and Son [**Name (NI) 17614**] [**Name (NI) 805**] ([**Telephone/Fax (1) 17615**] OR [**Telephone/Fax (1) 17616**] OR [**Telephone/Fax (1) 17617**]. Multiple discussions were held with family and it was felt that patient would benefit from transient rehabilitation stay as well as recommeneded by PT. . Patient was discharged in a hemodynamically stable condition, afebrile. . Issues requiring follow up: - Completion of ABx for UTI - Titration of diuretics for optimal volume status - Electrolyte monitoring with restarting of diuretics, 2d after discharge - Blood pressure regimen optimization - HCT labs 2d after discharge - MRI abdomen at [**Hospital1 18**] follow up - PCP and Liver Clinic follow up as arranged. Medications on Admission: VS 98.6F 140/90 94 18 100% RA General: comfortable and well nurished appearing HEENT: non-icteric sclera; MMM Lungs: CTA b/l, nl movement Cardio: RR, no m.r.g., no JVD Abd: obese, + BS, soft, NT/ND, no shifting dullness. Extremities: right leg external rotation > left at rest; flat solar surfaces, onychomycosis, no ulceration. Trace edema b/l. Skin: no rashes. Neuro: A&OX3, intact repetition, strength 5/5 in UE, [**5-6**] in LE proximally, [**4-6**] RLE at foot [**2-4**] pain. ? asterixis vs. intention tremor. No pronator drift, FTN intact. Discharge Medications: 1. Insulin Glargine 100 unit/mL Solution Sig: Eighty Five (85) units Subcutaneous at bedtime. 2. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble PO QAM (once a day (in the morning)). 3. Methadone 10 mg Tablet Sig: Three (3) Tablet PO QPM (once a day (in the evening)). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 5. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). 6. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)) as needed. 7. Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 8. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day). 9. Nadolol 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): Hold for SBP < 90, HR < 60, page house officer if holding. 10. Ciprofloxacin 250 mg Tablet Sig: Three (3) Tablet PO QMON (every Monday): SBP prophylaxis . 11. Insulin Lispro 100 unit/mL Solution Sig: One (1) Subcutaneous see sliding scale: see sliding scale. 12. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day: Hold for SBP < 90. 13. Spironolactone 50 mg Tablet Sig: One (1) Tablet PO once a day: Hold for SBP < 100. 14. Outpatient Lab Work CBC, chem 10, PTT/PT, AST/ALT/Tbili/AP two days after discharged and weekly there after. Please fax results to PCP and Dr. [**Last Name (STitle) **] at [**Hospital1 18**]. 15. MRI follow up Patient had undergone and MRI at [**Hospital1 18**] on day of discharge. This will require follow up by PCP. 16. Nitrofurantoin Macrocrystal 100 mg Capsule Sig: One (1) Capsule PO every six (6) hours for 2 days. Discharge Disposition: Extended Care Facility: [**Hospital3 1186**] - [**Location (un) 538**] Discharge Diagnosis: Primary: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Tear with hemorrhage, acute kidney injury, hepatic encephalopathy, urinary tract infection Secondary: Hepatitis C and Hepatocellular Carcinoma, Cirrhosis, Anemia of chronic disease, Esophageal Varices, Hypertension, Diabetes. Discharge Condition: Hemodynamically stable, improved encephalopathy and afebrile. Discharge Instructions: You were admitted to [**Hospital1 18**] with nausea and bloody vomiting. You underwent an endoscopy that showed a tear in a part of your esophagus as well as varices (blood vessel outpouchings in your esophagus due to your liver disease). You received blood transfusions for this and your blood levels stabilized. You also underwent a colonoscopy that showed several polyps (see below for follow up). . Because of the varices in your esophagus, you were started on a medication called nadolol to prevent bleeding. . In addition, you were found to have developed encephalopathy (an abnormality in the brain chemistry, due to liver disease or infection) that to you felt like confusion. Because of this you were started on two medications: lactulose and rifaximin. In addition, you were found to have a urinary tract infection, which was treated with intravenous antibiotic. . Finally, you stay was complicated by acute kidney failure on top of your chronic kidney failure. This was felt to be due to blood loss and infection. With blood transfusions and intravenous fluids your kidney function recovered. You were restarted on your diuretics the day of discharge at lower doses, 50mg daily of Spironolactone and Lasix at 40mg daily. . Should you experience any further or worsening confusion, fevers, chills, nausea, vomiting, bloody or black stools, coughing up blood, worsening swelling in your legs or abdomen, please call your primary care doctor or go to the nearest emergency room. . Your medications were adjusted. Please see list below and only take medications you were prescribed. . While at the hospital your liver was imaged. A small lesion in your liver was found concerning for recurrence of your cancer. You will require an outpatient CT scan to evaluate this further. In addition, you will require a repeat colonoscopy to remove the polyps in your colon. Followup Instructions: You have an appointment with your PCP, [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]. # [**Telephone/Fax (1) 7538**], on [**2-4**] at 6.15pm. You also have an appointment on Saturday, [**1-19**] with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], please call above number to confirm your appointment. Dr. [**Last Name (STitle) 497**], Liver center, [**2105-2-5**]:40 am, ([**Telephone/Fax (1) 1582**]. Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] CENTER (NHB) Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2104-1-23**] 9:00 Provider: [**Name10 (NameIs) **] [**Apartment Address(1) 9394**] (ST-3) GI ROOMS Date/Time:[**2104-1-25**] 9:30 Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) 2424**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2104-1-25**] 9:30. For repeat colonoscopy and polypectomy. Completed by:[**2104-1-17**] ICD9 Codes: 5849, 5990, 3572, 5715, 5859
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Medical Text: Admission Date: [**2124-3-10**] Discharge Date: [**2124-4-5**] Date of Birth: [**2048-1-2**] Sex: F Service: [**Last Name (un) **] HISTORY OF PRESENT ILLNESS: This is a 74-year-old female, recently diagnosed with a right femur osteosarcoma, status post 1 cycle of neoadjuvant chemotherapy with adriamycin and cisplatinum on [**2-28**], and a history of ulcerative colitis, status post total colectomy and ileostomy in the past, who presented to the Emergency Room with acute sharp abdominal pain, nausea and vomiting. PAST MEDICAL HISTORY: 1. Melanoma, right lower extremity, in [**2097**]. 2. Hyperthyroidism. 3. Migraines. 4. Proctocolectomy. 5. Total abdominal hysterectomy. 6. Cholecystectomy. 7. Hemithyroidectomy. 8. Appendectomy. 9. Ulcerative colitis. 10.Hypertension. MEDS AT HOME: 1. Aspirin 81. 2. OxyContin. 3. Norvasc. 4. Colace. 5. Compazine. 6. Cipro. 7. Propranolol. 8. Percocet. 9. Valium. 10.Ambien. 11.Imitrex. 12.Vioxx. ALLERGIES: No known allergies. SOCIAL HISTORY: Significant for 1-pack of cigarettes per day. No alcohol. EXAM ON ADMISSION: Temperature 97.6, heart rate 120-90, blood pressure 132/54, respiratory rate 18, sats 95percent on room air. In significant pain. Heart regular rate and rhythm. Chest clear to auscultation bilaterally. Abdomen tender on the right side with guarding. Stoma was digitalized. There was no gross blood, and it was heme positive. Extremities were warm. LABS: White count 0.1, hematocrit 27.6, platelets 88. Chemistries - sodium 132, potassium 3.6, chloride 101, bicarb 16, BUN 41, creatinine 1.7, glucose 131, lactate 1.7. UA was negative for infection. EKG showed sinus tachycardia. Chest x-ray showed COPD with no pneumonia or congestive heart failure. CT of the abdomen was done and showed thickening and stranding of the distal ileum with some fluid in the abdomen. There was little progression of contrast into the small bowel. The SMA and celiac were open. HOSPITAL COURSE: Over the few hours after presenting to the Emergency Room, her clinical picture worsened. She became tachycardic and intermittently hypotensive. In view of these symptoms and her very concerning CT scan, it was decided to take her the operating room. On [**2124-3-10**], she underwent an exploratory laparotomy. She was found to have ischemia of the distal small bowel to the stomach from previous adhesions and small bowel obstruction. The adhesions were taken down, as well as the stoma. The distal small bowel was resected, and a new ileostomy was constructed. Her long postoperative course is summarized as follows: 1. NEURO: Initially, her pain was controlled, and she was sedated with a fentanyl drip. This was later weaned and changed to prn morphine as needed, and prior to discharge her pain was well-controlled on Roxicet prn, and very small amounts of Ativan prn. On postoperative day 19, as she was beginning to wake-up and drips were weaned off, she was noted not to be moving her left side as well, and had left side neglect with right-sided gaze. A CT was done and showed recent infarctions in the middle cerebral arterial territory and left occipital territory. Further work-up for what seemed to be embolic strokes included an echo which did not show any source of emboli. She was seen by the neurology team and was started on aspirin. 1. CARDIOVASCULAR: Her immediate postop course was significant for septic shock and need for vasopressors which were gradually weaned as she stabilized. She developed atrial fibrillation which was converted back to sinus on an amiodarone drip. Prior to discharge, she was on amiodarone through her G-tube. She has remained in sinus and stable hemodynamically for many days. 1. RESPIRATORY: She had prolonged respiratory failure and vent dependency. This required a tracheostomy which was done on [**2124-3-30**]. Prior to discharge, she was gradually weaning off the vent on a pressure support mode, and had been on a trach mask for the last 48 hours prior to transfer to rehab. She still required some suctioning and chest physical therapy, but had been stable with good saturations, and normal respiratory rate, and seemed very comfortable on the trach mask. 1. GI: Initial postop nutrition was provided through TPN. Once her new ileostomy began to function, she was started on tube feeds, and on [**3-30**] a PEG was placed, and the tube feeds were then given through this access. She has been tolerating tube feeds at goal with 1 episode of vomiting 2 days prior to discharge. After starting her on Reglan, tube feeds were restarted, and she seemed to be tolerating it well. She was receiving Prevacid for prophylaxis. 1. GU: After her initial resuscitation around surgery, the patient significantly volume overloaded. Once stabilized hemodynamically, this required gentle diuresis. Her creatinine was slightly elevated to peak of 1.4, but had returned to [**Location 213**] prior to discharge. She was still 6 kg up. Her last weight on [**4-5**] was 70 kg. Her baseline was 64 kg. It was recommended still to continue gentle diuresis as we had been doing, and she seemed to be tolerating it well. 1. HEME: As noted on admission, the patient was significantly neutropenic and just needed to be supported by G-CSF. Blood counts, thereafter, improved. Her last white count was 15.2 on [**4-5**]. Her hematocrits have remained stable around 29/30 over the last few days. Throughout her hospitalization, she did require intermittent transfusions of blood and platelets, but none in the period prior to discharge. 1. ID: Of note, her immediate postop course was significant for sepsis and septic shock. She was broadly covered with antibiotics, including vancomycin, Levaquin, Flagyl, and fluconazole. Her OA positive culture was 1 out of 2 bottles of blood culture from the 22, the day of her admission, which grew presumptive Clostridium septicum. Once afebrile and her white counts were normal, this regimen was stopped. On [**3-28**], she had a low-grade temp and a slight elevation in her white count. At that point, cultures were taken, and a central line that she had in her IJ was removed. Her catheter, as well as 1 out of 4 bottles of blood grew Staph coag-negative, and her sputum on that day grew Pseudomonas and MRSA. She was, therefore, treated with Zosyn and vancomycin. She is now 7 days on these antibiotics, and the plan was to complete a 10-day course for suspected possible bacteremia. She has remained afebrile, hemodynamically stable, with a mild and stable elevation of her white count over the last few days. 1. MUSCULOSKELETAL: Because of her CVA, she was not moving her left side, and her left side seemed to be slightly more swollen. Work-up for that included an ultrasound which was negative for DVT. She will probably need occupational therapy to be involved in her care with a question of splints for her left upper extremity. She was seen by the oncology service, radiation oncology service and the orthopedic service here for questions regarding further treatment of her osteosarcoma. It was felt that at this point treatment, the patient would not be a good surgical candidate for an amputation, but would possibly benefit, at least initially, from radiation treatment, but even that should wait until the patient further recovers. She will need to follow-up with the oncology service in the future who will coordinate her care between radiation oncology and possibly orthopedics later on. She was discharged to rehab in stabile condition and with the following recommendations. DISCHARGE RECOMMENDATIONS: 1. Continue meds as listed in . 2. Continue PT, OT and respiratory rehabilitation. 3. Follow-up with oncology in 2 weeks. 4. Follow-up with surgery and scheduling on the same date would be optimal. DISCHARGE DIAGNOSES: 1. Small bowel obstruction. 2. Ischemic small bowel. 3. Exploratory laparotomy, status post small bowel resection and ileostomy. 4. Sepsis. 5. Bacteremia. 6. Respiratory failure, status post tracheostomy. 7. Status post percutaneous endoscopic gastrostomy. 8. Osteosarcoma, right lower extremity. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] Dictated By:[**Last Name (NamePattern1) 28297**] MEDQUIST36 D: [**2124-4-5**] 10:01:56 T: [**2124-4-5**] 11:17:09 Job#: [**Job Number 28298**] ICD9 Codes: 5185
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Medical Text: Admission Date: [**2188-4-19**] Discharge Date: [**2188-4-23**] Date of Birth: [**2107-4-2**] Sex: M Service: MEDICINE Allergies: Statins-Hmg-Coa Reductase Inhibitors Attending:[**Doctor Last Name 10493**] Chief Complaint: Bradycardia and seizure Major Surgical or Invasive Procedure: None History of Present Illness: 81yoM with h/o HTN, PR prolongation; otherwise no other significant cardiac history; also with R sided GBM s/p complete resection and XRT in [**7-7**], VPS for hydrocephalus and stroke (found per imaging in [**2-/2188**]) who is admitted to CCU for syncopal episode this morning, bradycardia, and with GTC seizure in the ambulance en route to hospital. . Most of the history is provided by the pt's wife due to the pt's minimal verbal interaction, and also per reports. She relates that she was downstairs this morning when he woke up, when she heard him fall down upstairs. Apparently the pt was up for at least 10 mins (on his feet), showering, shaving, getting dressed, when she heard him fall and went upstairs. He was on the ground a little dazed, and not moving much, but verbal. She and her daughter endorse that he hit his head, but was conscious at this point. After several minutes, he started crawling to, then got into, his bed. . The wife called EMS. They came and found his pulse to be in the 20's and reportedly in a junctional rhythm. She doesn't know any further vitals or his finger stick. They took him by EMS to [**Hospital3 10310**]. In the ambulance, she reports he was in the front seat and the EMS in the back noted he was seizing (reportedly grand mal) for about 3.5 mins that broke with 5mg IV Valium. . In the [**Hospital1 18**] ED: 97.2 154/78 60 12 99% on 15L (?) NC. Code stroke called for pt not moving his L side, normal strength on R. CT head done with prelim report showing: minimally increased MTT with decreased CBF globally of the right cerebral hemisphere and no intracranial hemorrhage. Neuro was consulted in the ED and felt the L sided paralysis to be consistent with [**Doctor Last Name 555**] Paralysis and that the hypoperfusion seen on the CT scan was not consistent with a vasculature territory (vessels were all patent), and so therefore more consistent with a seizure activity. His L sided "densely hemiplegic" deficits began to improve by the time the imaging was done in the ED, also more consistent with seizure. Also of note in the ED: CXR normal, WBC 10.5 (N86, L9), Hct 45.9, plts 174. Coags normal with slight elevation of PTT, chemistries normal, CE's negative x1, UA with blood but negative for infxn. . He is admitted to the CCU for workup of his bradycardia; he was apparently supposed to see Dr. [**Last Name (STitle) 7965**] on Monday (in 2 days) for evaluation of this bradycardia that has been noted by PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1007**], who had sent him for Holter, carotid u/s, and echo, and was down titrating his antihypertensives. His story is complicated by the fact that he can't get a permanent pacemaker in light of his frequent MRI's to monitor his brain malignancy. . He had some bradycardia and vomiting on arrival to the CCU, however by evaluation, his hr was in the 50's, bp stable in the 160-170's, satting and breathing OK, and he was not vomiting. . ROS is positive as above, also for ataxic gait, occasional "confusion" characterized as worsening short term memory, and weight loss from 185 to <150 now, all felt to be consistent by the family with his known GBM. At his baseline, his family reports he functions "perfectly," is totally conversant, can walk, was a practicing attorney until last [**Month (only) 216**], some weakness on his L side at baseline. ROS is negative extensively for all other major systems, including potential sources of infection, etc. to explain syncopal episode. His wife states he has never had problems with seizures, or with cardiac dysrhythmias (other than PR prolongation). Past Medical History: 1. CARDIAC RISK FACTORS: Hypertension, hyperlipidemia 2. CARDIAC HISTORY: Has PR prolongation per wife -CABG: NONE -PERCUTANEOUS CORONARY INTERVENTIONS: NONE -PACING/ICD: NONE 3. OTHER PAST MEDICAL HISTORY: - Brain tumor, glioblastoma. S/p resection [**2186**], by Dr. [**Last Name (STitle) 4887**] at [**Hospital1 112**]. Also s/p radiation and chemoTx. Has been followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 30318**]. Complicated by normopressure hydrocephalus, s/p shunt, with improvement in his gait disturbance, but still with problems with memory and executive fxn. Recent admissions in [**State 108**], [**Location 30319**], [**Hospital1 112**]. - Had small stroke noted on MRI brain per Dr. [**Last Name (STitle) 30318**] in the field of his prior radiation therapy, with subclinical stroke. - Residual L sided weakness and gait disorder - Chronic bradycardia with two syncopal episodes, most recent before this admission in [**1-/2188**] in [**State 108**], ? due to UTI? - Hyperlipidemia, currently on Zetia, h/o myalgias with statins Social History: Never smoker, no drugs or EtOH. He is back in his home on the [**Location (un) 1121**]. He had prolonged hospitalization and rehab stays. He has a supportive family with physician family members. [**Name (NI) **] has many grandchildren. He formerly worked as an attorney and an officer of a bank. He has not been able to work for many months. Family History: No family history of sudden cardiac death Physical Exam: 99.8 R 161/81 L 173/62 p50's 100% on RA Thin, elderly male in no distress but appears exhausted and dazed, which apparently is not his baseline. His eyes are open but he stares, but can be redirected with conversation. He answers with quiet, simple one word answers but answers appropriately. EOMI are grossly intact but cannot follow a finger. Sclera are clear, not icteric. Carotid pulsations present bilaterally. No JVD noted, no hepatojugular reflux. Radiation of AS type murmur heard in L neck, not in R (sounds more like AS murmur than carotid bruit) Lungs CTAB but poor air movement. No grossly adventitious lung sounds. Heart sounds barely perceptible but best heard at LLSB. A slight AS type murmur is heard. RRR. PMI is not felt. Abd soft, NT ND. BS diminished. BLE without edema, DP's barely palpable. Bilateral radials fairly thready but palpable. Has apparent L facial droop. Unable to follow my finger with eyes, bc not following the commands. His speech is soft but clear and not grossly dysarthric. He states he has sensation in his face bilaterally and can hear my fingers snapping bilaterally. His shoulder shrug is strong bilaterally. He is spontaneously moving all 4 extremities. L biceps and triceps are [**4-2**] compared to R, however L hand grip is noticeably weaker than the R, perhaps [**2-1**] compared to R [**4-2**]. His L arm is tonic/rigid, but then he moves it spontaneously and the muscular tone is normal. He can flex at the hip but is slightly weak, 4- to 4+ bilaterally. Distal flexion and extension of LE's is [**4-2**]. Biceps and triceps reflexes are normal to slightly hyperreflexic. Patellar and Achilles are bilaterally diminished. Pertinent Results: ADMISSION LABS: [**2188-4-19**] 04:50PM BLOOD WBC-10.5 RBC-4.77 Hgb-15.0 Hct-45.9 MCV-96 MCH-31.4 MCHC-32.6 RDW-12.8 Plt Ct-174 [**2188-4-19**] 04:50PM BLOOD Neuts-85.6* Lymphs-9.1* Monos-4.6 Eos-0.3 Baso-0.4 [**2188-4-19**] 04:50PM BLOOD PT-12.2 PTT-20.2* INR(PT)-1.0 [**2188-4-20**] 04:36AM BLOOD Glucose-116* UreaN-17 Creat-0.8 Na-140 K-3.8 Cl-104 HCO3-29 AnGap-11 [**2188-4-19**] 04:50PM BLOOD ALT-19 AST-23 LD(LDH)-157 CK(CPK)-41* AlkPhos-62 TotBili-0.6 [**2188-4-20**] 04:36AM BLOOD Calcium-8.8 Phos-3.2 Mg-1.9 [**2188-4-19**] 04:50PM BLOOD Prolact-26* [**2188-4-20**] 04:36AM BLOOD Phenyto-11.8 [**2188-4-19**] 05:00PM BLOOD Glucose-124* Na-142 K-3.9 Cl-102 calHCO3-18* . Cardiac enzymes: [**2188-4-19**] 04:50PM BLOOD ALT-19 AST-23 LD(LDH)-157 CK(CPK)-41* AlkPhos-62 TotBili-0.6 [**2188-4-19**] 04:50PM BLOOD CK-MB-NotDone [**2188-4-19**] 04:50PM BLOOD cTropnT-<0.01 [**2188-4-20**] 04:36AM BLOOD CK(CPK)-52 [**2188-4-20**] 04:36AM BLOOD CK-MB-NotDone cTropnT-<0.01 . Urinalysis [**2188-4-21**] 02:54AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.007 [**2188-4-21**] 02:54AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG [**2188-4-19**] 04:50PM URINE RBC-21-50* WBC-0-2 Bacteri-FEW Yeast-NONE Epi-0-2 [**2188-4-19**] 04:50PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015 [**2188-4-19**] 04:50PM URINE Blood-LG Nitrite-NEG Protein-25 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG Labs on discharge: [**2188-4-23**] 05:25AM BLOOD WBC-6.3 RBC-4.29* Hgb-13.5* Hct-40.2 MCV-94 MCH-31.4 MCHC-33.6 RDW-13.3 Plt Ct-143* [**2188-4-21**] 03:40AM BLOOD Neuts-76.7* Lymphs-13.4* Monos-7.1 Eos-2.5 Baso-0.4 [**2188-4-23**] 05:25AM BLOOD PT-12.3 PTT-30.1 INR(PT)-1.0 [**2188-4-23**] 05:25AM BLOOD Glucose-85 UreaN-17 Creat-0.9 Na-139 K-3.8 Cl-102 HCO3-32 AnGap-9 [**2188-4-23**] 05:25AM BLOOD Calcium-8.9 Phos-3.1 Mg-1.9 . [**2188-4-19**] CTA head IMPRESSION: 1. The patient is status post right temporal craniotomy. Shunt catheter is visualized via right frontal burr hole and terminating at the level of the foramen of [**Last Name (un) 2044**]. There is no evidence of significant enhancement to suggest recurrence or tumor activity. There is no evidence of acute intracranial hemorrhage. Chronic microvascular ischemic disease is visualized. . 2. Mild increased mean transit time with decreased cerebral blood flow globally is noted in the right cerebral hemisphere, possibly consistent with mild ischemia or recent seizure activity. . 3. Calcified plaques are visualized in the carotid siphons, more significant on the left with moderate stenosis. . 4. Pulmonary nodule is identified in the left lung, correlation with CT of the chest is recommended for further characterization of this nodule. This finding was notified in the critical radiology findings dashboard. . [**2188-4-19**] CXR . SINGLE FRONTAL VIEW OF THE CHEST: Lungs are clear without consolidation or pleural effusion. There is no pneumothorax. The heart size is normal. There is no hilar or mediastinal enlargement. The aorta is mildly tortuous. Pulmonary vascularity is normal. . IMPRESSION: No acute cardiopulmonary abnormality. [**2188-4-21**] CT Chest: Impression: The spiculated nodule in the left apex is concerning for a primary lung cancer and could be further assessed with a PET/CT. Brief Hospital Course: 81M with history of hypertension, hyperlipidemia, glioblastoma multiforme s/p resection and XRT in [**7-7**], VPS for hydrocephalus and stroke admitted to the CCU for syncopal event, bradycardia, and generalized tonic clonic siezure. . #BRADYCARDIA: The patient was admitted to the CCU on telemetry. He was noted to have 2 further episodes of bradycardia, once in the setting of nausea and vomiting, and another in the setting of carotid palpation during physical exam, however his pulse recovered without intervention. His symptoms were thought to be vasovagal. The patient was evaluated by the electrophysiology service with the recommendation being conservative management given it was not felt that a PPM would not prolong his life or improve his symptoms in this setting. There was also concern given that he requires serial MRIs to track his glioblastoma which would not be possible with a pacemaker. His heart rate was monitored with pulses maintained in the fifties, normotensive, with no concerning symptoms (dizziness, syncope). Upon transfer to the medical floor it was decided that no aggressive intervention would be implemented to treat his bradycardia. Telemetry was discontinued per family wish. Decision that no atropine or pacer pads would be used. Fortunately these were not necesary during his hospitalization. # SEIZURE: Pt had a witnessed 3 minutes GTC seizure in the ambulance which broke with 5mg IV Valium. Neuro consulted in the ED for L sided paralysis, which was thought to be Toddy's paralysis. Left sided weakness improved over the course of the hospitalization. He was initially started on dilantinbut there was concern about worsening fatigue. He was changed to Keppra, which he will continue as an outpatient, in consultation with his outpatient neurologist. Follow up with neurology was also arranged. . # GBM: The pt's neuro-oncologist was made aware of the pt's admission. CT head/neck noted a lung nodule which was further characterized on CT Thorax. PET scan was recommended as follow up for potential primary lung cancer. Family was aware of the nodule at time of discharge. Radiology was placed on CD and given to family at time of discharge. #Goals of care: Discussion of palliative care was brought up by Dr. [**Last Name (STitle) 1007**] prior to discharge. Family is presently considering options regarding further treatment vs palliative care. This will be a continuing discussion as outpt. Medications on Admission: Reconciled with wife's home list. ALLOPURINOL - 100 mg Tablet - 1 Tablet(s) by mouth daily DONEPEZIL [ARICEPT] - (Prescribed by Other Provider) - 5 mg Tablet - 1 Tablet(s) by mouth daily ESCITALOPRAM [LEXAPRO] - (Prescribed by Other Provider) - 10 mg Tablet - 1 Tablet(s) by mouth daily EZETIMIBE [ZETIA] - 10 mg Tablet - 1 Tablet(s) by mouth daily . LOSARTAN [COZAAR] - 100 mg Tablet - 1 Tablet by mouth daily --> reduced dose to 50mgs on [**2188-3-25**] . PREDNISONE - (Prescribed by Other Provider) - 5 mg Tablet - 1 Tablet(s) by mouth daily TESTOSTERONE [ANDROGEL] - (Prescribed by Other Provider) - 1.25 gram per Actuation (1 %) Gel in Metered-dose Pump - 2 squirts daily . Medications - OTC ASPIRIN [BABY ASPIRIN] - (OTC) - 81 mg Tablet, Chewable - 1 Tablet(s) by mouth daily B COMPLEX VITAMINS - (OTC) - Capsule - 1 Capsule(s) by mouth daily BISACODYL [DULCOLAX] - (OTC) - 5 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth daily MULTIVITAMINS-MINERALS-LUTEIN [CENTRUM SILVER] - (OTC) - Tablet - 1 Tablet(s) by mouth daily Discharge Medications: 1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 2. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO twice a day: From [**Date range (1) **], please give 1 capsule in morning and 1 at night. From [**Date range (1) 30320**], give 1 capsule in morning only. then stop. Disp:*8 Capsule(s)* Refills:*0* 3. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Aricept 5 mg Tablet Sig: One (1) Tablet PO once a day. 5. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO once a day. 7. Losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 11. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. B Complex Vitamins Capsule Sig: One (1) Capsule PO once a day. 13. AndroGel 1.25 g/Actuation Gel in Metered-dose Pump Sig: Two (2) squirts Transdermal once a day. Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: primary: bradycardia grand mal seizure secondary: Gliobastoma Multiforme NPH with VPL Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Mr. [**Known lastname 30321**] - It was a pleasure to care for you during your hospitalization. You were admitted with low heart rate and seizure. After discussion with Dr. [**Last Name (STitle) 30318**] and our neurology consultants here, the decision was made to taper on a new anti-seizure medication, called Keppra (or Levetiracetam). Please take: 1) Keppra 500mg twice a day. You will need this medication for the rest of your life. . Continue to take dilantin (phenytoin) as follows: 1. Dilantin 100 mg po at morning and night on [**4-23**] 2. Dilantin 100 mg po at morning on [**4-26**] Then stop taking dilantin Please continue to take all your prior medications as prescribed. Please keep all your follow up appointments. Followup Instructions: Department: INTERNAL MEDICINE When: WEDNESDAY [**2188-4-30**] at 2:30 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**], MD [**Telephone/Fax (1) 10492**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 24**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: Neuro-oncology, [**Hospital3 328**] Cancer Institute When: Wednesday [**2188-4-30**] 9:00am With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 30318**], MD [**Telephone/Fax (1) 30322**] Address: [**Hospital Ward Name 30323**], [**Location (un) 86**] MA Department: NEUROLOGY When: MONDAY [**2188-5-5**] at 4:30 PM With: DRS. [**Name5 (PTitle) 162**] & [**Doctor Last Name **] [**Telephone/Fax (1) 44**] Building: [**Hospital6 29**] [**Location (un) 858**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**] MD, [**MD Number(3) 10495**] Completed by:[**2188-4-24**] ICD9 Codes: 2720, 311, 2749, 4019
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Medical Text: Admission Date: [**2160-8-19**] Discharge Date: [**2160-8-23**] Date of Birth: [**2104-8-13**] Sex: M Service: PAST MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Coronary artery disease status post myocardial infarction in [**2147**]. PAST PSYCHIATRIC HISTORY: 1. Knee surgery. 2. Appendectomy. MEDICATIONS ON ADMISSION: 1. Aspirin 325 q.d. 2. Lipitor .................... 3. Atenolol 100 q.d. ALLERGIES: The patient has no known drug allergies. HISTORY OF THE PRESENT ILLNESS: The patient is a 56-year-old man status post myocardial infarction in [**2147**], catheterization of one vessel and now a catheterization in [**2150**]. The patient has recently been having chest discomfort symptoms, similar to his previous myocardial infarction. The patient was referred to [**Hospital1 69**] for further follow up and treatment. The patient had positive echocardiogram and EKG from an outside hospital. PHYSICAL EXAMINATION: Examination revealed the following: Vital signs: Blood pressure 161/65. CARDIOVASCULAR: Regular rate and rhythm, no murmur. Chest was clear to auscultation bilaterally. ABDOMEN: Soft, nontender, nondistended, bowel sounds positive. EXTREMITIES: Warm and perfused. HOSPITAL COURSE: The patient was taken to the operating room on [**2160-8-19**] at which time coronary artery bypass graft times three with LIMA to LAD, SVG to RCA and left radial to OM1 was performed. The procedure was without complications. Pacing wires. as well as mediastinal and pleural chest tubes were placed intraoperatively. The patient was transferred in good condition. On postoperative day #1, the patient was extubated without complications. The patient was afebrile. Vital signs were stable. He was started on oral Lopressor and transferred to the floor in stable condition. On postoperative day #2, the patient had a low grade fever of 100.3. Vital signs were stable. The wires were removed without complication. The patient was ambulating and working with PT. The temperature decreased with extensive pulmonary toilette. On postoperative day #3, the patient was afebrile. The vital signs were stable. The patient passed step 5 of PT. There were no issues. No active concerns. The patient will be sent home on postoperative day #4. CONDITION ON DISCHARGE: Good. DISCHARGE STATUS: The patient should follow up with Dr. [**Last Name (STitle) 1537**] in one month for postoperative check. MEDICATIONS ON DISCHARGE: 1. Lopressor 25 mg PO b.i.d. 2. Lasix 20 mg PO b.i.d. times 7 days. 3. Potassium chloride 20 mEq one tablet PO b.i.d. times 7 days. 4. Docusate sodium 100 mg PO b.i.d. 5. Enteric coated aspirin 325 mg PO q.d. 6. Tylenol 650 mg q.6h.p.r.n. 7. Motrin 400 mg, one tablet PO q.8h.p.r.n. 8. Percocet one tablet to two tablets PO q.4h. to 6h.p.r.n. for pain. 9. Isosorbide mononitrate ....................mg PO q.d. 10. Atorvastatin 20 mg PO q.d. DISCHARGE DIAGNOSES: 1. Hypertension. 2. Hypercholesterolemia. 3. Coronary artery disease status post myocardial infarction status post coronary artery bypass graft. [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D. [**MD Number(1) 1540**] Dictated By:[**Last Name (NamePattern4) 15509**] MEDQUIST36 D: [**2160-8-22**] 13:12 T: [**2160-8-22**] 13:34 JOB#: [**Job Number 44444**] ICD9 Codes: 4019, 2720, 412
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Medical Text: Admission Date: [**2196-5-24**] Discharge Date: [**2196-6-1**] Date of Birth: [**2128-3-22**] Sex: F Service: CARDIOTHORACIC Allergies: Lipitor / Codeine / Iodine Attending:[**First Name3 (LF) 2969**] Chief Complaint: Surgical reconstruction of metastatic Breast Cancer to sternum Major Surgical or Invasive Procedure: Left breast CA in past s/p left dorsi/gel implant. Now with metastatic breast Cancer to sternum. S/P sternectomy and reconstruction with [**Doctor Last Name **]-tex mesh to chest wall by Thoracic [**Doctor First Name **] with pedicled left dorsi flap by plastic surgery, 4 [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] drains, 2 chest tubes History of Present Illness: 68yo female with h/o L breast CA in past s/p left dorsi/gel implant. Now with metastatic breast CA to sternum. S/P sternectomy and reconstruction with [**Doctor Last Name **]-tex mesh to chest wall by CT [**Doctor First Name **] with pedicled l dorsi flap by us. 4 drains, 2 Chest tubes Past Medical History: Left breast cancer s/p mastectomy and reconstruction, Hypertension, dyslipidemia Social History: Husband died in [**2195-11-30**]. Six children. 50 pk year smoker. ETOH [**5-4**] drinks/wk- now decreased to 4 drinks/wk. Family History: Breast cancer in 2 sisters. One sister deceased from bone cancer. Physical Exam: General: well appaering female in NAD. HEENT: Atraumatic. PEERL. EOMI. Sclera white. Throat -no erythema. Heart: RRR No murmur, no rub. LUNGS: CTA bilat. Chest -ridge noted to left of midline of sternum post surgery. ABD: soft, NT, ND, +BS Extrem: no C/C/E. Pertinent Results: [**2196-5-24**] 07:05PM GLUCOSE-125* UREA N-13 CREAT-0.5 SODIUM-141 POTASSIUM-3.6 CHLORIDE-111* TOTAL CO2-21* ANION GAP-13 [**2196-5-24**] 07:05PM WBC-8.4 RBC-3.82* HGB-11.3* HCT-32.8* MCV-86 MCH-29.5 MCHC-34.3 RDW-13.5 [**2196-5-24**] Pathology Tissue: STERNAL MARGIN,PARTIAL [**2196-5-24**] [**Last Name (LF) **],[**First Name3 (LF) 2389**] M. Not Finalized Brief Hospital Course: 68 yo female with T2 N1 stage IIB carcinoma of the left breast with mastectomy and immediate reconstructionin [**2181**] who presents with adeno carcinoma of sternum. Pt was taken to the OR 4/ 26/05 for sternal resection and reconstruction. operative course was uneventful. Pt was kept intubated until POD#1 then weaned to extubate. Pain was managed w/ epidural Bup/Dilaudid). Sternal flap was well profused. Kefzol for JP drain prophylaxis. Chest tubes right/left placed in OR to SXN w/ serosang drainage. JP drains x4 to bulb sxn. POD #3 JP #1 d/c'd and chest tube to water seal. Right chest tube d/c'd and left chest tube clamped then d/c'd on POD#4. Left chest tube and two additional JP's d/c'd on POD #7. Flap continued to heal well. Progressed w/ ambulation, po's and epidural transitioned to po pain med. POD #8 pt d/c'd to home with one remaining JP drain in place and on po keflex until follow up appointment with plastics [**2196-6-10**] for JP drain removal. Medications on Admission: Atenolol 25", Lovastatin, Xanax, Wellbutrin Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed. Disp:*90 Tablet(s)* Refills:*0* 3. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 2 weeks: continue taking until the JP drain is removed AND you have [**Doctor First Name **] told to stop taking the antibiotic. Disp:*56 Capsule(s)* Refills:*0* 4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 6. Amoxicillin 500 mg Capsule Sig: Four (4) Capsule PO times one for once days: take all 4 pills one hour prior to your dental appointment. Disp:*4 Capsule(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Breast CA sternal resection and flap reconstruction Discharge Condition: good. Discharge Instructions: Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] for: shortness of breath, fever, chest pain, or redness or discharge from incision sites. Call Plastic Surgery office for issues with your JP drain [**Telephone/Fax (1) 274**]. for: a follow up appointment Resume medications as previous to hospitalization. Take all medications as directed. Obtain medical alert bracelet to indicate lack of sternal bone. You may shower on thursday; no tub baths for 3-4 weeks. Chest tube dressings may be removed on thursday and replaced with a bandaid. Followup Instructions: Call Dr.[**Doctor Last Name 4738**] office for appointment in [**1-31**] weeks-[**Telephone/Fax (1) 170**]. Please arrive to your Dr. [**Last Name (STitle) **] appointment 45 minutes prior for a follow up Chest XRAY- [**Location (un) **] radiology [**Hospital Ward Name 23**] Clinical Center. You have a Plastic Surgery Clinic appointment on [**2196-6-10**] at 1:30pm- [**Telephone/Fax (1) 274**]. Dr. [**Last Name (STitle) 1435**] office: [**Street Address(2) **]., [**Location (un) **], Ma. Phone [**Telephone/Fax (1) 1416**] Completed by:[**2196-6-3**] ICD9 Codes: 2724, 4019
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Medical Text: Admission Date: [**2154-6-3**] Discharge Date: [**2154-6-8**] Date of Birth: [**2107-5-11**] Sex: F Service: VSU CHIEF COMPLAINT: Aortoiliac disease. HISTORY OF PRESENT ILLNESS: 47-year-old non-diabetic white female with hypertension, hypercholesterolemia, seizure disorder, schizo-affective disorder, gastroesophageal reflux disease, asthma, who continues to smoke two packs of cigarettes per day complained of bilateral hip and thigh claudication and rest pain. The patient had been admitted to the hospital in [**Month (only) 547**] and had undergone an aortogram with bilateral run off via the left brachial artery on [**2154-5-13**]. The study showed severely diseased infrarenal aorta with complete occlusion of bilateral external and internal iliac arteries. There was reconstitution of the common femoral artery bilaterally with severe disease at the common femoral artery level. Both profunda arteries were patent. The cardiology service cleared the patient for surgery after an exercise Thallium stress test was done which was normal and showed an ejection fraction of 77% Several days after discharge the patient was readmitted with complaints of left upper arm hematoma with numbness and tingling of the left fingers. Her left radial and ulnar arteries were not palpable. An ultrasound confirmed occlusion of the left brachial artery. The patient underwent a left brachial artery thrombectomy and primary repair on [**2154-5-17**]. The patient now presents for an elective aortobifemoral bypass graft. PAST MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Gastroesophageal reflux disease. 4. Migraine headaches. 5. Schizo-affective disorder. 6. Seizure disorder; most recent episode one month ago. 7. Asthma; last exacerbation was one year ago. 8. History of goiter. 9. Chronic low back pain following trauma. 10. Vertigo. 11. Cystocele causing urinary incontinence. PAST SURGICAL HISTORY: 1. Tonsillectomy. 2. Ovarian cyst [**2144**]. 3. Excision of benign right axillary mass. 4. Right tibial fracture. 5. Thrombectomy of the left brachial artery on [**2154-5-17**] by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**]. FAMILY HISTORY: Significant for myocardial infarction. Maternal aunts two sons diagnosed with myotonia congenita. SOCIAL HISTORY: The patient lives alone. She has been smoking two to three packs of cigarettes per day for almost 30 years. Currently she smokes two packs of cigarettes per day. She ambulates independently. She is divorced times two. She has two adult sons and a stepdaughter, who is supportive. ALLERGIES: Penicillin. Demerol. Pistachios. MEDICATIONS: 1. Lisinopril 10 mg p.o. q day. 2. Lipitor 20 mg p.o. q h.s. 3. Topamax 200 mg p.o. twice a day. 4. Prolixin 5 mg p.o. q AM. 5. Seroquel 50 mg p.o. q h.s. 6. Nexium one capsule p.o. q day. 7. Vicodin p.r.n. pain. PHYSICAL EXAMINATION: Vital signs: Pulse 110, respirations 20, blood pressure 126/74. Height 4 feet, 11 inches, weight 154 pounds. General: Alert, cooperative white female in no acute distress. Chest: Heart regular rate and rhythm without murmur. Lungs clear bilaterally. Abdomen soft, nontender, bowel sounds active. No masses or bruits. Extremities: Left brachial artery incision well healed. Feet equally warm. Right foot has rubor with mildly dusky toes. Pulse oximetry, carotid pulses 1+ bilaterally without bruits. Right radial pulse is nonpalpable but has a Doppler signal. Left radial pulse is 1+. Femoral pulses and pedal pulses have Doppler signals bilaterally. Neurologic examination: Alert and oriented times three. Cranial nerves 2 through 12 intact. Motor and sensory function intact. Romberg negative. LABORATORY FINDINGS: White blood cells 10.6, hemoglobin 13.6, hematocrit 40.2. Platelets 267,000. Prothrombin 12.2, PTT 25.6, INR 1.0. Sodium 139, potassium 4.1, chloride 107, bicarbonate 19, BUN 15, creatinine 0.6, glucose 94. Calcium 9.6, phosphorus 4.5, magnesium 2.0. Urinalysis negative. Chest X-ray showed no acute pulmonary disease. EKG showed a normal sinus rhythm at a rate of 90. Abnormal R-wave progression present. HOSPITAL COURSE: The patient was admitted to the hospital on [**2154-6-3**]. On [**2154-6-4**] the patient underwent an uneventful aortobifemoral bypass graft with right profundoplasty. At the end of surgery the patient had equally warm feet with dopplerable pedal pulses bilaterally. She received Vancomycin perioperatively. Postoperative pain was managed with a Dilaudid PCA. The Acute Pain Service followed the patient. On postop day two, the patient's nasogastric tube was removed. She was started on clear liquids the following day and advanced to a regular diet without difficulty. Physical Therapy evaluated the patient and recommended short- term rehabilitation stay initially. However, patient had no insurance benefits for rehabilitation stay. Physical therapy worked with the patient until she was able to ambulate well on her own. They recommended home physical therapy at discharge. Lopressor was started for heart rate control. The patient continued on her Lisinopril as well. During hospitalization the patient said that she wanted to stop smoking and was ordered the nicotine patch. By postop day four she had removed the Nitroglycerin patch and had been found smoking in the patient room bathroom. She was reminded again of the dangers of wearing the nicotine patch and smoking at the same time. She planned to continue using the nicotine patch and not resuming smoking cigarettes. At the time of discharge the patient's abdominal and groin incisions were clean, dry and intact. She had dopplerable pedal pulses bilaterally. She was instructed to follow-up with Dr. [**Last Name (STitle) **] in the office in one to two weeks for surgical staple removal. DISCHARGE MEDICATIONS: 1. Lisinopril 10 mg p.o. q day, to be restarted at home. 2. Lipitor 20 mg p.o. q h.s, to be restarted when home. 3. Lopressor 50 mg p.o. twice a day. 4. Topamax 200 mg p.o. twice a day. 5. Prolixin 5 mg p.o. q AM. 6. Seroquel 50 mg p.o. q h.s. 7. Pepcid 20 mg p.o. twice a day. 8. Nicotine patch 21 mg/24 hour apply q day. 9. Percocet one to two tabs p.o. q 4 to 6 hours p.r.n. pain. CONDITION ON DISCHARGE: Satisfactory. DISPOSITION: Home with VNA services. PRIMARY DISCHARGE DIAGNOSIS: 1. Aortoiliac disease. 2. Aortobifemoral bypass graft and right profundoplasty on [**2154-6-4**]. SECONDARY DIAGNOSIS: 1. Current cigarette smoker; quitting smoking using the nicotine patch. 2. Hypertension. 3. Hyperlipidemia. 4. Schizoaffective disorder. 5. Seizure disorder. 6. Asthma. 7. Gastroesophageal reflux disease. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Dictated By:[**Last Name (NamePattern1) 7259**] MEDQUIST36 D: [**2154-6-11**] 10:59:27 T: [**2154-6-11**] 11:49:21 Job#: [**Job Number 98001**] ICD9 Codes: 4019, 2720, 3051
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Medical Text: Admission Date: [**2136-7-8**] [**Month/Day/Year **] Date: [**2136-7-24**] Date of Birth: [**2064-2-24**] Sex: F Service: MEDICINE Allergies: Streptomycin / Versed / Fentanyl Attending:[**First Name3 (LF) 1515**] Chief Complaint: Chest Pain and SOB Major Surgical or Invasive Procedure: None History of Present Illness: PCP:[**Name Initial (NameIs) 7274**]: [**Last Name (LF) 8682**], [**Name8 (MD) **] MD Location: [**Hospital1 **] HEALTHCARE - [**Hospital **] MEDICAL GROUP Address: [**Street Address(2) 2687**],8TH FL, [**Location (un) **],[**Numeric Identifier 822**] Phone: [**Telephone/Fax (1) 133**] Fax: [**Telephone/Fax (1) 445**] Email: [**University/College 12500**] Date : [**2136-7-8**] Time 4:48 am History obtained from Russian interpreter over the telephone. 72yo Russian speaking F with h/o diastolic CHF recently discharged 2 weeks ago here with 5 lb weight gain, SOB, worsening LE edema and CP x 3 days. Similar to previous admission. She been taking meds at home as prescribed- asked the interpretor this many times. She has a home VNA that assists her with her pills 2x per day. Neg cath for CAD [**1-15**]. She only CP and SOB when she walks around and not at rest. She also has R sided abominal pain. CD improved with 1 SLNG. Received lasix 80 mg IV with diuresis. She is not very active at baseline because of leg swelling and leg pain. She can only walk 10 yards. She uses CPAP at home. She has a VNA who comes and checks her weight/BP twice per week. She does not have daily weight and BP monitoring daily. Discussed diet with daughter with daughter who confirms that she is has a low salt diet. Her husband cooks for her. In ER: (Triage Vitals: 98.4, 104/48, 77, 20, 97% RA) Meds Given: SLNG x T, lasix 80 mg IV x T Fluids given: none/380 cc out [**Month/Year (2) **] Studies: portable CXR, increased pulmonary vasculature consults called: none PAIN SCALE: [**10-14**] in both legs She also developed pin point 5/10 chest pain in the L chest without radiation worse with palpation during the encounter. ________________________________________________________________ REVIEW OF SYSTEMS: CONSTITUTIONAL: [] All Normal [] Fever [+] Chills 1 week ago [ ] Sweats [ ] Fatigue [ ] Malaise [ ]Anorexia [ ]Night sweats [+] _5___ lbs. wt gain over _2____weeks HEENT: [] All Normal [ ] Blurred vision [-] Blindness [ ] Photophobia [ ] Decreased acuity [ ] Dry mouth [ ] Bleeding gums [ ] Oral ulcers [- ] Sore throat [ ] Epistaxis [ ] Tinnitus [ ] Decreased hearing [ ]Tinnitus [ ] Other: RESPIRATORY: [] All Normal [+ ] SOB [ ] DOE [+] Can't walk 2 flights [+] Dry cough x 1 day [ ] Wheeze [ ] Purulent sputum [ ] Hemoptysis [ ]Pleuritic pain [ ] Other: CARDIAC: [] All Normal [ ] Angina [ ] Palpitations [+] Edema [ ] PND [ ] Orthopnea [+] Chest Pain [ ] Other: GI: [] All Normal Last BM - [**2136-7-7**] [ ] Blood in stool [ ] Hematemesis [ ] Odynophagia [ ] Dysphagia: [ ] Solids [ ] Liquids [ ] Anorexia [-] Nausea [-] Vomiting [ ] Reflux [ ] Diarrhea [+] Constipation [+] Abd pain [ ] Other: GU: [] All Normal [ ] Dysuria [ ] Frequency [ ] Hematuria [][**Month/Day/Year **] []Menorrhagia SKIN: [] All Normal [ ] Rash [ ] Pruritus MS: [] All Normal [X]B/L leg pain[ ] Jt swelling [ ] Back pain [ ] Bony pain NEURO: [] All Normal [ ] Headache [-] Visual changes [ ] Sensory change [ ]Confusion [ ]Numbness of extremities [ ] Seizures [ ] Weakness [+ ] Dizziness/Lightheaded with standing[+]Vertigo [ ] Headache [+]Dizziness when she moves her head from side to side ENDOCRINE: [X] All Normal [ ] Skin changes [ ] Hair changes [ ] Temp subjectivity HEME/LYMPH: [X] All Normal [ ] Easy bruising [ ] Easy bleeding [ ] Adenopathy PSYCH: [X] All Normal [] Mood change []Suicidal Ideation [ ] Other: [X]all other systems negative except as noted above Past Medical History: 1. Atrial fibrillation 2. Hypertension 3. Dyslipidemia 4. Obstructive sleep apnea with secondary pulmonary HTN (on CPAP) 5. Chronic diastolic heart failure 6. Type 2 Diabetes Mellitus - [**2135-1-31**] HbA1c 7.7 [**2135-8-24**] 7. Chronic Renal Failure 8. S/p lap appy ([**9-11**]) 9. Diabetic neuropathy 10. Osteoporosis 11. h/o cataract surgery Social History: Lives with her husband. Denies alcohol, tobacco, or illicit drug use. Family History: Non-contributory. Mother: died of 'old age' at 73, Father: killed during the war. No other family members with heart disease. Physical Exam: PAIN SCORE [**5-14**] VS T = 97.3 P = 67 BP = 106/60 RR = 20 O2Sat =100% RA Wt, ht, BMI GENERAL:Obese female laying in bed. She is in NAD. Nourishment: good Grooming: good Mentation: Alert, speaking in full sentences Eyes:NC/AT, EOMI without nystagmus, no scleral icterus noted Ears/Nose/Mouth/Throat: MMM, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Respiratory:Decreased BS throughout, not moving a great deal of air. Cardiovascular: RRR, nl. S1S2, no M/R/G noted Gastrointestinal: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Genitourinary: Skin: no rashes or lesions noted. No pressure ulcer 2+ edema b/l. DPP pulses barely appreciatd b/l. Xerosis of b/l feet noted. Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses b/l. Lymphatics/Heme/Immun: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Neurologic: -mental status: Alert, oriented x 3. Able to relate history without difficulty. -cranial nerves: II-XII intact -motor: normal bulk, strength and tone throughout. No abnormal movements noted. Psychiatric: Appropriate full affect Pertinent Results: EKG: Atrial fibrillation at 91 bpm, no acute changes Admission CXR: Increased interstitial markings, ? L pleural effusion Admission Labs: [**2136-7-8**] 01:19AM PT-23.1* PTT-24.7 INR(PT)-2.2* [**2136-7-8**] 12:40AM GLUCOSE-278* UREA N-47* CREAT-2.4* SODIUM-133 POTASSIUM-4.8 CHLORIDE-91* TOTAL CO2-32 ANION GAP-15 [**2136-7-8**] 12:40AM estGFR-Using this [**2136-7-8**] 12:40AM cTropnT-<0.01 [**2136-7-8**] 12:40AM proBNP-3101* [**2136-7-8**] 12:40AM WBC-5.8 RBC-2.81* HGB-7.8* HCT-25.2* MCV-90 MCH-27.7 MCHC-30.9* RDW-18.8* [**2136-7-8**] 12:40AM NEUTS-74.3* LYMPHS-18.6 MONOS-4.6 EOS-2.1 BASOS-0.4 [**2136-7-8**] 12:40AM PLT COUNT-166 [**2136-7-8**] 12:40AM BLOOD TSH-7.9* Labs on [**Month/Day/Year **]: [**2136-7-24**] 06:10AM BLOOD WBC-4.8 RBC-3.52* Hgb-10.0* Hct-31.5* MCV-90 MCH-28.6 MCHC-31.9 RDW-21.4* Plt Ct-156 [**2136-7-24**] 06:10AM BLOOD PT-20.6* PTT-26.9 INR(PT)-1.9* [**2136-7-24**] 06:10AM BLOOD Glucose-181* UreaN-46* Creat-1.8* Na-140 K-3.9 Cl-97 HCO3-34* AnGap-13 [**2136-7-24**] 06:10AM BLOOD Calcium-9.4 Phos-3.5 Mg-2.2 Other Notable Labs: [**2136-7-11**] 07:08AM BLOOD ALT-15 AST-26 CK(CPK)-43 AlkPhos-69 TotBili-0.5 [**2136-7-16**] 12:05PM BLOOD Type-ART pO2-84* pCO2-64* pH-7.49* calTCO2-50* Base XS-21 Intubat-NOT INTUBA [**2136-7-16**] 12:05PM BLOOD Lactate-0.9 [**2136-7-10**] BLOOD Cr 3.2 [**2136-7-13**] BLOOD Cr 1.5 [**2136-7-21**] BLOOD Cr. 2.6 TTE [**2136-7-11**]: The left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. 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 is probably normal (LVEF>55%). There is no ventricular septal defect. The right ventricular cavity is dilated with depressed free wall contractility. 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. There is no mitral valve prolapse. Mitral regurgitation is present but cannot be quantified. The tricuspid valve leaflets are mildly thickened. At least moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the prior study (images reviewed) of [**2136-1-30**], the degree of TR seen has probably increased. Right Cardiac Cath [**2136-7-13**]: 1. Invasive hemodynamics using swan-ganz catheter demonstrated elevated ventricular filling pressures, and normal cardiac output. 2. The pulmonary vascular resistance was high-normal. FINAL DIAGNOSIS: 1. Elevated ventricular filling pressures. 2. Normal cardiac output. Brief Hospital Course: Floor Course: Admitted to [**Hospital1 18**] for chest pain and shortness of breath, and an acute diastolic CHF exacerbation. On the floor she was given Lasix with initially good urine output. However, she became oliguric and increasingly dyspneic, hypotensive in the setting of decompensated heart failure. She was transfered to the [**Hospital Ward Name 332**] ICU for close management. [**Hospital Ward Name 332**] ICU course: #Atrial Fibrillation/A Flutter: Decompensated heart failure was likely driving A. fib. She was rate controlled with Diltiazem and Metorpolol and home. EP assessed patient and recommended we start Amiodarone drip which showed some rate control. #Hypotension: Pt was hypotensive upon arrival to ICU. She was started on empiric antibiotics (Vanco and Cefepine) for coverage of possible sepsis. All cultures came back negative. Hypotension likely attributed to decompensated heart failure with intravascular hypovolemia. She had cardio-renal syndrome and was put on both pressors and lasix drip. #Acute Renal Failure: Cr increased, secondary to pre-renal and poor forward flow. Renal was consulted and encouraged lasix. #Diabetes: Had a few hypoglycemic episodes, given D5W. #Hypothyroidism: Continued her home thyroid medications. #Sleep Apnea: Has sleep apnea, uses CPAP at home. CCU Course: The patient is a 72yo female with h/o dCHF, DM2, a fib and recent CHF exacerbation who was admitted to [**Hospital1 18**] on [**2136-7-8**] with chest pain, SOB, and acute on diastolic CHF exacerbation. She was transferred to the [**Hospital Ward Name 332**] ICU for hypotension in the setting of decompensated heart failure. EP recommended cardiac cath to evaluate whether patient's hypotension was cardiogenic in nature. The patient was started on amiodarone and diltiazem for a flutter/a fib. She required pressors to maintain BP while she underwent aggressive diuresis as treatment for her heart failure. #) Hypotension: The differential for the patient's hypotension included worsening dCHF, intravascular volume depletion, and acute blood loss in setting of supratherapeutic INR. She was aggressively diuresed, initially on a Lasix gtt. She had a CVL and Swan catheter placed to monitor the cardiogenic portion of her hypotension. Right cath on [**2136-7-13**] revealed elevated ventricular filling pressures and normal cardiac output. The pulmonary vascular resistance was high-normal. She required pressors initially to maintain her BP while she underwent aggressive diuresis for diastolic CHF, but was able to be weaned off pressors with more stable blood pressures by [**2136-7-12**]. Swan catheter was removed on [**2136-7-16**]. #) Acute on Chronic Heart Failure: Thought to be diastolic heart failure, and a TTE obtained during the admission revealed LVEF of 55-60%. Right heart cath findings were consistent with dCHF, revealing elevated ventricular filling pressures and LVEF of 55%. The patient was thought to be up to 30 pounds over her dry weight, and was aggressively diuresed. She was initially on a lasix gtt, and was later transitioned to IV Lasix boluses. She also received a course of diamox in the setting of increased bicarb/metabolic alkalosis, part of a mixed acid-base status with a concurrent respiratory acidosis. The patient's diuretic regimen was gradually tailored back, with close monitoring of her hemodynamics, fluid balance, and renal function. #) Atrial Fibrillation: Patient was in a fib on admission, and was monitored on telemetry throughout her hospital course. Her Coumadin was initially held as her INR was supratherapeutic, but was later resumed. She was on a heparin gtt at the time. She received both diltiazem and metoprolol for rate control during her hospital course, and was started on an amiodarone load. She underwent a DC cardioversion on [**2136-7-20**], after which she was temporarily in a rhythm felt to be sinus bradycardia (rate 40s) with junctional escape and rate in the 60s. Her amiodarone was continued, but her metoprolol was temporarily held given her lower HR. She reverted back to a fib prior to [**Date Range **], and her metoprolol was re-started. She may benefit from a repeat cardioversion in the future. #) Acute Kidney Injury: The patient was noted to have poor urine output and rising Cr, which peaked at 3.2 on [**2136-7-10**]. Her [**Last Name (un) **] was thought to pre-renal in setting of hypotension/poor forward flow, and less likely to be intrinsic renal failure. Renal consult involved early in hospital course. The patient did not require ultrafiltration, and her Cr trended back to near baseline at 1.5 on [**2136-7-15**]. However, her Cr rose again to as high as 2.6 on [**2136-7-21**], likely secondary to continued diuresis and poor forward flow. Urine electrolytes were not suggestive of an intrinsic renal etiology. Renal continued to follow, and recommended decreasing the amount of diuresis as the patient was nearing her weight prior to her CHF exacerbation. #) Anemia - The patient's HCT dropped to a low of 21 on [**2136-7-13**], down from her baseline of 26. In the setting of a supratherapeutic INR and concern for possible blood loss, she was transfused one unit PRBCs on [**2136-7-13**]. Per renal recs, she was also started on epo 3x/week for her anemia. She was also started on iron prior to [**Date Range **]. Her HCT remained stable for the rest of the admission. #) Diabetes Type 2 - She was on an insulin sliding scale during her hospital course. For her diabetic neuropathy, she received renally dosed neurontin. #) Hypothyroidism: She was continued on levothyroxine. #) Sleep apnea: She was encouraged to use CPAP at night during her CCU admission. Medications on Admission: The patient could not tell the team any of the names of any pills that she is taking. Her family brought in her medications and this list is the result of direct inspection of her pill bottles reviewed on [**2136-7-8**]. ECASA 81mg qd Torsemide 20mg 2 tabs [**Hospital1 **] Metoprolol XL 150mg (1.5 tabs 100mg) qd Gabapentin 300mg tid Glipizide 5mg [**Hospital1 **] Spironolactone 25mg qd Pantoprazole 40mg qd Warfarin 5mg tabs ([**1-7**] tab Saturday, 1 tab qSunday-[**Month/Day (2) 2974**]) Senna 2 tabs [**Hospital1 **] Docusate 100mg qd Vitamin D [**Numeric Identifier 1871**] one dose qweek (husband thinks started a few weeks PTA) Folic acid 1mg qd Diltiazem CD 180mg [**Hospital1 **] TRICOR 145mg qd atorvastatin 10mg qhs Levothyroxine 125 mcg qd Insulin 70/30 ?15 units (25units qam/15 units qpm) Nocturnal Oxygen (2L/min) with CPAP at bedtime Please follow up for Sleep Study for further instructions. [**2131-7-12**] These medications were not provided by the patient's family, but appear in her recent records per OMR: Cyanocobalamin 1,000 mcg/mL Solution 1 ml once a month IM [**2136-5-7**] [**Year (4 digits) **] Medications: 1. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day) for 5 days: Last day [**7-28**]. Disp:*20 Tablet(s)* Refills:*0* 2. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO once a day. Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*2* 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day. 6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 8. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q24H (every 24 hours). 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 10. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day for 2 days: take on [**7-25**] and [**7-26**], then Dr. [**Last Name (STitle) **] will tell you what to take. 11. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO once a week. 12. Fenofibrate Micronized 48 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 13. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical DAILY (Daily) as needed for pruritus. 14. Cyanocobalamin 1,000 mcg/mL Solution Sig: One (1) ml Injection once a week. 15. Levothyroxine 125 mcg Capsule Sig: One (1) Capsule PO once a day. 16. Glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day. 17. Novolog Mix 70-30 100 unit/mL (70-30) Solution Sig: Twenty Five (25) units Subcutaneous once a day: in the am. 18. Novolog Mix 70-30 100 unit/mL (70-30) Solution Sig: Fifteen (15) units Subcutaneous at bedtime. 19. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 20. Bisacodyl 10 mg Suppository Sig: One (1) suppository Rectal once a day as needed for constipation. 21. Tuberculin Syringe 1 mL Syringe Sig: One (1) syringe Miscellaneous once a week. Disp:*4 syringes* Refills:*2* 22. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 23. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1) ml Injection once a week. Disp:*4 ml* Refills:*2* 24. Miralax 17 gram Powder in Packet Sig: One (1) packet PO once a day. Disp:*30 packets* Refills:*2* 25. Outpatient Lab Work Please check INR, Chem 7 on thursday [**2136-7-26**] and call results to Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 133**] 26. Torsemide 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* [**Telephone/Fax (1) **] Disposition: Home With Service Facility: [**Hospital1 **] Family & [**Hospital1 1926**] Services [**Hospital1 **] Diagnosis: Acute on chronic Diastolic congetive Heart Failure Acute on chronic Kidney Disease Fe deficiency Anemia Atrial Fibillation with rapid ventircular response/Atrial tachycardia Diabetes Mellitus type 2 [**Hospital1 **] Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). [**Hospital1 **] Instructions: You had an acute exacerbation of your congestive heart failure and required aggresive diuretics to take off the fluid. Your kidney function worsened temporarily because of the diureteics but is improving now. We had some kidney doctors follow [**Name5 (PTitle) **] [**Name5 (PTitle) 1028**] you were here and they will see you after [**Name5 (PTitle) **] as well. We cardioverted you to try to restore a normal rhythm to your heart. This was not effective but we started a new medicine, Amiodarone, to try to control your heart rate. We may try another cardioversion in the future. it is very important that you weigh yourself every morning, call Dr. [**Last Name (STitle) 171**] if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. You must not eat salt. A low sodium diet was described to you. Eating too much salt will cause you to be readmitted to the hospital and will worsen your kidney function. . Medication changes: 1. Start taking amidarone to control your heart rate and rhythm. You will take 2 pills twice a day until Saturday [**7-28**], then decrease to 1 pill daily. Dr. [**Last Name (STitle) 18542**] will follow your liver and thyroid function while on this medicine. 2. Increase Toprol to 200 mg daily 3. Decrease Gabapentin to 300 mg daily because of your kidney function, this may be increased later. 4. Decrease Tricor to 48 mg daily because of your kidney function, this may be increased later. 5. Discontinue your Lisinopril, spironolactone and Diltiazem because of your kidney function. 6. Start Epoetin injections every week to help your body make more red blood cells. Your kidney doctors [**Name5 (PTitle) **] adjust the dose. 7. Start ferrous sulfate (iron) tablets to treat your anemia. Make sure you take colace and Miralax as this medicine is very constipating. 8. Decrease your Torsemide to 20 mg daily. Dr. [**Last Name (STitle) 171**] will tell you when to increase the dose. Followup Instructions: Department: CARDIAC SERVICES When: MONDAY [**2136-8-6**] at 1 PM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital Ward Name 706**] When: WEDNESDAY [**2136-8-8**] at 3:15 PM With: [**Year (4 digits) 706**] [**Telephone/Fax (1) 327**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 861**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: CARDIAC SERVICES When: MONDAY [**2136-11-12**] at 11:20 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Name: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **],MD Department: Internal Medicine When: [**Last Name (NamePattern1) 2974**] [**7-27**] at 10:45am Location: [**Hospital1 **] HEALTHCARE - [**Hospital **] MEDICAL GROUP Address: [**Street Address(2) 2687**],8TH FL, [**Location (un) **],[**Numeric Identifier 809**] Phone: [**Telephone/Fax (1) 133**] Department: WEST [**Hospital 2002**] CLINIC, NEPHROLOGY When: THURSDAY [**2136-8-30**] at 8:30 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 721**] Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **] Campus: WEST Best Parking: [**Street Address(1) 592**] Garage Completed by:[**2136-7-27**] ICD9 Codes: 5849, 2851, 2762, 5990, 4280, 2449, 2724, 3572
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Medical Text: Admission Date: [**2126-10-31**] Discharge Date: [**2126-11-7**] Date of Birth: [**2063-9-7**] Sex: F Service: MEDICINE Allergies: Codeine / Lisinopril Attending:[**First Name3 (LF) 678**] Chief Complaint: altered mental status, hyperglycemia, renal failure Major Surgical or Invasive Procedure: None History of Present Illness: 63 yof with IDDM c/b nephropathy, neuropathy and retinopathy, htn, and anemia who presents with three days of nausea, vomiting, cough, and high blood sugars. On the night prior to admission her sugars where critically high, > 600. She was evaluated by Dr. [**First Name (STitle) 216**] at her home who recommended 20U of NPH at night and 40U lispro. She became altered overnight and was brought into the ED in the AM for hydration. PCP recommended adjustment of BP medications while hospitalized. . In the ED, vs were T101 BP126/60 HR56 RR16 O2 sat 100% 2L. Her mental status had improved at this point and she was alert and oriented X 3. She was given Ceftriaxone 1gm, Tylenol 1mg and Azithromycin 500mg. She refused Levofloxacin. She was given 2L normal saline. Labs were notable for normal electrolytes, AG of 15, ketones in the urine. CXR showed left lower lobe infiltrate. . On the floor, pt is refusing to answer questions, affirms thirst, nausea, vomiting. Admits to low po intake and low urine output for three days. Asks that all questions be directed to her husband. Past Medical History: DM1, last A1c 8.5% on [**4-/2123**], c/b gastroparesis, retinopathy, and neuropathy Hypertension Depression Anemia OSA on CPAP 11 CM Legally blind h/o pneumonia x2 h/o MSSA bacteremia h/o T10-T11 discitis s/p lap cholecystectomy s/p ORIF left ankle Social History: Lives w/ husband. [**Name (NI) 1403**] as an administrator at BU. Walks w/ cane. Never smoked. [**1-26**] glass wine daily. No illicits. Family History: Non-contributory Physical Exam: Physical Exam: Vitals: T 98.9 BP 151/56 P 61 RR 18 SaO2 97 RA Blood glucose 133-440 General: mildly fatigued elderly woman with left eye closed HEENT: Sclera anicteric, MM dry, oropharynx clear Neck: supple, JVP flat, no LAD, thyromegally Lungs: Reduced breathsounds at LL base, otherwise clear bilatearlly without wheezes, rales or rhonchi. CV: RRR, 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 Pertinent Results: Admission labs: Labs: WBC 11.7 Hct 30.3 Plt 220 N:80.3 L:12.1 M:7.1 E:0.2 Bas:0.3 . 133 92 69 ---------------181 4.3 26 3.9 [**2126-10-31**] 01:40PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-150 GLUCOSE-1000 KETONE-50 BILIRUBIN-SM UROBILNGN-NEG PH-5.0 LEUK-NEG [**2126-10-31**] 02:21PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2126-10-31**] 02:21PM URINE HOURS-RANDOM [**2126-10-31**] 03:37PM URINE OSMOLAL-355 [**2126-10-31**] 12:10PM GLUCOSE-181* UREA N-69* CREAT-3.9*# SODIUM-133 POTASSIUM-4.3 CHLORIDE-92* TOTAL CO2-26 ANION GAP-19 [**2126-10-31**] 12:10PM estGFR-Using this [**2126-10-31**] 12:10PM CK(CPK)-90 [**2126-10-31**] 12:10PM CK-MB-3 cTropnT-0.06* [**2126-10-31**] 12:10PM OSMOLAL-306 [**2126-10-31**] 12:10PM WBC-11.7*# RBC-3.17* HGB-10.2* HCT-30.3* MCV-96 MCH-32.3* MCHC-33.8 RDW-14.5 [**2126-10-31**] 12:10PM NEUTS-80.3* LYMPHS-12.1* MONOS-7.1 EOS-0.2 BASOS-0.3 [**2126-10-31**] 12:10PM PLT COUNT-220 CXR: [**10-30**]: Minimal left basilar atelectasis. Unchanged right minor fissural thickening. CXR: [**10-31**]: In comparison with the study of [**10-30**] there is little overall change. Continued low lung volumes with mild engorgement of pulmonary vessels and atelectatic changes primarily in the retrocardiac region. Minimal blunting of both costophrenic angles could reflect some small pleural effusions. There is slight asymmetric opacification in the left perihilar region when compared to the right. This could merely reflect slight differences in pulmonary vascular engorgement. However, if there is strong clinical concern for infection, this could be an area of developing consolidation. CXR [**11-5**] 1. Interval improvement in vascular congestion. 2. Trace atelectasis at the left costophrenic angle. No evidence of aspiration. Brief Hospital Course: 63 year old female with IDDM, who presents with DKA c/b worsening dysphagia. . # DKA/hyperglycemia - The patient presented with DKA, perhaps precipitated by an acute viral syndrome. On admission she was sent to the ICU. Her anion gap was small and likely atleast partially contiributed to by her acute on chronic renal failure. However, there were ketones in the urine, though these may also be secondary to poor po intake. HONK was also on the differential initially but her serum osms were within normal limits. Her blood glucose on presentation was 184, which had been increasing slowly. She was started on insulin drip administered with D5, 1/2NS when sugars < 200. This was stopped once glucose was controlled. Once anion gap was closed and sugars were under better control the patient was switched to ISS and home NPH (qAM) and transferred to the floor. Despite being on the home regimen, pt's sugars continued to have some high elevations with episodes of hypoglycemia. Given the patient had been hard to manage diabetic, [**Last Name (un) **] was consulted and recommended lantus and changing sliding scale. The patient's sugars were better managed however did continue to experience some elevations. The patient will follow-up with [**Last Name (un) **] as an outpatient. . # Inability to swallow: Speech and Swallow evaluated the patient and found she was at aspiration risk for solids and liquids. The cause was unclear, could be recrudescence of deficits from [**2-3**] lacunar infarct [**2-26**] hypovolemia. The patient was made NPO but was adamant that she could eat full diet. The patient and husband were counseled about the risks of aspiration and potential morbidities associated with it and agreed that they were willing to accept the risk of aspiration. On repeat S&S the following recommendations were made: 1. Safest recommendation would be videoswallow study for better objective assessment of swallow function 2. If pt remains uninterested in discussion of aspiration risk, modified diet, and further testing, would return her to regular diet with thin liquids at her own risk. 3. If pt is to take PO, aspiration precautions including: a) feed only when awake/alert b) sit fully upright for all PO c) remain upright at least 30 minutes after meals d) do not lower HOB below 30 degrees. . # LLL infiltrate - The patient had a CXR questionable for LLL infiltrate, along wiht cough, fever, and leukocytosis. She was started on ceftriaxone and azithro given suspicion for CAP. However given the inconclusiveness of the xray, the fact that the patient was asymptomatic, and her slight leukocytosis on admission was likely [**2-26**] DKA, we stopped antibiotics and the pt continued afebrile, stable on ra. Repeat PA and lateral showed interval improvement. UA negative, blood cx neg. . # Acute on chronic renal failure: Pt shows evidence of volume depletion from hyperosmolar state suggesting a prerenal azotemia. No sediment on UA to suggest intrinsic renal pathology. No evidence of outflow obstruction. She was treated with IVF and Cr improved to baseline. . #Hypertension - Dr. [**First Name (STitle) 216**] had been concerned about her blood pressure for some time and recommended titration while hospitalized. However, in the ICU she was normotensive, likely due to volume depletion. Chlorthalidone 25mg daily was held due to acute on chronic renal failure, and reduced diltiazem to 30mg qid (120mg daily vs 540mg home dose)changed atenolol 25mg daily to metoprolol tartrate 12.5mg tid given renal failure and continued clonidinen 0.1mg qAM and 0.2mg qPM. On the floor, Diltiazem was uptitrated to 360mg, she was continued on metoprolol 25mg TID, continued clonidine and started on hydralazine 25mg PO TID, as well as restarted on chlorthalidone home dose. . #Elevated troponins - without elevation in CK/MB, no ECG changes, there was very low suspicion for MI. . # Anemia: Hct trended from 34 to 27 this admission, likely secondary volume resuscitation. Now 30. Baseline anemia is likely due to CKD. . # Depression: Psych was consulted and signed off due to patient's lack of interest in talking to them further. She was continued on home fluoxetine . #HL - continued home simvastatin Medications on Admission: Atenolol 25mg daily Chlorthalidone 25mg daily Clonidine 0.1mg qAm and 0.2mg qpm Diltiazem 540mg daily Fluoxetine 40mg daily Lispro 4 units tid for BG > 200 Metoclopramide 5mg daily Omprazole 20mg daily Percocet 0.5-1 tab q6h prn pain Simvastatin 40mg qhs ASA 81mg daily Calcium + vit D [**Hospital1 **] Vit D 100 U daily MVI NPH 20mg daily Fish oil 1000mg daily . Allergies: Codeine Lisinopril Discharge Medications: 1. fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 6. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day). 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily) as needed for constipation. 10. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 11. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO qAM. 12. chlorthalidone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. diltiazem HCl 180 mg Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO DAILY (Daily). Disp:*60 Capsule, Sustained Release(s)* Refills:*2* 14. hydralazine 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 15. metoclopramide 5 mg Tablet Sig: One (1) Tablet PO once a day. 16. clonidine 0.2 mg Tablet Sig: One (1) Tablet PO qPM. 17. M.V.I. Adult 1-5-10-200 mg-mcg-mg-mg Solution Sig: One (1) Intravenous once a day. 18. Fish Oil 1,000 mg Capsule Sig: One (1) Capsule PO once a day. 19. insulin glargine 100 unit/mL Cartridge Sig: Eighteen (18) unit Subcutaneous at bedtime. Disp:*1 month supply* Refills:*2* 20. insulin lispro 100 unit/mL Cartridge Sig: sliding scale insulin units per ss Subcutaneous qachs: BREAKFAST: <80 give 4, 80-130 give 7, 131-180 give 8, 181-230 give 9...increase 1unit lispro every 50 increase of sugar. LUNCH and DINNER: <80 give 3u, 80-130 give 5u, 131-180 give 6u, continue to increase insulin 1u for every 50 increase of blood sugar. BEFORE BED: if blood sugar 181-230 give 2u lispro, continue to increase 1u insulin per 50 increase sugar. . Disp:*1 month supply* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: 1) DKA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mrs. [**Known lastname **], You were admitted for diabetic ketoacidosis (very high blood sugars) likely precipitated by a respiratory illness probably from a virus. You were in the intensive care unit where they brought down your sugars with an insulin drip and then transitioned you to the general wards. While here you were consulted by [**Last Name (un) **] Diabetes Center and they changed your insulin sliding scale and switched you from NPH to Lantus (insulin glargine). You will follow up with a doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] as an outpatient to further optimize your diabetes management. You were also found to have difficulty swallowing and were evaluated by speech and swallow. They found that you do aspirate some food and liquids while eating and drinking, especially thin liquids. However, in consultation with you and your husband, you decided to accept the risks of eating in order to have an unrestricted diet. If you decide in the future that you want more specific recommendations on diet in order to decrease the risk of aspirating, further imaging can be done to better identify the source of this difficulty swallowing. If you develop increased pain, sugars >500 that are not being controlled with insulin, or other symptoms that concern you, please call Dr. [**First Name (STitle) 216**] or return to the ED. ********* Please START the following medications: Lantus 18u at bedtime Metoprolol 25mg every 8h Hydralazine 25mg every 8h Senna, Colace, Miralax as needed for constipation . Please STOP the following medications: Atenolol NPH insulin . The following medications have been CHANGED: Take Diltiazem at 360mg daily The Lispro sliding scale has changed Followup Instructions: Department: [**Hospital3 249**] When: WEDNESDAY [**2126-11-13**] at 10:30 AM With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 250**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**Last Name (un) **] Diabetes Center will call you with an appointment. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(1) 684**] ICD9 Codes: 5849, 3572, 5859, 2720, 311
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6772 }
Medical Text: Admission Date: [**2114-2-23**] Discharge Date: [**2114-3-15**] Date of Birth: [**2060-4-19**] Sex: F Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1271**] Chief Complaint: Intractable Seizures Major Surgical or Invasive Procedure: placement of left hemisphere grid ([**2-23**]) and removeal of grid ([**2-26**]) History of Present Illness: 53yo RH woman s/p left partial frontal lobectomy and VNS placement, with extensive history of seizure comes to [**Hospital1 18**] for elective placement of grid for seizure focus localization. Seizures started when patient was 13yo. Observers noted that the patient would stare blankly and then her head would slowly slump to her chest. These seizures last only a few moments and then the patient would become aware and usually laugh as if embarrassed by the event. Patient also has partial complex seizures, starting at age 13 where she loses tone and consciousness, falling to the ground. Had to wear a helmet in later years for this. These tend to last less than a minute. A third type of seizure is noted in previous notes where the patient has altered consciousness and shaking of the left arm (family denies). These three types of seizure are not preceded by an aura, or any other sign that the patient recognizes (no warning). The family thinks that the patient may have been hit in the head with a shovel when she was 6 years old by her cousin. Also, Forceps were used on the patient when she was born. In [**2091**] the patient had a left partial frontal lobe resection. However, seizures returned following the procedure and have continued to this day. Patient had a VNS placed in [**2106**], which decreased the frequency of seizures. Recently, the frequency of seizures had increased coincident with the battery failing on the VNS. The battery was replaced; however the VNS never provided the same level of seizure protection as prior to the battery replacement. Currently the patient experiences [**3-20**] seizures per day, with and average of 8 seizures per day. Approximately 2 of these seizures are partial complex involving loss of tone and falling. The remaining seizures are of the blank stare type. She has never had a grand mal seizure or bit her tongue during a seizure. She has been incontinent as a result of the partial complex seizures. The patient??????s seizures occur with a fairly stable frequency. The patient wanted grid placement for localization and an eventual removal of the seizure focus. The seizure focus has been localized with SPECT scan to the left hippocampus, followed by Dr. [**Last Name (STitle) **]. At baseline, patient has always had memory difficulties, which she attributes to the seizures; however she was able to graduated from nursing school and work as a nurse [**First Name (Titles) **] [**Last Name (Titles) 1281**] Hospital. Her seizures eventually stopped her from working as a nurse [**First Name (Titles) **] [**2113-3-7**] and recently she has been living at the [**Hospital 1456**] [**Hospital **] Rehab Center. She has had to wear a helmet and use a wheel chair due to frequent falls. Some of these falls have resulted in head trauma. Past Medical History: -Seizure disorder: The patient first developed epilepsy at the age of 8 when she had staring spells. She then developed complex partial seizures at the age of 13. She had been intermittently treated with several anticonvulsants, none of which fully controlled her seizures. She had a presurgical evaluation that showed a left temporal lobe focus of her seizures over 20 years ago. She underwent left temporal lobe resection in [**2091**] with mild improvement of her symptoms for a short period of time before her seizure activity returned to baseline. The patient had a vagus nerve stimulator placed in [**2106**]. She has had an increased in her seizure activity over the last year. Her seizures appear now as drop attacks that come without warning. She loses consciousness and is awakes anywhere from right away to 45 seconds later. They are brought on by stress. She states that she has had 4 seizures/day for the last year. She was recently admitted to the [**Hospital1 18**] for medication adjustment, as above. -S/P Cholecystectomy -S/P Benign breast mass removal -Hypercholesterolemia Social History: Currently lives at [**Hospital 1456**] Rehab facility, had a boyfriend, no children, former nurse [**First Name (Titles) **] [**Last Name (Titles) 1281**] Hospital, no drinking, no alcohol no drug use. Family History: No seizures in other family members. Physical Exam: T 97.5 BP 124/64 HR 72 RR 22 O2Sat 100% RA Gen: Lying in bed, eyes initially closed, arouses to stimulus HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, supple, neg brudzinskis CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: CTAB aBd: +BS soft ext: no edema, wwp Neurological examination: Mental status: Somnolent but rousable to voice and pain. Intermittently follows simple commands. Verbal output minimal, attempted to speak a number of times was frustrated when unable to find words. At one point was able to form a phrase of words, but did not make sense. Unable to name. Unable to use hands well enough to assess writing. Patient tends to turn head to the left and will drift back to left after the head is repositioned. Possible neglect of right side. Cranial Nerves: I: not tested II: Pupils equally round and reactive to light, 3 to 2 mm bilaterally. III, IV, VI: Lateral eye movements appear intact. Left eye was slightly slower tracking and caused disconjugate movement. However, stationary gaze was conjugate V: unable to assess, + corneals bilaterally VII: mild lower facial droop on right side, no involvement of forehead VIII: unable to assess IX, X: unable to assess [**Doctor First Name 81**]: unable to assess XII: Tongue midline, movements intact Motor: Normal bulk bilaterally. Tone normal. No observed myoclonus or tremor. Had difficulty following commands due to aphasia. Was essentially full strength on the left and had right leg externally rotated. [**Doctor First Name **] Tri [**Hospital1 **] WF WE FE FF IP H Q DF PF TE TF R ? 4 5 ? ? ? 5 5 4 5 ? ? 5 5 L 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Sensation: Intact to painful stimuli all 4 extremities, withdrawls but less vigorously on the right side. Reflexes: B T Br P A R 2 2 2 0 0 L 2 2 2 0 0 Toes upgoing bilaterally Coordination: Not assessed Gait: Not assessed Romberg: Not assessed Pertinent Results: [**2114-2-23**] 03:53PM PLT COUNT-166 [**2114-2-23**] 03:53PM WBC-6.9# RBC-3.16* HGB-10.1* HCT-28.4* MCV-90 MCH-31.8 MCHC-35.4* RDW-14.8 [**2114-2-23**] 03:53PM CALCIUM-8.6 PHOSPHATE-3.5 MAGNESIUM-1.4* [**2114-2-23**] 03:53PM GLUCOSE-177* UREA N-15 CREAT-0.7 SODIUM-147* POTASSIUM-3.7 CHLORIDE-118* TOTAL CO2-18* ANION GAP-15 [**2114-2-23**] 08:21PM CK-MB-6 cTropnT-<0.01 [**2114-2-23**] 08:21PM CK(CPK)-300* HEAD CT: [**2-23**] postop; Interval placement of a grid in the left frontoparietal area with mass effect and slight contralateral shift of normally midline structures. Mild-to-moderate amount of subarachnoid hemorrhage also present in the basilar cisterns and left sylvian fissure. CT HEAD W/O CONTRAST [**2114-2-25**] 9:13 AM [**Hospital 93**] MEDICAL CONDITION: 53 year old woman with epilepsy s/p grid placement on the left. Small amount of shift and subarachnoid blood. REASON FOR THIS EXAMINATION: please assess for progression of blood, shift. INDICATION: Status post grid placed on the left, epilepsy, assess for progression of bleed and shift. CT OF THE BRAIN WITHOUT INTRAVENOUS CONTRAST: The patient is status post left craniotomy with metallic grid in place overlying the left convexity. There is continued pneumocephalus, approximately unchanged in degree since [**2-24**]. Since the examination of one day prior, there is increase in mass effect, with increased left to right subfalcine shift, previously 2 mm and now approximately 12 mm. The degree of subarachnoid blood within the suprasellar cistern appears approximately unchanged. Visualization of the brain parenchyma is limited by streak artifact arising from the metallic density structures overlying the left hemisphere, however, there is diffuse sulcal narrowing within the right hemisphere and probably within the left convexity as well. The left temporal [**Doctor Last Name 534**] is effaced, a new finding. Encephalomalacic change in the left frontal lobe appears unchanged. There is questioned mild diffuse loss of [**Doctor Last Name 352**]-white differentiation, although no focal vascular territorial areas of loss of differentiation are identified to suggest a major vascular territorial infarct. The osseous structures appear unchanged. There is a question of increased displacement of the grid from the inner table of the calvarium on the left, a finding that could indicate increase in the extra-axial fluid. CT HEAD W/O CONTRAST [**2114-2-26**] 7:51 PM [**Hospital 93**] MEDICAL CONDITION: 53 year old woman s/p postop brain grid removal HISTORY: 53-year-old woman status post brain grid removal. FINDINGS: There has been interval removal of the left-sided grid. There are small amounts of left frontal and temporal intraparenchymal, subarachnoid, and subdural blood. Pneumocephalus is also identified. Hypodensity in the frontal and temporal lobes are again noted. There is decreased mass effect and shift of normally midline structures to the left. Less compression on the left lateral ventricle is also identified. The patient is status post left frontal, parietal, and temporal craniotomy. A small extra-axial drainage catheter is identified as are skin staples. The paranasal sinuses are clear. IMPRESSION: Status post grid removal with small amounts of intracranial hemorrhage and pneumocephalus. Overall decreased mass effect and shift of normally midline structures compared to prior examination. EEG FINDINGS: [**2114-3-6**] ABNORMALITY #1: A broad area of low and slow voltage activity was seen from the left anterior quadrant, with predominantly low voltage delta seen throughout much of the record. ABNORMALITY #2: Focal discharges were seen from the left anterior sylvian to mid-temporal to posterior temporal region which from extension to left central seen most notably during waking with left posterior quadrant fast activity followed by several second bursts of wicket-like 10 Hz rhythmic activity from the temporal region with a persisting rhythmic theta lasting several additional seconds from the left anterior quadrant. Occasional scattered spike and sharp discharges were seen from the same left temporal region with left ventral extension in both waking and drowsiness. BACKGROUND: Somewhat unevenly modulated 10 Hz activity was seen in the brief most alert portions of the record without significant asymmetry. SLEEP: The patient appeared to be drowsy throughout much of the record with only brief waking. Stage II sleep was not, however, seen. No abnormalities of sleep architecture were seen in Stage I sleep. CARDIAC MONITORING: No abnormalities noted. IMPRESSION: Abnormal EEG, due to left anterior quadrant voltage reduction and slowing indicative of a structural obstructive process with evidence of increased irritability and discharges from surrounding regions on the left. Brief Hospital Course: The patient was admitted on [**2114-2-23**] for a scheduled left craniotomy revision with implantation of subdural strip and grids by Dr. [**Last Name (STitle) 739**] (please see operative note for details). The operation went well with no complications. A post-operative CT scan showed interval placement of a grid in the left frontoparietal area with mass effect and slight contralateral shift of normally midline structures, with a mild-to-moderate amount of subarachnoid hemorrhage also present in the basilar cisterns and left sylvian fissure. On POD 1, she was transfused one unit of red blood cells for blood loss anemia. A follow-up CT of her head showed no interval change. She was placed on dexamethasone for 24 hours. She was also on Cefazolin for post operative empiric coverage. On POD 2, she was opening her eyes to pain. she followed commands on her left. She was transferred to the Neurology service. Throughout the day, she became more lethargic. A CT scan showed an interval increase in the mass effect in comparison with [**2114-2-24**], with increased left to right subfalcine shift and mass effect upon the left lateral ventricle. Mannitol was started to decrease edema. Steroids were deferred due to the risk of infection. She was transferred to step-down for more frequent neurologic checks. On POD 4, she was taken to the OR for a craniotomy for removal of grid and strip electrodes and removal of peg electrodes (please see operative note for details). She had been nonresponsive to mannitol. Postoperatively, her CT showed an overall decreased mass effect and shift of normally midline structures compared to prior examination. She was transferred to the ICU while intubated. Antiepileptic drugs were continued. Mannitol was to continue as long as her sodium was kept over 130 and her serum osmolarity was kept above 310. She was opening her eyes to voice. She had no spontaneous movements or movements to commands. She localized her left UE to pain. Dexamethasone was continued. On POD 1, her mannitol and dexamethasone were decreased and then stopped the next day. Her JP drain was discontinued. She was tansfused 2 unitis of red blood cells for blood loss anemia. Tube feeds were slowly advanced to goal via her NG tube. On POD 2, her CT scan showed persistent edema of the left frontal and temporal lobes. She was transfused 2 more units of red cells for blood loss anemia. Cefazolin was discontinued. On POD 3, she was openinge her eyes. she followed commands on her left side. On POD 4, a CT showed no evidence of new hemorrhage, and the degree of edema as well as its attenuation pattern within the left frontal lobe is unchanged. Mannitol was discontinued. On POD 6, she was started on Zosyn for pseudomonas in her sputum, enterococcus in her urine, a WBC of 16, and a low grade fever of 100. On POD 7, her Tmax was 101.5. She was moving her left side well and withdrawing her right side to pain. Surgical staples were removed. On POD 8 she was more alert than the day before. She was moving her left side well and withdrawing her right lower extremity to pain. An EEG was done and was abnormal due to left anterior quadrant voltage reduction and slowing indicative of a structural obstructive process with evidence of increased irritability and discharges from surrounding regions on the left. Her Tmax was 100.5 and her antibiotics were changed to ampicillin and meropenem for her Kelbsiella and Pseudomonas in her sputum. She was following some commands but was still rather lethargic. Physical therapy saw her for balance and gait training. On POD 9, her vagus nerve stimulator was tested and found to be working properly. The ICU team tried to wean her vent but she had some thick secretions. On POD 10 a CT of her head was unchanged. She was extubated successfully. She was following commands with both lower extremities. PT got her out of bed to a chair. Gentamycin was started for persistent low grade fevers and a WBC of 20 the day before. On POD 11, her right upper extremity was rather flaccid. Her WBC decreased from 17 (the day before) to 11. A speech and swallow evaluation was done- she failed due to decreased mental status, so she was kept NPO with hydration and nutrition via her NG tube. On POD 12, she was more lethargic, but had some tone in her right upper extremity. On POD 13, she was more awake. Her WBC was down to 8. She was following commands with all 4 extremities, although her right upper extremity strength was [**3-11**] only. She was transferred to stepdown care. On POD 14, another speech and swallow evaluation was done- although her mental status was improved, she was still to be kept NPO. Her gentamycin and ampicillin were discontinued and Levaquin was started as per ID recommendations. On POD 15 a 14-French gastrojejunostomy tube was successfully placed by interventional radiology. On POD 16, she was transferred to regular floor status. Tube feeds were tolerated through her GJ tube. On POD 17, her antibiotics were stopped. She was alert and was regaining strength in her extremities. She was doing very well and was discharged to [**Hospital3 **] later that day. Medications on Admission: vit D, keppra 1500'', zonegram 300'', clorazepate [**7-11**]'', clorazepate 15 Qpm, lipitor, tylonol PRN, ativan PRN Discharge Medications: 1. Acetaminophen 325 mg Tablet [**Month/Day (1) **]: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 2. Oxycodone-Acetaminophen 5-325 mg Tablet [**Month/Day (1) **]: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 3. Atorvastatin 40 mg Tablet [**Month/Day (1) **]: One (1) Tablet PO DAILY (Daily). 4. Docusate Sodium 150 mg/15 mL Liquid [**Month/Day (1) **]: One (1) PO BID (2 times a day). 5. Senna 8.6 mg Tablet [**Month/Day (1) **]: One (1) Tablet PO BID (2 times a day) as needed. 6. Magnesium Hydroxide 400 mg/5 mL Suspension [**Month/Day (1) **]: Thirty (30) ML PO Q6H (every 6 hours) as needed. 7. Calcium Carbonate 500 mg Tablet, Chewable [**Month/Day (1) **]: Two (2) Tablet, Chewable PO QAM (once a day (in the morning)). 8. Cholecalciferol (Vitamin D3) 400 unit Tablet [**Month/Day (1) **]: One (1) Tablet PO DAILY (Daily). 9. Clorazepate Dipotassium 3.75 mg Tablet [**Month/Day (1) **]: Four (4) Tablet PO HS (at bedtime). 10. Clorazepate Dipotassium 3.75 mg Tablet [**Month/Day (1) **]: Two (2) Tablet PO BID (2 times a day). 11. Levetiracetam 500 mg Tablet [**Month/Day (1) **]: Three (3) Tablet PO BID (2 times a day). 12. Zonisamide 100 mg Capsule [**Month/Day (1) **]: Three (3) Capsule PO BID (2 times a day). 13. Heparin (Porcine) 5,000 unit/mL Solution [**Month/Day (1) **]: One (1) Injection twice a day. 14. Insulin Regular Human 100 unit/mL Solution [**Month/Day (1) **]: One (1) Injection ASDIR (AS DIRECTED). 15. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 16. Lorazepam 2 mg/mL Syringe [**Last Name (STitle) **]: One (1) Injection Q4H (every 4 hours) as needed for seizures. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: intractable seizures, blood loss anemia, post operative fever, pneumonia Discharge Condition: stable Discharge Instructions: Please call or come to the ED for fevers > 101, decreased mental status, decreased motor function, uncontrollable seizures, nausea, vomiting, or any other worrisome issues. Please do not use heat, diathermy, electrostimulation or any procedures on patient without speaking to epilepsy neurologist - could damage vagal nerve stimulator. Followup Instructions: Please call the office of Dr. [**Last Name (STitle) 739**] in 6 weeks for a follow-up appointment with Head CT Also call Dr[**Name (NI) 3536**] office for seizure management and FU appointment [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**] Completed by:[**2114-3-15**] ICD9 Codes: 2859, 2720
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Medical Text: Admission Date: [**2198-9-30**] Discharge Date: [**2198-10-2**] Date of Birth: [**2164-11-15**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4654**] Chief Complaint: Melena Major Surgical or Invasive Procedure: Upper endoscopy x 2 History of Present Illness: Mr. [**Known lastname 26808**] is a 33 year old male without any significant past medical history who was in his usual state of health until the day prior to admission. He reports that he awoke around 1 am, at which time he had a loose, black bowel movement. Shortly thereafter, he felt nauseus and began to vomit bright red blood with clots. He felt slightly lightheaded and drove himself to the emergency room. He denies any associated abdominal pain at the time or in the weeks prior to hematamsis/melena - just occ vague ache associated with hunger that was slightly stronger than previously. Of note, patient had been taking 2 full strength aspirin every 4-6 hours for relief of discomfort from a cold sore that began over two weeks ago, and had taken this dosing for about 10 days. He last took aspirin about 10 days ago. In the emergency room, his presenting vital signs were temperature 97.0, heart rate 77, blood pressure 144/86, respiratory rate of 17, and 100% on room air. As laboratories were being drawn, the patient became acutely diaphoretic and his heart rate went down to the 40's. His blood pressure dipped to a systolic of 90. Two 18 gage peripheral IV's were placed, and a NG tube was placed, at which time the patient vomitted bright red blood. NG lavage was completed with bright red blood and clots that did not clear. Rectal exam was notable for melena in the vault. He was given a bolus of protonix 80 mg and then continued on a protonix drip. He was type and crossed for 4 units of packed red blood cells. Upon arrival to the ICU, he received 4 units pRBC's, fluids and IV protonix infusion. EGD performed by GI: Diffuse friability, erythema and congestion of the mucosa were noted in the whole stomach. A single ulcer was found in the stomach body with evidence of a visible vessel. Epinephrine 1/[**Numeric Identifier 961**] injections and cauterizations were applied for hemostasis with success. A second endoscopy was performed the next day which revealed sucessful hemostasis. The patient had no further melena or hematemasis. He currently reports feeling well. Past Medical History: 1)Hyperlipidemia 2)Status post tonsillectomy [**5-/2197**] Social History: Patient works in the bio-technology field. He has a supportive husband who is at the bedside. He does not smoke or use ilicit drugs. He drinks a [**12-27**] alcoholic drinks a few nights a week, sometimes more on a weekend while out with friends. [**Name (NI) **] enjoys gardening. Family History: Non-contributory. Physical Exam: VS 96.9 120/65 71 20 99% RA General: Pleasant male, in NAD, resting comfortably in bed. HEENT: NC/AT. MMM, clear oropharynx, no scleral icterus. PERRL Neck: Supple Cardiac: Regular rate & rhythm, no rubs or gallops, possible soft systolic murmur, although not heard consistently Lungs: CTAB no w/r/r Abdomen: Soft, NT, ND, +BS Extr: Warm, well perfused, capillary refill WNL Neuro: A&Ox3, CN's sym and intact. Speech fluent and coherent Skin: No lesions or rashes Pertinent Results: [**2198-9-30**] 08:15AM BLOOD WBC-5.4 RBC-4.50* Hgb-14.0 Hct-38.3* MCV-85 MCH-31.1 MCHC-36.6* RDW-12.3 Plt Ct-225 [**2198-10-1**] 12:10AM BLOOD WBC-10.1 RBC-3.20*# Hgb-10.6*# Hct-27.7* MCV-87 MCH-33.2* MCHC-38.3* RDW-12.3 Plt Ct-205 [**2198-10-2**] 07:00AM BLOOD Hct-33.2* [**2198-9-30**] 08:15AM BLOOD PT-12.7 PTT-22.5 INR(PT)-1.1 [**2198-9-30**] 08:15AM BLOOD Glucose-116* UreaN-28* Creat-0.8 Na-140 K-3.9 Cl-107 HCO3-24 AnGap-13 [**2198-9-30**] 08:15AM BLOOD ALT-13 AST-15 AlkPhos-52 TotBili-0.4 [**2198-9-30**] 08:15AM BLOOD Albumin-4.3 Calcium-9.0 Phos-3.8 Mg-1.9 Relevant Imaging: 1)Cxray ([**9-30**]): NG tube is in the first portion of the duodenum. Cardiomediastinal contours are normal. The lungs are clear. There is no pleural effusion. 2)EGD: [**2198-9-30**]: Mixture of red and clotted blood was seen in the stomach. Extensive washout was performed to obtain better visualization. Residual clot remained, but we were able to see the majority of the gastric mucosa by repositioning patient. Diffuse friability, erythema and congestion of the mucosa were noted in the whole stomach. Excavated Lesions A single ulcer was found in the stomach body with evidence of a visible vessel. [**2198-10-1**]: Gastritis in the entire stomach. Non-bleeding gastric ulcer s/p cautery from previous EGD. Brief Hospital Course: Mr. [**Known lastname 26808**] is a 33 year old male without past medical history who presents with hematemesis and melena in setting of significant aspirin use 10 days ago. 1)Upper GI Bleed: Patient presented with melena and NG lavage in the ED was positive. Likely in the setting of Aspirin use. Hct on admission was 38.3 but dropped to 27.7. He received a total of 4 units pRBCs. He was initially transferred to the MICU for closer monitoring. An IV PPI was started at this time. GI was consulted and the patient underwent an upper endoscopy which revealed gastritis with a single bleeding ulcer, which was cauterized. He was rescoped the next day which showed no further bleeding. H. pylori serologies were sent and returned positive. He was started on Prevpak. IV PPI was transitioned to PO and his diet was advanced. Hct at time of discharge was approximately ~33. He is scheduled in [**Hospital **] clinic for follow-up in 3 weeks with Dr. [**Last Name (STitle) 4539**]. 2)Positive blood cultures: [**12-29**] blood culture bottles positive for GPC's in clusters. Thought to be a contaminant but he was started on Vancomycin which was stopped the next day. He has no murmurs on exam and no other focal findings. Repeat blood cultures were obtained prior to discharge. Patient is scheduled for follow-up in [**Company 191**] at the end of this week. In addition, he will be contact[**Name (NI) **] day after discharge to inform him of his results. Medications on Admission: Aspirin 650mg PO q4-6 hours for 10 days, last taken about 1-1.5 weeks ago Acyclovir (only recently for cold sore) Discharge Medications: 1. 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* 2. PrevPak Please use as directed for 14 day course. Dispense 1 pack, no refills. Discharge Disposition: Home Discharge Diagnosis: Primary: Upper GI Bleed H. Pylori infection Discharge Condition: Stable Discharge Instructions: 1) You were admitted because you were found to have an upper gastrointestinal bleed likely due to Aspirin use. You had an upper endoscopy which showed a single bleeding ulcer within your stomach. The bleeding was stopped via cauterization and on repeat endoscopy the following day, there was no evidence of additional bleeding. Due to the fact that you've had a GI bleed, you are to avoid using aspirin or NSAIDs (ibuprofen, naproxen). 2) You were also diagnosed with H. pylori, which is an infection of the lining of your stomach. For this infection, you were started on two antibiotics, amoxicillin and clarithromycin along with an anti-acid medication. 3) As part of your laboratory evaluation, blood cultures were obtained. You were found to have bacteria in one of the blood cultures. We believe that this may be a contaminant. As a precaution, an additional set of blood cultures were obtained immediately prior to discharge. However, you should call your primary care physician's office tomorrow ([**2198-10-3**]) for the results of the first set of blood cultures. You will need to follow-up the results of the most recent set of blood cultures at your follow-up appointment with your primary care physician on Thursday, 10/09/[**Numeric Identifier 12623**]. 4) You were started on several new medications during your hospital course. You were started on pantoprazole which you should continue taking until you are seen in follow-up by your gastroenterologist. You were also started on two antibiotics for your H. pylori infection, which you will continue taking for 14 days. Please take all other medications as listed below. 5)Please attend all appointments as listed below. 6) If you have shortness of breath, difficulty breathing, chest pain, fevers, chills, or any other concerning symptoms, please seek immediate medical attention. Followup Instructions: 1) You will need to follow-up the results of the 1st set of blood cultures by calling your primary care physician's office tomorrow ([**2198-10-3**]). 2) You have a follow-up appointment with your primary care physician on Thursday, [**2198-10-4**] at 2:20 pm. 3) You have a follow- up appointment with your gastroenterologist, Dr. [**Last Name (STitle) 4539**], on [**2198-10-23**] at 2:00 pm. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8718**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2198-10-23**] 2:00 [**First Name8 (NamePattern2) **] [**Name8 (MD) 474**] MD [**MD Number(2) 4658**] ICD9 Codes: 2724, 4589
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Medical Text: Admission Date: [**2123-1-24**] Discharge Date: [**2123-2-3**] Date of Birth: [**2044-5-7**] Sex: M Service: MEDICINE Allergies: Darvocet A500 Attending:[**First Name3 (LF) 2186**] Chief Complaint: ETOH withdrawl Major Surgical or Invasive Procedure: intubation [**1-24**], extubation [**1-25**] EGD on [**2123-2-2**] History of Present Illness: 78 yo M with PMHx of ETOH use and HTN, was transferred to our ED from the OSH ED for management of frostbite of hands, knees and feet. He was in his USOH until yesterday evening when he had a few drinks in the bar, then was unable to open the door to his house and fell asleep in his doorsteps last night. ? fall from the porch. He woke this morning, got into the house, slept some more, then woke up with increasing pain in his hands, feet and knees. He presented to the OSH ED on [**2123-1-24**] where his work up was significant only for the abovementioned frostbite, for which he was trasnferred to the [**Hospital1 18**] ED. . In our ED, he was evaluated by plastics (conservative management). He was also found to be withdrawing from ETOH (tachycardic, hypertensive, hyperthermic and tremulous). He was given a total of 30 mg of Valium. His respirations were noted to be coarse, his O2 sat was 91% on RA, then 95% on a few liters NC, then 100% on NRB. CXR showed bibasilar atelectasis vs PNA. His Tm was 102 rectally during a withdrawal episode. He was given empiric ABXs (Vanc and Levofloxacin) here (got Unasyn at the OSH). Head CT neg. . For the first several hours of the ED stay he was found to have no UOP. He got a total of 3.5 L fluids. Bladder scan showed significant urinary retension. Foley was changed to 20F: he put out 1 L (with some hematuria and clots), then his SBP dropped to 70s--> spont back up to 100s. Repeat CXR in the ED without significant change. The pt then began to have coffee ground emesis and the pt was intubated for airway protection (copious oral secretions noted). ROS prior to intubation: raspy voice; coughing up thick sputum; loss of sensation in his fingers and his R great toe. In the [**Hospital Unit Name 153**] [**2123-1-24**] pt initially hypotensive upon arrival w/ SBP 70s but responded to IVFs without pressor requirement. Pt had [**Hospital1 **] dressing changes for his frostbite wounds and was by plastics. He was extubated without complications on [**2123-1-25**]. Due to refusal to eat his NG tube was continued for medication administration. As his ankle was notes to be painful, X-rays were performed and showed ankle fracture - ortho was contact[**Name (NI) **] for evaluation with plans to cast. Due to hypertension metoprolol was started. Out of concern for cellulitis associated with frostbite as well as to cover possible aspiration pneumonia, Unasyn was initiated. Regarding bloody emesis, hct remained stable, GI consulted with plan to perform EGD once stable. . ROS prior to intubation: raspy voice; coughing up thick sputum; loss of sensation in his fingers and his R great toe. . Meds in the ED: Dilaudid (3 mg IV); Fentanyl (100 mcg); Versed (4 mg); Propofol gtt, Levofloxacin Past Medical History: Varicous veins HTN Social History: ETOH of approx 5 beers per day; neg tobacco and illicit drugs Family History: NC Physical Exam: PE: 98.5 160/90 95 17 100% RA HEENT: MMM Neck: no JVD CV: RRR; distant heart sounds Lungs: CTA anteriorly Ab: obese; + BS; no organomegaly; visible superficial veins; redusible umbilical hernea Extrem: escars B knees w/ surrounding erythema; moves all toes. pulses by doppler only. hands with extensive blistering and discolaration. loss of sensation distal to PIP all 5 digits B and B great toes per chart; 2+ edema B LEs . Pertinent Results: ABDOMEN ULTRASOUND: The liver is diffusely echogenic consistent with fatty infiltration. No nodular outer contour is appreciated. There is no intra or extrahepatic ductal dilatation. The common bile duct measures 3 mm. The gallbladder contains several stones. There is no gallbladder wall thickening. There is a large cyst in the upper pole of the right kidney, measuring up to 9 cm in diameter. A single thin septation is seen within the cyst. The right kidney is otherwise unremarkable. Two simple cysts are present within the left kidney, with the largest at the lower pole measuring 1.8 cm in diameter. The spleen is unremarkable. The pancreatic head is normal. IMPRESSION: 1. Echogenic liver consistent with fatty infiltration. Other forms of liver disease and more advanced liver disease including significant hepatic fibrosis/cirrhosis cannot be excluded on this study. 2. Cholelithiasis. . RIGHT ANKLE: AP, oblique, and lateral views. Osseous detail is obscured by the overlying cast. The distal fibular fracture is again seen, with minimal distraction of the fracture fragments. The ankle mortise is preserved. Pes planus is again noted. Vascular calcifications are also again noted. . EGD ([**2123-2-2**]): ulceration of esophagus and stomache, antral gastritis . ECHO: MEASUREMENTS: Left Atrium - Long Axis Dimension: *5.7 cm (nl <= 4.0 cm) Left Ventricle - Septal Wall Thickness: *1.4 cm (nl 0.6 - 1.1 cm) Left Ventricle - Inferolateral Thickness: *1.4 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 4.7 cm (nl <= 5.6 cm) Left Ventricle - Ejection Fraction: >= 70% (nl >=55%) Aorta - Valve Level: 2.2 cm (nl <= 3.6 cm) Aorta - Ascending: *3.7 cm (nl <= 3.4 cm) Aortic Valve - Peak Velocity: 2.0 m/sec (nl <= 2.0 m/sec) INTERPRETATION: Findings: LEFT ATRIUM: Moderate LA enlargement. LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. Suboptimal technical quality, a focal LV wall motion abnormality cannot be fully excluded. Hyperdynamic LVEF. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic root diameter. Mildly dilated ascending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets. No valvular AS. The increased transaortic gradient related to high cardiac output. No AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. No MR. TRICUSPID VALVE: Tricuspid valve not well visualized. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Suboptimal image quality - poor echo windows. Conclusions: The left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Left ventricular systolic function is hyperdynamic (EF>75%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets are mildly thickened. There is no valvular aortic stenosis. The increased transaortic gradient is likely related to high cardiac output. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. No mitral regurgitation is seen. There is no pericardial effusion. Brief Hospital Course: Briefly, this is a 78 yo with h/o ETOH abuse who presented with frostbite on hands, broken right ankle, and hematemesis secondary to stomach/esophageal ulcers and gastritis. On arrival the pt was admitted to the [**Hospital Unit Name 153**] s/p intubation in the ED for respiratory distress and airway protection. . 1)ETOH abuse: He was written for CIWA protcol but never required any valium. He was started on daily thiamine and folate. He was started on metoprolol 12.5 mg po tid for likely both underlying baseline HTN and perhaps minor withdrawl. Social work was consulted . 2)Respiratory Distress: Initially in the [**Name (NI) **] pt had appearance of increased resp. distress but was satting at 100% on NRB; subsequently was intubated for airway protection in the setting of coffee ground emesis. Pt may have had another aspiration event or had flash pulmonary edema s/p fluid resuscitation at that time. The pt was extubated [**1-25**] without diffficulty, satting 100% on 50% shovel mask. TTE showed some mild diastolic dysfunction with EF >70%, mild symmetric LVH; perhaps explaining flash edema on admission. Given mild rales on exam and 3L positive fluid balance on HD3, the pt was given Lasix 20 mg IV x1. Over the course of the hospitalization pt was diuresed with good effect, no longer requiring supplemental oxygen. . 3)Fever/Elevated WBC: WBC on admission 20.1 with 6%bands. WBC on HD3 was down to 10 with no bands. Most likely source of fever and elevated WBC was either ETOH withdrawl/stress demargination vs. aspiration pneumonitis vs pneumonia vs skin infection in light of frostbite. The pt was initially started on levo and flagyl on admission; however Unasyn was started also on the night of admission to cover the pts skin given his frostbite, and levo/flagyl were discontinued given redundant coverage. Pts wbc count returned to [**Location 213**], no fevers, was switched to Augmentin for antibiotic prophylaxis against skin infection. . 4)Ankle fracture: The pt c/o medial R ankle pain. XR on [**1-26**] revealed oblique fx of distal fibula likely secondary to eversion injury. Ortho was consulted and casted ankle. Knee films obtained demonstrated no fracture at knee. Ortho team suggested weight bearing as tolerated and follow up with Dr. [**Last Name (STitle) **] 2 weeks from dicharge. Appointment made and listed in discharge plan. . 5)Stomach/esophagheal ulcers and gastritis: The pt had an episode of coffee ground emesis in the ED. Hct remained stable throughout course. On [**2123-2-2**] EGD performed and showed stomach/gastric ulcers and gastritis. Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) 2161**] and Dr. [**Last Name (STitle) **]. [**Doctor Last Name 3815**] of [**Hospital1 18**] GI department recommended protonix [**Hospital1 **] for 8 weeks followed by repeat EGD. Appointment made and listed in discharge plan. Biopsies obtained and pending. . 6)Frostbite: The pt sustained extensive frostbite injury to his hands and fet with sensory loss distal to all PIPs and in his BL 1st toes. The pt was seen by plastics in the ED who recommended xerofrom dressings [**Hospital1 **] and volar splints. The pt was covered for potential infection with Unasyn which was switched to Augmentin. . 7Episode of Hypotension: The pt has one episode of hypotension in the ED of unclear etiology, but self-limited (likely contribution from sedatives received in the ED). His hypotension quickly resolved with 1 L fluid bolus on admission to the [**Hospital Unit Name 153**] and he never required pressors. In fact, the pt became hypertensive by HD2. . 8)Traumatic foley placement: Bleeding with foley placment resolved. Four days prior to day of discharge foley removed, pt voiding w/o difficulty. . 9)Abdominal distension: Given unknown hx and alcohol abuse, ultrasound obtained. LFTs normal. No ascities by ultrasound. Liver with fatty infiltrations c/w alcoholic damage. . 10) HTN: Difficult to control, typically 160-200/80-100 once off ICU. Titrated up Lisinopril to max, Toprol started, Amlodopine started ([**2123-2-2**]). Will need further titration at rehab. . Medications on Admission: ? Lisinopril Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). 2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 5. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) for 4 days. 6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Ipratropium Bromide 0.02 % Solution Sig: one treatment Inhalation Q6H (every 6 hours) as needed. 9. Albuterol Sulfate 0.083 % Solution Sig: one treatment Inhalation Q6H (every 6 hours) as needed. 10. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 11. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 13. Toprol XL 200 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO once a day. Tablet Sustained Release 24HR(s) 14. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO once a day. 15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 16. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: frostbite ankle fracture CHF GI bleed Discharge Condition: stable Discharge Instructions: Please call your PCP or return to emergency room with chest pain, difficulty breathing, fever, increased pain in your hands. Please call your PCP or return to emergency room with chest pain, difficulty breathing, fever, increased pain in your hands. Followup Instructions: 1) Regarding the ulcers in your stomach and esophagus, you will need a repeat EGD to ensure that these have healed. You are scheduled for [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2123-3-31**] 10:30; Place: SUITE GI ROOMS on the [**Hospital Ward Name 5074**] of [**Hospital1 **] Hospital. 2)Please follow up with the Plastic Surgeons. You have make an appointment to be seen in two weeks phone number ([**Telephone/Fax (1) 65943**]. Completed by:[**2123-2-2**] ICD9 Codes: 5070, 4280, 2761, 4019
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Medical Text: Admission Date: [**2136-6-5**] Discharge Date: [**2136-6-12**] Date of Birth: [**2136-6-5**] Sex: F Service: Neonatology HISTORY: This is a 2255-gram product of a 34-6/7 week twin gestation pregnancy to a 36-year-old G6, P2-4 mother, whose pregnancy was complicated by pregnancy induced hypertension and preterm labor prompting transfer from [**Hospital **] Hospital to the [**Hospital1 69**] at 34 weeks. Mother was treated here with tocolysis. She had received betamethasone when evaluated for preterm labor at 31 weeks. This is spontaneous diamniotic-dichorionic twins pregnancy. She was also noted to have increased liver function tests, increased uric acid. She gradually weaned off of her magnesium sulfate, but on day of delivery was noted to have increasing blood pressures and uterine activity. Due to a vertex-breech presentation, a cesarean section was performed. This baby emerged vigorous with [**Name (NI) **] of 8 and 9. Was given blow-by oxygen and stimulation, and brought to the NICU after visiting with the parents. Also notable prenatal screens: Blood type A positive, antibody negative, rubella immune, RPR nonreactive, hepatitis B surface antigen and group B Strep positive. SOCIAL HISTORY: Notable for 12 year old and 10-year-old siblings. PHYSICAL EXAMINATION ON ADMISSION: Pink, active, nondysmorphic infant. Skin is without any rash or lesions. HEENT is within normal limits. Heart sounds are normal, regular, rate, and rhythm, normal S1, split S2, no murmur. Pulses are plus 2 and equal. Respirations are comfortable. Lungs are clear. Abdomen is benign, no hepatosplenomegaly. Spine is intact. Hips are normal to examination. Extremities: Moves all equally, warm, and well perfused. Neurologic: Nonfocal and appropriate for gestational age. On the physical examination, the birth weight was 2.255 kg, 50th percentile for gestational age. Length 42.5 cm, 20th percentile and head circumference 31 cm, 30th percentile. HOSPITAL COURSE BY SYSTEMS: Respiratory: Initially was comfortable in room air. Continued to have respiratory rates noted in the 30s-40s with O2 saturations greater than 95. Cardiovascular: AP is noted to be 130s-150s with mean blood pressures in the 40s. Last blood pressure 72/43 with a mean of 53. Has remained hemodynamically stable. Has not required any IV access. Fluid, electrolytes, and nutrition: Initially had D sticks of 40s, 44, then 67. Was started on premature Enfamil 20 calories formula or breast milk and required gavage feeding. She currently is all p.o. feeding and is also feeding at the breast. Intake over the last 24 hours was 139 cc/kg plus breast feeding. Baby has had a normal stooling pattern and is voiding. Gastrointestinal: Bilirubin was noted to be elevated with a peak bilirubin on [**6-11**] of 10.5/0.2 (it has been stable in this range for several days). This baby has not required any phototherapy. Hematologic: Initial CBC was done on admission, and revealed a white blood cell count of 11.2 with 40 polys and 0 bands, 53.2 percent hematocrit, and 217,000 platelets. Baby received no blood products during the hospitalization. Infectious disease: The blood culture was obtained on admission and has remained negative. Baby was not started on antibiotic and has remained clinically well. Temperature is stable in an open crib. Neurologic: Baby has appropriate exam for gestational age. Maintains her temperature in an open crib. Sensory: Audiology. A hearing screen was performed on [**6-9**] and baby passed the automated auditory brain stem response hearing screen. Ophthalmology examination is not indicated at this time. Social worker has been involved with this family. The social worker's name is [**Name (NI) 553**] and she may be reached at [**Telephone/Fax (1) 55529**]. DISCHARGE CONDITION: Good. DISCHARGE DISPOSITION: Home with parents. NAME OF PRIMARY PEDIATRICIAN: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 55413**], [**Street Address(1) **] Pediatrics, [**Location (un) 56138**] ([**Telephone/Fax (1) 56139**], FAX ([**Telephone/Fax (1) 56140**]. CARE AND RECOMMENDATIONS: Feedings: Continue breast and bottle feeding ad lib demand. There were no medications at this time. Car seat screening passed. State newborn screening was sent on day of life three. Results at this time are pending. Immunizations received is hepatitis B vaccine, initial vaccine on [**6-9**]. Follow-up appointment is recommended for week of discharge. DISCHARGE DIAGNOSES: 1. Prematurity at 34-6/7 weeks twin number one. 2. Sepsis suspect ruled out. 3. Physiologic jaundice. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 54936**] Dictated By:[**Last Name (NamePattern1) 55876**] MEDQUIST36 D: [**2136-6-12**] 04:26:01 T: [**2136-6-12**] 06:46:01 Job#: [**Job Number 56141**] ICD9 Codes: 7742, V053, V290
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Medical Text: Admission Date: [**2123-5-11**] Discharge Date: [**2123-5-18**] Date of Birth: [**2041-2-23**] Sex: F Service: SURGERY Allergies: Levofloxacin Attending:[**First Name3 (LF) 2597**] Chief Complaint: Ischemic ulcer and rest pain of the left foot. Major Surgical or Invasive Procedure: [**2123-5-12**] Thrombectomy L iliac stent w/ restenting x 2, L CFA/Profunda endarterectomy w/ SFA patch/venous patch angioplasty History of Present Illness: This 82-year-old lady with severe peripheral [**Month/Day/Year 1106**] disease and end-stage kidney disease (on hemodialysis) has rest pain of her left foot with a small ulceration. She has previously undergone a left external iliac artery angioplasty and stent via a percutaneous approach. Recent CT angiography showed the stent to be occluded with complete thrombosis of her common femoral artery. Her superficial femoral artery is chronically occluded, and the profunda femoris artery is patent. We are attempting to reopen the previously placed covered stent graft in the iliac and then revise the problem. Past Medical History: -ESRD on HD, had renal artery stenosis, s/p stent -Afib -Controversial dx of SCLCA -Hypothyroid -Hx GI bleed in the past -Hx old foot drop (presumed left based on exam) -s/p bilateral cataract surgeries Social History: She formerly worked for Gilette in financial controls department; divorced; smoked 1ppd x 50 yrs, quit in [**2116**] at time of ca dx. She does not drink or use drugs. Family History: The patient's father died secondary to coronary artery disease at the age 66. The patient's sister died at age 51 secondary to myocardial infarction. The patient's mother has diabetes mellitus. Physical Exam: PHYSICAL EXAMINATION Vitals: BP: 109/70 mmHg supine, HR 132 bpm, RR 25 bpm, O2: 93 % on 2LNC. CONSTITUTIONAL: No acute distress, mildly sedated. EYES: No conjunctival pallor. No icterus. ENT/Mouth: MMM. OP clear. THYROID: No thyromegaly or thyroid nodules. CV: Nondisplaced PMI. Normal rate. irregular rhythm. nl S1, S2. No extra heart sounds. No appreciable murmurs (limited by loud rhonchi, [**Year (4 digits) 13042**] noise) LUNGS: Coarse rhonchorous breath sounds bilaterally. No crackles, wheezes. GI: NABS. Soft, NT, ND. No HSM. MUSCULO: Supple neck. Normal muscle tone. Full strength grossly. HEME/LYMPH: No palpable LAD. Trace peripheral edema. Dopplerable distal pulses bilaterally. SKIN: Cool extremities. NEURO: A&Ox3, although mildly lethargic. Grossly normal without any significant focal deficits PSYCH: Mood and affect were appropriate. Pertinent Results: [**2123-5-17**] 07:40AM BLOOD WBC-6.4 RBC-3.43* Hgb-10.6* Hct-32.0* MCV-93 MCH-30.9 MCHC-33.1 RDW-16.3* Plt Ct-150 [**2123-5-17**] 07:40AM BLOOD Calcium-9.4 Phos-3.4 Mg-1.8 CT SCAN IMPRESSION: 1. No evidence of hematoma. 2. Renal cysts. 3. Small pleural effusions with atelectasis and right lower lobe infiltrate. Brief Hospital Course: Mrs. [**Known lastname 27974**],[**Known firstname 27975**] [**Last Name (NamePattern1) 27976**] admitted on [**5-11**] with Ischemic ulcer and rest pain of theleft foot. She agreed to have an elective surgery. Pre-operatively, she was consented. A CXR, EKG, UA, CBC, Electrolytes, T/S - were obtained, all other preperations were made. It was decided that she would undergo a: Left external iliac thrombectomy with common and deep femoral artery endarterectomy and patch angioplasty using endarterectomized superficial femoral artery and saphenous vein with selective left iliac angiography, stenting of proximal common/external iliac and distal external iliac/common femoral arteries, and completion arteriography. She was prepped, and brought down to the operating room for surgery. Intra-operatively, he was closely monitored and remained hemodynamically stable. He tolerated the procedure well without any difficulty or complication. Post-operatively, she was extubated and transferred to the [**Month/Year (2) 13042**] for further stabilization and monitoring. While in the [**Name (NI) 13042**] pt went into Atrial fibrillation. A cardiology consult was obtained. They recommended to hold amiodaron, Give IV lopressor and fluid resusitation. To note pt did have history of tachybrady syndrome and has a PPM in place. A renal consult was alos obtained. for HD. She did recieve HD on her scheduled days while here. Pt was also noted to have a HCT of 19. She did recieve blood products. A stat cat scan was obtained. She did not have a retroperitoneal bleed. Her HCT was stable post operative period. She was admitted to the CVICU for further care. A EP consult was also obtained. They agreed with cardiology plans. They also recommended to hold amiodarone and to titrated BB as needed. She was then transferred to the VICU for further recovery. While in the VICU she recieved monitered care. When stable she was delined including her aline. Her diet was advanced. A PT consult was obtained. To note her troponins were followed, she plateued. EP and cardiology signed off. They recommended no amiodarone and to titrate the BB as necessary. When she was stabalized from the acute setting of post operative care, she was transfered to floor status On the floor, she remained hemodynamically stable with his pain controlled. She progressed with physical therapy to improve her strength and mobility. Also on the floor her abdomen became distended. KUB demonstarted an ileus. Her pain meds were held. Made NPO. Reglan and erthromycin were started. She also had a coughing episode where the expectorant was purulent. This was sent for gram stain. Antibiotics were then started. CXR revealed atelectasis vs PNA. GRAM STAIN (Final [**2123-5-14**]): [**12-6**] PMNs and <10 epithelial cells/100X field. 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). RESPIRATORY CULTURE (Final [**2123-5-16**]): SPARSE GROWTH Commensal Respiratory Flora. Pt afebrile, no WBC. After sputum cx showed Commensal Respiratory Flora, her antibiotics where then stopped. Her ileus resolved with conservative treatment. She is taking PO without difficulty. She continues to make steady progress without any incidents. She was discharged to a rehabilitation facility in stable condition. Medications on Admission: levothyroxine 88', oxezepam 15 qhs, plavix, amiodarone 200', asa 81' Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 4. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 5. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: PMH: tachybrady syndrome s/p PPM placed [**11-20**] PVD CHF Afib ESRD on HD Renal artery stenosis Hypothyroidism GI bleed PSH: -[**11-20**] stenting of the left external iliac artery and Balloon angioplasty of the left profunda femoris artery. -[**5-22**] Left external iliac thrombectomy with common and deep femoral artery endarterectomy and patch angioplasty, stenting of proximal common/external iliac and distal external iliac/common femoral arteries, -renal artery stent - bilateral cataracts 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: Division of [**Month/Year (2) **] and Endovascular Surgery Lower Extremity Angioplasty/Stent Discharge Instructions Medications: ?????? Take Aspirin 325mg (enteric coated) once daily ?????? Plavix (Clopidogrel) 75mg once daily ?????? Continue all other medications you were taking before surgery, except amiodarone ?????? You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort What to expect when you go home/rehab: It is normal to have slight swelling of the legs: ?????? Elevate your leg above the level of your heart (use [**3-17**] 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, 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 ?????? Call and schedule an appointment to be seen in [**4-15**] weeks for post procedure check and ultrasound What to report to office: ?????? 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 [**Date Range 1106**] office [**Telephone/Fax (1) 1237**]. If bleeding does not stop, call 911 for transfer to closest Emergency Room. Followup Instructions: Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2123-6-7**] 1:00 Completed by:[**2123-5-18**] ICD9 Codes: 5856, 2449, 496, 4280, 4240
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Medical Text: Admission Date: [**2184-8-18**] Discharge Date: [**2184-9-3**] Service: MED Allergies: Penicillins Attending:[**First Name3 (LF) 689**] Chief Complaint: Lower GI bleed Major Surgical or Invasive Procedure: NGT placement (now d/c'd). PICC placement (now d/c'd). CXR. EKG. Blood transfusion. Left upper extremity ultrasound. Incision and drainage of small left upper extremity abscess. History of Present Illness: This is a [**Age over 90 **] year-old woman with history of stroke seven weeks ago, atrial fibrillation, hypertention, CAD s/p MI, and BRBPR in [**2182-1-15**] with colonscopy at [**Hospital6 2561**] revealing extensive diverticulosis and internal hemorrhoids who presents with copious BRBPR at home on [**2184-8-18**]. The patient noted a large amount BRB in her undergarments with large clots and BRB noted on the toilet seat. No melena was noted. In addition to starting aspirin and aggrenox seven weeks ago, she was also taking celebrex. She was prescribed Fosamax at the time as well, but had refused to take it since her stroke. She had BRBPR in [**2182**] while on celebrex and fosamax. Past Medical History: 1. [**6-18**]: small acute lacunar infarct: right periventricular white matter, started on ASA and aggrenox 2. Diverticulosis/int hemorrhoids seen on colonscopy in [**2182**] and abdominal CT [**2181**] Colonscopy [**Hospital3 **] [**1-16**] for guiac postive stool/LGIB: -- Two right colon polyps, excised. -- Extensive diverticulosis of the distal colon. -- No blood encountered. -- Internal hemorrhoids. 3. AFIB- not on coumadin as fall risk 4. HTN 5. CAD s/p MI 6. Depression 7. GERD/HH 8. Hip surgery [**2178**] and [**2179**] 9. s/p shoulder fracture and surgery in [**2182**] 10. glaucoma s/p eye surgery [**91**]. Lumbar stenosis 12. BPPV 13. 7-beat run of asymptomatic ventricular tachycardia on Holter monitor in [**2182**]. Social History: Widowed and lives alone on [**Location (un) 453**] of 2-family apartment. Daughter lives above. Two sons (one in [**Name (NI) **], one in CT) also involved. Retired bookkeeper. Distant history of tobacco and rare ETOH. Family History: Sister w/ breast CA, urinary CA Parents with PVD Physical Exam: PE on admission: T98 BP 96/53 --> 70/p --> 100/75 HR 101-118 RR18-22 O2sat 94-97% RA gen- elderly frail woman in NAD HEENT-L surgical pupil, R pinpoin but reactive, OP moist NECK- supple, no LAD CHEST- bibasilar crackles - very poor effort/cooperation with exam (Bowel sounds at left base) CV- irreg irreg no m/r/g ABD- hyperactive BS, soft, NT/ND, frank gross blood noted in ED EXT- no c/c/e, 2+ DP b/l, warm Neuro- alert, follows some commands, oriented x 1 (self), moving all extremities, ? right facial drop PE on discharge: T97 BP 130/70 HR 75-93 RR1 18 O2sat 93-97% RA gen- elderly frail woman in NAD HEENT-L surgical pupil, R reactive, OP moist NECK- supple, no LAD CHEST- bibasilar crackles - poor cooperation with exam CV- irreg irreg no m/r/g ABD- nl BS, soft, NT/ND EXT- WWP; no c/c/e, 2+ DP b/l Neuro- poor attention; alert, oriented to person only; follows commands intermittently, moving all extremities symmetrically Pertinent Results: [**2184-9-2**] 08:45PM BLOOD WBC-10.3 RBC-3.92* Hgb-11.9* Hct-36.3 MCV-93 MCH-30.3 MCHC-32.7 RDW-15.1 Plt Ct-373 [**2184-9-1**] 07:30AM BLOOD WBC-7.6 RBC-3.88* Hgb-12.2 Hct-35.3* MCV-91 MCH-31.4 MCHC-34.5 RDW-15.7* Plt Ct-377 [**2184-8-31**] 07:00AM BLOOD WBC-9.4 RBC-3.99* Hgb-12.1 Hct-37.6 MCV-94 MCH-30.3 MCHC-32.2 RDW-15.0 Plt Ct-374 [**2184-8-30**] 07:00AM BLOOD WBC-12.1* RBC-3.96* Hgb-12.1 Hct-36.8 MCV-93 MCH-30.6 MCHC-32.9 RDW-15.3 Plt Ct-439 [**2184-8-29**] 06:55AM BLOOD WBC-9.7 RBC-3.67* Hgb-11.0* Hct-34.2* MCV-93 MCH-30.0 MCHC-32.2 RDW-15.0 Plt Ct-304 [**2184-8-28**] 06:45AM BLOOD WBC-10.9 RBC-3.83* Hgb-11.7* Hct-35.2* MCV-92 MCH-30.5 MCHC-33.2 RDW-15.2 Plt Ct-342 [**2184-8-27**] 07:00AM BLOOD WBC-11.4* RBC-4.19* Hgb-12.9 Hct-38.1 MCV-91 MCH-30.9 MCHC-34.0 RDW-16.0* Plt Ct-337 [**2184-8-26**] 09:37PM BLOOD WBC-9.9 RBC-4.11* Hgb-12.8 Hct-36.4 MCV-89 MCH-31.1 MCHC-35.2* RDW-16.1* Plt Ct-308 [**2184-8-26**] 09:30AM BLOOD WBC-11.4* RBC-4.29 Hgb-13.2 Hct-38.7 MCV-90 MCH-30.7 MCHC-34.0 RDW-15.6* Plt Ct-305 [**2184-8-25**] 04:48AM BLOOD WBC-8.6 RBC-4.04* Hgb-12.4 Hct-36.3 MCV-90 MCH-30.8 MCHC-34.3 RDW-15.9* Plt Ct-277 [**2184-8-24**] 06:26AM BLOOD WBC-9.0 RBC-4.07* Hgb-12.5 Hct-36.4 MCV-90 MCH-30.7 MCHC-34.3 RDW-15.4 Plt Ct-237 [**2184-8-23**] 10:30PM BLOOD Hct-35.2* [**2184-8-23**] 11:59AM BLOOD WBC-8.1 RBC-4.04* Hgb-12.2 Hct-36.0 MCV-89 MCH-30.3 MCHC-34.0 RDW-15.4 Plt Ct-216 [**2184-8-23**] 07:00AM BLOOD Hct-39.0 [**2184-8-23**] 06:00AM BLOOD WBC-9.5 RBC-3.93* Hgb-12.5 Hct-35.5* MCV-90 MCH-31.8 MCHC-35.2* RDW-15.9* Plt Ct-208 [**2184-8-22**] 10:25PM BLOOD Hct-35.9* [**2184-8-22**] 05:34AM BLOOD WBC-9.5 RBC-4.28# Hgb-13.3# Hct-38.9 MCV-91 MCH-31.0 MCHC-34.1 RDW-15.3 Plt Ct-191 [**2184-8-21**] 02:41PM BLOOD Hct-37.1# [**2184-8-21**] 03:12AM BLOOD WBC-8.2 RBC-3.31* Hgb-10.1* Hct-29.2* MCV-88 MCH-30.6 MCHC-34.6 RDW-15.2 Plt Ct-164 [**2184-8-20**] 08:17PM BLOOD Hct-29.8* [**2184-8-20**] 03:40PM BLOOD Hct-31.6* [**2184-8-20**] 09:55AM BLOOD Hct-34.7* [**2184-8-20**] 03:23AM BLOOD WBC-13.0*# RBC-3.98* Hgb-11.9* Hct-37.5 MCV-94 MCH-30.0 MCHC-31.9 RDW-14.7 Plt Ct-219 [**2184-8-19**] 08:04PM BLOOD Hct-37.9 [**2184-8-19**] 12:50PM BLOOD WBC-7.5 RBC-3.91* Hgb-11.9* Hct-36.1 MCV-93 MCH-30.4 MCHC-32.8 RDW-14.7 Plt Ct-193 [**2184-8-19**] 05:19AM BLOOD WBC-7.4 RBC-4.00* Hgb-12.0 Hct-37.3 MCV-93 MCH-30.0 MCHC-32.1 RDW-14.6 Plt Ct-177 [**2184-8-19**] 01:05AM BLOOD Hct-35.2* [**2184-8-18**] 11:35AM BLOOD WBC-7.2 RBC-4.25 Hgb-12.8 Hct-39.0 MCV-92 MCH-30.2 MCHC-32.8 RDW-14.8 Plt Ct-234 [**2184-9-1**] 07:30AM BLOOD Neuts-74.9* Lymphs-18.5 Monos-4.4 Eos-1.1 Baso-1.1 [**2184-8-31**] 07:00AM BLOOD Neuts-71.6* Lymphs-20.1 Monos-5.9 Eos-1.9 Baso-0.4 [**2184-8-30**] 07:00AM BLOOD Neuts-76.7* Lymphs-17.1* Monos-5.0 Eos-0.8 Baso-0.4 [**2184-8-22**] 05:34AM BLOOD Neuts-77.2* Lymphs-17.6* Monos-3.8 Eos-1.0 Baso-0.4 [**2184-8-18**] 11:35AM BLOOD Neuts-67.9 Lymphs-26.4 Monos-3.6 Eos-0.7 Baso-1.4 [**2184-8-31**] 07:00AM BLOOD Hypochr-1+ Macrocy-1+ [**2184-8-30**] 07:00AM BLOOD Hypochr-1+ Macrocy-1+ [**2184-9-2**] 08:45PM BLOOD Plt Ct-373 [**2184-9-1**] 07:30AM BLOOD Plt Ct-377 [**2184-8-31**] 07:00AM BLOOD Plt Ct-374 [**2184-8-30**] 07:00AM BLOOD Plt Ct-439 [**2184-8-29**] 06:55AM BLOOD Plt Ct-304 [**2184-8-28**] 06:45AM BLOOD Plt Ct-342 [**2184-8-27**] 07:00AM BLOOD Plt Ct-337 [**2184-8-26**] 09:37PM BLOOD Plt Ct-308 [**2184-8-26**] 09:30AM BLOOD Plt Ct-305 [**2184-8-25**] 04:48AM BLOOD Plt Ct-277 [**2184-8-24**] 06:26AM BLOOD Plt Ct-237 [**2184-8-23**] 11:59AM BLOOD Plt Ct-216 [**2184-8-23**] 06:00AM BLOOD Plt Ct-208 [**2184-8-22**] 05:34AM BLOOD Plt Ct-191 [**2184-8-22**] 05:34AM BLOOD PT-12.6 PTT-25.2 INR(PT)-1.1 [**2184-8-21**] 03:12AM BLOOD Plt Ct-164 [**2184-8-20**] 03:23AM BLOOD Plt Ct-219 [**2184-8-20**] 03:23AM BLOOD PT-12.9 PTT-37.4* INR(PT)-1.1 [**2184-8-19**] 12:50PM BLOOD Plt Ct-193 [**2184-8-19**] 05:19AM BLOOD Plt Ct-177 [**2184-8-19**] 05:19AM BLOOD PT-12.7 PTT-25.2 INR(PT)-1.1 [**2184-8-18**] 11:35AM BLOOD Plt Ct-234 [**2184-8-18**] 11:35AM BLOOD PT-14.8* PTT-25.8 INR(PT)-1.5 [**2184-9-2**] 08:45PM BLOOD Glucose-105 UreaN-18 Creat-1.1 Na-144 K-4.6 Cl-106 HCO3-28 AnGap-15 [**2184-9-1**] 07:30AM BLOOD Glucose-97 UreaN-16 Creat-0.8 Na-142 K-3.7 Cl-104 HCO3-30* AnGap-12 [**2184-8-31**] 07:00AM BLOOD Glucose-122* UreaN-17 Creat-0.9 Na-140 K-4.1 Cl-101 HCO3-30* AnGap-13 [**2184-8-30**] 07:00AM BLOOD Glucose-100 UreaN-23* Creat-1.0 Na-146* K-4.3 Cl-104 HCO3-30* AnGap-16 [**2184-8-29**] 06:55AM BLOOD Glucose-103 UreaN-24* Creat-0.8 Na-144 K-4.2 Cl-105 HCO3-30* AnGap-13 [**2184-8-28**] 06:45AM BLOOD Glucose-109* UreaN-22* Creat-0.8 Na-145 K-4.6 Cl-106 HCO3-30* AnGap-14 [**2184-8-27**] 07:00AM BLOOD Glucose-170* UreaN-25* Creat-0.7 Na-145 K-4.7 Cl-107 HCO3-29 AnGap-14 [**2184-8-26**] 09:37PM BLOOD Glucose-140* UreaN-24* Creat-0.8 Na-145 K-4.4 Cl-108 HCO3-27 AnGap-14 [**2184-8-26**] 09:30AM BLOOD Glucose-116* UreaN-23* Creat-0.8 Na-144 K-4.6 Cl-108 HCO3-25 AnGap-16 [**2184-8-25**] 04:48AM BLOOD Glucose-113* UreaN-22* Creat-0.7 Na-144 K-4.3 Cl-111* HCO3-25 AnGap-12 [**2184-8-24**] 06:26AM BLOOD Glucose-93 UreaN-18 Creat-0.8 Na-145 K-3.4 Cl-110* HCO3-26 AnGap-12 [**2184-8-23**] 06:00AM BLOOD Glucose-124* UreaN-14 Creat-1.0 Na-145 K-3.8 Cl-114* HCO3-21* AnGap-14 [**2184-8-22**] 05:34AM BLOOD Glucose-133* UreaN-15 Creat-1.0 Na-145 K-3.9 Cl-117* HCO3-20* AnGap-12 [**2184-8-21**] 03:12AM BLOOD Glucose-132* UreaN-19 Creat-1.0 Na-143 K-3.3 Cl-116* HCO3-16* AnGap-14 [**2184-8-20**] 03:23AM BLOOD Glucose-133* UreaN-23* Creat-1.0 Na-146* K-3.9 Cl-113* HCO3-16* AnGap-21* [**2184-8-19**] 05:19AM BLOOD Glucose-84 UreaN-26* Creat-0.8 Na-147* K-4.3 Cl-119* HCO3-19* AnGap-13 [**2184-8-18**] 11:35AM BLOOD Glucose-108* UreaN-32* Creat-1.0 Na-144 K-4.8 Cl-112* HCO3-24 AnGap-13 [**2184-8-26**] 09:37PM BLOOD CK(CPK)-190* [**2184-8-24**] 06:26AM BLOOD CK(CPK)-183* [**2184-8-23**] 10:30PM BLOOD CK(CPK)-230* [**2184-8-23**] 11:59AM BLOOD CK(CPK)-224* [**2184-8-22**] 05:34AM BLOOD CK(CPK)-320* [**2184-8-21**] 03:12AM BLOOD CK(CPK)-489* [**2184-8-20**] 08:17PM BLOOD CK(CPK)-484* [**2184-8-19**] 05:19AM BLOOD CK(CPK)-32 [**2184-8-26**] 09:37PM BLOOD CK-MB-6 cTropnT-<0.01 [**2184-8-24**] 06:26AM BLOOD CK-MB-6 cTropnT-0.02* [**2184-8-23**] 10:30PM BLOOD CK-MB-7 cTropnT-0.02* [**2184-8-23**] 11:59AM BLOOD CK-MB-8 cTropnT-0.03* [**2184-8-22**] 05:34AM BLOOD CK-MB-10 MB Indx-3.1 [**2184-8-21**] 03:12AM BLOOD CK-MB-11* MB Indx-2.2 [**2184-8-20**] 08:17PM BLOOD CK-MB-9 cTropnT-0.02* [**2184-8-19**] 05:19AM BLOOD CK-MB-4 cTropnT-<0.01 [**2184-8-18**] 11:35AM BLOOD cTropnT-<0.01 [**2184-9-2**] 08:45PM BLOOD Calcium-8.8 Phos-4.3 Mg-2.3 [**2184-9-1**] 07:30AM BLOOD Calcium-8.2* Phos-3.8 Mg-2.1 [**2184-8-31**] 07:00AM BLOOD Calcium-8.6 Phos-3.9 Mg-2.1 [**2184-8-30**] 07:00AM BLOOD Calcium-9.0 Phos-4.4 Mg-2.2 [**2184-8-29**] 06:55AM BLOOD Calcium-9.1 Phos-4.1 Mg-2.2 [**2184-8-28**] 06:45AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.2 [**2184-8-27**] 07:00AM BLOOD Calcium-8.9 Phos-2.2* Mg-2.1 [**2184-8-26**] 09:37PM BLOOD Calcium-8.8 Phos-2.4* Mg-2.2 [**2184-8-26**] 09:30AM BLOOD Calcium-8.2* Phos-2.1* Mg-2.1 [**2184-8-25**] 04:48AM BLOOD Calcium-8.1* Phos-2.4* Mg-2.1 [**2184-8-24**] 06:26AM BLOOD Calcium-7.7* Phos-1.8* Mg-1.8 [**2184-8-23**] 06:00AM BLOOD Calcium-8.5 Phos-2.4* Mg-1.8 [**2184-8-22**] 05:34AM BLOOD Calcium-7.4* Mg-1.9 [**2184-8-21**] 03:12AM BLOOD Calcium-6.6* Phos-2.2* Mg-1.6 [**2184-8-19**] 05:19AM BLOOD Calcium-7.0* Phos-3.1 Mg-1.8 [**2184-8-20**] 12:27PM BLOOD Type-ART Temp-37.2 O2-21 pO2-79* pCO2-27* pH-7.36 calHCO3-16* Base XS--8 Intubat-NOT INTUBA [**2184-8-20**] 12:27PM BLOOD Lactate-1.8 [**2184-8-18**] 11:55AM BLOOD K-4.7 [**2184-8-18**] 04:37PM BLOOD Hgb-10.7* calcHCT-32 [**2184-8-29**] 11:24AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020 [**2184-8-21**] 05:35PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.006 [**2184-8-19**] 05:12PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020 [**2184-8-19**] 08:12AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.021 [**2184-8-29**] 11:24AM URINE Blood-LG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD [**2184-8-21**] 05:35PM URINE Blood-LG Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2184-8-19**] 05:12PM URINE Blood-LGE Nitrite-NEG Protein-NEG Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR [**2184-8-19**] 08:12AM URINE Blood-LG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-50 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR [**2184-8-29**] 11:24AM URINE RBC-0 WBC-2 Bacteri-MANY Yeast-NONE Epi-1 [**2184-8-21**] 05:35PM URINE RBC-[**12-4**]* WBC-0-2 Bacteri-OCC Yeast-NONE Epi-<1 [**2184-8-19**] 05:12PM URINE RBC-17* WBC-2 Bacteri-NONE Yeast-NONE Epi-0 [**2184-8-19**] 08:12AM URINE RBC-[**3-19**]* WBC-[**3-19**] Bacteri-FEW Yeast-NONE Epi-0 [**2184-8-19**] 08:12AM URINE CastHy-0-2 [**2184-8-29**] 11:24AM URINE Mucous-RARE [**2184-8-19**] 05:12PM URINE Hours-RANDOM [**2184-8-19**] 05:12PM URINE Hours-RANDOM Creat-110 Na-59 [**2184-8-29**] 11:24 am URINE Site: NOT SPECIFIED **FINAL REPORT [**2184-8-31**]** URINE CULTURE (Final [**2184-8-31**]): GRAM POSITIVE BACTERIA. 10,000-100,000 ORGANISMS/ML.. Alpha hemolytic colonies consistent with alpha streptococcus or Lactobacillus sp. 2ND ISOLATE. <10,000 organisms/ml. [**2184-8-19**] 8:12 am URINE **FINAL REPORT [**2184-8-20**]** URINE CULTURE (Final [**2184-8-20**]): NO GROWTH. Brief Hospital Course: Mrs. [**Known lastname 96619**] was brought to the ED by EMS. Her SBP was 80/palp en route but improved to 95/63 on arrival. It fell to the 70s after Valium was given and improved to the 100s with 4L IVF. Mrs. [**Known lastname 96619**] was persistently tachycardic (110-115). She had [**2-17**] more episdoes of BRBPR in the ED and was evaluated by GI. Her HCT fell from 39 on arrival to 32. An NGT was placed by IR (large hiatal hernia present) and gastric lavage was negative. In total she was transfused 2 units PRBCS. Mrs. [**Known lastname 96619**] was admitted to the MICU for close monitoring and resuscitation. Colonscopy was declined by the patient and family. As her vital signs stabilized and as no intervention was planned, Mrs. [**Known lastname 96619**] was transferred from the MICU to the floor on [**2184-8-22**], for further management. Neuro/delirium: Her mental status waxed and waned with intermittent agitation that responded to Zyprexa. Her delirium is likely multifactorial related to her recent CVA, infection, electrolyte imbalance, ICU stay on top of her underlying dementia. In regard to her recent CVA, on [**9-1**] she was started on a baby aspirin and had no evidence of bleeding or fall in her hematocrit as a result. She will f/u with neurology as outpatient CV: She was in atrial fibrillation chronically with episodic tachycardia to the 160s that was controlled acutely with IV metoprolol and diltiazem. Over time, her daily medications were adjusted such that po atenolol and diltiazem XR kept heart rate below 100 with acceptable blood pressure. She was also started on lisinopril and remained normotensive.She experienced recurrent asymptomatic 5-12 beat runs of ventricular tachycardia that self-resolved. There is evidence of these episoded dating back to [**2182**]. She had episodes of chest pain when her heart rate was elevated but did not have evidence of MI by EKG changes or by troponin elevation. GI: ASA and aggenox were held as well as all blood thinners. She did not experience any further bleeding, and, with assistance and encouragement, was able to take an adequate po diet. On [**8-31**], her NGT was removed FEN: pt requires assistance with PO diet since discontinuation of tube feeds ID: On [**2184-8-29**], she developed a urinary tract infection that was treated with oral antibiotics. . On [**9-2**] she developed a cellulitis with small abscess at the former site of an IV on her left arm. Absence of vascular involvement was confirmed by ultrasound. The abscess was drained by surgery (no pus was seen) and she was started on levofloxacin on [**9-3**] for treatment of cellulits (PCN allergy) PT: She was encouraged to work with PT and get out of bed to a chair. Code status: DNR/DNI Medications on Admission: ASA 81mg po qd Aggrenox 1 tab [**Hospital1 **] Protonix 40mg po qd Megace 40mg po qd Celebrex 100mg po qd Paxil 30mg po qd Lopressor 25mg po bid Trazodone 50mg po qhs Lipitor 10mg po qd Vitamin D 400 IU po qd Calcium 500mg po qd Discharge Medications: 1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO QD (once a day). 2. Therapeutic Multivitamin Liquid Sig: Five (5) ML PO QD (once a day). 3. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for Chest pain. 4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 5. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 6. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 7. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day). 8. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: 0.5 Tablet, Rapid Dissolve PO HS (at bedtime). 9. Atenolol 100 mg Tablet Sig: One (1) Tablet PO QD (once a day). 10. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO QD (once a day). 11. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: 0.5 Tablet, Rapid Dissolve PO every eight (8) hours as needed for agitation. 12. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 13. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO QD (once a day). 14. Diltiazem HCl 360 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO QD (once a day): Hold for SBP<100, HR<60. 15. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for t>101. 16. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO once a day for 6 days. 17. Vitamin D 400 unit Tablet Sig: One (1) Tablet PO once a day. 18. Lipitor 10 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: Primary diagnosis: Lower GI bleed Secondary diagnoses: Left upper extremity cellulitis s/p I&D Urinary tract infection Atrial fibrillation with rapid ventricular response Dementia/delerium Episodic nonsustained ventricular tachycardia Failure to thrive hx CVA [**7-18**] Discharge Condition: Afebrile , hemodynamically stable, no evidence of ongoing bleeding (stable Hct) Discharge Instructions: Please take all medications as prescribed. Continue levofloxacin for six days as an outpatient. Continue diltiazem, atenolol, lisinopril, and zyprexa as prescribed. Continue your glaucoma medications as prior to hospitalization. Take one baby aspirin daily. Change dressings on left arm wound twice daily (wet to dry) until healed. Please return to the hospital if you have bleeding, chest pain, shortness of breath or any other worrisome symptoms. Followup Instructions: Follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 410**], on Friday [**9-10**] at 1:30pm or reschulde if necessary [**Telephone/Fax (1) 2660**] Follow up with your neurologist in the next 2 weeks. ([**Telephone/Fax (1) 44**]) Follow up with your cardiologist, Dr. [**Last Name (STitle) **], in the next 2 weeks . Completed by:[**2184-9-3**] ICD9 Codes: 2851, 5990, 2765, 4280, 2762
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Medical Text: Admission Date: [**2184-8-23**] Discharge Date: [**2184-8-28**] Service: NEUROLOGY HISTORY OF THE PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old right-handed woman with hypertension, high cholesterol, who had a large left MCA territory stroke. She was last known to be in her usual state of health on [**2184-8-22**] at 4:00 p.m. On [**2184-8-23**] at 11:00 a.m. she apparently fell and then called a family member. The family member then found her at 1:30 p.m. to be confused with slurred speech. She was taken to the [**Hospital6 256**] Emergency Department. Her initial examination at approximately 5:00 p.m. noted her to be nonfluent with a right facial droop and a right pronator drift. MRI/MRA was done and showed decreased flow in the left internal carotid artery. There was a suggestion of a subacute to chronic infarct in the right periatrial white matter. Upon returning from MRI, at approximately 7:30 p.m., she had the acute onset of global aphasia and left gaze preference and right hemiplegia. A stat head CT and CTA showed absent flow in the left internal carotid artery. Her vessel imaging and examination findings were felt to be consistent with a large left MCA territory acute stroke. Due to the unclear onset of her symptoms, she was felt not to be a TPA candidate after discussion with the family as well. She was admitted to the Intensive Care Unit. HOSPITAL COURSE IN THE INTENSIVE CARE UNIT: 1. NEUROLOGY: A carotid ultrasound was suggestive of distal left ICA occlusion. A repeat head CT on [**2184-8-24**] showed a large acute left MCA stroke in the left frontal lobe extending into the insula as well as the left parietal lobe with a blurred [**Doctor Last Name 352**]-white junction. She was initially loaded on Dilantin for concern of seizure but this was then discontinued. A transthoracic cardiogram was performed and showed left ventricular systolic dysfunction consistent with coronary artery disease. There was no visualized thrombus. She was started on aspirin for secondary prophylaxis. 2. CARDIOVASCULAR: The patient ruled out for a myocardial infarction based on enzymes. 3. RESPIRATORY: The patient had chest x-rays performed which were consistent with mild pulmonary edema. She had normal saturations on 3 liters nasal cannula. 4. FLUIDS, ELECTROLYTES, AND NUTRITION: The patient was kept n.p.o. with IV fluids running. 5. INFECTIOUS DISEASE: The patient was started on levofloxacin for pyuria with urine culture pending. 6. CODE STATUS: The patient was made DNR, DNI by the family. On [**2184-8-24**], the patient was transferred to the Neurology floor. Her examination at that time showed a temperature of 97.2, blood pressure 120/58, pulse 61, respiratory rate 22, oxygen saturation 97% on 3 liters. General: She is an elderly appearing female with her eyes closed in no apparent distress. Her neck showed no carotid bruits. The lungs had bilateral basilar crackles. Her cardiac examination showed a regular rate and rhythm with a II/VI systolic murmur at the left sternal border. Her abdomen was soft. On neurological examination, on mental status examination, her eyes were closed. She did not open her eyes to voice or to painful stimuli. She had no speech production. She was not following commands. Cranial nerve examination: There was deviation of gaze to the left but she was able to cross the midline with doll's maneuver. The pupils were 3 mm bilaterally and reacted to 2 mm. The left corneal reflex is present. Right corneal reflex is absent. There is a right facial droop. On motor examination, there was decreased tone in the right upper and lower extremity. There was spontaneous movement of the left upper and lower extremity. There was extensor posturing of the right upper extremity in response to noxious stimuli. There was triple flexion response of the right lower extremity in response to painful stimuli. Reflexes were 1+ and symmetric. Toes were upgoing bilaterally. The patient was continued on supportive care with IV fluids, aspirin prophylaxis, respiratory monitoring, and levofloxacin. Her urine culture returned with no growth to date and the levofloxacin was discontinued. Her chest x-ray showed progressive pulmonary edema and her IV fluids were decreased. On [**2184-8-26**], after extensive discussions with the Neurology Team, her family decided to redirect care towards comfort measures only. At this point in time, the next step would have been a PEG tube placement, but the patient had previously discussed this with the family that she would not have wanted this invasive measure. Therefore, the patient was placed on comfort measures only. Her nasogastric tube was discontinued. Laboratories and chest x-rays were discontinued. Accu-Cheks were discontinued. Her neurologic examination showed her to be slightly more alert with eyes open. However, she did not have any speech production and was not following any commands. Her right upper and lower extremity remained hemiplegic. She was seen by the palliative care service and placed on medications as needed for comfort, including morphine, Ativan, Scopolamine and Tylenol. She was screened for hospice care and will likely be transferred to hospice within the next one to two days to continue on comfort measures. CONDITION ON DISCHARGE: Poor. DISCHARGE STATUS: Hospice. DISCHARGE DIAGNOSIS: Left middle cerebral artery territory stroke. DISCHARGE MEDICATIONS: 1. Morphine 5 to 20 mg sublingually q. four hours p.r.n. distress. 2. Ativan 0.5 to 1 mg sublingually q. four hours p.r.n. agitation. 3. Scopolamine 1.5 mg patch transdermally q. 72 hours p.r.n. secretions. 4. Tylenol 650 mg p.r. q. four hours p.r.n. fever. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 12114**] Dictated By:[**Name8 (MD) 33494**] MEDQUIST36 D: [**2184-8-27**] 05:31 T: [**2184-8-27**] 18:43 JOB#: [**Job Number 98869**] ICD9 Codes: 5990, 2720
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Medical Text: Admission Date: [**2106-7-25**] Discharge Date: [**2106-8-6**] Date of Birth: [**2031-5-28**] Sex: M Service: MEDICINE Allergies: Lipitor / Shellfish / Ace Inhibitors Attending:[**First Name3 (LF) 3276**] Chief Complaint: Fever Major Surgical or Invasive Procedure: None History of Present Illness: 75-yr-old male with PAF (on amio), HTN, AAA, CRI (Cr baseline 1.4), SCLC with brain and spinal mets (diagnosed in [**7-19**], treated with five cycles of carboplatin/Taxol + chest XRT) s/p recent whole brain radiation, who presented to the ED with LE swelling but was found to have hypotension and fever. . Pt noted mild b/l LE swelling over the last two days which he has never experienced before. He denies any CP, SOB but noted some dizziness and lightheadedness over the last few days. He continued to take his BP meds despite these symptoms. Per his report, he developed the LE swelling after his last whole brain radiation on Friday and was told by his radiation-oncologist that it might be related to that and the steroids he is currently receiving. However, he was concerned and called his daughter in [**Name (NI) 108**] who came up to [**Name (NI) 86**] and brought him to the ED. . In the ED, his BP was found to be 65/40. He was tachy to the 120s and had a Temp of 100.6. Lactate of 2.1. A UA was negative. However, a CXR revealed an infiltrate below his lung mass in line with post-obstructive pneumonia. He received 4L IVF with only transient effect on his BP. He was started on Levo and Clindamycin for presumed postobstructive pneumonia. Code Sepsis was called and a right IJ was placed. Levophed was started given hypotension that was resistant to fluid resuscitation. His Levophed drip was at 0.75 mcg/kg on transfer to the ICU. . On ROS, he endorsed a mildly productive cough over the last two weeks. Sputum has only been whitish to clear. No F/C/N noted. No sick contacts. [**Name (NI) **] CP or SOB as above. No urinary symptoms or abnormal bowel movements. No blood in stool or urine noted. No nosebleeds but easy bruising. Chronic back pain from spinal mets with no change in severity. . Oncologic History (per onc notes from [**6-25**] and [**7-13**]): Dx in 8/[**2104**]. Initially presentation with bulky disease and near complete tracheal obstruction s/p Y stenting (removed again in 10/[**2104**]). S/p chemo with carboplatin and etoposide on [**2105-8-11**]. His first cycle of chemotherapy was complicated by S. bovis endocarditis; completed 4 weeks of IV penicillin in early [**Month (only) 359**]. Initially, believed to have extensive stage disease, with metastases in the left adrenal gland and liver. However, follow-up CT scans revealed no change in the adrenal lesion while his pulmonary lesions decreased in size. In addition, the hepatic lesions seen on his initial CT were not seen on later exams were felt to be an artifact and not metastatic spread. Mr. [**Known lastname 4401**] completed five cycles of chemotherapy and radiation therapy to the chest. Past Medical History: - PAF, on Amio, not on anticoagulation (has been on coumadin prior to his first round of chemo in [**2104**]); followed by Dr. [**Last Name (STitle) 73**] (last seen on [**2106-7-7**]) - HTN - Hyperlipidemia - CRI, Cr baseline 1.4 - PVD - AAA S/P repair over one year ago - ? Etoh abuse - H/o S. bovis endocarditis (during first cycle of chemo); s/p 4 wks of penicillin in [**9-/2105**] - Colonoscopy on [**2105-9-1**]: fragments of adenoma with high grade dysplasia and focal intramucosal carcinoma but no invasive carcinoma. - SCLC as above Social History: Lives alone. Family lives in [**State 38104**] and [**State 108**]. Has five kids and many grandchildren. Divorced. Quit smoking over two years ago. Smoked 1 pack per week for 50 years. Remote EtOH use in the past (1-2 drinks per month). No drug use. Family History: Son died of brain tumor at age 16. Did not know parents, was raised by step parents. Physical Exam: VS: Temp: 97.0, BP: 119/76 (on NE), HR: 97, RR: 18, O2sat 94% on 2L GEN: pleasant, comfortable, NAD HEENT: PERRL, EOMI, anicteric, dry MM NECK: no supraclavicular or cervical lymphadenopathy, no jvd, right IJ in place RESP: coarse BS at both bases, no wheezes, rhales or rhonchi CV: Tachy, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: 1+ LE edema b/l, cold feet but good pulses SKIN: bruises b/l on UEs, no jaundice NEURO: AAOx3. 5/5 strength throughout. Pertinent Results: 141 106 62 ============117 4.6 25 1.8 . CK: 290 MB: 7 Trop-T: 0.04 . WBC 5.1, Hct 45.0, Plt 58 N:93 Band:2 L:4 M:1 E:0 Bas:0 . PT: 12.4 PTT: 26.0 INR: 1.1 . Lactate 2.1 . . EKG: Afib at HR of 101, normal axis, no ST changes . Imaging: CXR [**2106-7-25**]: Comparison was made with a prior chest radiograph dated [**2106-3-9**]. Again note is made of opacity in the right upper lobe extending from the right hilum, representing post-radiation change as seen on prior torso CT dated [**2106-5-27**]. Thoracic aorta is tortuous. Cardiac contour is unchanged. Linear atelectasis in right upper lobe with pleural thickening is again noted. There is atelectasis in the right lower lobe. Overall appearance of the chest is unchanged. Left lung is clear. IMPRESSION: Overall unchanged appearance of the chest with post-radiation change and volume loss of the right lung. . MRI spine [**2106-7-19**]: Diffuse leptomeningeal metastases involving the lower thoracic cord, the conus medullaris, and the cauda equina. Abdominal aortic aneurysm just above the aortic bifurcation measuring approximately 3.1 cm in size. Mild degenerative changes of the lumbar spine with multilevel mild bilateral foraminal stenoses, but without canal stenosis. . MRI brain [**2106-6-25**]: Multiple, new metastatic lesions (left parietal; left medial temporal lobe; met extending from the pituitary infundibulum into the hypothalamus; right lateral pons; left cerebellar tonsil and the left cerebellar hemisphere; right frontal leptomeningeal metastasis). Brief Hospital Course: 75-yr-old male with PAF (on amio), HTN, AAA, CRI (Cr baseline 1.4), SCLC with brain and spinal mets (diagnosed in [**7-19**], treated with five cycles of carboplatin/Taxol + chest XRT) s/p recent whole brain radiation, who presented to the ED with LE swelling but was found to have hypotension, fever and RLL infiltrate. . # Fever/hypotension: Met SIRS criteria given BP, HR and temp. Lactate of 2.1 in the ED. Normal AG. Left-shift on differential with 2% bands. Likely source is lungs given RLL infiltrate on CXR, which was confirmed on CT. UA was negative and no urinary symptoms. No lines as entry sites. No open wounds on skin or mucosa. No abdominal tenderness and LFTs wnl. Thus, no other obvious sources making pneumonia most likely reason for his fever/hypotension. Pt received 4L IVF in the ED and was started on Levophed after CVL placement. Antihypertensive meds were held. Levophed was weaned off, as well as supplemental O2. Received Levo/Clinda x1 in the ED. Started Vanc/Zosyn in ICU. Hemodynamically stable off pressors. Likely component of dehydration contributing to hypotension as out of proportion of other clinical picture. Patient was transfered to the oncology floor when he was stabilized. Was stepwise titrated down off antibiotics to levo, and patient completed [**9-26**] day course. He remained off suppelmental oxygen and was afebrile with normal WBC. Patients blood pressure's returned to [**Location 213**] normal, and patient returned to baseline hypertension. HTN meds were restarted, and patient was well controlled. Towards the end of hospitalization, patient developed presumed herpetic oral ulcers. Patient had continued hypotension, HTN meds held, believed to be due to poor PO intake. Pressures maintained w/ IVF. Patient should have PO intake enouraged, and IVF if necessary. Patients SBP has ranged from 90-105 at time of discharge, and patient is asymptomatic. . # Thrombocytopenia, now leukocytopenia: Plt of 58 on admission. H/o easy bruising but no overt bleeding. Last Plt count was 214 one month ago. Baseline around 100-200 indicating chronic thrombocytopenia, likely due to current radiation therapy. Coags unremarkable. HIT ab negative. Patient was transfused with one unit of platelets, increasing count from 21 to 54. Patient w/ leukocytopenia, but ANC > 1000. Should have continued monitoring. . # LE swelling: new onset per patient. LE minimal on exam today. Preserved EF on Echo from [**2104**]. Possibly due to steroids per radiation-oncologist. Lenis negative. Consider Echo as well once stable and euvolemic, in order to assess EF. . # Acute on CRF: CRI due to HTN per OMR. Cr baseline around 1.4. Cr of 1.8 on admission. Likely prerenal given dehydration and recent orthostatic hypotension as outpatient. Received IVF for septic picture and Cr down to 0.9 today. . # Cardiac: PAF, on Amio, not on anticoagulation since first cycle of chemo in [**2104**]; followed by Dr. [**Last Name (STitle) 73**], last seen on [**2106-7-7**]. Found to be in Afib on admission EKG but not in RVR. Pt between Afib and tachy sinus on tele, but hemodynamically stable. Patient was continued on amioderone for rhythem control, and BB was held at times due to hypotension. . # SCLC: SCLC with brain and spinal mets. Diagnosis in [**7-/2105**] with bulky disease and near complete tracheal obstruction s/p Y stenting and removal. S/p five cycles of chemotherapy and radiation therapy to the chest in [**2104**]. Patient completed whole brain radiation to treat brain disease. Was complaining of back pain radiating down buttocks. Patient completed spinal XRT during this hospitalization with a significant improvmeent in pain. Dexamethasone was increased during this XRT therapy, and is now being tapered. . # Chronic anemia: Hct baseline around 26-36. Normal B12/folate in [**2105-10-14**], but high Ferritin in line with ACD due to malignancy. Hct of 45 on admission, likely due hemoconcentration in setting of dehydration/infection. . # Oral Ulcers- Believed to be herpetic in appearence. Patient started on acyclovir and given lidocain gel for pain relief. Patient with poor PO intake due to ulcers causing hypotension. PO intake must be encouraged utill ulcers heal. Medications on Admission: amiodarone 200 daily aspirin 81 daily dexamethasone 8mg daily, per tapering protocol (OMR note from [**2106-7-16**]) Diovan 80 per day metoprolol tartrate 50 mg twice a day Percocet 5/325 mg twice a day for pain Protonix 40 once a day Discharge Medications: 1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 5. Dexamethasone 2 mg Tablet Sig: Two (2) Tablet PO once a day for 8 days: Take 4mg every day on [**8-5**], then take 2mg every day for three days until [**8-8**], then take 2mg every other day for three days until [**8-13**], then stop taking. Disp:*8 Tablet(s)* Refills:*0* 6. Lidocaine HCl 2 % Solution Sig: One (1) ML Mucous membrane TID (3 times a day) as needed. Disp:*1 ML(s)* Refills:*1* 7. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-15**] Drops Ophthalmic PRN (as needed) as needed for dry eyes. Disp:*1 bottle* Refills:*2* 8. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed. Disp:*250 ML(s)* Refills:*0* 9. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours) for 4 days. Disp:*12 Capsule(s)* Refills:*0* 1. Amiodarone 200 mg Tablet Sig: One (1) Tablet 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. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO once a day for 8 days: Take 2mg every day for three days until [**8-9**], then take 2mg every other day for three days until [**8-15**], then stop taking. Disp:*0 Tablet(s)* Refills:*0* 4. Lidocaine HCl 2 % Solution Sig: One (1) ML Mucous membrane TID (3 times a day) as needed. Disp:*1 ML(s)* Refills:*1* 5. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-15**] Drops Ophthalmic PRN (as needed) as needed for dry eyes. Disp:*1 bottle* Refills:*2* 6. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed. Disp:*250 ML(s)* Refills:*0* 7. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours) for 4 days. Disp:*12 Capsule(s)* Refills:*0* 8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed. 9. Oral Wound Care Products Gel in Packet Sig: One (1) Mucous membrane tid (). 10. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 11. Saliva Substitution Combo No.2 Solution Sig: One (1) Mucous membrane [**3-23**] x day () as needed for use prior to eating for mouth pain. 12. Artificial Saliva 0.15-0.15 % Solution Sig: One (1) ML Mucous membrane QID (4 times a day). Discharge Disposition: Extended Care Facility: [**Hospital 1456**] [**Hospital **] Health Care Center Discharge Diagnosis: Pneumonia Small Cell Lung Cancer sepsis acute renal failure hypotension Pneumonia Small Cell Lung Cancer sepsis acute renal failure Discharge Condition: Stable Discharge Instructions: You are being discharged from the hospital after an admission for fevers and low blood pressure. You were found to have pneumonia. This pneumonia was so serious that it required hospitalization to the intensive care unit. We have successfully been treating this infection with antibiotics, and your blood pressures have returned to [**Location 213**]. If you develop fevers, SOB, CP, confusion, or any other concerning symptoms call your doctor. You have also developed oral ulcers which has made it difficult for you to eat/drink. We are giving you medication to treat the source of the ulcers, as well as medication to numb the pain. It is important that you drink at least 8 glasses of water of day, as poor water intake has caused low blood pressure. You are being discharged from the hospital after an admission for fevers and low blood pressure. You were found to have pneumonia. This pneumonia was so serious that it required hospitalization to the intensive care unit. We have successfully been treating this infection with antibiotics. If you develop fevers, SOB, CP, confusion, or any other concerning symptoms call your doctor. You have also developed oral ulcers which has made it difficult for you to eat/drink. We are giving you medication to treat the source of the ulcers, as well as medication to numb the pain. It is important that you drink at least 8 glasses of water of day, as poor water intake has caused low blood pressure. If you develop light headedness, dizziness, confusion, or faint, call your doctor. You have also developed low blood counts, believed to be due the the radiation. If you develop bleeding, SOB/weakness, or fevers, call your doctor. Followup Instructions: Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**0-0-**] Date/Time:[**2106-8-26**] 2:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2503**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2106-8-26**] 2:30 [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**] ICD9 Codes: 486, 5849, 5856
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Medical Text: Admission Date: [**2198-10-28**] Discharge Date: [**2198-10-31**] Date of Birth: [**2139-12-20**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1945**] Chief Complaint: hematemesis Major Surgical or Invasive Procedure: EGD Intubation/ Self-Extubation History of Present Illness: Mr. [**Known lastname 88114**] is a 58M with h/o ulcers and GIB, who presented s/p intubation from OSH with massive hematemesis. History obtained through outside records, girlfriend, and mother. . The patient was seen at [**Hospital3 **] for 2 day h/o hematemesis and melena per EMS note. Also with c/o abdominal pain. Pt was AOx3 and speaking in full sentences at that time. In the ED, he started vomiting frank blood and became "hypotensive + barely responsive", so was intubated presumably for airway protection. Initial HCT was 25.5, INR 1.6. He was given Protonix 80mg, Pepcid 40mg, Morphine 4mg, Thamine, Folate, Ativan, Etomidate, Succ, and started on a Fentanyl/Versed gtt. He was transfused 2units pRBCs en route. Two attempts at fem line were unsuccessful. . In the ED, initial vs were: T 96.4 P 133 BP 133/78 RR 19 O2sat 99%. Pt noted to be moving all 4 extremities when sedation lightened. NGL positive >1.5L. Labs notable for WBC 16.4, HCT 29.0, INR 1.8, lactate 7.3. ABG 7.26/49/121. Patient was given CTX, Octreotide, and Pantoprazole. Cordis was placed in RIJ. He was transfused 4 units pRBCs, 1unit FFP, 4LNS. BP transiently dropped to SBP 80s. Vitals prior to transfer: P 103 BP 103/65 RR 22 O2sat 100%. . On the floor, the patient remains intubated and sedated at this time. Past Medical History: Ulcers, + h/o bleeding Social History: Lives alone. Has a partner - [**Name (NI) 7019**] [**Name (NI) 1193**]. - Tobacco: + tobacco use - Alcohol: + EtOH use - Illicits: none Family History: Unable to assess Physical Exam: On admission: Vitals: T 95.6 P 106 BP 105/64 RR 22 O2sat 100% General: intubated, sedated HEENT: pupils 2mm sluggish Neck: supple, JVP not elevated Lungs: CTA b/l anteriorly CV: tachycardic, S1S2 Abdomen: mildly distension, +bs GU: foley Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema Pertinent Results: On admission: [**2198-10-28**] 07:05PM BLOOD WBC-16.4* RBC-2.78* Hgb-9.7* Hct-29.0* MCV-105* MCH-34.9* MCHC-33.4 RDW-21.7* Plt Ct-183 [**2198-10-28**] 07:05PM BLOOD PT-19.5* PTT-27.5 INR(PT)-1.8* [**2198-10-28**] 07:05PM BLOOD Fibrino-163 [**2198-10-28**] 07:05PM BLOOD UreaN-17 Creat-1.0 [**2198-10-28**] 07:05PM BLOOD ALT-34 AST-47* AlkPhos-67 TotBili-0.8 [**2198-10-28**] 07:05PM BLOOD Lipase-12 [**2198-10-28**] 10:59PM BLOOD Calcium-6.8* Phos-3.1 Mg-1.0* [**2198-10-28**] 08:06PM BLOOD Type-ART pO2-121* pCO2-49* pH-7.26* calTCO2-23 Base XS--5 [**2198-10-28**] 07:11PM BLOOD Glucose-187* Lactate-7.3* Na-143 K-4.3 Cl-110 calHCO3-19* [**2198-10-28**] 07:11PM BLOOD Hgb-9.9* calcHCT-30 [**2198-10-28**] 07:11PM BLOOD freeCa-0.98* [**2198-10-28**] 07:05PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.016 [**2198-10-28**] 07:05PM URINE Blood-SM Nitrite-NEG Protein-75 Glucose-TR Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2198-10-28**] 07:05PM URINE RBC-0-2 WBC-0 Bacteri-RARE Yeast-NONE Epi-0-2 [**2198-10-28**] 07:05PM URINE CastHy-0-2 . ECG [**2198-10-28**]: Regular supraventricular tachycardia, likely sinus given age. Diffuse non-specific ST-T wave abnormalities, likely secondary to rapid rate. No other diagnostic abnormalities. No previous tracing available for comparison. . Chest X-ray [**2198-10-28**]: FINDINGS: Single supine AP portable view of the chest was obtained. There is an endotracheal tube is seen, terminating approximately 5 cm above the level of carina. A nasogastric tube is seen, coursing below the diaphragm, terminating in the expected position of the stomach. There are relatively low lung volumes. Medial right base opacity may relate to low lung volumes and prominent vasculature, although an underlying consolidation from pneumonia or aspiration cannot be entirely excluded. No focal consolidation, pleural effusion or pneumothorax is seen. No displaced fracture is appreciated. IMPRESSION: 1. Endotracheal and nasogastric tubes in appropriate position. 2. Low lung volumes. Medial right base opacity may relate to prominent vasculature, although an underlying consolidation cannot be entirely excluded, which could be due to aspiration or pneumonia. Labs at discharge: [**2198-10-31**] 06:47AM BLOOD WBC-8.4 RBC-3.61* Hgb-11.8* Hct-35.3* MCV-98 MCH-32.8* MCHC-33.5 RDW-20.9* Plt Ct-89*# [**2198-10-31**] 03:05AM BLOOD Hct-29.5* [**2198-10-31**] 06:47AM BLOOD Plt Ct-89*# [**2198-10-31**] 06:47AM BLOOD PT-13.8* PTT-23.0 INR(PT)-1.2* [**2198-10-31**] 06:47AM BLOOD Glucose-103* UreaN-10 Creat-0.9 Na-139 K-3.5 Cl-104 HCO3-23 AnGap-16 [**2198-10-31**] 06:47AM BLOOD Calcium-8.1* Phos-2.9 Mg-2.0 Brief Hospital Course: MICU Course: Pt was admitted from OSH with massive hematemesis and had been intubated. He underwent EGD upon arrival to MICU. EGD showed blood in stomach body and fundus and two small areas of likely NG trauma. There were no varices. There was edema and erythema at GE junction and on gastric mucosa and patchy area of columnar epithelium suggestive of barrett's. Biopsies were obtained. One lesion that could be a dieulafoye's was clipped. He was initially kept on IV PPI gtt that was transitioned to IV PPI [**Hospital1 **] and then to po PPI [**Hospital1 **]. He was also put on octreotide and ceftriaxone which were also d/c-ed when esophageal varices was ruled out. Hct remained stable in low 30s. He had no further episodes of hematemesis while on floor and was hemodynamically stable. He was doing well on pressure support ventilation and self-extubated on [**2198-10-29**]. He tolerated self-extubation well with oxygen saturations consistently above 90. He was monitored on CIWA for alcohol/benzo withdrawal and received one dose diazepam for insomnia. Per family, pt has had recent decrease in mental status and self-medicating with aspirin, alcohol, and ativan. Pt was noted to be speaking inappropriately at times and having conversations with himself. Psych consult was obtained who suggested Haldol 1mg at night and 1mg PRN agitation. On the floor the pt was hemodynamically stable and had a stable HCT at 35.3. He continued to exhibit slightly pressured speech and his thought pattern appeared tangential. He did not have repeat emesis or black/bloody stool. He was deemed stable for discharge home on Omeprazole with follow-up at [**Company 191**] and follow-up with gastroenterology Medications on Admission: Ativan Aspirin Discharge Medications: 1. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 5. Ativan 1 mg Tablet Sig: One (1) Tablet PO twice a day as needed for anxiety. Disp:*14 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary: Upper GI bleeding Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 88114**], You were admitted to the [**Hospital3 **] Medical center for vomiting blood and passing blood in your stool. You were intubated in the ICU to protect your airway. You received blood transfusions and an endoscopy to evaluate the source of your bleeding. We did find a lesion in your esophagus but this lesion was not actively bleeding. You were extubated and watched closely for 2 days. During these 2 days time you did not have repeat episode of bleeding either through vomiting or in your stool. Your red blood cell level remained stable. We feel that you are stable for discharge home with follow-up appointments with a primary care physician. You should START the following medications: - Omeprazole 40mg twice a day - Folic Acid - Vitamins - Ativan as needed for anxiety You should take all your other medications as prescribed in this discharge packet. You should call your doctor and return to the Emergency immediately if you vomit blood or if you have bloody stools. Followup Instructions: Please note the following appointments: Department: [**Hospital3 249**] When: WEDNESDAY [**2198-11-7**] at 3:50 PM With: [**Last Name (NamePattern5) 65657**], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage This is your new Primary Care Physician within [**Hospital **]. Department: GASTROENTEROLOGY When: FRIDAY [**2198-12-7**] at 9:30 AM With: [**Name6 (MD) 81**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1983**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage ICD9 Codes: 2930, 2875, 3051
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Medical Text: Admission Date: [**2108-2-28**] Discharge Date: [**2108-3-15**] Date of Birth: [**2037-10-7**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: increased SOB, lower extremity edema Major Surgical or Invasive Procedure: AVR (25mm [**First Name8 (NamePattern2) **] [**Male First Name (un) **] tissue), CABGx3(SVG>PDA, SVG>LAD, SVG>Diag)/ Lt CEA [**3-8**] tooth extraction [**3-3**] History of Present Illness: 70 yo M who has not received medical care for most of his life presented to ED on [**2-23**] with SOB, edema. Received lasix gtt with some relief, cath at OSH with 2 VD, ech with AS and EF 10%. Past Medical History: DM, ischemic cardiomyopathy-new dx, etoh abuse, s/p cyst removal from tailbone as child Social History: worked in plumbing and heating quit tobacco [**2060**] quit etoh 25 years ago Family History: NC Physical Exam: NAD HR 86, R 14 BP 87/56 HEENT teeth in poor repair Lungs decreased t/o Heart RRR 2/6 SEM Abdomen benign Extrem with 1+ edema to knees No varicose veins, 1+ dp/pt pulses Left carotid with loud bruit Pertinent Results: [**2108-3-15**] 06:55AM BLOOD WBC-9.7 RBC-3.44* Hgb-9.7* Hct-30.0* MCV-87 MCH-28.0 MCHC-32.2 RDW-17.1* Plt Ct-319 [**2108-3-15**] 06:55AM BLOOD Plt Ct-319 [**2108-3-13**] 07:15AM BLOOD PT-14.9* INR(PT)-1.3* [**2108-3-15**] 06:55AM BLOOD Glucose-128* UreaN-26* Creat-1.5* Na-140 K-4.2 Cl-101 HCO3-29 AnGap-14 [**2108-3-13**] 07:15AM BLOOD Glucose-137* UreaN-36* Creat-2.0* Na-134 K-4.2 Cl-99 HCO3-26 AnGap-13 [**2108-3-12**] 01:15PM BLOOD UreaN-33* Creat-1.9* K-4.9 CHEST (PA & LAT) [**2108-3-14**] 2:35 PM CHEST (PA & LAT) Reason: eval for pleural effusions [**Hospital 93**] MEDICAL CONDITION: 70 year old man s/p AVR CABG REASON FOR THIS EXAMINATION: eval for pleural effusions PROCEDURE: Chest PA and lateral on [**2108-3-14**]. COMPARISON: [**2108-3-12**]. HISTORY: 70-year-old man status post AVR and CABG, evaluate for pleural effusions. FINDINGS: In the interim, there is a gradual decrease in the bilateral pleural effusions with gradual decrease in the bibasilar lower lobe atelectasis. Persistent stable cardiomegaly. There is no evidence of pulmonary edema. IMPRESSION: 1. Gradual decrease in the bilateral bibasilar pleural effusions which are small to moderate on today's examination along with gradual decrease of the bilateral bibasilar lower lobe atelectasis. [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 77685**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 77686**] (Complete) Done [**2108-3-8**] at 9:22:59 AM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) 177**] [**Hospital Unit Name 927**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2037-10-7**] Age (years): 70 M Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: CABG/AVR ICD-9 Codes: 428.0, 402.90, 435.9, 786.05, 786.51, 799.02, 440.0, 424.1, 424.0 Test Information Date/Time: [**2108-3-8**] at 09:22 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2008AW-1: Machine: [**Pager number **] Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Inferolateral Thickness: *1.2 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: *7.5 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 10% to 15% >= 55% Aorta - Ascending: *3.5 cm <= 3.4 cm Aorta - Descending Thoracic: 2.5 cm <= 2.5 cm Aortic Valve - Peak Velocity: *2.8 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *30 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 23 mm Hg Aortic Valve - LVOT pk vel: 0.50 m/sec Aortic Valve - LVOT diam: 2.2 cm Aortic Valve - Valve Area: *0.7 cm2 >= 3.0 cm2 Findings LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. LEFT VENTRICLE: Severely depressed LVEF. RIGHT VENTRICLE: Severe global RV free wall hypokinesis. AORTA: Normal ascending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Severely thickened/deformed aortic valve leaflets. Severe AS (AoVA <0.8cm2). Mild (1+) AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. Moderate (2+) MR. TRICUSPID VALVE: Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR. 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 under general anesthesia throughout the procedure. The TEE probe was passed with assistance from the anesthesioology staff using a laryngoscope. No TEE related complications. Conclusions Pre-CPB: No spontaneous echo contrast is seen in the left atrial appendage. Overall left ventricular systolic function is severely depressed (LVEF= 10 - 15%). RV also with severe global free wall hypokinesis. There are simple 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 (area <0.8cm2). Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Moderate (2+) mitral regurgitation is seen. There is no pericardial effusion. Post- CPB: The patient is in SR, with infusions of milrinone and epinephrine. A well-seated and functioning aortic valve prosthesis is seen, with no AI, and no perivalvular leak. Mean gradient is 15. Aorta intact. MR is 1+. Biventricular systolic fxn is still moderately depressed. Brief Hospital Course: He was admitted to cardiac surgery. Carotid duplex showed Left CCA stenosis of 80-99%, he was seen by vascular surgery. CT scan showed very calcified aortic arch and carotid arteries and CEA was recommended. He was seen by dentistry and tooth extraction was recommended. He underwent 1 tooth extraction on [**3-4**]. On [**3-8**] he was taken to the operating room where he underwent an AVR, CABG x 3 and Left CEA. He was transferred to the ICU in critical but stable condition on epinephrine, nitroglycerine, and milrinone. He was extubated on POD #1. He was weaned from his milrinone over several days and transferred to the floor on POD #3. He required extensive diuresis. he was seen by [**Last Name (un) **] for preoperative HbA1c of 9 and uncontrolled diabetes postop. He was started on lantus and humalog sliding scale. He was seen by PT and cleared for home over several days. He was ready for discharge on POD #7. Medications on Admission: aspirin Discharge Medications: 1. Aspirin 81 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:*0* 2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 5. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0* 6. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed. Disp:*50 Tablet(s)* Refills:*0* 8. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) units Subcutaneous at bedtime. Disp:*qs 1 month* Refills:*0* 9. Insulin Lispro 100 unit/mL Solution Sig: sliding scale Subcutaneous four times a day. Disp:*qs 1 month* Refills:*0* 10. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 10 days: then 40 mg daily. Disp:*60 Tablet(s)* Refills:*0* 11. Diabetic Supplies one touch ultra glucometer, Test strips for one touch ultra, Insulin syringes, Lancets QS 1 month Refills per PCP Discharge Disposition: Home With Service Facility: [**Hospital3 6011**] Care Discharge Diagnosis: AS/CAD now s/p AVR/CABG uncontrolled diabtes acute on chronic systolic heart failure L carotid stenosis now s/p CEA DM, ischemic cardiomyopathy-new dx, etoh abuse, s/p cyst removal from tailbone as child Discharge Condition: Stable 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 for 10 weeks, no driving until follow up with surgeon. Followup Instructions: Dr. [**Last Name (STitle) **] 1 week Dr. [**Last Name (STitle) 914**] 2 weeks Dr. [**Last Name (STitle) 39975**]/[**Last Name (un) 55499**] 4 weeks Dr. [**Last Name (STitle) 77687**] 6 weeks Completed by:[**2108-3-15**] ICD9 Codes: 4241, 4254, 4280, 4240, 4019
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Medical Text: Admission Date: [**2118-2-24**] Discharge Date: [**2118-3-8**] Date of Birth: [**2062-3-4**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: Decompensated cirrhosis Major Surgical or Invasive Procedure: Multiple paracenteses EGD History of Present Illness: Mr. [**Known lastname 99200**] is a pleasant 55 yo man with recently-diagnosed presumed alcoholic cirrhosis who presents from clinic today with gross volume overload. He had not seen a doctor for 10-15 years until about 1 month prior toadmission, at which time he found a primary care physician for generalized malaise and fatigue. He was apparently sent from her office to an OSH for evaluation. During that admission, he was diagnosed with cirrhosis and what appears to be acute alcoholic hepatitis, as he was discharged on prednisone. He returned to the OSH with abdominal pain and chills. He was found to be in renal failure, which was thought to be secondary to a combination of obstruction and contrast-induced nephropathy, and he was discharged with a Foley catheter after being started on tamsulosin and finasteride. He has had loose stools for about 6 months, and he was apparently started on an empiric course of vancomycin PO for C. difficile, although D/C summaries from the second hospitalization showed no evidence of C. diff in his stool. In addition, he has been on a course of amoxicillin-clavulanic acid for an unknown indication. He has also been taking levofloxacin qweek for his chronic Foley catheter. He presented to liver clinic today, and was admitted for management of decompensated liver failure. He reports increasing lower extremity swelling and abdominal girth since being discharge [**2-11**]. Over the past few days, he also reports lower back pain that is both positional and worse with movement. He has been having trouble ambulating because of the swelling in his legs and his increasing weight. He has not weighed himself since his last discharge. He denies fevers, chills, night sweats, cough, nausea, vomiting, hematemesis, coffee-ground emesis, melena, abdominal pain. He does report mild abdominal distension. He does report blood-streaked light-brown stool but he does have a h/o hemorrhoids. ROS was otherwise essentially negative. Past Medical History: Cirrhosis Alcoholism BPH Social History: Drank 1.5L of wine per day for 10-15 years; has been abstinent for about one month now; denies tobacoo or drug use; no h/o transfusions; no tattoos; no h/o incarceration or homelessness; no IVDU Family History: No h/o liver disease Physical Exam: Vitals: T: 96.5 BP: 109/80 P: 115 R: 18 SaO2: 98% General: Awake, alert, NAD, pleasant, appropriate, cooperative HEENT: NCAT, PERRL, EOMI, mild scleral icterus, MMM, no lesions noted in OP Neck: supple, no significant JVD or carotid bruits appreciated Pulmonary: Lungs CTA bilaterally, bibasilar rales, no wheezes or ronchi Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated Abdomen: Distended, nontender, + shifting dullness, normoactive bowel sounds, no masses or organomegaly noted Extremities: Deep pitting edema to midcalf, with edema evident to thighs bilaterally Lymphatics: No cervical, supraclavicular lymphadenopathy noted Skin: no spider angiomata, no gynecomastia Neurologic: Alert, oriented x 3. Able to relate history without difficulty. Cranial nerves II-XII intact. Normal bulk, strength and tone throughout. No abnormal movements noted. No deficits to light touch throughout. No nystagmus, dysarthria, intention or action tremor. 2+ biceps, triceps, brachioradialis, patellar reflexes and 2+ ankle jerks bilaterally. Plantar response was flexor bilaterally. Pertinent Results: [**2118-2-24**] 12:40PM URINE RBC-398* WBC-2 BACTERIA-NONE YEAST-MANY EPI-0 [**2118-2-24**] 12:40PM URINE BLOOD-LGE NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-NEG PH-5.0 LEUK-TR [**2118-2-24**] 12:40PM URINE COLOR-LtAmb APPEAR-SlCloudy SP [**Last Name (un) 155**]-1.018 [**2118-2-24**] 12:40PM PT-17.7* PTT-34.2 INR(PT)-1.7* [**2118-2-24**] 12:40PM PLT COUNT-107* [**2118-2-24**] 12:40PM NEUTS-88.8* LYMPHS-6.0* MONOS-5.1 EOS-0.1 BASOS-0.1 [**2118-2-24**] 12:40PM WBC-20.8* RBC-3.90* HGB-13.5* HCT-42.2 MCV-108* MCH-34.4* MCHC-31.9 RDW-14.6 [**2118-2-24**] 12:40PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG marijuana-NEG [**2118-2-24**] 12:40PM URINE HOURS-RANDOM [**2118-2-24**] 12:40PM HCV Ab-NEGATIVE [**2118-2-24**] 12:40PM ETHANOL-NEG [**2118-2-24**] 12:40PM HBsAg-NEGATIVE HBs Ab-NEGATIVE HBc Ab-NEGATIVE HAV Ab-NEGATIVE [**2118-2-24**] 12:40PM TSH-2.1 [**2118-2-24**] 12:40PM TOT PROT-5.9* ALBUMIN-3.2* GLOBULIN-2.7 CALCIUM-8.9 PHOSPHATE-3.8 MAGNESIUM-2.4 [**2118-2-24**] 12:40PM LIPASE-76* [**2118-2-24**] 12:40PM ALT(SGPT)-441* AST(SGOT)-293* ALK PHOS-267* AMYLASE-66 TOT BILI-6.2* DIR BILI-3.6* INDIR BIL-2.6 [**2118-2-24**] 12:40PM LIPASE-76* [**2118-2-24**] 12:40PM ALT(SGPT)-441* AST(SGOT)-293* ALK PHOS-267* AMYLASE-66 TOT BILI-6.2* DIR BILI-3.6* INDIR BIL-2.6 [**2118-2-24**] 12:40PM estGFR-Using this [**2118-2-24**] 12:40PM UREA N-45* CREAT-1.8* SODIUM-133 POTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-19* ANION GAP-17 [**2118-2-24**] 12:40PM GLUCOSE-146* [**2118-2-24**] 05:51PM ASCITES WBC-51* RBC-51* POLYS-18* LYMPHS-16* MONOS-46* MESOTHELI-2* MACROPHAG-18* [**2118-2-24**] 05:51PM ASCITES TOT PROT-0.4 GLUCOSE-181 LD(LDH)-39 ALBUMIN-<1.0 [**2118-2-24**] 06:01PM URINE HOURS-RANDOM UREA N-806 CREAT-66 SODIUM-18 Brief Hospital Course: 55 yo man with newly-diagnosed cirrhosis and BPH who presented with decompensated cirrhosis and renal failure and subsequent shock. . On presentation, patient was found to be in shock with MRSA bacteremia. He was started on Vancomycin and his blood pressure was supported with pressors and steroids. He eventually became hemodynamically stable and pressors were being weaned off. However, his overall prognosis was poor with decompensated cirrhosis and resultant renal failure and pulmonary edema/ARDS. Patient was also very sedated and even off sedating medications, had a depressed mental status, likely from hepatic encephalopathy. Discussions with the family about goals of care eventually caused the patient to become CMO. All unnecessary medications were discontinued. The patient passed away on [**2118-3-8**] with his family at the bedside. Medications on Admission: lactulose Tamsulosin Finasteride Prednisone 20 [**Hospital1 **] Pantoprazole . Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: Cirrhosis Discharge Condition: Expired Discharge Instructions: N/A Followup Instructions: N/A ICD9 Codes: 0389, 5849, 5859, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6783 }
Medical Text: Admission Date: [**2174-8-1**] Discharge Date: [**2174-8-4**] Date of Birth: [**2116-11-12**] Sex: M Service: MEDICINE Allergies: Percocet Attending:[**First Name3 (LF) 943**] Chief Complaint: Direct admission for paracentesis and blood transfusion in anticipation of TIPS Major Surgical or Invasive Procedure: TIPS mechanical ventilation central line placement therapeutic paracentesis History of Present Illness: 57 year old man with alcoholic cirrhosis and resultant portal hypertension and ascites scheduled for TIPS this week who presented to Dr.[**Name (NI) 948**] clinic today with reaccumulated ascites. He has had multiple large volume paracenteses in the past month most recently 2 days ago in the ED when he had 6 liters tapped from his abdomen (he was given 50g albumin at that time). In addition, Hemoglobin was noted to be 8.4 (down from 10.2 on [**7-19**]). He was discharged home from the ED with planned TIPS scheduled for [**8-2**]. However, in clinic today, his fluid had reaccumulated and given his recent drop in Hemoglobin, per Dr. [**Last Name (STitle) 497**], he is being admitted today for paracentesis of reaccumulated fluid as seen in clinic today and a 2 unit blood transfusion in anticipation of TIPS planned for tomorrow. . His ascites has been recurrent since [**Month (only) 547**] and has been refractory to diuretics. Prior to that, his last episode of ascites was a few years ago. The differential of his worsening ascites was initially thought to include progression of liver disease, portal vein thrombosis, HCC, hepatic mets, peritoneal carcinomatosis. During an admission in [**Month (only) 116**], he had a RUQ US with normal vasculature and no liver lesions. AFP was within normal limits. Fluid from paracenteses has been negative for SBP and cultures have also been consistently negative. He has known esophageal varices that were visualized on 3 EGDs in [**Month (only) 116**] and were found to be nonbleeding. He had no evidence of encephalopathy and was maintained on prophylactic lactulose. The team was initially considering performing a TIPS procedure in [**Month (only) 116**], however, when he developed bacteremia, it was felt to be safer to administer 2 weeks of antibiotics and then plan for TIPS scheduled for this week. . He denies fever, chills, abdominal pain, N/V, constipation, BRBPR/melena, hematemesis, cough, SOB, LE edema, headache, neck stiffness, confusion, pruritus, change in BMs. He does report some daytime somnolence and mild nighttime insomnia. He reports he first developed ascites approximately 4y ago, for which he underwent paracentesis. He states he had no further ascites until last month. Past Medical History: 1. EtOH cirrhosis: decompensated with ascites and varices, on transplant list 2. Colonic adenoma: polypectomy in [**2171**] 3. Esophageal varices: grade 1 on last EGD in [**8-26**], s/p banding of grade II varices in [**10-25**], h/o hematemesis in the past 4. Cholelithiasis 5. Partial colectomy: at [**Hospital3 **] in [**2158**] [**2-24**] severe GI bleed after polypectomy 6. hernia repair Social History: [**Month/Day (2) **] Priest. [**Name (NI) **] children. No tobacco. Currently no EtOH. Formerly a heavy drinker (cannot quantify). Currently living with parents Family History: no fam hx of cirrhosis/liver disease; 6 siblings, all healthy. parents both alive and healthy Physical Exam: T 97.8 BP 98/62 HR 83 RR 20 Sat 100% ra Gen: thin man lying in bed in NAD HEENT: no scleral icterus; nasogastric feeding tube in place with small amount of dried blood Neck: no LAD, no JVP Pulm: cta bilaterally CV: reg rate, nl s1s2, no murmurs Abd: moderately distended; nontender; normoactive bowel sounds; (+)shifting dullness; no liver edge or spleen tip palpated Extr: 2+ PT pulses Skin: no jaundice; no rashes Neuro: alert, oriented, nonfocal Pertinent Results: REPORTS: . Procedure [**2174-8-2**]: 1. Ultrasound-guided paracentesis. 2. Transjugular intrahepatic portosystemic shunt placement (TIPS). 3. Single coronary vein varix ablation with absolute alcohol. 4. Quadruple lumen central venous line, right internal approach. PRESSURE MEASUREMENTS: Initial direct portal vein pressure = 22 mmHg. Initial free hepatic vein pressure = 4 mm. Post TIPS direct portal vein pressure = 17 mm. Post TIPS free hepatic vein pressure = 14 mm. Post TIPS inferior vena cava pressure = 8 mm. A single coronary vein was ablated with a bolus of 5 cc of absolute alcohol. IMPRESSION: 1. Status post paracentesis. 1500 cc of clear amber acetic fluid was collected. 2. Status post TIPS procedure with deployment of the 10 mm x 68 mm wall stent in the transparenchymal tract. Initial portosystemic gradient was 19 mm. Subsequent to stent creation, portosystemic gradient was 9 mm 3. Status post single coronary vein varix ablation with absolute alcohol. 4. Status post quadruple lumen central venous line placement. . DUPLEX DOPP ABD/PEL [**2174-8-3**] 2:05 PM IMPRESSION: Patent TIPS with flow rates from 122.1 to 226.6 cm/sec. The velocites are upper limits of normal and follow-up is recommended. Patent and appropriate direction of flow within the anterior right and left portal veins, hepatic veins, left and main hepatic artery. . LABS: . [**2174-8-4**] 01:57AM BLOOD WBC-7.4 RBC-3.06* Hgb-9.4* Hct-26.7* MCV-88 MCH-30.9 MCHC-35.3* RDW-16.8* Plt Ct-49* [**2174-8-3**] 08:02AM BLOOD Hct-27.6* [**2174-8-3**] 03:30AM BLOOD WBC-9.4 RBC-3.08* Hgb-9.5* Hct-26.9* MCV-87 MCH-30.7 MCHC-35.1* RDW-17.0* [**2174-8-2**] 11:50PM BLOOD WBC-7.8 RBC-3.15* Hgb-9.7* Hct-27.4* MCV-87 MCH-30.8 MCHC-35.5* RDW-17.0* [**2174-8-2**] 08:47PM BLOOD WBC-8.3 RBC-3.26* Hgb-9.9* Hct-28.2* MCV-87 MCH-30.5 MCHC-35.2* RDW-16.9* [**2174-8-2**] 04:55PM BLOOD WBC-8.4 RBC-3.15* Hgb-9.8* Hct-27.3* MCV-87 MCH-31.1 MCHC-35.8* RDW-17.0* Plt Ct-74* [**2174-8-2**] 02:24PM BLOOD WBC-7.5# RBC-3.33* Hgb-10.1* Hct-29.0* MCV-87 MCH-30.2 MCHC-34.7 RDW-17.4* Plt Ct-76* [**2174-8-2**] 04:25AM BLOOD WBC-4.9 RBC-2.72* Hgb-8.3* Hct-24.5* MCV-90 MCH-30.6 MCHC-34.0 RDW-16.5* Plt Ct-86* [**2174-8-2**] 12:00AM BLOOD Hct-22.9* [**2174-8-1**] 12:45PM BLOOD WBC-7.3 RBC-2.32* Hgb-7.3* Hct-21.5* MCV-92 MCH-31.5 MCHC-34.1 RDW-16.7* [**2174-8-4**] 01:57AM BLOOD Neuts-76.9* Lymphs-8.4* Monos-9.5 Eos-4.9* Baso-0.3 [**2174-8-2**] 04:55PM BLOOD Neuts-82.9* Lymphs-3.8* Monos-9.7 Eos-2.9 Baso-0.7 [**2174-8-1**] 12:45PM BLOOD Neuts-79.3* Lymphs-6.7* Monos-8.1 Eos-5.3* Baso-0.5 [**2174-8-4**] 01:57AM BLOOD Plt Smr-VERY LOW Plt Ct-49* [**2174-8-4**] 01:57AM BLOOD PT-16.7* PTT-36.1* INR(PT)-1.5* [**2174-8-3**] 08:02AM BLOOD Plt Smr-UNABLE TO [**2174-8-3**] 08:02AM BLOOD PT-15.9* PTT-36.1* INR(PT)-1.5* [**2174-8-3**] 03:30AM BLOOD Plt Smr-VERY LOW Plt Ct-69* [**2174-8-3**] 03:30AM BLOOD Plt Smr-UNABLE TO LPlt-1+ [**2174-8-3**] 03:30AM BLOOD PT-14.9* PTT-34.4 INR(PT)-1.3* [**2174-8-3**] 01:48AM BLOOD Plt Smr-LOW Plt Ct-81* [**2174-8-2**] 11:50PM BLOOD Plt Smr-UNABLE TO [**2174-8-2**] 11:50PM BLOOD PT-15.2* PTT-33.9 INR(PT)-1.4* [**2174-8-2**] 08:47PM BLOOD Plt Smr-VERY LOW Plt Ct-79* [**2174-8-2**] 08:47PM BLOOD Plt Smr-UNABLE TO [**2174-8-2**] 08:47PM BLOOD PT-15.5* PTT-35.9* INR(PT)-1.4* [**2174-8-2**] 04:55PM BLOOD PT-15.8* PTT-36.0* INR(PT)-1.4* [**2174-8-2**] 02:24PM BLOOD Plt Smr-VERY LOW Plt Ct-76* [**2174-8-2**] 02:24PM BLOOD PT-16.1* PTT-58.0* INR(PT)-1.5* [**2174-8-1**] 12:45PM BLOOD Plt Smr-UNABLE TO [**2174-8-1**] 12:45PM BLOOD PT-15.9* PTT-33.7 INR(PT)-1.5* [**2174-8-2**] 04:25AM BLOOD PT-16.0* PTT-36.8* INR(PT)-1.5* [**2174-8-3**] 03:30AM BLOOD Fibrino-254 [**2174-8-2**] 11:50PM BLOOD Fibrino-241 [**2174-8-2**] 08:47PM BLOOD Fibrino-236 [**2174-8-2**] 02:24PM BLOOD Fibrino-221 [**2174-8-2**] 02:24PM BLOOD Ret Aut-4.5* [**2174-8-4**] 01:57AM BLOOD Glucose-128* UreaN-30* Creat-1.1 Na-133 K-4.2 Cl-105 HCO3-21* AnGap-11 [**2174-8-3**] 03:30AM BLOOD Glucose-88 UreaN-39* Creat-1.1 Na-132* K-4.0 Cl-99 HCO3-22 AnGap-15 [**2174-8-2**] 11:50PM BLOOD Glucose-92 UreaN-40* Creat-1.1 Na-132* K-4.1 Cl-99 HCO3-22 AnGap-15 [**2174-8-2**] 04:55PM BLOOD Glucose-91 UreaN-42* Creat-1.1 Na-130* K-4.1 Cl-98 HCO3-22 AnGap-14 [**2174-8-2**] 02:24PM BLOOD Glucose-92 UreaN-43* Creat-1.1 Na-127* K-4.3 Cl-98 HCO3-19* AnGap-14 [**2174-8-2**] 04:25AM BLOOD Glucose-100 UreaN-52* Creat-1.3* Na-125* K-4.6 Cl-94* HCO3-21* AnGap-15 [**2174-8-2**] 12:00AM BLOOD K-4.9 [**2174-8-1**] 12:45PM BLOOD Glucose-102 UreaN-50* Creat-1.3* Na-125* K-5.3* Cl-94* HCO3-22 AnGap-14 [**2174-8-4**] 01:57AM BLOOD ALT-29 AST-39 AlkPhos-88 TotBili-1.9* [**2174-8-3**] 03:30AM BLOOD ALT-26 AST-37 LD(LDH)-153 AlkPhos-85 TotBili-3.0* [**2174-8-2**] 04:55PM BLOOD ALT-23 AST-35 LD(LDH)-145 AlkPhos-79 TotBili-3.5* [**2174-8-2**] 02:24PM BLOOD ALT-23 AST-37 LD(LDH)-151 AlkPhos-77 TotBili-3.7* [**2174-8-2**] 04:25AM BLOOD ALT-18 AST-26 LD(LDH)-136 AlkPhos-80 TotBili-2.3* [**2174-8-1**] 12:45PM BLOOD ALT-21 AST-30 LD(LDH)-154 AlkPhos-97 TotBili-1.4 [**2174-8-4**] 01:57AM BLOOD Calcium-8.1* Phos-3.2 Mg-2.0 [**2174-8-3**] 03:30AM BLOOD Albumin-3.5 Calcium-8.8 Phos-4.0 Mg-2.1 [**2174-8-2**] 11:50PM BLOOD Calcium-8.9 Phos-4.2 Mg-2.1 [**2174-8-2**] 04:55PM BLOOD Albumin-3.5 Calcium-8.6 Phos-3.8 Mg-2.1 [**2174-8-2**] 04:25AM BLOOD Albumin-3.7 Calcium-8.6 Phos-4.5 Mg-2.1 [**2174-8-1**] 12:45PM BLOOD Albumin-3.8 Calcium-8.7 Phos-3.7 Mg-2.2 [**2174-8-2**] 02:24PM BLOOD Hapto-<20* [**2174-8-2**] 04:25AM BLOOD AFP-2.1 [**2174-8-3**] 05:39AM BLOOD Type-ART Temp-36.1 Rates-/16 PEEP-5 FiO2-50 pO2-150* pCO2-33* pH-7.46* calTCO2-24 Base XS-1 Intubat-INTUBATED [**2174-8-2**] 05:13PM BLOOD Type-ART Temp-37.2 Rates-/14 Tidal V-450 PEEP-5 FiO2-50 pO2-161* pCO2-36 pH-7.42 calTCO2-24 Base XS-0 Intubat-INTUBATED Vent-SPONTANEOU [**2174-8-2**] 02:35PM BLOOD Type-ART pO2-153* pCO2-32* pH-7.42 calTCO2-21 Base XS--2 [**2174-8-2**] 05:48PM BLOOD HEPARIN DEPENDENT ANTIBODIES: negative [**2174-8-1**] 04:38PM ASCITES TOT PROT-0.6 LD(LDH)-19 ALBUMIN-LESS THAN [**2174-8-1**] 12:30PM ASCITES WBC-105* RBC-1085* POLYS-11* LYMPHS-33* MONOS-47* EOS-7* MESOTHELI-2* . MICRO: . Time Taken Not Noted Log-In Date/Time: [**2174-8-1**] 4:38 pm FLUID RECEIVED IN BLOOD CULTURE BOTTLES PERITONEAL. AEROBIC BOTTLE (Pending): ANAEROBIC BOTTLE (Pending): . Time Taken Not Noted Log-In Date/Time: [**2174-8-1**] 4:38 pm FLUID RECEIVED IN BLOOD CULTURE BOTTLES PERITONEAL. BLOOD/FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. BLOOD/AFB CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. Brief Hospital Course: On admission, pt was transfused 2 U PRBC's, with minimal bump in hct from 21.5 to 24.5. He also underwent therapeutic paracentesis, and 5L of fluid was removed. Pt was placed on Hep SC for DVT ppx. Pt then underwent TIPS procedure, which was successful. A therapeutic paracentesis of 1600cc was also performed during the TIPS. However, after the procedure, he was found to have blood pooling in his oropharynx, as well as oozing of blood from his nares and R IJ site. There was ? of coffee ground aspirated from NG tube. He was kept intubated for airway protection, and labs were sent. He was then given 2L NS, 1 U PRBC's, 2U FFP, and 1 bag of platelets. Pt had been on Neosynephrine briefly during the TIPS procedure, but did not require pressors after the procedure. He remained hemodynamically stable in the PACU, and was transferred to the MICU for further management. His hct remained stable s/p initial transfusion, and he remained hemodynamically stable throughout his stay in the MICU. He was given Vitamin K 10mg SC to treat an INR of 1.5. Pt's platelets dropped during the admission, and a HIT Ab test was negative. The platelet drop was of unclear etiology. The pt was started on protonix for GI ppx, but this was started after the platelet drop, and this med was subsequently d/c'd (although not thought to be cause of inital platelet decrease). Heparin products were held after his initial episode of bleeidng. He had fibrinogen levels >200, so DIC was thought unlikely. He had an episode of increased bleeding from his nasal passage overnight in the ICU, so he was given an additional 2 [**Location 16678**] and treated with Afrin. The bleeding then ceased, and the pt was successfully extubated on [**8-3**]. It was believed that the initial episode of bleeding s/p TIPS was due to epistaxis from possible NGT trauma, in the setting of dysfibrinoginemia and coagulopathy from liver disease. GI bleed or bleeding from his airway were thought much less likely. Pt's diuretics and lactulose were held during his MICU stay and on discharge. His hct remained stable s/p extubation, and he was discharged directly from the ICU in good condition. Medications on Admission: 1. omeprazole 30mg daily 2. Folic Acid 1mg daily 3. Multivitamin one tab daily 4. Bupropion SR 100mg qAM 5. Benzonatate 100mg TID 6. Hydroxyzine 25mg [**Hospital1 **] 7. Furosemide 60mg [**Hospital1 **] 8. Spironolactone 100mg [**Hospital1 **] 10. Lactulose 30 ML PO TID 11. Metoclopramide 10mg TID prn 12. Ferrous Sulfate 325mg daily Discharge Medications: 1. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Bupropion 100 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO QAM (once a day (in the morning)). 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 5. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for nausea. 6. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO twice a day. 7. Lactulose (for Encephalopathy) 10 g/15 mL Solution Sig: Thirty (30) ml PO three times a day. Discharge Disposition: Home With Service Facility: All Care VNA of Greater [**Location (un) **] Discharge Diagnosis: Primary diagnosis: cirrhosis requiring TIPS procedure Secondary diagnosis: epistaxis requiring intubation and ICU monitoring Discharge Condition: stable Discharge Instructions: please seek medical attention immediately if you experience bleeding, chest pain, shortness of breath, fevers, chills, nausea, vomiting, diarrhea, dizziness, or any other concerning symptoms. Please take all medications as prescribed. Please attend all follow-up appointments. Followup Instructions: You have the following appointment scheduled: Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2174-8-10**] 8:20 Please follow-up with your PCP [**Last Name (NamePattern4) **] 1 week as well. Completed by:[**2174-8-5**] ICD9 Codes: 2875
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6784 }
Medical Text: Admission Date: [**2164-10-16**] Discharge Date: [**2164-11-9**] Date of Birth: [**2087-7-13**] Sex: F Service: CARDIOTHORACIC Allergies: Shellfish Derived Attending:[**First Name3 (LF) 922**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2164-10-22**]: 1. Aortic valve replacement with a 21-mm [**Doctor Last Name **] Magna Ease aortic valve bioprosthesis, model #3300TFX, serial #[**Serial Number 87002**]. 2. Mitral valve replacement with a 27-mm St. [**Male First Name (un) 923**] Epic mitral bioprosthesis, reference #[**Serial Number 87003**], serial #[**Serial Number 87004**]. 3. Coronary bypass grafting x1 with reverse saphenous vein graft from aorta to distal right coronary artery. History of Present Illness: 77 year old female that presented to OSH with worsening dyspnea on exertion x 3 days with known murmur. She was found to be in failure and echocardiogram revealed severe aortic stenosis with [**Location (un) 109**] 0.5. She received lasix for diuresis and was transferred in for surgical evaluation and cardiac catheterization Cardiac Catheterization: Date: [**2164-10-16**] Place: [**Hospital1 18**] Revealed three vessel disease. The LMCA was normal without stenosis. The LAD has a 50% proximal stenosis. The LCx has a 40% proximal stenosis with a 40% distal stenosis. The RCA has an 80% proximal stenosis. Resting hemodynamics demonstrated elevated left and right sided filling pressures with RVEDP of 13 mmHg and mean PCWP of 28 mmHg. There is moderate pulmonary arterial hypertension of 53/23 mmHg as well as persistent systemic arterial hypertension (151/61 with a mean of 101 mmHg). The cardiac index was preserved at 2.93 l/min/m2 (using an assumed oxygen consumption) Past Medical History: Hypertension Hyperlipidemia Aortic Stenosis [**Location (un) **] 0.5 Hodgkin's stage IIIB s/p chemotherapy and radiation ( was from level of ears to pelvis done in [**2137**]) Breast Cancer diverticulosis stage III - found on colonscopy [**2164-9-8**] Upper airway obstruction secondary to papillomas - although multiple areas note home oxygen - she states that she does not wear oxygen at home Epitaxis every 2-3 months left nares only Glaucoma s/p laser in left eye to reduce pressure Past Surgical History splenectomy hysterectomy laryngeal papillomas removal - last attempt [**2164-5-9**] Left mastectomy [**2162**] Social History: Race: caucasian Last Dental Exam: long time ago Lives with: daughter Occupation: health clinic in school Tobacco: denies ETOH: denies Family History: grandfather deceased 65 MI brother deceased 74 MI Grandmother stroke deceased 60 Physical Exam: Pulse: 94 Resp: 20 O2 sat: 100% 2 l nc B/P Right: 132/49 Left: not done due to mastectomy General: pleasant, no acute distress Skin: Dry [x] intact [x] right groin cath site, left subclavian surgical scar, left chest surgical scar HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur 3/6 systolic murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] non palpable masses Extremities: Warm [x], well-perfused [x] Edema none Varicosities: multiple bilateral lower extremities Neuro: Grossly intact Pulses: Femoral Right: +1 Left: +1 DP Right: +1 Left: +1 PT [**Name (NI) 167**]: +1 Left: +1 Radial Right: +2 Left: +2 Carotid Bruit transmitted murmur Pertinent Results: Admission: [**2164-10-17**] 06:35AM BLOOD WBC-10.4 RBC-3.90* Hgb-10.9* Hct-33.6* MCV-86 MCH-27.9 MCHC-32.4 RDW-14.5 Plt Ct-494* [**2164-10-17**] 06:35AM BLOOD Plt Ct-494* [**2164-10-17**] 06:35AM BLOOD Glucose-98 UreaN-36* Creat-1.3* Na-142 K-4.2 Cl-100 HCO3-29 AnGap-17 [**2164-10-18**] 03:11PM BLOOD ALT-24 AST-21 AlkPhos-110* TotBili-0.3 [**2164-10-17**] 06:35AM BLOOD CK(CPK)-154 [**2164-10-18**] 03:11PM BLOOD Lipase-31 Discharge: [**2164-11-8**] 11:32AM BLOOD Vanco-26.0* [**2164-11-8**] 05:01AM BLOOD WBC-12.0* RBC-2.92* Hgb-8.6* Hct-26.3* MCV-90 MCH-29.3 MCHC-32.5 RDW-16.2* Plt Ct-349 [**2164-11-8**] 05:01AM BLOOD Plt Ct-349 [**2164-11-8**] 05:01AM BLOOD PT-22.3* PTT-30.3 INR(PT)-2.1* [**2164-11-8**] 05:01AM BLOOD UreaN-25* Creat-1.0 Na-132* K-4.8 Cl-103 [**2164-11-6**] 04:57AM BLOOD Glucose-141* UreaN-23* Creat-0.8 Na-134 K-5.0 Cl-104 HCO3-25 AnGap-10 [**2164-11-1**] 05:56AM BLOOD ALT-66* AST-48* AlkPhos-209* TotBili-0.7 Radiology Report VIDEO OROPHARYNGEAL SWALLOW Study Date of [**2164-11-7**] [**Hospital 93**] MEDICAL CONDITION: 77 year old woman with s/p AVR, MVR, CABG REASON FOR THIS EXAMINATION: evaluate dysphagia Final Report FINDINGS: Multiple consistencies of barium were administered. Barium passed freely through the oropharynx without evidence of obstruction. Mild penetration was seen with rapid swallows of thin barium; otherwise, there is no evidence of aspiration. For more information, please see the speech and swallow division note in the online medical record. Radiology Report CHEST (PA & LAT) Study Date of [**2164-11-6**] 2:46 PM [**Hospital 93**] MEDICAL CONDITION: 77 year old woman s/p AVR/CABG/ex lap REASON FOR THIS EXAMINATION: assess for infiltrates There has been little interval change in bilateral pleural effusions, right greater than left, with marked retrocardiac opacity. Upper lungs remain relatively well aerated without new focus of consolidation. There is no pneumothorax. The cardiomediastinal silhouette is grossly unchanged. IMPRESSION: Little change in bilateral pleural effusions with retrocardiac opacity. Superimposed consolidation at the lung bases cannot be excluded. [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: *1.2 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *1.2 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 5.5 cm <= 5.6 cm Left Ventricle - Systolic Dimension: 4.5 cm Left Ventricle - Fractional Shortening: *0.18 >= 0.29 Left Ventricle - Ejection Fraction: 50% to 55% >= 55% Aorta - Annulus: 2.3 cm <= 3.0 cm Aorta - Sinus Level: 2.8 cm <= 3.6 cm Aorta - Sinotubular Ridge: 2.1 cm <= 3.0 cm Aorta - Ascending: 2.6 cm <= 3.4 cm Aorta - Arch: 2.4 cm <= 3.0 cm Aorta - Descending Thoracic: 2.0 cm <= 2.5 cm Aortic Valve - Peak Velocity: *3.6 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *52 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 32 mm Hg Aortic Valve - LVOT diam: 1.9 cm Aortic Valve - Valve Area: *0.6 cm2 >= 3.0 cm2 Mitral Valve - MVA (P [**1-28**] T): 2.0 cm2 Mitral Valve - E Wave: 0.5 m/sec Mitral Valve - A Wave: 0.5 m/sec Mitral Valve - E/A ratio: 1.00 Findings LEFT ATRIUM: No spontaneous echo contrast or thrombus in the LA/LAA or the RA/RAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is seen in the RA and extending into the RV. No ASD by 2D or color Doppler. LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Mild symmetric LVH. Normal LV cavity size. Low normal LVEF. [Intrinsic LV systolic function likely depressed given the severity of valvular regurgitation.] RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal ascending aorta diameter. Focal calcifications in ascending aorta. Normal aortic arch diameter. Simple atheroma in aortic arch. Normal descending aorta diameter. Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: Three aortic valve leaflets. Severely thickened/deformed aortic valve leaflets. Critical AS (area <0.8cm2). Mild to moderate ([**1-28**]+) AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. Severe mitral annular calcification. Mild valvular MS (MVA 1.5-2.0cm2). Moderate to severe (3+) MR. TRICUSPID VALVE: Moderately thickened tricuspid valve leaflets. Moderate [2+] TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. The TEE probe was passed with assistance from the anesthesioology staff using a laryngoscope. No TEE related complications. The patient appears to be in sinus rhythm. patient. Conclusions PRE BYPASS 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. Overall left ventricular systolic function is low normal (LVEF 50-55%). [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. There are simple atheroma 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 critical aortic valve stenosis (valve area <0.8cm2). Mild to moderate ([**1-28**]+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. There is severe mitral annular calcification. There is mild valvular mitral stenosis (area 1.5-2.0cm2). Moderate to severe (3+) mitral regurgitation is seen. The tricuspid valve leaflets are moderately thickened. Moderate [2+] tricuspid regurgitation is seen. Dr. [**Last Name (STitle) 914**] was notified in person of the results in the operating room at the time of the study. POST BYPASS The patient is receiving epinephrine by infusion. Biventricular systolic function appears normal. There is a bioprosthesis located in the mitral position. It appears well seated. The leaflets are seen to be moving normally. There is trace, central, valvular mitral regurgitation. The maximum gradient through the mitral valve was 16 mmHg with a mean gradient of 7 mmHg at a cardiac output around 3.5 liters/minute. There is a bioprosthesis located in the aortic position. It also appears well seated and displays normal leaflet movement. There is trace, central valvular aortic regurgitation. The maximum gradient through the aortic valve was 16 mmHg with a mean gradient of 8 mmHg at a cardiac ouput of 3.5 liters/minute. The thoracic aorta appears intact after decannulation. The tricuspid regurgitation may be slightly improved - now closer to mild to moderate. Brief Hospital Course: Patient was initially admitted to cardiology service after being seen at OSH for chest pain and dyspnea. An echo showed aortic stenosis and she was referred to [**Hospital1 18**] for cardiac catheterization. Her catheterization revealed 3 vessel coronary disease. Cardiac surgery was consulted. After the usual preoperative workup the patient was brought to the operating room on [**2164-10-22**]. Please see operative report for details, in summmary she had: 1. Aortic valve replacement with a 21-mm [**Doctor Last Name **] Magna Ease aortic valve bioprosthesis, model #3300TFX, serial #[**Serial Number 87002**]. 2. Mitral valve replacement with a 27-mm St. [**Male First Name (un) 923**] Epic mitral bioprosthesis, reference #[**Serial Number 87003**], serial #[**Serial Number 87004**]. 3. Coronary bypass grafting x1 with reverse saphenous vein graft from aorta to distal right coronary artery. 4. Endoscopic left greater saphenous vein harvesting. 5. Epiaortic duplex scanning. Her bypass time was 160 minutes with a crossclamp time of 136 minutes. She tolerated the operation well and was transferred post-operatively to the cardiac surgery ICU in stable condition. The patient woke from anesthesia with tachycardia and hypertension and was resedated. On the morning of POD1 she was extubated. Over the next few days she remained hemodynamically stable but had generalized complains aof pain with some localization to the abdomen. On POD2 her lactate rose from 1.2 to 2.1 and general surgery was consulted. She was brought to the operating room by general surgery on [**10-25**] for Exploratory laparotomy, cholecystectomy. Please see operative report for details. She again was brought to the cardiac surgery ICU in stable condition. She extubated the day after surgery but remained in the ICU for hemodynamic monitoring. During this time she had several episodes of atrial fibrillation and was treated with Beta blockers, amiodarone and anticoagulation. She was very deconditioned and her activity was minimal in this initial period, she failed a swallow evaluation and a feeding tube was placed. She slowly gained strength and on POD 9 and 6 she was transferred from the ICU to the cardiac stepdown floor. Once on the floor she was started on some oral nutrition and appeared to have aspirated, with a leukocytosis and chest XRay the revealed a right lower lobe infiltrate. She was started on broad spectrum antibiotics and her leukocytosis gradually resolved. She worked with physical therapy and the nursing staff to regain strength and mobility, again the progress was slow. ON POD 18 she was transferred to rehabilitation at Life Care Center of [**Location (un) **] for continued recovery. Medications on Admission: Torsemide 20 mg daily - will increase to 40 mg if weight increased Metoprolol 25 mg [**Hospital1 **] Atorvastatin 10 mg daily Aspirin 81 mg daily Multivitamin 1 daily Lumigan 0.03% 1 drop each HS Klor-con 20 meq daily Plavix - last dose: none Allergies: shellfish - vomiting 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. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 4. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). 6. famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. tramadol 50 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain. 8. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Yx Inhalation Q6H (every 6 hours) as needed for wheezing. 9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every [**5-1**] hours as needed for fever, pain. 10. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): 200mg [**Hospital1 **] x7 days then 200mg QD. 13. ondansetron HCl (PF) 4 mg/2 mL Solution Sig: Four (4) mg Injection Q8H (every 8 hours) as needed for nausea. 14. sodium chloride 0.9 % 0.9 % Parenteral Solution Sig: Three (3) ML Intravenous QD and PRN as needed for line flush. 15. vancomycin 750 mg Recon Soln Sig: Seven [**Age over 90 1230**]y (750) mg Intravenous Q 12H (Every 12 Hours) for 8 days: please check trough after 3rd dose. 16. heparin, porcine (PF) 10 unit/mL Syringe Sig: Ten (10) ML Intravenous PRN (as needed) as needed for line flush: 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. . 17. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 8 days. 18. warfarin 1 mg Tablet Sig: as directed to keep INR 2-2.5 Tablets PO Once Daily at 4 PM: Target INR 2-2.5(AFib) [**11-8**] dose 1mg. 19. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 20. metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 10 days. Discharge Disposition: Extended Care Facility: [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] Discharge Diagnosis: 1. Aortic stenosis/aortic regurgitation. s/p AVR 2. Mitral stenosis/mitral regurgitation. s/p MVR 3. Coronary artery disease. s/p CABG 4. s/p Cholecystectomy PMH: Hypertension, Hyperlipidemia, AS, MS, CVD, PVD, Hodgkin's stage IIIB s/p chemo and radiation,Upper airway obstruction secondary to papillomas, on Home O2 2 liters, splenectomy, hysterectomy, laryngeal papillomas, tubular adenoma, diverticulosis stage III Discharge Condition: Alert and oriented x3 nonfocal Ambulating with asssistance Incisional pain managed with Ultram and Tylenol Incisions: Sternal - healing well, no erythema or drainage Leg Right - healing well, no erythema or drainage. 1+ Edema Exploratory Laporotomy wound- no eryhtema or drainage 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: Surgeon: [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**] Date/Time: [**2164-11-27**] 2:45PM Cardiologist: Dr [**First Name (STitle) 7756**] on [**11-26**] at 2:15PM General Surgeon: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD (abdominal surgeon)Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2164-11-23**] 2:20 Please call to schedule appointments with your Primary Care Dr [**First Name4 (NamePattern1) 2048**] [**Last Name (NamePattern1) **] in [**4-30**] weeks [**Telephone/Fax (1) 28262**] ****Pulm nodules on Chest CT needs f/u study in 6 mo** **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 for Coumadin ?????? indication Atrial fibrillation Goal INR 2.0-2.5 First draw [**2164-11-10**] Completed by:[**2164-11-9**] ICD9 Codes: 5070, 4280, 4019, 2859, 4168
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Medical Text: Admission Date: [**2136-8-30**] Discharge Date: [**2136-9-11**] Date of Birth: [**2058-7-4**] Sex: M Service: CARDIOTHORACIC Allergies: Md-76 R Attending:[**First Name3 (LF) 165**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2136-9-5**] Urgent coronary artery bypass graft x5: Left internal mammary artery to left anterior descending artery and saphenous vein grafts to diagonal, posterior descending artery and saphenous vein sequential grafts to obtuse marginal 1 and 2 [**8-30**] Cardiac Cath History of Present Illness: 78 yo M with PMH significant for hypertension, diabetes, and known CAD s/p BMS to LCx who presented to [**Hospital6 33**] with exertional substernal chest pain. EKG showed slight ST depressions and patient requested transfer to [**Hospital1 18**]. Cardiac catheterization showed 3VD and we are asked to evaluate for surgical revascularization. Past Medical History: Coronary Artery Disease PMH: Hypertension Hyperlipidemia NSTEMI [**8-/2126**] s/p BMS to LCx Diabetes Mellitus-Type II Benign Prostatic Hypertrophy Osteoarthritis Essential Tumor PNA with empyema as child s/p rib resection Glaucoma Social History: Lives with:wife Occupation:Retired Tobacco:quit 45 years ago; smoked 1ppd x 15 yrs ETOH:occasional beer [**Location (un) 686**] native and a a graduate of [**Location (un) 86**] Tech, no college. He used to work at [**Location (un) 511**] Telephone as an installer. Married for 53 yrs with 4 adult children: 3 girls and 1 boy. Enjoys playing golf daily. He has a remote history of tobacco use, DC'ing this in the mid-60s. He consumes an occasional beer, and there is no history of injecting or other drug use. Exercise consists of walking both on and off the golf course. The patient remains quite active. He adheres to relatively [**Name2 (NI) **] diet although does acknowledge still a sweet tooth. Recent death of his son from advanced renal failure against the backdrop of hypertension, diabetes and previous closed head injury. This has been quite devastating to the patient and his wife. Family History: Notable for malignancy of undetermined type in an aunt, HTN and CHF in son, and ETOH abuse in an uncle. There is no family history of premature coronary artery disease or sudden death. Physical Exam: Pulse:58 Resp:16 O2 sat:94%RA B/P Right:187/ Left: 226/87 Height:5'[**37**]" Weight:205lbs (93 kg) General: Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] umbilical hernia Extremities: Warm [x], well-perfused [x] Edema 0 Varicosities:+ R knee incision Neuro: Grossly intact Pulses: Femoral Right: dressing Left: +2 DP Right: +2 Left: +2 PT [**Name (NI) 167**]: +2 Left: +2 Radial Right: +2 Left: +2 Carotid Bruit Right: 0 Left: 0 Pertinent Results: [**8-30**] Cath: 1. Selective coronary angiography in this right dominant system demonstrates three vessel disease. The LMCA was a short vessel with no angiographically apparent disease. The LAD was heavily calcified proximally with diffuse disease in the proximal portion of the vessel. The ostium of the LAD had a 90% stenosis, the mid LAD had a 50% stenosis and the distal LAD had a 70% stenosis. The Cx had a proximal 50% stenosis. OM1 had a 60% stenosis, the origin of OM2 had a 50% stenosis and the origin of OM3 had a 40% stenosis. The RCA was known occluded and not injected. However, the RCA was seen to fill via robust left sided collaterals and only mild disease was seen in the vessel after the known total occlusion. 2. Limited resting hemodynamics revealed a central aortic pressure of 179/80 mmHg. [**8-31**] Carotid U/S: Right ICA stenosis <40%. Left ICA stenosis 40-59% . [**8-31**] Vein mapping: Duplex and color Doppler demonstrate wide patency of both greater saphenous veins. Please see digitized image on PACS for formal sequential measurements of these vessels [**9-5**] Echo: PRE BYPASS The left atrium is mildly 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. Overall left ventricular systolic function is normal (LVEF>55%). The right ventricle displays normal free wall contractility. The aortic root is mildly dilated at the sinus level. The ascending aorta is mildly dilated. The descending thoracic aorta is mildly dilated. There are complex (>4mm) atheroma in the descending thoracic aorta. 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. Trivial mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the study. POST BYPASS The patient is a-paced. Normal biventricular systolic function. No change in valvular function. The thoracic aorta appears intact status post decannulation. [**2136-9-11**] 05:30AM BLOOD Hct-32.3* [**2136-9-10**] 05:05AM BLOOD WBC-8.7 RBC-3.73* Hgb-11.1* Hct-33.6* MCV-90 MCH-29.6 MCHC-32.9 RDW-14.6 Plt Ct-227 [**2136-9-11**] 05:30AM BLOOD PT-12.7 INR(PT)-1.1 [**2136-9-10**] 05:05AM BLOOD PT-11.8 PTT-25.7 INR(PT)-1.0 [**2136-9-5**] 02:15PM BLOOD PT-13.5* PTT-29.8 INR(PT)-1.2* [**2136-9-11**] 05:30AM BLOOD UreaN-29* Creat-1.2 Na-143 K-4.3 Cl-106 [**2136-9-10**] 05:05AM BLOOD Glucose-142* UreaN-33* Creat-1.2 Na-142 K-3.9 Cl-107 HCO3-28 AnGap-11 [**2136-9-9**] 06:50AM BLOOD Glucose-144* UreaN-28* Creat-1.3* Na-143 K-3.9 Cl-106 HCO3-29 AnGap-12 Brief Hospital Course: Mr. [**Known lastname 26172**] presented to [**Hospital6 33**] with exertional substernal chest pain. EKG showed slight ST depressions and patient requested transfer to [**Hospital1 18**]. On [**8-30**] he underwent a cardiac cath which revealed severe three vessel coronary artery disease. He underwent appropriate work-up which included carotid ultrasound and bilateral vein mapping. He received medical management while awaiting Plavix washout. On [**9-5**] he was brought to the operating room where he underwent a coronary artery bypass graft x 5. Please see operative report for surgical details. Following surgery he was transferred to the CVICU for invasive monitoring in stable condition. Within 24 hours he was weaned from sedation, awoke neurologically intact and extubated. On post-op day one chest tubes were removed and he was transferred to the telemetry floor for further care. Beta-blockers and diuretics were initiated and he was diuresed towards his pre-op weight. He did develop rapid atrial fibrillation and was treated with amiodarone and titration of beta blocker. He was started on coumadin. The patient was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on POD 6 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. The patient was discharged to home in good condition with appropriate follow up instructions. Dr. [**Last Name (STitle) **] will follow coumadin/INR through [**Hospital 191**] [**Hospital 2786**] clinic. Medications on Admission: Medications at home: Lipitor 20mg po daily Imdur 60mg po daily Lisinopril 40mg po daily NTG Tamsulosin 0.4mg po daily Metformin 850mg po BID Avodart ASA 325mg po daily HCTZ 25mg po daily Carvedilol 25mg [**Hospital1 **] Transfer meds: Lipitor 20mg po daily ASA 325mg po daily Carvedilol 25mg [**Hospital1 **] Lisinopril 40mg po daily HCTZ 25mg po daily Tamsulosin 0.4mg po daily Imdur 60mg po daily Finasteride 5mg po daily Topamax 25mg po BID Plavix - last dose: 300mg [**2136-8-30**] Discharge Medications: 1. Outpatient Lab Work Labs: PT/INR Coumadin for atrial fibrillation Goal INR [**2-22**] First draw day after discharge, [**2136-9-12**] Then please do INR checks Monday, Wednesday, and Friday for 2 weeks then decrease as directed by Dr. [**Last Name (STitle) **] Results to [**Hospital 191**] [**Hospital3 **] phone: [**Telephone/Fax (1) 2173**] 2. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day: dose will change daily for goal INR [**2-22**], managed by [**Hospital 191**] [**Hospital 2786**] clinic. Disp:*30 Tablet(s)* Refills:*2* 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 7. Dutasteride 0.5 mg Capsule Sig: One (1) Capsule PO once a day. 8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): 400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week, then 200mg daily until further instructed. Disp:*120 Tablet(s)* Refills:*2* 9. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 10. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 11. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO QID (4 times a day) as needed for phlebitis for 7 days. Disp:*28 Capsule(s)* Refills:*0* 12. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*2* 13. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day) for 2 weeks. Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 2203**] VNA Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 5 PMH: Hypertension Hyperlipidemia NSTEMI [**8-/2126**] s/p BMS to LCx Diabetes Mellitus-Type II Benign Prostatic Hypertrophy Osteoarthritis Essential Tumor PNA with empyema as child s/p rib resection Glaucoma Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage edema 2+ bilaterally 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 until follow up with surgeon 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: Surgeon Dr. [**First Name (STitle) **] on [**2136-10-1**] at 1PM [**Telephone/Fax (1) 170**] Please call to schedule appointments Primary Care Dr. [**Known firstname 449**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 250**] in [**1-21**] weeks Cardiologist Dr. [**First Name4 (NamePattern1) 919**] [**Last Name (NamePattern1) 911**] in [**1-21**] weeks Labs: PT/INR Coumadin for atrial fibrillation Goal INR [**2-22**] First draw day after discharge, [**2136-9-12**] Then please do INR checks Monday, Wednesday, and Friday for 2 weeks then decrease as directed by Dr. [**Last Name (STitle) **] (conf. with [**Doctor Last Name **]) Results to [**Hospital 191**] [**Hospital3 **] phone: [**Telephone/Fax (1) 2173**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2136-9-11**] ICD9 Codes: 5849, 4111, 4019, 2724, 412
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Medical Text: Admission Date: [**2201-6-26**] Discharge Date: [**2201-7-5**] Date of Birth: [**2134-1-31**] Sex: F Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 78**] Chief Complaint: Nausea/vomiting Major Surgical or Invasive Procedure: [**2201-6-27**]: Cerebral Angiogram with coiling History of Present Illness: 67F fell off step stool 2 days ago and possible LOC. Had laceration on back of head with much bleeding. Did not seek medical attention at that time. Has been nauseaous and vomiting since that time. Daughters brought to OSH, found diffuse SAH and possible R MCA distribution, loaded with dilantin and transferred to [**Hospital1 18**] ED. Past Medical History: High cholesterol Social History: Married, has three children. Family History: Parents deceased, sister and 3 children alive and well Physical Exam: On admission: PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]: grade 1 [**Doctor Last Name **]:2 GCS 15 E:4 V:5 Motor:6 O: T:98.6 BP: 148/66 HR:57 R18 O2Sats96 Gen: WD/WN, comfortable, NAD. HEENT: Pupils: 3->2 EOMs Neck: in hard collar Extrem: Warm and well-perfused. No C/C/E. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**4-9**] 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 finger rub bilaterally. 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 [**6-11**] throughout. No pronator drift Sensation: Intact to light touch bilaterally Toes downgoing bilaterally On the day of Discharge: [**2201-7-5**] alert and oriented to person, place and time patient has full strength and sensation EOMs are intact 3-2mm with brisk reaction bilaterally No pronator drift. The patient ambulate with a steady gait and is out of bed to the chair this morning eating breakfast. Pertinent Results: CTA Head [**2201-6-26**]: IMPRESSION: Subarachnoid hemorrhage seen on head CT. CT angiography of the head demonstrates a 3.5 x 5.5 mm aneurysm at the anterior communicating artery with irregular contour. Study Date of [**2201-6-26**] 2:33:56 PM Sinus bradycardia. Non-diagnostic inferior Q wave pattern may be a normal variant but cannot exclude prior inferior myocardial infarction. Left ventricular hypertrophy with marked repolarization abnormalities consistent with left ventricular strain pattern. No previous tracing available for comparison. Read by: [**Last Name (LF) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 975**] Intervals Axes Rate PR QRS QT/QTc P QRS T 52 [**Telephone/Fax (3) 88997**]/502 47 54 -147 CT Cspine [**2201-6-26**]: IMPRESSION: No evidence of acute fracture or dislocation of the cervical spine. CHEST (PORTABLE AP) Study Date of [**2201-6-26**] 6:20 PM IMPRESSION: Mild lingular and bibasilar atelectasis. No focal consolidation. CT Head [**2201-6-27**]: Impression: post-embolization of the ACOMM aneurysm. SAH stable. CTA Head [**6-28**]: IMPRESSION: 1. Interval coiling of anterior communicating artery aneurysm. There is no evidence of large vessel occlusion or significant vasospasm. The coil pack obscures the aneurysm itself and some adjacent vessels of the anterior circle of [**Location (un) 431**]. 2. Persistent moderate hydrocephalus with intraventricular hemorrhage. ECHO [**6-29**]: The left atrium is elongated. 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. Left ventricular systolic function is hyperdynamic (EF>75%). There is a very mild resting left ventricular outflow tract obstruction. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic arch is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no valvular aortic stenosis. The increased transaortic velocity is likely related to high cardiac output. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. CTA HEAD W&W/O C & RECONS Study Date of [**2201-7-2**] 11:05 AM IMPRESSION: 1. No evidence to suggest vasospasm in the intracranial arterial vasculature. 2. Further evolution of the subarachnoid and intraventricular hemorrhage. Brief Hospital Course: Ms. [**Known lastname **] is a 67 year old woman who was admitted to the NSICU under the care of Dr. [**Last Name (STitle) 739**] on [**2201-6-26**] after a fall with CT findings of SAH and ACOMM aneurysm. She was on dilantin for seizure prophylaxis.A UA showed a UTI and she was started on Cipro. Seh had some heart block on EKG and some bradycardia in the ICU. She received a dilantin bolus for a low drug level. On [**6-27**] she underwent a cerebral angiogram with coiling. Immediately Post-angio she was lethargic, a head CT was obtained which was stable, as patient awoke from sedation her exam was stable. On [**6-28**] her dilantin level was 11.3. Cardiology consult was called for persistant HTN and bradycardia. They noted <3sec sinus pauses & episodes of sinus arrest with ventricular escape with heart rate to 30s, but SBP was stable at 140. EKG showed changes consistent with Left Ventricular Hypertrophy vs cerebral T waves consistent with SAH. They felt that her bradycardia and HTN were consistent with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] effect from her SAH. They asked that her calcium channel blocker be stopped which it was on [**6-29**]. On [**6-28**] at 1330 she was noted to have a new left facial droop and she was lethargic. She had some right deltoid and grasp weakness, this strength exam has varied during her admission. CTA was ordered, there was no increase in ventricular size and no concern for vasospasm. She was transfered to Dr. [**Last Name (STitle) **] service on [**6-29**]. Her ICU course was uneventful. She had serial TCDs as of [**7-1**] which have showed no evidence of vasospasms. Nimodipine was discontinued secondary to bradycardia and hypotension. She completed her course of Cipro for Urinary tract infection. The patients serum sodium was 136 and her serum BUN of 16. On [**7-2**], patient was transferred to the step down unit in stable condition.The patient has a CTA consistent with no evidence to suggest vasospasm in the intracranial arterial vasculature and further evolution of the subarachnoid and intraventricular hemorrhage.The patient's serum sodium was 134 and her serum BUN of 16. On [**7-3**], The patients serum sodium was 133 and her serum BUN of 17. On [**7-4**], routine laboratory blood work was sent and a serum sodium was 130* and her serum BUN of 24. sodium chloride tablets 2 grams po BID were initiated for hyponatremia. Po intake was encouraged. Her floor course was otherwise uneventful. Now the day of discharge [**2201-7-5**], she is afebrile, vital signs were stable, and neuro exam stable. She is tolerating a good oral diet and her pain is well controlled. The patient has had a bowel movement and is voiding without difficulty. The patient's serum sodium was 133 and her serum BUN of 23. The patient had a 3 point rise in her serum sodium since the day prior while on the sodium chloride tablets. The patient will go home on this medication for 5 days at a lower dose of 1 gram [**Hospital1 **] with follow up with her primary care this week for follow up of hyponatremia, elevated BUN, and hypertension. She is set for discharge home. Medications on Admission: None Discharge Medications: 1. hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). Disp:*120 Tablet(s)* Refills:*0* 2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain: do not exceed 4 grams tylenol in 24 hours. 3. bisacodyl 5 mg Tablet Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation: hold for loose stools. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 4. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for Pain: do not drive while taking this medication, di not take if lethargic. Disp:*60 Tablet(s)* Refills:*0* 5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*2* 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): hold for loose stools. Disp:*60 Tablet(s)* Refills:*2* 7. sodium chloride 1 gram Tablet Sig: One (1) Tablet PO every twelve (12) hours for 5 days: please follow up at your primary care physicians to follow your sodium level this week. Disp:*10 Tablet(s)* Refills:*0* 8. Outpatient Lab Work please draw a chem 10 wednesday [**2201-7-8**] (to monitor BUN- slightly elevated 23 the day of discharge and serum sodium trending down currently 133 day of discharge while on sodium tablet repleation) 9. follow-up with your primary care this week please make an appointment with your primary care physcian this week after having your labs drawn on wenesday- to follow up your slightly elevated BUN and low trending serum sodium. and to eveluate further need of sodium chloride tablets 1 po every 12 hours and hypertension and initiation of hydralazine for treatment of high blood pressure during your hospital stay. Discharge Disposition: Home Discharge Diagnosis: Subarachnoid Hemorrhage Anterior Comunicating artery Aneurysm (ruptured) Urinary tract infection Bradycardia Hyponatremia Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Angiogram with Embolization coiling ofanterior communicating artery 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 Room! Followup Instructions: Please follow up with Dr [**First Name (STitle) **] in 4 weeks with a MRI/MRA of the brain ([**Doctor Last Name **] protocol). Please call [**Telephone/Fax (1) 4296**] to make this appointment. Please follow up with you primary care physician this week as your serum BUN has been slightly elevated and your serum sodium is has been trending slightly low. You will be given a prescription to have your lab studies drawn and please follow up with you primary care by Friday to dicuss. You were also started on a medication for high blood pressure -hydralazine-please discuss further management of your hypertension at that time Completed by:[**2201-7-5**] ICD9 Codes: 2761, 5990, 4019, 2724
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Medical Text: Admission Date: [**2110-6-25**] Discharge Date: [**2110-6-30**] Date of Birth: [**2047-5-23**] Sex: M Service: MED HISTORY OF PRESENT ILLNESS: This 63 year-old male with a history of chronic obstructive pulmonary disease, head and neck cancer, lower extremity deep venous thrombosis and status post a recent extended hospitalization and intubation for pneumonia and sepsis and adult respiratory distress syndrome who returned from [**Hospital3 **] Hospital after a witnessed aspiration. The patient had previously been discharged with a PEG tube for tube feedings as he had failed a swallow study with aspiration of all consistencies of food or fluid. However, at the rehab facility the patient developed respiratory distress and suctioning revealed tube feed material in his lungs. The patient developed an increased oxygen requirement and a low grade fever and was transferred to the Emergency Department at [**Hospital1 346**] for further management. In the Emergency Department the patient was felt to be in respiratory distress and was hypoxic with an arterial blood gas of 7.32/70/81. The patient was asked if he would like to be intubated for his respiratory distress and he responded yes. The patient was intubated and he was transferred to the Medical Intensive Care Unit. PAST MEDICAL HISTORY: Hypertension. Head and neck cancer. Tongue cancer status post radiation therapy. Hypercholesterolemia. Chronic tobacco use. Lower extremity deep venous thrombosis. Recent hospitalization for pneumonia, sepsis and adult respiratory distress syndrome. ALLERGIES: No known drug allergies. MEDICATIONS ON ADMISSION: 1. Levoxyl 50 micrograms daily. 2. Colace. 3. Lovenox 60 b.i.d. 4. Albuterol and Atrovent nebs. 5. Protonix 40 mg daily. 6. Coumadin. 7. He had received one dose of Vancomycin and Ceftazidine at the rehab facility. SOCIAL HISTORY: The patient was a long time smoker and is a pool player. PHYSICAL EXAMINATION: Temperature 101.8. Heart rate 116. Blood pressure 148/77. Respiratory rate 40. Oxygen saturation 60 percent on room air, 88 percent on nonrebreather. General tachypneic, uncomfortable. HEENT on BiPAP. Pupils are equal, round and reactive to light. Supple neck. Cardiovascular examination tachycardic, regular. Lungs diffuse crackles. Decreased breath sounds on the left and rhonchi on the right. Abdomen soft, nontender, nondistended. PEG tube in the left upper quadrant. Extremities no lower extremity edema. Chest x-ray showed diffuse patchy infiltrates consistent with acute on chronic aspiration pneumonia. LABORATORIES ON ADMISSION: White blood cell count 12.6, hematocrit 32.2, platelets 415, sodium 142, potassium 4.6, bicarbonate 31, BUN 20, creatinine 0.7, lactate 1.9. INTENSIVE CARE UNIT COURSE: 1. Respiratory failure: The patient was admitted to the Intensive Care Unit and remained intubated overnight. The following morning he was switched to pressure support ventilation and was weaned off of the vent to face mask within 48 hours. He was continued on his Albuterol Atrovent nebulizers. The patient was felt to have had an aspiration pneumonitis and he was not given any further doses of antibiotics. He remained afebrile without systemic signs of infection during his entire Intensive Care Unit stay. The patient will need to be fed with tube feeds with the head of the bed elevated to decrease his risk of recurrent aspiration. 1. Aspiration: The patient has a history of head and neck cancer, tongue cancer and a long intubation recently for adult respiratory distress syndrome. After he was extubated during his previous hospitalization he was unable to swallow any fluid or liquid without aspiration. At that time the decision was made to place a PEG tube with a post pyloric entry point into the gastrointestinal tract to facilitate nutrition for this patient, however, this does not decrease his risk of aspiration significantly and the patient should continue to be fed with the head of the bed elevated. 1. Deep venous thrombosis: The patient has a known lower extremity deep venous thrombosis. He was continued on Lovenox 60 b.i.d. during his Intensive Care Unit stay and was started on transition to Warfarin. 1. Hypothyroidism: The patient was continued on his outpatient dose of Levoxyl 50 micrograms daily. The remainder of this discharge summary will be dictated by the covering intern. [**First Name11 (Name Pattern1) 122**] [**Last Name (NamePattern4) 24325**], [**MD Number(1) 24326**] Dictated By:[**Last Name (NamePattern1) 18139**] MEDQUIST36 D: [**2110-6-30**] 08:27:42 T: [**2110-6-30**] 08:49:01 Job#: [**Job Number 56132**] ICD9 Codes: 5070, 7907, 4019
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Medical Text: Admission Date: [**2186-9-17**] Discharge Date: [**2186-9-21**] Service: [**Last Name (un) **]/MED Please note that the patient was admitted on the Orthopedic Service and discharged on the Medicine Service. HISTORY OF PRESENT ILLNESS: Mr. [**Known lastname 95026**] is a 79 year old male with a past medical history significant for a non-small cell lung carcinoma with metastases to the brain status post two cycles of chemotherapy with Carboplatin/Taxol, who experienced a fall on [**9-15**] upon exiting his car and walking five to six steps. He notes no preceding events prior to the fall, and notes that it was not mechanical in etiology. The patient was taken to an outside hospital and was found to have a left hip subtrochanteric fracture without neurovascular impairment. At the time, he was found to have a decreased hematocrit and was transfused. He was subsequently transferred to [**Hospital1 188**] for an open reduction and internal fixation. In the Operating Room during this procedure, the patient had two episodes of supraventricular tachycardia associated with a decrease in blood pressure ameliorated by cardioversion on each occasion. The patient was started on an Amiodarone drip, remained normotensive throughout the rest of the case, and was transferred to the Surgical Intensive Care Unit. The patient had a third episode of supraventricular tachycardia while in the Intensive Care Unit which was treated successfully with adenosine. Mr. [**Known lastname 95026**] experienced a fourth episode of supraventricular tachycardia while in the Intensive Care Unit which converted into normal sinus rhythm with Lopressor. On subsequent episodes of supraventricular tachycardia with hypotension, the patient was bolused with normal saline. The Cardiology Service was consulted and evaluated the patient in the Intensive Care Unit. The recommendations per Cardiology were to continue the Amiodarone intravenously and continue to use Adenosine as needed for symptomatic supraventricular tachycardia. The patient was transferred to the Floor and continued on intravenous Amiodarone and was started on an oral Amiodarone load. On [**9-19**], the patient was transferred to the Medical Service. PAST MEDICAL HISTORY: 1. Metastatic non-small cell lung carcinoma diagnosed in [**2186-8-6**], metastatic to the brain. The patient was noted to have three left frontal lobe metastases, who of which have regressed after systemic chemotherapy. The patient is status post two cycles of chemotherapy, Carboplatin/Taxol. During the last admission, Mr. [**Known lastname 95026**] was evaluated by the Radiation Oncology Service and was to have a stereotactic radio surgery for removal of the brain metastases. 2. Malignant pleural effusions status post pleurodesis. 3. Hypertension. 4. History of supraventricular tachycardia during his last hospitalization. 5. Benign prostatic hypertrophy. 6. Status post meningioma resection in [**2177**]. 7. Status post left inguinal hernia repair in [**2182**]. ALLERGIES: Dilantin (liver toxicity, rash). MEDICATIONS ON TRANSFER: 1. Amiodarone 400 mg p.o. three times a day. 2. Amiodarone intravenous drip. 3. Ativan p.r.n. 4. Morphine p.r.n. 5. Calcium gluconate p.r.n. 6. Potassium chloride p.r.n. 7. Magnesium sulfate p.r.n. 8. Acetaminophen 325 to 650 mg p.o. q. four to six hours p.r.n. 9. Lovenox 30 mg subcutaneously q. 12 hours. 10. Colace 100 mg p.o. twice a day. 11. Zofran p.r.n. 12. Percocet one to two tablets p.o. q. four to six hours p.r.n. 13. Metoprolol 12.5 mg p.o. twice a day. 14. Terazosin 5 mg p.o. q. h.s. SOCIAL HISTORY: The patient has been married to his wife for the last 54 years. No children. He is a retired Lieutenant Colonel in the Air Force and has worked as a defense contractor. He has no known occupational exposures. He notes a half pack per day usage of tobacco for 30 years. He also notes one cocktail imbibed each evening. FAMILY HISTORY: His mother expired at age 75; she had a history of hypertension. Father deceased at age 87 secondary to pneumonia. His brother is 74 years old and in good health. His sister had passed away from breast cancer. PHYSICAL EXAMINATION: Temperature 98.0 F.; blood pressure 150/80; heart rate 62; respiratory rate 18; oxygen saturation 95 to 96% on room air. In general, the patient appears in no acute distress sitting up in a chair. HEENT: Sclerae anicteric. Normocephalic, atraumatic. Mucous membranes were moist. Oropharynx is clear. Pupils equally round and reactive to light and accommodation. Extraocular movements are intact. Neck is supple with no lymphadenopathy and no carotid bruits. Chest is symmetric excursion, moderate air movement, no dullness to percussion. Cardiovascular: Regular rate and rhythm, S1 and S2; II/VI systolic ejection murmur with no gallops, no rubs. Abdomen is soft, nontender, nondistended, normoactive bowel sounds. Extremities: Left leg was bandaged in an ACE. Right leg had one plus edema. Neurologic: Cranial nerves II through XII intact. Alert and oriented times three, appropriate responses with mood and affect full. LABORATORY ON TRANSFER: White blood cell count 3.6, hematocrit 28.1, platelets 162. Sodium 137, potassium 4.2, chloride 104, bicarbonate 24, BUN 16, creatinine 0.6, glucose 102. STUDIES: ECG on [**2186-9-18**], demonstrated sinus rhythm, right bundle branch block, QRS morphology, potential left atrial abnormality, no significant changes from previous tracing on [**9-17**]. HOSPITAL COURSE: 1. CARDIOVASCULAR: Mr. [**Known lastname 95026**] has a history of supraventricular tachycardia present during his last hospitalization treated with beta blockade. He had experienced a fall without a clear precipitating factor or mechanical reason which led to this admission. During his prior admission, the patient was asymptomatic during his episodes of supraventricular tachycardia on Telemetry. It is possible that the patient's supraventricular tachycardia led to his fall prior to admission. Mr. [**Known lastname 95026**] had experienced episodes of supraventricular tachycardia during the procedure and peri-procedure and he was initiated on an Amiodarone drip after two cardioversions. The Cardiology Service was following and recommended to continue an Amiodarone load. Mr. [**Known lastname 95026**] will be continued on Amiodarone 400 mg p.o. twice a day until [**9-30**]. He will begin a maintenance dose of 200 mg p.o. q. day starting on [**10-1**]. Mr. [**Known lastname 95026**] has a history of hypertension and has been on Lopressor and Terazosin as an outpatient. During this admission, an ACE inhibitor was initiated and he will be titrated up on this medication as tolerated. Mr. [**Known lastname 95026**] will follow-up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] for his supraventricular tachycardia on [**10-18**] at 01:00 p.m. in the [**Hospital Ward Name 23**] Building. 2. ORTHOPEDICS: Mr. [**Known lastname 95026**] was diagnosed with a left subtrochanteric hip fracture status post fall and transferred from the outside hospital for open reduction and internal fixation. This procedure was performed on [**2186-9-17**], with the complication of supraventricular tachycardia as described above. The patient remained on the Orthopedic Service until transfer on [**2186-9-19**]. Physical Therapy had evaluated the patient and continued to follow while admitted. Mr. [**Known lastname 95026**] was changed to a touch-down weight bearing status to the left lower extremity on postoperative day three. Recommendations were made to continue daily dressing changes to the wound sites and the patient was to continue with thigh-high TEDS stockings to the lower extremities. 3. HEMATOLOGY/ONCOLOGY: Mr. [**Known lastname 95026**] was recently diagnosed in [**2186-8-6**] with non-small cell lung cancer and has received two cycles of Carboplatin/Taxol. He is being followed by Dr. [**Last Name (STitle) **] for his oncologic care. During his last admission to [**Hospital1 69**] he was evaluated by Radiation Oncology for the brain metastases and stereotactic radio surgery was recommended. Mr. [**Known lastname 95026**] was scheduled to have this SRS on [**9-19**], however, this therapy was deferred while he is dealing with the acute issue of his hip fracture. Further decisions regarding his oncologic care - SRS and chemotherapy - will be determined by Dr. [**Last Name (STitle) **] as an outpatient. Mr. [**Known lastname 95026**] was noted to have a significant hematocrit drop while admitted. Postoperatively the patient received two units of packed red blood cells. On the day prior to discharge, Mr. [**Known lastname 95026**] received another two units of packed red blood cells. Hematocrit is pending at the time of this discharge. Secondary to the patient's chemotherapy, last cycle completed [**9-14**], his cell counts are expected to nadir on [**9-21**]. Secondary to Mr. [**Known lastname 95027**] brain metastases and issue of anti-coagulation that was raised at his left hip open reduction and internal fixation, the decision was to anti-coagulate Mr. [**Known lastname 95026**] with maintenance doses of Lovenox, 30 mg subcutaneously q. 12 hours, for a total of six weeks. CONDITION AT DISCHARGE: Stable. DISCHARGE STATUS: The patient is to be discharged to [**Location (un) 2716**] Point in [**Location (un) 55**] for further rehabilitation. DISCHARGE DIAGNOSES: 1. Left hip open reduction and internal fixation performed on [**2186-9-17**]. 2. Supraventricular tachycardia. 3. Anemia. 4. Non-small cell lung carcinoma. 5. Metastatic lesions to the left frontal lobe of the brain. 6. Anti-coagulation. 7. Hypertension. DISCHARGE MEDICATIONS: 1. Amiodarone 400 mg p.o. twice a day, last dose on [**9-30**] in the evening. 2. Amiodarone 200 mg p.o. q.day to be started on [**10-1**]. 3. Lorazepam 0.5 mg p.o./IV four times a day p.r.n. - hold for excessive sedation ( respiratory rate less than 8; oxygen saturation less than 92%). 4. Tylenol 325 to 650 mg p.o. q. four to six hours p.r.n. 5. Lovenox 30 mg subcutaneously q. 12 hours. 6. Colace 100 mg p.o. twice a day. 7. Percocet one to two tablets p.o. q. four to six hours p.r.n. pain. 8. Metoprolol 12.5 mg p.o. twice a day - hold for systolic blood pressure less than 100, heart rate less than 50. 9. Terazosin 7 mg p.o. h.s. 10. Captopril 6.25 mg p.o. three times a day. DISCHARGE INSTRUCTIONS: 1. Mr. [**Known lastname 95026**] is to follow-up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] on [**10-18**], at 01:00 p.m., office located on the [**Location (un) **] of the [**Hospital Ward Name 23**] Building. 2. The patient also has a follow-up appointment with Dr. [**Last Name (STitle) 284**] in the [**Hospital 5498**] Clinic on the [**Location (un) 1773**] of the [**Hospital Ward Name 23**] Building, appointment scheduled for [**9-28**] at 12:20 p.m. 3. The patient is to have daily dressing changes to the wound sites. 4. He is currently on touch-down weight bearing status on the left lower extremity until further directed by Dr. [**Last Name (STitle) 284**]. 5. Mr. [**Known lastname 95026**] is to have thigh high TEDS stockings in place. 6. Mr. [**Known lastname 95027**] blood counts and electrolytes should be monitored three times per week. [**First Name11 (Name Pattern1) 312**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 313**], M.D. [**MD Number(1) 314**] Dictated By:[**Name8 (MD) 44562**] MEDQUIST36 D: [**2186-9-20**] 16:05 T: [**2186-9-20**] 19:10 JOB#: [**Job Number **] ICD9 Codes: 9971, 4271, 4275
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Medical Text: Admission Date: [**2173-5-23**] Discharge Date: [**2173-6-4**] Date of Birth: [**2091-3-20**] Sex: F Service: MEDICINE Allergies: Aspirin Attending:[**First Name3 (LF) 2160**] Chief Complaint: seizures Major Surgical or Invasive Procedure: Lumbar puncture intubation History of Present Illness: 82F with multiple sclerosis, dementia, seizures, renal calculi s/p recent lithotripsy and recurrent UTI was being moved from bed to chair by [**Doctor Last Name **] lift and was noted by care taker to have convulsive motion in all four extremities. Given ativan 2mg by EMS with completeresolution and transferred to [**Hospital 8125**] Hospital. There she was seen to have additional convulsive movements, given ativan again with ultimate resolution of symptoms. However, during the evalution at the OSH she had a SBP as low as 40s. Central access was attempted at bilateral femoral arteries without success and therfore peripheral dopamine was initiated with moderate effect. She was found to be hypothermic at 93.0 with a pH of 7.17. She was given ceftriaxone 2gm imperically. CT head at OSH was normal. Patient was transferred to [**Hospital1 18**]. Of note the patient was pn ciprofloxacin s/p lithotripsy presumably for renal stones. . In the ED her vital signs were T 92 rectally, HR 84 BP 105/34 RR13 she was 80mg of hydrocortisone for adrenal insufficiency and on chronic prednisone recently titrated down to 5mg PO daily. In addition she was given 600mg of linezolid given her history of UTIs only responsive to this antibiotic. The patient was intubated and a right subclavian central line was placed. 7mg of versed was given while the patient was taken to the CT scanner for a head and torso CT. . Seen by Neuro in the ED - suggesting EEG, repeat head CT, restarting home dose antiepileptics and to treat the UTI/closely control the temperature today. Past Medical History: MS - followed by Dr. [**Last Name (STitle) 10835**] in the past dementia, with frontal dysfunction seizure disorder (prior to recent events, last sz was in [**2154**]) HTN h/o hyponatremia osteoporosis s/p R leg fracture gait disturbance urinary incontinence Social History: Lives with husband and has full-time caregiver x 7 years. The patient is not independent of her ADLs. She is reported to follow commands and interact with broken speech but is generally non-communicative at baseline. Family History: Sister and Father had MS, both deceased Physical Exam: VS T 95.2 HR85 BP91/47 RR15 Sa02100% AC TV 500 Rate 14 Peep 5 FiO2 100% GENERAL:intubate, sedated HEENT: has bits of blood in her hair. Disheveled. No obvious trauma. Eyes closed. Anicteric once opened. NECK: JVP is flat. Neck was very stiff on exam prior to intubation. CARDIOVASCULAR: regular rate on telemtry. difficult to auscultate in the setting of rhonchorus upper airway sounds when we examined her in the ED. LUNGS: CTAB no W/W/R ABDOMEN: soft,NT/ND,positive bowel sounds. EXTREMITIES: no clubbing cyanosis or edema. NEURO: Intubated and sedated. Minimally responsive to pain. No corneal reflex on right but does have a corneal reflex on the left. Pupils reactive bilaterally. Pertinent Results: [**2173-5-22**] 10:00PM URINE BLOOD-LG NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-MOD [**2173-5-22**] 10:00PM URINE RBC-0-2 WBC->50 BACTERIA-FEW YEAST-NONE EPI-[**3-29**] [**2173-5-22**] 10:30PM LACTATE-1.3 [**2173-5-23**] 04:00AM CEREBROSPINAL FLUID (CSF) WBC-3 RBC-1* POLYS-9 LYMPHS-55 MONOS-36 . [**5-22**] cxr: IMPRESSION: Left retrocardiac opacity is seen, which may represent an area of consolidation and/or atelectasis. Small left pleural effusion may also be present. . ct chest/abdomen:([**2173-5-23**]) IMPRESSION: 1. Small bilateral pleural effusions and adjacent atelectasis. 2. Bilateral renal calculi, without evidence of hydronephrosis or hydroureter. The largest stone on the right appears similar in size, but there are several calcific densities within the right renal pelvis which may represent small fragments from reported recent lithotripsy. No perinephric fluid collections are identified. 3. Small 9 mm enhancing focus within the liver, which was not seen on the prior study, but this may reflect differences in contrast timing. This is not completely evaluated on this study, however, the differentials would include a hemangioma/FNH/adenoma, though a malignancy cannot be entirely excluded. . ct head [**5-23**]: CT HEAD WITHOUT IV CONTRAST: No hemorrhage or mass effect is identified. The ventricles are symmetric, there is no shift of normally midline structures. The [**Doctor Last Name 352**]-white matter differentiation is stable. There is marked enlargement of the ventricles, which is symmetric, and stable in comparison to prior study. Soft tissue and osseous structures are within normal limits. . IMPRESSION: No mass effect or hemorrhage is identified. No interval change from the prior exam from [**2173-1-9**]. . [**5-23**] EEG: IMPRESSION: This is an abnormal EEG due to the frequent electrographic seizures with origin in the left hemisphere, left hemisphere slowing, a slow and disorganized background and infrequent suppressed background activitiy. The first abnormality suggests frequent electrographic seizures with origin in the left hemisphere with secondary generalization. The left hemisphere slowing suggests corresponding subcortical dysfunction. The last two abnormalities suggest a severe encephalopathy, which may be seen with infections, toxic metabolic abnormalities or medication effect. . [**5-24**] EEG: IMPRESSION: This 24-hour video EEG telemetry demonstrated many electrographic seizures characterized by rhythmic 1-1.5 Hz spikes and sharp waves seen with a widespread distribution bilaterally although sometimes with a left hemisphere emphasis. It was not clear whether there was any clinical correlate to these electrographic seizures. At other times, frequent widespread epileptiform discharges were seen in a more isolated or non-rhythmic manner. The background was slow and disorganized throughout the recording suggestive of a moderate encephalopathy. Brief Hospital Course: Ms. [**Known lastname **] is an 82 year old woman with advanced multiple sclerosis, dementia, seizures, renal stones, and recurrent UTI who presented after two seizure episodes. . 1) Seizure - The patient has presented several times in the past with seizures in the setting of urinary tract infections. In [**11-30**] the patient presented in non-convulsive status epilepticus that was felt to be triggered by a UTI. In [**12-30**] the patient again presented with a seizure and a UTI but this time the seizure was felt to be triggered by hyponatremia. On admission the patient was therapeutic on dilantin. Based on neurology consultation recommendations her lamotrigine was increased by 50mg each weak to achieve goal of 200mg [**Hospital1 **]. As an outpatient her dilantin can be decreased by 100 q week. It should be noted that repeat Dilantin levels should be checked every 3 days, and adjusted accordingly while the patient is taking ciprofloxacin. . 2) Hypotension - Etiology of acute decompensation was likely sepsis in the setting of elevated mixed venous oxygen saturation, no elevation of cardiac enzymes, unchanged EKG and recurrent UTI. Required low dose IV dopamine, than changed to levophed for improved predictability and greater inotropic effect. Weaned to off. Pt was placed on high dose steroids on admission given chronic prednisone of 5mg daily. She was tapered back to prednisone 5mg daily. . 3) Infection - WBC from 7.5 to 13.7 over 5 hours. Grossly positive UA. Patient had very stiff neck on physical exam in the ED prior to intubation. However this was unlikely meningitis as lumbar tap performed in the MICU revealed only 3 WBC and gram stain was negative She was given Linezolid for history of VRE UTI and Ceftriaxone for gram negative coverage. Urine, blood, CSF, and sputum cultures were all negative. Given negative cultures, she was changed to linezolid and ciprofloxacin to complete a 14 day course. - three days prior to discharge the patient developed a slight leucocytosis to 13.3 and temp 100.1. Blood cultures, and chest x-ray were repeated without evidence of infection. UA was grossly contaminated- Urine cultures did not reveal any growth. . 4) Respiratory failure: Patient was intubated for airway protection, and did well with extubation on [**5-25**]. . 5[**Last Name (STitle) **]istory of Nephrolithiasis- The patient has history of nephrolithiasis s/p lithotripsy. On admission the patient was without evidence for obstruction by CT. She should follow up with her urologist Dr. [**Last Name (STitle) **] as an outpatient should clinical suspicion dictate further evaluation. . 5) FEN: Tube feeds, speech and swallow evaluation x2 revealed failure of pt to adequately protect her airway while swallowing. She should remain NPO. Her NG tube needs to be pulled to prevent erosion as soon as she is re-evaluated by speech and swallow at rehab. Code status: DNR/DNI Medications on Admission: Medications: 1. Lamotrigine 50 mg PO BID 2. Phenytoin Sodium Extended 100 qam and 200 qpm. 3. Sodium Chloride 2 g TID 4. Pyridoxine 50 mg PO DAILY 5. Cyanocobalamin 50 mcg PO once a day 6. Docusate Sodium 100 mg PO BID (Possibly the Liquid) 7. Ascorbic Acid 500 mg PO TID 8. Ferrous Sulfate 325 PO DAILY . The following are from a [**2173-2-9**] Hospitalist note. 9.Calcium Carbonate 500 mg PO TID 10.Cholecalciferol (Vitamin D3) 400 unit PO DAILY Discharge Medications: 1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 6 days. Disp:*20 Tablet(s)* Refills:*0* 2. Linezolid 600 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 3 days. 3. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) 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. 5. Phenytoin 100 mg/4 mL Suspension Sig: One (1) PO QAM (once a day (in the morning)). 6. Phenytoin 100 mg/4 mL Suspension Sig: Two (2) PO QPM (once a day (in the evening)). 7. Vitamin B-12 50 mcg Tablet Sig: One (1) Tablet PO once a day. 8. Pyridoxine 50 mg Tablet Sig: One (1) Tablet PO once a day. 9. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 10. Lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO twice a day. 11. Ferrous Sulfate 300 mg/5 mL Liquid Sig: One (1) PO DAILY (Daily): to be given at least two hours after ciprofloxacin dose. 12. Prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Sepsis- suspected urinary source Respiratory Failure Seizure Disorder Multiple Sclerosis Discharge Condition: Fair. Discharge Instructions: You were admitted for seizure and low blood pressure. You required intensive care unit monitoring with mechanical ventilation and medications to support your blood pressure. You were treated for a suspected urinary tract infection. . take all of your medications as prescribed . call your doctor or 911 of any fevers, furhter seizure activity, shortness of breath or chest pains, or any other concerning symptoms Followup Instructions: Please keep the following appointment: [**First Name8 (NamePattern2) 161**] [**Name6 (MD) 162**] [**Name8 (MD) 163**], MD Phone:[**Telephone/Fax (1) 921**] Date/Time:[**2173-6-11**] 9:00 ICD9 Codes: 0389, 5990, 5185, 4589, 4019
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Medical Text: Admission Date: [**2133-3-12**] Discharge Date: [**2133-3-20**] Date of Birth: [**2084-2-22**] Sex: F Service: MEDICINE Allergies: Iodine / Latex / Sulfa (Sulfonamides) / Erythromycin Stearate / Morphine / Vistaril / Benadryl / Nifedipine / Ventolin Hfa / Penicillins Attending:[**First Name3 (LF) 1257**] Chief Complaint: Abdominal pain, nausea, vomiting Major Surgical or Invasive Procedure: Upper endoscopy UGI Gastric emptying study History of Present Illness: Ms. [**Known lastname 36038**] is a 49F with PMH of GERD s/p Nissen fundoplication x 2 ([**2118**]), Factor V Leiden, HTN, depression, and chronic abdominal pain (since [**2118**]) presenting with recurrence of her abdominal pain, nausea and vomiting and inability to tolerate PO's. These symptoms had been well controlled over the last two years but recurred in late [**2132-12-23**]. She says that she is nauseous all day and vomits about 2-3 times/week. She localizes her pain to her epigastrium and says that it radiates throughout her entire abdomen. She says that it worsens slightly with eating, but identifies no other precipitating or palliating factors. She states that she has been regurgitating all her food, and that it comes up undigested. For these symptoms, she went to her GI doctor Dr. [**Last Name (STitle) 77510**] on [**2133-1-27**], and UGI series and manometry were normal at that time, making mechanical obstruction unlikely. She was thought to have functional bowel disease. In the middle of [**Month (only) 404**], she had to be hospitalized at [**Hospital 1774**] Hospital for dehydration, and EGD at that time was normal. She had her Protonix increased to 40mg [**Hospital1 **], and was started on Buspirone and Pepcid. Her symptoms did not improve, and she continued to vomit with any PO intake. On [**3-12**], she called Dr. [**Last Name (STitle) **] and was told to present to the emergency room. In the emergency room the patient's vitals were T 97.8 HR 88 BP 136/75 RR 18 O2 sat 100. Labs in the ED were WBC 8.7/HCT 39.8/Plt 341. Lytes were WNL. She received Zofran 4mg and Dilaudid 0.5 mg with no relief. She was admitted for workup of her abdominal pain, as well as pre-treatment for known contrast allergy before her scheduled inpatient CT scan. Given her possible iodine allergy, she was pre-medicated with Prednisone 40mg PO 16, 8, and 2 hours prior to her exam. In addition, Cimetidine 300mg and Benadryl 50mg were given 1 hour prior to exam. Following her CT scan, the patient developed diffuse urticaria (over arms, chest, back, face), cough, and subjective SOB. She remained hemodynamically stable, afebrile, and non hypoxic. She was given IV solumedrol and famotidine and was transferred to the ICU. In the ICU, she was treated with IV solumedrol q6h and H2 blocker for her contrast allergy. She was also given ISS while on steroids. For her abdominal pain, she was treated symptomatically with zofran, dilaudid, and miralax. In addition, her PPI, pepcid, and buspirone were continued. During her ICU course, her vitals were 96.2 to 97.3, 76-109, 95-143/47-78, [**11-11**], and 93% on RA. Labs in the ICU were WBC 10.9/RBC 33.2/Plt 311. Lytes were WNL except for glucose (181). LFTs and amylase/lipase were WNL.+ Past Medical History: PMH: - GERD s/p Nissen fundoplication x 2 - Chronic abdominal pain - Factor V Leiden: h/o UE clot, unclear if deep or superficial; (patient reports she received Lovenox and Coumadin as an inpatient but only continued Coumadin for a few weeks) - Depression - Hypertension - Colonic inertia - Insomnia - Asthma Social History: - Smoking: denies - EtOH: Denies - IVDU: Denies - Lives at home with her husband and three sons (26yo, 23yo, 21yo). - Homemaker - Practicing Catholic Family History: - Mother with [**Name2 (NI) 499**] cancer in her 60's - Maternal aunt with breast cancer - Sister with diabetes - No FH of clots. Physical Exam: VS: 92/43 89 14-16 99 Gen: Awake, alert, NAD HEENT: NCAT, EOMI, anicteric CV: RRR, no m/r/g Pulm: CTA B, no wheezes or crackles Abd: Soft, ND, tender in RLQ, no rebound, no guarding Ext: no LE edema, DP/PT 2+ Pertinent Results: [**2133-3-12**] 06:30PM BLOOD WBC-8.7 RBC-4.76 Hgb-13.8 Hct-39.8 MCV-84 MCH-29.1 MCHC-34.8 RDW-13.6 Plt Ct-341 [**2133-3-13**] 07:10AM BLOOD WBC-5.9 RBC-4.21 Hgb-12.5 Hct-36.2 MCV-86 MCH-29.7 MCHC-34.5 RDW-13.1 Plt Ct-323 [**2133-3-14**] 04:01AM BLOOD WBC-10.9# RBC-3.85* Hgb-11.4* Hct-33.2* MCV-86 MCH-29.5 MCHC-34.2 RDW-13.3 Plt Ct-311 [**2133-3-12**] 06:30PM BLOOD Glucose-96 UreaN-10 Creat-0.7 Na-142 K-4.4 Cl-106 HCO3-27 AnGap-13 [**2133-3-13**] 07:10AM BLOOD Glucose-166* UreaN-10 Creat-0.7 Na-139 K-5.2* Cl-105 HCO3-24 AnGap-15 [**2133-3-14**] 04:01AM BLOOD Glucose-181* UreaN-7 Creat-0.6 Na-142 K-3.5 Cl-108 HCO3-23 AnGap-15 [**2133-3-12**] 06:30PM BLOOD ALT-19 AST-19 AlkPhos-120* TotBili-0.5 [**2133-3-14**] 04:01AM BLOOD ALT-16 AST-13 CK(CPK)-53 AlkPhos-91 TotBili-0.4 CT abdomen/pelvis ([**2133-3-13**]): IMPRESSION: 1. No evidence of acute intra-abdominal pathology. 2. Post-surgical changes related to fundoplication. Brief Hospital Course: This is a 49 year old woman who presented with chronic symptoms (since [**2132-12-23**]) of epigastric abdominal pain, persistent nausea, food regurgitation immediately after eating, and weight loss. She has history of severe constipation following her Nissen fundoplication that was attributed to colonic inertia. The differential diagnosis for her upper GI symptoms were esophageal obstruction, esophageal motility disorder, Zenker's diverticulum, a disease process related to her fundoplication (nerve damage or compression), gastroparesis, rumination syndrome, and psychiatric causes. She has had extensive workup in the past by GI for her symptoms, and thus far, all studies have been negative including EGD, UGI series, manometry,and CT abdomen. During this hospitalization, she had a repeat UGI series, which was normal, and EGD which was also normal. She had a gastric emptying study that showed delayed gastric emptying. She, however, was receiving Dilaudid before and during the study, which may have affected the results. Her symptoms of immediate vomiting after eating and nausea despite being NPO for a weak were inconsistent with gastroparesis. However, we treated her with IV and then PO Reglan as she may have significant GI motility disorder with severe constipation and the above mentioned upper GI symptoms. For her severe constipation, she was continued on a bowel regimen with Colace, Senna, MiraLax, and Dulcolax with no problems. Rumination syndrome seemed unlikely as she had 2 inconsistent features: persistent nausea and abdominal pain. However, she exhibited depressive syndrome and indifference to her GI illness. A psychiatric component may potentially aggravate her symptoms. She was discharged with GI follow up with Dr.[**First Name (STitle) **]. Total discharge time 35 minutes. Of note she had allergic reaction with hives and subjective SOB after IV contrast administration for the CT abdomen on [**2133-3-13**]. She was treated with IV Solu-Medrol in ED/ICU and then oral steroids with complete recovery. Medications on Admission: Home meds: Protonix 40 mg PO BID Pepcid 20 mg PO qHS BuSpar 15mg PO qHS Ambien 5mg PO qHS Prozac 20mg PO qAM Trileptal 150mg PO qHS Miralax 6 capfuls qHS Diovan 160mg PO Daily Advair 500/50 qAM Singulair qAM Atrovent PRN SOB Meds on transfer: Heparin 5000U TID Zolpidem Tartrate 5 mg PO qhs Fluoxetine 20 mg po daily Oxcarbazepine 150 mg po qhs PEG 17 g po daily Valsartan 160 mg po daily Pantoprazole 40 mg po bid Famotidine 20 mg [**Hospital1 **] Advair Diskus 1 inh [**Hospital1 **] Montelukast sodium 10 mg po daily Buspirone 15 mg po qhs IV solumedrol 125 mg IV q6h Sarna Lotion 1 ppl tp qid Ipratropium nebs 1 nb q6h Insulin SC per ISS Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: Primary Diagnosis: Primary GI motility syndrome: Gastroparesis Constipation from colonic inertia . Secondary Diagnoses: Factor V Leiden deficiency Hypertension Gastroesophageal reflux disease Asthma Depression Discharge Condition: Mental Status: Clear and coherent Level of Consciousness: Alert and interactive Activity Status: Ambulatory - Independent Discharge Instructions: You were admitted to [**Hospital1 18**] with abdominal pain, nausea, and vomiting. You had a CT scan in the emergency department and developed an allergic reaction to IV contrast. You were hospitalized in the ICU for monitoring and received IV steroids. You were given anti-emetics for your nausea and pain medications for your abdominal pain. You were also found to be constipated and were started on a bowel regimen. You had a normal endoscopy and barium study. A gastric emptying study showed slow stomach. However, you were taking Dilaudid which may interfere with the study results. Please take Reglan 30 minutes before each meal to help your slow stomach. Keep laxatives. We found you to have depression. Please see your psychiatric doctor as depression may worsen or significantly contributes to your symptoms of nausea and vomiting. Please follow up with Dr. [**Last Name (STitle) **]. Followup Instructions: Provider: [**Name10 (NameIs) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2133-4-7**] 2:40 ICD9 Codes: 4019, 2768, 311
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Medical Text: The patient admitted to her PCP that she ingested several Seroquel tablets given to her by a neighbor prior to admission. This may have contributed to her hypotension and altred mental status. tName: [**Known lastname 108672**], [**Known firstname **] Unit No: [**Numeric Identifier 108673**] Admission Date: [**2116-9-28**] Discharge Date: [**2116-10-2**] Date of Birth: [**2070-7-25**] Sex: F Service: Medicine CHIEF COMPLAINT: Hypotension. Change in mental status. HISTORY OF PRESENT ILLNESS: The patient is a 46 year old female with a history of HIV and polysubstance abuse who pneumonia, who is readmitted with hypotension and change in mental status. The patient was at home and took three Klonopin. The patient states that she felt like she had taken many Klonopin and felt lethargic and sedated. The patient then called her infectious disease attending, who referred her to the Emergency Room. The patient called emergency medical services and was brought to the Emergency Room by ambulance. Upon admission, the patient denied any chest pain or shortness of breath. She did have a slight cough, which was unchanged from discharge three days ago. She denied any abdominal pain, nausea, vomiting, diarrhea, dysuria, rashes, fevers or chills. She admitted to mild neck pain and lethargy. She was also thirsty. In the Emergency Room, the patient's picture was concerning for meningitis. A lumbar puncture was done, which was negative. The patient's blood pressure remained low, with a systolic blood pressure in the 70s despite five liters of intravenous fluids. She was transferred to the Medical Intensive Care Unit for blood pressure monitoring and evaluation of her mental status. She had been given a dose of ceftriaxone and vancomycin in the Emergency Room prior to the lumbar puncture. She was also given Narcan times four, with no change in her mental status. The patient denied suicidal ideation or overdose. PAST MEDICAL HISTORY: 1. HIV/AIDS, diagnosed in [**2108**], last CD-4 count 238 on [**2116-9-22**]; patient has been on HAART therapy in the past but this was discontinued as she was poorly compliant with her regimen. 2. Polysubstance abuse with a history of intravenous heroin use and benzodiazepine abuse. 3. Endocarditis. 4. Hepatitis C. 5. Abnormal PAP smears. 6. History of Pneumocystis carinii pneumonia, status post intubation. 7. History of cerebrovascular accident without residual deficits. 8. Bilateral lower extremity neuropathy. 9. Status post cesarean section. 10. History of seizures, status post alcohol and benzodiazepine withdrawal. 10. Status post vein stripping in left arm. ALLERGIES: The patient has no known drug allergies. MEDICATIONS ON ADMISSION: Paxil 20 mg p.o.q.d., Bactrim DS one p.o.q.d., Neurontin 1,200 mg p.o.t.i.d., diazepam 10 mg p.o.q.6h., methadone 120 mg p.o.q.d. SOCIAL HISTORY: The patient is the fourth of five children, born to two working parents. She is still in contact with her three brothers, one sister and her parents. She completed high school and worked as a waitress, but has been on unemployment for the last seven years. She has been arrested multiple times for drug related and prostitution charges. She has a history of domestic abuse with a boyfriend who stabbed her in the back. She is no longer in this relationship. The patient was married in [**2087**] but has been divorced since [**2091**]. She has an adult daughter who works as a mutual funds broker. The patient was married again in [**2108**]. Her second husband died in [**2110**] at the age of 45 from AIDS. The patient currently lives in a subsidized studio apartment in [**Location (un) 1468**] but has been homeless in the past. The patient has a history of intravenous drug abuse with heroin and alcohol abuse. She currently smokes a few cigarettes per day. She has been on methadone since [**Month (only) 216**] but had been on it intermittently over the past nine years. PHYSICAL EXAMINATION: On physical examination, the patient's vital signs were 82, 88, 80/50, 18, 95% in room air. General: Mildly distracted middle-aged woman with poor focus but answered questions appropriately. Head, eyes, ears, nose and throat: Normocephalic, atraumatic, pupils equal, round, and reactive to light and accommodation, extraocular movements intact, oropharynx stained with charcoal, dry mucous membranes, no neck stiffness. Cardiovascular: Regular rate and rhythm, no murmur, rub or gallop. Lungs: Clear to auscultation bilaterally except for a few rhonchi. Abdomen: Soft, nontender, nondistended, positive bowel sounds, guaiac negative in Emergency Room. Extremities: No edema, 2+ pedal pulses. Neurologic examination: Alert and oriented times three, oriented to hospital and year, appropriate only slowly. LABORATORY DATA: White blood cell count was 6.2, hematocrit 35.1, BUN 69, creatinine 2.1 and creatinine clearance 32.3. Urinalysis: Negative. Toxicology screen: Positive for benzodiazepines and opiates. Chest x-ray: Negative. Cerebrospinal fluid: No white blood cells, no red blood cells, Gram stain with 1+ polycytes, protein 22, glucose 71. HOSPITAL COURSE: 1. Neurologic: The patient was admitted with a change in mental status. The patient was sedated and there was concern over ingestion. Toxicology screen did not reveal any ingestion, however, she does take benzodiazepines and opiates on a regular basis. Psychiatry was consulted, who did not feel that the patient had suicidal ideation or had a suicide attempt. Neuropsychiatric consultation demonstrated diffuse deficits with lack of attention. An electroencephalogram was performed, which demonstrated diffuse slowing consistent with mild encephalopathy. The patient's mental status improved slightly over the next few days and she became less lethargic. She continued to deny any ingestion. After consultation with infectious disease, psychiatry, neuropsychiatry and the medical team, the patient was felt safe for discharge and near her baseline. The patient is to follow up immediately after discharge with the psychiatric social worker at the methadone clinic.. 2. Hypotension: The patient was initially brought to the Medical Intensive Care Unit and given a total of nine liters of normal saline. The patient's blood pressure responded adequately and normalized. She was transferred to the floor on hospital day number one and her blood pressure remained stable throughout her hospital course. It is unclear why her blood pressure dropped initially. This may have been secondary to ingestion or volume depletion. 3. Pulmonary: The patient's oxygen saturation remained normal in room air. She completed her azithromycin course from her last hospitalization for community acquired pneumonia. She continued to have a mild cough but was afebrile on discharge. 4. Renal: The patient was admitted with a creatinine of 2.1. Following the fluid challenge, her creatinine improved to her baseline. This likely due to a pre-renal state from volume depletion. 5. Hematology: The patient's hematocrit was slightly lower than her baseline. However, the patient was guaiac negative and did not demonstrate signs of bleeding. The patient was menstruating and this was felt to contribute to her anemia. Her hematocrit remained stable and she was safe for discharge. CONDITION AT DISCHARGE: Stable. DISCHARGE STATUS: The patient was discharged with direct follow-up with the psychiatric social worker at the [**Hospital 2514**] Clinic. She was then discharged to home. Of note, occupational therapy was also consulted, who felt that the patient was safe to live at home. DISCHARGE DIAGNOSES: 1. Hypotension, likely secondary to volume depletion. 2. Change in mental status, may be secondary to volume depletion or toxic ingestion. 3. Anemia. 4. Acute renal failure, secondary to volume depletion. 5. Community acquired pneumonia. 6. Methadone maintenance for heroin addiction. 7. HIV. DISCHARGE MEDICATIONS: Paxil 20 mg p.o.q.h.s. Bactrim one p.o.q.d. Neurontin 400 mg p.o.t.i.d. Methadone 120 mg p.o.q.d. HAART therapy on hold. Diazepam on hold, no signs of withdrawal on discharge. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 15731**], M.D. [**MD Number(1) 15732**] Dictated By:[**Name8 (MD) 17420**] MEDQUIST36 D: [**2116-10-4**] 16:48 T: [**2116-10-5**] 10:11 JOB#: [**Job Number 41928**] ICD9 Codes: 2765, 5849, 486
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Medical Text: Admission Date: [**2193-1-7**] Discharge Date: [**2193-1-18**] Service: Cardiothoracic Surgery CHIEF COMPLAINT: This patient was transferred from an outside hospital for cardiac catheterization, where his chief complaint had been shortness of breath. HISTORY OF PRESENT ILLNESS: Mr. [**Known lastname 17702**] is an 81-year-old white male with a past medical history significant for hypertension, benign prostatic hypertrophy, and a remote tobacco history, who was in generally good health with no known coronary artery disease, and presented to an outside hospital with acute shortness of breath the night prior to admission while sitting and watching television. He stated that his shortness of breath worsened with ambulation and other activity. He denied having any associated chest pain, nausea, vomiting, palpitations, or diaphoresis. He was taken to the Emergency Department of the outside hospital, where an EKG done showed poor R wave progression in leads V1 through V3. Cardiac enzymes were cycled and showed a troponin of 39.21, and a CK of 246. At this time he was transferred to the coronary care unit at the outside hospital, where a chest x-ray was found to be consistent with congestive heart failure. The patient received a 40 mg intravenous dose of Lasix, and responded with a 1,200 cc diuresis. He was started on heparin, aspirin, a beta blocker and an ACE inhibitor. The heparin was however discontinued secondary to some mild hematuria. He continued to remain symptom free, and was transferred to the [**Hospital1 188**] for cardiac catheterization. PAST MEDICAL HISTORY: 1. Hypertension. 2. Gout. 3. Hypercholesterolemia. 4. Remote history of kidney stones. 5. Benign prostatic hypertrophy with normal biopsy. MEDICATIONS ON ADMISSION: 1. Univasc 15 mg p.o. q.d. 2. Allopurinol 300 mg p.o. q.d. 3. Atenolol 100 mg p.o. q.d. 4. Hydrochlorothiazide. ALLERGIES: The patient has no known drug allergies.. SOCIAL HISTORY: Mr. [**Known lastname 17702**] has a 20-pack-year smoking history, but quit smoking approximately 20 years before. He denies any alcohol or other illicit drug use. He lives with his son in [**Name (NI) 5110**] and is a retired employee of [**Company 86**] [**Male First Name (un) 17703**] Company. FAMILY HISTORY: His mother and sister both passed away in their 70s secondary to coronary artery disease. PHYSICAL EXAMINATION: On admission Mr. [**Known lastname 17702**] was a pleasant elderly man in no acute distress. He was found to have a temperature of 98.1 degrees, heart rate of 78 and sinus rhythm, blood pressure 178/90, respiratory rate 18 and an oxygen saturation on room air of 95%. His pupils were equally reactive to light and accommodation and his extraocular movements were intact. His neck was supple with jugular venous distension at approximately 8 cm, 2+ palpable carotid pulses with no bruits. His cardiac examination revealed a regular rate and rhythm with normal S1 and S2, as well as a 2/6 systolic ejection murmur. He did not have any S3, S4 or rubs. His lungs were clear to auscultation bilaterally. His abdomen was soft, nontender, nondistended with no hepatosplenomegaly or other palpable masses. His extremities were warm and dry, with minimal bilateral pedal edema. He had 2+ palpable pedal pulses. Neurologically he was alert and oriented to person, place and time, with 5/5 strength and sensation in both upper and lower extremities. LABORATORY DATA: On admission his complete blood count was significant for a white blood cell count of 9.9, hematocrit 44 and a platelet count of 188. Chem-7 showed a sodium of 136, potassium 3.9, chloride 99 and a bicarbonate of 29, BUN and creatinine of 46 and 1.8, and a blood glucose of 154. His prostate specific antigen at the time of admission was 18. At the outside hospital he was found to have successive troponins of 39.2 and 47.1 as well as a CK of 246. His initial PT and PTT were 12.2 and 31.8, and at the time that his heparin was stopped due to hematuria his PTT was 91.5. HOSPITAL COURSE: Mr. [**Known lastname 17702**] was accepted as a transfer from [**Hospital3 **], and admitted to the cardiac catheterization laboratory. While there, he was found to have a left ventricular ejection fraction estimated to be 20-25%. He was also found to have distal 40% occlusion of his left main coronary artery, subtotal occlusion of the left anterior descending artery, proximal 70% focal disease as well as distal occlusion of the left circumflex artery, and a proximal 70% occlusion of the obtuse marginal artery. The patient tolerated his catheterization well, and was subsequently transferred to the floor in stable condition. On hospital day two, through various discussions with his family and the cardiac surgery service, the patient decided to proceed with coronary artery bypass grafting surgery. On hospital day two the patient was restarted on heparin at which time he redeveloped hematuria. The urology service was subsequently consulted to further evaluate this issue. He underwent flexible cystoscopy which revealed a likely prostatic source to his gross hematuria. The heparin drip was restarted and a three-way Foley catheter was placed so that he could have continuous bladder irrigation to keep his urine clear. Follow up was arranged with the urology service as an outpatient in the future once his cardiac issues have been resolved. Mr. [**Known lastname 17702**] was taken to the operating room on [**2193-1-11**] where he underwent coronary artery bypass grafting x 3. Please refer to the dictated operative note for full details of his procedure. The patient tolerated the procedure well, and was transferred in stable condition to the cardiac surgery recovery unit. At the time of transfer, he was found to have a mean arterial pressure of 72, being A-paced at 80 beats per minute. He was on a milrinone drip at 0.25 mcg per kg per minute as well as a propofol drip at 10 mcg per kg per minute. Following arrival in the CSRU, the patient subsequently required a small dose of Levophed to maintain a mean arterial pressure in the 60s. He also received two units of packed red blood cells for an hematocrit of 24.6, and was found to have a post transfusion hematocrit of 25.6. On postoperative day one the patient was reversed, weaned from the ventilator, and successfully extubated. He was weaned off of his milrinone and Levophed drips, continuing only on an insulin drip at approximately two units per hour. He continued at this time to have continuous bladder irrigation through his three-way Foley catheter. In the days following extubation, the patient did require intermittent milrinone to maintain his cardiac index. At this time diuresis was also started with Lasix with excellent response. Levofloxacin was also started for treatment of a urinary tract infection. On postoperative day four, the patient was weaned off milrinone altogether, received one unit of blood for an hematocrit of 27%, and captopril was slowly titrated up. At this time, he was deemed stable and ready for transfer to the floor. Continuous bladder irrigation had been stopped, and urine draining into the Foley catheter was tea colored. On transfer to the floor, the patient initially had a large oxygen requirement, requiring six liters of nasal cannula oxygen to maintain oxygen saturations above 95%. This was slowly weaned, as he improved, and diuresis continued. He continued to improve as well in terms of functional mobility in his therapy sessions with the physical therapy service. His Foley catheter was discontinued on [**1-17**] which was postoperative day six, and the patient was initially able to void, though in small amounts. By lateral that night, the patient became uncomfortable and was subsequently unable to void. A three-way Foley catheter was replaced, and 800 cc of clear yellow urine as well as one large blood clot drained into the Foley catheter. On postoperative day seven, it was felt that the patient was stable and ready for discharge from a cardiopulmonary standpoint. It was felt at this time that he would benefit from a short stay at an extended care rehabilitation facility. It was also deemed necessary at this time that the Foley catheter, which was placed on the night prior to discharge remain in place for approximately 1-2 weeks with outpatient urology follow up. Physical examination on discharge: Mr. [**Known lastname 17702**] was found to have a temperature of 99.1 degrees with a heart rate of 78 in sinus rhythm and a blood pressure of 120/56. He had an oxygen saturation on room air of approximately 92%, but continued to require some nasal cannula oxygen for activity. He continued to diurese well at this time. His neck was supple with no abnormalities. On cardiac examination he had a regular rate and rhythm with normal S1 and S2 and a grade 2/6 systolic ejection murmur. His lungs were clear to auscultation bilaterally. His sternal incision was healing nicely with no erythema or drainage, and his sternum was stable. His abdomen was soft, nontender, nondistended, with no organomegaly or other probable masses. He had a three-way Foley catheter in place with a small amount of fresh blood around the penile meatus. His extremities were warm and well perfused with minimal lower extremity edema. DISCHARGE MEDICATIONS: 1. Enteric-coated aspirin 325 mg p.o. q.d. 2. Lasix 20 mg p.o. b.i.d. x 7 days. 3. Potassium chloride 20 mEq p.o. b.i.d. x 7 days. 4. Captopril 12.5 mg p.o. t.i.d. 5. Lopressor 12.5 mg p.o. b.i.d. 6. Zantac 150 mg p.o. q. day. 7. Trazodone 100 mg p.o. q.h.s. for sleep. 8. Tylenol 650 mg p.o. q. 4 hours as needed for pain or discomfort. CONDITION ON DISCHARGE: Stable. DISCHARGE DIAGNOSES: 1. Coronary artery disease status post coronary artery bypass grafting x 3. 2. Hypertension. 3. Gout. 4. Hypercholesterolemia. 5. Benign prostatic hypertrophy with hematuria, and failure to void following surgery. The patient is being discharged with a three-way Foley catheter in place. His activity should be as tolerated, though he requires continued sessions with physical therapy to increase strength, mobility and endurance. During this time he should slowly be weaned from his nasal cannula oxygen requirement with activity. His diet should be a cardiac heart healthy diet. FOLLOW UP: He will follow up with his cardiologist in approximately one to two weeks, with the wound clinic in approximately two weeks. He should also follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in approximately four weeks' time. Follow up should also be with Dr. [**Last Name (STitle) 986**] of the Urology Department at [**Hospital1 69**] in approximately one to two weeks' time, phone #[**Telephone/Fax (1) 990**]. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Name8 (MD) 17704**] MEDQUIST36 D: [**2193-1-18**] 09:24 T: [**2193-1-18**] 09:33 JOB#: [**Job Number 17705**] ICD9 Codes: 4280, 4271, 5990, 4589, 2749
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Medical Text: Admission Date: [**2159-1-15**] Discharge Date: [**2159-1-23**] Date of Birth: [**2093-8-8**] Sex: M Service: CARDIAC SURGERY CHIEF COMPLAINT: Three-vessel disease. HISTORY OF PRESENT ILLNESS: This is a 65-year-old male with a [**5-12**] month history of exertional dyspnea and shortness of breath. The patient had an ETT in [**2158-7-31**] which was positive and was treated medically at that time, but the exertional angina persisted, and the patient had a cardiac catheterization that showed three-vessel disease with a normal ejection fraction. PAST MEDICAL HISTORY: Status post right knee surgery. Hypercholesterolemia. Coronary artery disease. SOCIAL HISTORY: He is retired and lives alone. He denied tobacco. Occasional alcohol, approximately [**5-7**] drinks per week. FAMILY HISTORY: Uncle had a history of myocardial infarction in his 60s. Brother died in his 50s from diabetes. ALLERGIES: PERCOCET. MEDICATIONS ON ADMISSION: Aspirin 81 mg p.o. q.d., Lipitor 10 mg p.o. q.d., Atenolol 25 mg p.o. q.d., Lorazepam 0.5 mg q.h.s. p.r.n., Nitroglycerin p.r.n. CATHETERIZATION RESULTS: Left anterior descending with subostial occlusion, left circumflex proximal 30%, 70% in obtuse marginal 2, and 70% in obtuse marginal 3. Right coronary artery with high-rising posterior descending artery 80% ostial, 70% proximal posterior lateral. ETT showed 70% maximal PHR. Electrocardiogram showed [**Street Address(2) 4793**] depression inferior in V4-6, resolved at rest. Anterior septal and apical ischemia. Ejection fraction of 60%. REVIEW OF SYSTEMS: The patient denied diabetes, cerebrovascular accident, transient ischemic attack, seizures, and hypertension. He denied asthma, chronic obstructive pulmonary disease, upper respiratory infection, cough, orthopnea. The patient did complain of dyspnea on exertion. He denied peptic ulcer disease, hematochezia, melena, blood in stool. He denied claudication, edema, peripheral vascular disease, vein stripping. He denied nausea, vomiting, diarrhea, or constipation. He denied voiding difficulties, benign prostatic hypertrophy, or hematuria. LABORATORY DATA: On [**1-9**] white count was 6.1, hematocrit 42.7, platelet count 170; sodium 140, potassium 5.1, chloride 103, bicarb 28, BUN 14, creatinine 0.7; INR 1.0, PT 12.5. Electrocardiogram showed sinus rhythm at 72, there were T-waves in III, Q-waves in AVF and III. Chest x-ray showed no pulmonary congestion, infiltrates, or nodules, no effusions. PHYSICAL EXAMINATION: Vital signs: Heart rate 78 in sinus rhythm, blood pressure 122/72, respirations 18, oxygen saturation 96% on room air. General: The patient was resting in bed in no apparent distress. He was alert and oriented times three. The patient followed commands. Neurological: Grossly intact. HEENT: Pupils equal, round and reactive to light. Extraocular movements intact. Anicteric. Noninjected eyes. Moist mucous membranes. Normal mucosa. Nasopharynx: Supple. No lymphadenopathy. No bruits. Lungs: Clear to auscultation bilaterally. Heart: Regular, rate and rhythm. Normal S1 and S2. No murmurs, rubs, or gallops. Abdomen: Soft, nontender, nondistended. No masses. Extremities: Warm and well perfused extremities. No clubbing, cyanosis, or edema. No varicosities. Pulses: Carotid 2+ bilaterally, dorsalis pedis and posterior tibial were 2+ bilaterally. HOSPITAL COURSE: The patient was admitted to the Cardiac Surgery Service and underwent coronary artery bypass grafting times four with LIMA to left anterior descending, saphenous vein graft to obtuse marginal 2 and obtuse marginal 3, and saphenous vein graft to posterior descending artery. The patient had a mean arterial pressure of 68, CVP of 8, and atrial paced at 88 on Propofol drip and Neo-Synephrine at 0.5 pressure support. The patient was transferred to the CSRU on postoperative day #1. The patient had a dose of Lasix for a low urine output, and the patient was extubated. The patient was continued on Neo-Synephrine drip at 0.5 for pressure support and was on prophylactic antibiotics. The patient's T-max was 101.8??????. He had good blood pressure and good pulse. He was in normal sinus rhythm. He was positive at 1.6 L. White count was 15.3, hematocrit was 31.5, creatinine 0.8. He otherwise was doing well. The patient was started on Lasix b.i.d., and the patient's medial chest tube was removed. On postoperative day #2, the patient was on the floor. The patient remained afebrile with a heart rate of 104 in sinus rhythm. Blood pressure was 140s/80s. The patient otherwise had good p.o. intake and making good urine. The patient's chest tube was removed, and JP was removed. He was placed on Lopressor 25 b.i.d. to control his blood pressure. On postoperative day #3, the patient was paranoid in the hospital and became confused. The patient locked himself in the bathroom and refused all services. Psychiatry was [**Name (NI) 653**], and the patient was given Haldol which relieved the symptoms. The patient remained afebrile with a pulse of 106, white count 23.3. The patient was pancultured, and ABG and chest x-ray was obtained, as well as contacting [**Name (NI) **] for elevated blood sugar. Psychiatry stated that the patient had an acute episode of confusion and paranoia and was consistent with delirium, and they recommended to minimize narcotics, which were subsequently stopped, and to obtain a head CT, which was obtained. Head CT showed no acute infarction, hemorrhage, or masses. The Haldol was started on a standing dose at night and p.r.n. dose and to monitor the patient for alcohol withdraw symptoms. On postoperative day #4, the patient had a temperature of 101.4??????. He otherwise was doing well. White count came down to 15.5. The patient's paranoia had slightly improved, and the patient was more cooperative with the staff and was less confused. On postoperative day #5, the patient had continued to improve. The patient's T-max was 100.9??????. He was in sinus rhythm and tachycardiac up to 140-150s. Lopressor was increased to control blood pressure and the heart rate. The patient's white count went down to 10.8. Psychiatry recommended adding Trazodone p.r.n. and at night for sleep, and the patient was also placed on Metformin for blood glucose control and to stop the Insulin [**First Name8 (NamePattern2) **] [**Last Name (un) **]. On postoperative day #6, the patient had a temperature of 102.4??????. He otherwise was doing well. The patient complained of increased breathing. The patient's ABG was 7.48, 35, 70, 27, and 2, in room air. The patient was taking good p.o. and making good urine. The patient continued to have a white count of 10.6. No other cultures came back positive. The patient continued to improve. On postoperative day #7, the patient had a low-grade temperature of 100.4??????, but otherwise was taking good p.o., making good urine, and the patient's white count continued to stay low at 10.4 On postoperative day #7, Psychiatry recommended that the patient obtain an Occupational Therapy consult for safety at home. They also recommended to stop the Haldol. On postoperative day #8, the patient continued to improve. The patient had a white count of 11.9, which had been stable. Occupational Therapy cleared the patient to go home, and Psychiatry felt that the patient was safe to go home. CONDITION ON DISCHARGE: Good. DISPOSITION: Home with VNA. DISCHARGE DIAGNOSIS: 1. Coronary artery disease. 2. Delirium. 3. Hypercholesterolemia. 4. Status post right knee surgery. 5. Status post coronary artery bypass grafting times four. FOLLOW-UP: Please follow-up with Dr. [**Last Name (STitle) 70**] in six weeks; please call for a follow-up appointment. Follow-up with Dr. .................. in [**12-1**] weeks. Follow-up with endocrinologist in [**12-1**] weeks. Follow-up with cardiolgoist in [**12-1**] weeks. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Last Name (NamePattern1) 3118**] MEDQUIST36 D: [**2159-1-23**] 11:48 T: [**2159-1-23**] 12:22 JOB#: [**Job Number 35334**] ICD9 Codes: 2720
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Medical Text: Admission Date: [**2199-2-1**] Discharge Date: [**2199-2-9**] Date of Birth: [**2146-4-2**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2534**] Chief Complaint: S/P Laparoscopic appendectomy presents with LLQ pain and abdominal distension. Major Surgical or Invasive Procedure: Sigmoid colectomy and sigmoid colostomy and Hartmann's procedure, drainage of retroperitoneal and peritoneal abscesses. History of Present Illness: Patient is a 52 yo male s/p laparoscopic appencedtomy [**2199-1-25**]. Patient with abdominal pain in the left lower quadrant and abdominal distension. He was transferred to [**Hospital1 18**] one week post op for further evaluation and treatment. CT scan reveals perforated sigmoid colon and retroperitoneal intraperitoneal abscess. Past Medical History: PMH: Prostate CA Hyperlipidemia CAD s/p cath HTN GERD Social History: No tobacco, daily ETOH, married, lives with family Family History: non contributory Physical Exam: Temp 98.5 HR 84 BP 121/76 RR 20 O2 sat 98% RA Exam: Gen: NAD, Awake, alert Ox3 CVS: RRR S1& S2 Lungs: CTA BL Abd: Soft, greatly distended, hypertympanic, Tender LLQ,no guarding or rebound Ext: No edema Pertinent Results: [**2199-2-1**] 09:45PM WBC-14.8* RBC-3.99* HGB-12.2* HCT-34.0* MCV-85 MCH-30.6 MCHC-35.9* RDW-12.9 [**2199-2-1**] 09:45PM NEUTS-81.8* LYMPHS-10.6* MONOS-4.6 EOS-2.2 BASOS-0.8 [**2199-2-1**] 09:45PM PLT COUNT-386 [**2199-2-1**] 09:45PM PT-13.4 PTT-34.4 INR(PT)-1.1 [**2199-2-1**] 09:45PM CALCIUM-7.8* PHOSPHATE-4.3 MAGNESIUM-2.5 [**2199-2-1**] 09:45PM GLUCOSE-115* UREA N-23* CREAT-0.8 SODIUM-136 POTASSIUM-3.4 CHLORIDE-96 TOTAL CO2-27 ANION GAP-16 [**2199-2-2**] 7:20 pm SWAB PERITONEAL FLUID CULTURE. **FINAL REPORT [**2199-2-6**]** GRAM STAIN (Final [**2199-2-2**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN SHORT CHAINS. WOUND CULTURE (Final [**2199-2-6**]): A swab is not the optimal specimen collection to evaluate body fluids. Due to mixed bacterial types (>=3) an abbreviated workup is performed; P.aeruginosa, S.aureus and beta strep. are reported if present. Susceptibility will be performed on P.aeruginosa and S.aureus if sparse growth or greater.. Work-up of organism(s) listed below discontinued (excepted screened organisms) due to the presence of mixed bacterial flora detected after further incubation. ESCHERICHIA COLI. SPARSE GROWTH. Piperacillin/tazobactam sensitivity testing available on request. ENTEROCOCCUS SP.. MODERATE GROWTH. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | ENTEROCOCCUS SP. | | AMPICILLIN------------ <=2 S =>32 R AMPICILLIN/SULBACTAM-- <=2 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S LINEZOLID------------- 2 S MEROPENEM-------------<=0.25 S PENICILLIN G---------- =>64 R TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S VANCOMYCIN------------ =>32 R ANAEROBIC CULTURE (Final [**2199-2-6**]): NO ANAEROBES ISOLATED. [**2199-2-2**] CT Abdomen/pelvis : Findings compatible with perforated viscus with likely source at the sigmoid colon/descending colon junction. At this junction, a fluid collection measuring up to 6.6 cm, containing air, enteric contrast and fluid is demonstrated. This collection tracks and involves to the retroperitoneum anterior to the psoas muscle where another discrete collection is demonstrated measuring up to 6.7 cm in its greatest dimension (SI). A third discrete collection is demonstrated within the lateral intraperitoneal cavity (series 2, image 48) measuring up to 4.9 cm in its greatest dimension (AP). Extensive associated pneumoretroperitoneum tracking to dissecting to involve the mediastinum. There is also a moderate amount of pneumoperitoneum. Brief Hospital Course: Patient is a 52 yo male s/p laparoscopic appendectomy at an OSH on [**2199-1-25**]. Patient's post operative course was complicated by SOB, abdominal distension, and LLQ pain. Patient with pain in his LLQ that is constant and worsens with movement. Patient was kept in the hospital and placed on TPN and IV ABX. Patient with no nausea or vomiting. No fevers or chills. Patient having bowel movements and passing flatus. He was transferred to [**Hospital1 18**] for further evaluation and management. Patient with repeat CT scan showing perforated sigmoid colon and retroperitoneal intraperitoneal abscess. He underwent a sigmoid colectomy and sigmoid colostomy and Hartmann's procedure, drainage of retroperitoneal and peritoneal abscesses on [**2199-2-2**]. Post operatively patient sent to the ICU intubated. He had a PCA for pain. He was extubated on [**2-3**]. He remained NPO/LR with an NGT to low continuous wall suction. Foley is in place with adequate urine output. He stayed on Cipro/Flagyl x 10 days for peritonitis and intra/RP abscesses. He was transferred to a regular nursing floor on [**2198-2-4**]. Culture grew VRE, and in consultation with ID, he was started on linezolid. Following transfer to the Surgical floor he continued to make good progress. As his bowel function returned his nasogastric tube was removed and he began a liquid diet which was gradually advanced to regular and tolerated well. He was seen on a regular basis by the ostomy nurse for general care and teaching and was slowly understanding the necessary treatments although he did wax and wane in his ability to care for the ostomy. Prior to discharge, he did demonstrate adequate understanding and ability to care for the ostomy. Medications on Admission: Amlodipine Besylate 10 mg QD Metoprolol Succinate ER 75 mg QD Hydrochlorothiazide 25 mg QD Quinapril 40 mg QD Aspirin 81 mg QD Citalopram HBR 10 mg QHS Simvastatin 40 mg QHS Alprazolam 0.5 mg PRN Claritan 10 mg PRN Famotidine 20 mg PRN Discharge Medications: 1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 2. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: Three (3) Tablet Extended Release 24 hr PO DAILY (Daily). 4. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 5. citalopram 20 mg Tablet Sig: 0.5 Tablet PO QHS (once a day (at bedtime)): STOP taking this medication and do not restart until 2 weeks after finishing linezolid. 6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. quinapril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Tylenol 325 mg Tablet Sig: Two (2) Tablet PO every 4-6 hours as needed for pain. 9. metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours): thru [**2199-2-12**]. Disp:*11 Tablet(s)* Refills:*0* 10. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours): thru/[**2199-2-12**]. Disp:*7 Tablet(s)* Refills:*0* 11. linezolid 600 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). Disp:*12 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: VNA of Southeastern Mass. Discharge Diagnosis: Perforated sigmoid colon retroperitoneal intraperitoneal abscess. 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 with abdominal pain from a hole in your sigmoid colon. Surgery was done which entailed a temporary colostomy. Hopefully when the inflammation resolves and you have lost some weight (30-40 pounds), you can have the colostomy reversed, probably not for 3-4 months. It is very important that you start a weight loss program after you have recovered from this operation. * Your incision is healing from the inside out therefore you will need to have dressing changes daily while it heals. You will also need to continue to learn how to care for your colostomy. The VNA will be able to help you with that. Please take the three antibiotics as prescribed. The linezolid has been pre-approved by your insurance company. If there are any issues, the approval number is #[**Numeric Identifier 52931**]. The linezolid can interact with citalopram (Celexa), so STOP taking citalopram, and do not restart it until 2 weeks after finishing the linezolid. Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within 8-12 hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than [**4-30**] lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: * Continue packing wound daily with saline damp gauze followed by a dressing on top. *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. Monitoring Ostomy output/Prevention of Dehydration: *Keep well hydrated. *Replace fluid loss from ostomy daily. *Avoid only drinking plain water. Include Gatorade and/or other vitamin drinks to replace fluid. * Continue all of your instructions from the Ostomy nurse. Followup Instructions: Call the Acute Care Clinic at [**Telephone/Fax (1) 600**] for a follow up appointment in 2 weeks. Call Dr. [**Last Name (STitle) **] for an appointment in [**2-22**] weeks to help with a safe weight loss program. ICD9 Codes: 2724, 4019
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Medical Text: Admission Date: [**2163-7-17**] Discharge Date: [**2163-7-20**] Date of Birth: [**2087-9-21**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 425**] Chief Complaint: Dizziness/Lightheadedness Major Surgical or Invasive Procedure: Temporary Pacemaker Wire Placement Permanent Pacemaker Placement History of Present Illness: Patient is a 75 yo male with hx of CAD, HTN, Hypercholesterolemia who presented to [**Hospital1 18**]-[**Location (un) 620**] this am after developing dizzuness and lightheadedness at home this am. The pt reports he was getting coffee this AM when he felt lightheaded, and dizzy but no overt chest pain, palpitations, shortness of breath, syncope. He subsequently sat down and finished his coffee but appeared pale to his wife who checked his pulse and noted it to be irregular and bradycardic with a heart rate of 26. The pt was BIBA to [**Hospital1 18**] [**Location (un) 620**] where an EKG demonstrated complete heart block with junctional escape in the 20s to 30s. Otherwise his ECG was significant for LBBB with LAD. He was afebrile with HR of 30 and BP of 160/82, with RR of 10 and SaO2 of 100%. He was never hypotensive during his OSH stay. He received atropine in the [**Location (un) 620**] ED and his rhythm converted to sinus bradycardia. He was subsequently transferred to [**Hospital1 18**] for further evaluation and management. . ROS: The pt denies any chest pain, palpitations, sob, abd pain, n/v/d, URI, sick contact, insect bites - specifically tick bites, arthritis symptoms, black stools, melana, back pain. Past Medical History: 1. CAD: NSTEMI in '[**53**] when he presented with chest pain (positive top but neg CK) s/p cardiac catheterization with POBA of LCx. The pt had a neg Thallium stress test in '[**60**]. 2. Hypertension 3. Hypercholesterolemia 4. Increased intraocular pressure Social History: The pt is a retired realtor who lives in [**State **] with his wife. [**Name (NI) **] is visiting his daughter who lives in MA. He has intact ADL and IADLs at home. Tob: quit; former smoked 4-5cig/day for 40 years but quit 20+years ago EtOH: occasional Family History: Father: CAD, COPD, tob+ Mother: None [**Name (NI) 18806**] and [**Name (NI) 68213**]: none Physical Exam: Vitals: T: 96.9, HR: 56, BP: 147/52, RR: 10, SaO2: 100% RA GEN: Well appearing middle aged man who appears younger than stated age. Conversing fluently in full sentences. NAD HEENT: EOMI, anicteric, op clear, mmm NECK: No JVD, no [**Doctor Last Name **] a waves. CHEST: CTA bilaterally anteriorly CV: RRR, S1, S2. ABD: soft, NT, ND, BS+ GROIN: Right groin line in place without obvious echymosis, hematoma, bruits. EXT: wwp, no c/c/e NEURO: A+O x3, appropriate. . . Pertinent Results: [**2163-7-17**] 12:50PM WBC-10.3 RBC-4.88 HGB-15.6 HCT-43.6 MCV-89 MCH-32.0 MCHC-35.9* RDW-13.3 [**2163-7-17**] 12:50PM PLT COUNT-194 [**2163-7-17**] 12:50PM NEUTS-73.9* BANDS-0 LYMPHS-21.0 MONOS-2.9 EOS-1.4 BASOS-0.9 [**2163-7-17**] 12:50PM PT-12.0 PTT-25.0 INR(PT)-1.0 [**2163-7-17**] 12:50PM GLUCOSE-150* UREA N-11 CREAT-1.1 SODIUM-132* POTASSIUM-3.4 CHLORIDE-95* TOTAL CO2-26 ANION GAP-14 [**2163-7-17**] 12:50PM CK(CPK)-62 [**2163-7-17**] 12:50PM cTropnT-<0.01 .................. RADIOLOGY Final Report CHEST (PORTABLE AP) [**2163-7-17**] 10:10 PM COMPARISON: [**2163-7-17**]. AP CHEST RADIOGRAPH: There has been interval placement of a pacing lead that appears to be entering via the IVC. Tip is seen overlying the right ventricle. Otherwise no significant change is seen from prior study with stable cardiac and mediastinal contours. No focal consolidations or pleural effusions identified. ................... TTE [**7-19**]: Conclusions: The left atrium is normal in size. 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 mild-moderate pulmonary artery systolic hypertension. There is a partially echo filled space anterior to the distal right ventricular free wall which most likely represents a fat pad. IMPRESSION: Preserved global and regional biventricular systolic function. No definite pericardial effusion identified. Mild-moderate pulmonary artery systolic hypertension. ...................... EXERCISE MIBI [**2163-7-20**] Reason: CAD S/P PCI, ? ISCHEMIA RADIOPHARMECEUTICAL DATA: 3.2 mCi Tl-201 Thallous Chloride; 22.0 mCi Tc-[**Age over 90 **]m Sestamibi; HISTORY: Chest pain. History of heart block and pacer placement. SUMMARY OF THE PRELIMINARY REPORT FROM THE EXERCISE LAB: Exercise protocol: Modified [**Doctor First Name **] Resting heart rate: 60 Resting blood pressure: 170/90 Exercise duration: 7.5 min. Peak heart rate: 77 Percent max predicted HR: 53% Peak blood pressure: 176/90 Symptoms during exercise: none Reason exercise terminated: stopped at patient request ECG findings: uninterpretable due to left bundle branch block INTERPRETATION: Imaging Protocol: Gated SPECT Resting perfusion images were obtained with Tl-201. Tracer was injected 15 minutes prior to obtaining the resting images. Exercise images were obtained with Tc-[**Age over 90 **]m sestamibi. This study was interpreted using the 17-segment myocardial perfusion model. The image quality is good. Uptake is seen in the left axilla and arm, likely venous in etiology. Left ventricular cavity size is normal. Resting and stress perfusion images reveal uniform tracer uptake throughout the myocardium. Gated images reveal normal wall motion. The calculated left ventricular ejection fraction is 63%. No prior studies. IMPRESSION: Normal myocardial perfusion study at the level of exercise achieved. Normal ejection fraction. Brief Hospital Course: A/P: 75 yo male with history of HTN, CAD, inc chol, who presented earlier today with symptoms of dizziness and lightheadedness. Found to be in heart block, received atropine in the ED. . 1. CV: A. Bradycardia: The pt is currently in NSR, however was found to be in high degree AV block thought to be paroxysmal AV block secondary to diseased intrinsic conduction system. The pt has a history of MI in the past with LCx disease which may partially explain the conduction disease (but not well). Other etiologies of CHB include Lyme disease, viruses, med, toxins, rheumatoid disorders, however these all seem unlikely. Cardiac enzymes were negative. Precise etiology of AV block remains unclear. Temporary pacing wires were placed by EP fellow via fluoro and patient underwent placement of a permanent pacemaker on [**2163-7-17**]. Patient tolerated the procedure well. He will follow-up in the device clinic on [**2163-7-18**]. . B. CAD: The pt has a history of CAD with PTCA in the past but had normal stress test in '[**60**]. Given symptomatic bradycardia as above, we did not aggressively treat his blood pressure or heart rate given risk for further bradycardia or hypotension. He was continued on ASA 325 mg qd and Zocor 10mg qd. On [**2163-7-19**] he had an episode of chest pain which was sub-sternal, difficult to characterize, then moved to R side. Responded to SL NG x 2 and morphine. No associated SOB, N/V. EKG unrevealing. CE sent. Pulsus was 2. HD stable with SBP 130s, HR 70s. He underwent a PMIBI which showed a normal myocardial perfusion study at the level of exercise achieved. Normal ejection fraction. He was able to exercise for 7.5 mins. He did not have any anginal symptoms. No further episodes of chest pain while in-patient. Prior to discharge was restarted on atenolol and lisinopril after placement of pacer. . 2. Hypertension: Beta blocker and thiazide diuretics that patient takes as an out-patient were initially held given his bradycardia. After pacer placement these were restarted. Patient was also started on lisinopril for better blood pressure control. He will follow-up with his PCP [**Last Name (NamePattern4) **] [**1-31**] weeks for further titration of his anti-hypertensives and will have his electrolytes checked at that time. . 3. Hyperglycemia on admission labs: The pt does not carry a history of DM, and this could reflect a stress response. Fasting AM sugars was within normal limits at time of discharge, however, patient was advised to follow-up with his PCP regarding his blood sugar. He should be monitored for fasting and post prandial hyperglycemia and should have an HgA1C checked. . Medications on Admission: ALLERGIES: NKDA . MEDICATIONS: 1. Metoprolol XL 50mg once daily 2. Indapamide (Thiazide Diuretic) 2.5mg once daily 3. Zocor 10mg once daily 4. ASA 325mg once daily 5. Eye drops - Cosopts for right eye and ?Xelotan for both eyes Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Indapamide 2.5 mg Tablet Sig: One (1) Tablet PO once a day. 4. Cosopt 2-0.5 % Drops Sig: One (1) gtt Ophthalmic twice a day: Right eye. 5. Xalatan 0.005 % Drops Sig: One (1) gtt Ophthalmic at bedtime. 6. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis Complete heart block .. Secondary diagnoses hypertension CAD hypercholesterolemia Discharge Condition: Good Discharge Instructions: You were admitted for heart block and had a pacemaker placed. You should follow up in device clinic as arranged. You should return to the ED with increasing pain at the pacer site, fevers, chills, palpitations, fainting, chest pain, shortness of breath, or for any other problems that concern you. Followup Instructions: You have an appointment at the device clinic on [**2163-7-28**] at 10 am in the [**Hospital Ward Name 23**] building on the [**Location (un) 436**]. . You should follow up with your PCP and your primary cardiologist when you return to [**State **]. You will need to see a cardiologist that specializes in pacer makers. You should have your blood pressure checked by your PCP as you may need to have your blood pressure medications adjusted. You should also have your PCP check your blood sugar as it was intermittently elevated while you were in the hospital. ICD9 Codes: 412, 4019
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Medical Text: Admission Date: [**2143-4-11**] Discharge Date: [**2143-4-12**] Date of Birth: [**2071-2-1**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Doctor First Name 1402**] Chief Complaint: Elective Pulmonary Vein Isolation for Atrial Fibrillation - Post-PVI monitoring Major Surgical or Invasive Procedure: Pulmonary Vein Isolation History of Present Illness: Since Dr [**Last Name (STitle) **] last saw him in [**Month (only) 359**], Mr. [**Known lastname 37217**] had an overall increase in his burden of AF, with fairly frequent episodes with progressively increasing fatigue over the last few months despite being on amiodarone. This led to him having a repeat echocardiogram that was done earlier this month, which exhibited a left ventricular ejection fraction of 40% as well as mild AR, mild-to-moderate MR, and borderline pulmonary hypertension, which was unchanged from his previous study. He continues to take amiodarone 200 mg a day as well as warfarin for thromboembolic prophylaxis. His ventricular response to AF fibrillation that day was about 110 beats per minute. He had previously been on Toprol and then was switched to Bystolic and he believes that his heart rate has been faster in AF since switching to Bystolic. . In terms of his ongoing management, he wished to be aggressive in restoring consistent sinus rhythm. He requested to undergo pulmonary vein isolation. He did a cardiac MRI prior to this procedure as ordered post-consult (see below). . He went for a pulmonary vein isolation today ([**2143-4-11**]). Ablation started at 9:37am; at 1228 noted to go into heart block with RFA, external pacing without effect at 200ma, CPR started and sustained for 2minutes. BP stable and saturation did not drop throughout episode. Patient reverted to flutter. At 1243 pt in flutter with SBP in 80s, external DCCV with 100J with reversion to sinus briefly. Patient received totals of 4L NS/LR with UOP: 16500cc. Decision made to transfer patient to the CCU for post-isolation monitoring. In the CCU VSS, telemetry with intermittent sinus tachy with flips to sinus brady. His only complaint is some soreness at the back of his throat which he attributes to "putting a breathing tube" during the procedure, but it does not bother him otherwise. He currently denies any chest discomfort, SOB, palpitations, dizziness, lightheadedness, fatigue. Past Medical History: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension (Patient denies this as per pre-procedure interview dated [**2143-4-9**] but in old notes) 2. CARDIAC HISTORY: - Paroxysmal atrial fibrillation, on Amiodarone, Coumadin and Toprol s/p cardioversion x2 ([**2141-3-31**]) - Coronary Artery Disease - PERCUTANEOUS CORONARY INTERVENTIONS: Initial stenting done in [**2131**], clean cath in [**2139**], repeat cardiac catheterization in [**Month (only) **] [**2141**] for chest discomfort in the setting of AFib, which demonstrated mild in-stent restenosis to 30% in the LAD stent. - PACING/ICD: None - CABG: None 3. OTHER PAST MEDICAL HISTORY: - GERD - Left hernia repair, excision of inclusion cyst from chest wall ([**8-/2142**]) - Ptosis surgery - Bilateral cataract surgery Social History: Married with 3 children and stays with wife. ADL independent. Works as a lawyer. - Tobacco history: Remote. - ETOH: One drink 5x/week. - Illicit drugs: None. Family History: Father (51), uncle (51) and grandfather (51) all had MIs at ages provided. Sister with DM, valve disease and heart failure at age 50. Otherwise, no family history of arrhythmia, cardiomyopathies, or sudden cardiac death. Physical Exam: VS: T=96.4 BP=124/83 HR=119 RR=20 O2 sat=96% on 3L delivered through nasal prongs GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NEURO: PERRL, EOMI. Facial asymmetry on inspection with decreased nasolabial fold and facial drooping on left. Able to raise eyebrows, but R>L.Power Grade [**4-4**] in all extremities throughout. Biceps, triceps, knee, ankle reflexes 2+ throughout. Downgoing plantars bilaterally. In-the-ear hearing aids present ears bilaterally. Facial sensation intact throughout. No uvulal deviation. Able to swallow water without choking. No tongue fasiculations or deviation. Full power in shrugging shoulders and on lateral rotation of head. NECK: Supple with JVP of 3 cm. CARDIAC: PMI located in 6th intercostal space, 1cm lateral to the midclavicular line, thrusting in nature. Regular rhythm (but varies from bradycardia of 50s to tachycardia of 120s throughout examination), normal S1, S2. Grade [**1-6**] pansystolic murmur heard at the apex radiating to the axilla. No rubs / gallops. No thrills, lifts. No S3 or S4. No midline sternotomy scar. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp was unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: 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: [**2143-4-11**] 07:10AM WBC-5.7 RBC-3.92* HGB-13.3* HCT-38.0* MCV-97 MCH-33.8* MCHC-34.9 RDW-13.6 [**2143-4-11**] 07:10AM PLT COUNT-221 [**2143-4-11**] 07:10AM PT-28.0* PTT-49.0* INR(PT)-2.7* [**2143-4-11**] 07:10AM GLUCOSE-214* UREA N-20 CREAT-1.0 SODIUM-141 POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-26 ANION GAP-15 [**2143-4-11**] 08:51PM SODIUM-138 POTASSIUM-3.8 CHLORIDE-102 [**2143-4-11**] 08:51PM MAGNESIUM-1.6 [**2143-4-12**] 04:56AM BLOOD WBC-9.2# RBC-3.43* Hgb-11.8* Hct-33.7* MCV-98 MCH-34.4* MCHC-35.0 RDW-14.0 Plt Ct-170 [**2143-4-12**] 04:56AM BLOOD PT-24.8* PTT-46.3* INR(PT)-2.3* [**2143-4-12**] 04:56AM BLOOD Glucose-148* UreaN-18 Creat-0.9 Na-136 K-4.0 Cl-102 HCO3-28 AnGap-10 . EKG: [**2143-4-11**] 0723h Atrial fibrillation with ventricular response rate 66-120. . [**2143-4-11**] 0835h Pre-Procedure / Baseline Atrial fibrillation with ventricular response rate 75-100. QT 440ms. . [**2143-4-11**] 1232h Post-Procedure Sinus bradycardia 50 beats per minute. . DISCHARGE LABS: [**2143-4-12**] 04:56AM BLOOD WBC-9.2# RBC-3.43* Hgb-11.8* Hct-33.7* MCV-98 MCH-34.4* MCHC-35.0 RDW-14.0 Plt Ct-170 [**2143-4-12**] 04:56AM BLOOD Glucose-148* UreaN-18 Creat-0.9 Na-136 K-4.0 Cl-102 HCO3-28 AnGap-10 [**2143-4-12**] 04:56AM BLOOD Calcium-8.0* Phos-3.1 Mg-2.4 Brief Hospital Course: Mr [**Known lastname 37217**] is a 72 year old man with history of paroxysmal atrial fibrillation s/p pulmonary vein isolation with procedure complicated by complete heart block transferred to the CCU for monitoring. . # Complete Heart Block/Arrthymias. Complete heart block transient in the setting of PVI. Question of vagal event precipitating event. In the CCU patient oscillated from sinus bradycardia to sinus tachycardia. Blood pressures remained stable and patient largely asymptomatic. On evening of transfer patient given 400mg PO QD. Decision made to uptitrate amio to 200mg PO TID for one week followed by 200mg PO BID x 3-4weeks. Patient also discharged with [**Doctor Last Name **] of Hearts Monitor for planned 3 week monitoring. OUTPATIENT ISSUES: -- Rhythm control with Amio: 600QD x1 week, followed by 200mg PO BID -- Discharged with [**Doctor Last Name **] of Hearts -- Continued on home metoprolol 25mg XL QD. . # Paroxysmal Atrial Fibrillation s/p PVI. Unfortunately procedure terminated prior to complete ablation. Post-procedure patient was monitored for general procedure-related complications: groin site pain / erythema / swelling / bleeding, Retroperitoneal bleeding. Patient reverted back into aflutter intermittently. 1. Rhythm/Rate. Amio uptitrated and beta-blocker contined. 2. Anticoagulation continued with home Coumadin; INR therapeutic in house . # Coronary Artery Disease s/p stent placement in [**2131**] (Successful PTCA and stenting of the mid LAD) Currently without cardiac complaints, ECG without changes concerning for ischemia. Patient continued on Aspirin 325mg PO daily, metoprolol, lisinopril. . # HTN: Normotensive in house. Held metoprolol, lisinopril, lasix on evening on admission in acute post-procedure setting. Pressures remained stable throughout stay. Patient restarted on home regimen prior to discharge. . # DM: Continued on home Metformin, Pioglitazone and Glucophage with Insulin SC sliding scale for additional coverage. Finger sticks controlled in house OUTPATIENT ISSUE - f/u pendng HbA1c . # DYSLIPIDEMIA. Continued on home Rosuvastatin . # GERD: Continued on home Omeprazole . Patient was full code during this admission Medications on Admission: - Amiodarone 200mg tab qpm - Furosemide 20mg tab qam - Lisinopril 10mg tab at bedtime - Lorazepam 2mg tab qhs - Metformin 1000mg tab [**Hospital1 **] - Metoprolol succinate 25mg tab extended release tab qhs - Omeprazole 20mg capsule delayed release EC [**Hospital1 **] - Pioglitazone (Actos) 30mg po od - Rosuvastatin (Crestor) 10mg tab qam - Sildenafil (Viagra) - 50mg tab prn - Warfarin 5mg tab 1-1.5 tab qhs as directed by PCP OTC [**Name Initial (PRE) **] Aspirin 81mg 2 tab qpm Pre-procedural - Coumadin 2.5mg on [**2143-4-9**] Discharge Medications: 1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO TID (3 times a day): Take 200mg three times a day x1 week; decrease to 200mg twice daily . Disp:*90 Tablet(s)* Refills:*0* 2. lisinopril 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO HS (at bedtime). 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 5. rosuvastatin 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day. 8. lorazepam 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed for insomnia. 9. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 10. warfarin 5 mg Tablet Sig: 1.5 Tablets PO 1X/WEEK ([**Doctor First Name **]): as directed by PCP and coumadin clinic. 11. warfarin 5 mg Tablet Sig: One (1) Tablet PO 6X/WEEK (MO,TU,WE,TH,FR,SA). 12. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary: Atrial Fibrillation Sinus Bradycardia Complete heart block . Secondary: Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr [**Known lastname 37217**] it was a pleasure taking care of you. . You presented to [**Hospital1 18**] for elective pulmonary vein isolation for treatment of your atrial fibrillation. Unfortunately the procedure was terminated early when you developed what is known as complete heart block, which indicates an electrical dysychronization between atria and ventricles. You were monitored closely in the CCU without event. . CHANGES TO YOUR MEDICATIONS: INCREASE Amiodorane. Please take one 200mg tablet 3 times daily for one week (total of 600 daily); after that decrease dosing to twice daily (total of 400mg daily). . No other changes were made to your medications. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Name: [**Last Name (LF) **],[**First Name3 (LF) **] L. Location: CARDIOLOGY ASSOCIATES OF GREATER [**Location (un) **] Address: [**Street Address(2) **], [**Location (un) **],[**Numeric Identifier 809**] Phone: [**0-0-**] Appointment: Friday [**4-19**] at 1PM Name: [**Last Name (LF) **], [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Location: [**Hospital1 18**] - CARDIAC SERVICES Address: [**Location (un) **], [**Hospital Ward Name **] 7, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 62**] We are working on a follow up appointment with Dr. [**Last Name (STitle) **] within 1-2 weeks. You will be called at home with the appointment. If you have not heard from the office by Wednesday [**4-17**] or have any questions, please call the number above. Completed by:[**2143-4-13**] ICD9 Codes: 9971, 4168
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Medical Text: Admission Date: [**2165-5-24**] Discharge Date: [**2165-5-28**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 9853**] Chief Complaint: Abdominal pain Major Surgical or Invasive Procedure: ERCP History of Present Illness: 84 yo M w/ PMH of CHF, afib, LGIB, gastric ulcer s/p clipping, gallstone pancreatitis and cholecystitis p/w abd pain, elevated amylase/lipase and GNR bacteremia for ERCP from OSH in NH. Pt. was initially admitted in early [**Month (only) **] to the OSH with abdominal pain and diagnosed with cholecystitis and gallstone pancreatitis. He reportedly had an NSTEMI during this episode and so was only treated with antibiotics as surgery was too risky. He was also admitted in [**Month (only) **] w/ GIB and had gastric ulcer clipped. Most recently, he was watching a red sox game on [**5-21**] when he began having abdominal pain then nausea and vomitting. He had some blood in his emesis but at OSH his Hct remained stable and his vomiting resolved. His amylase and lipase were elevated in the 1000 range and his LFTs and Tbili/AP were elevated as well. He was tachycardic and moderately hypotense to 96/67. He was planned for MRCP but this was not done given recent ulcer clipping w/ metal clip and he was transfered to [**Hospital1 18**] for ERCP and close monitoring from the ICU at St. [**Hospital 11042**] Hospital in [**Location (un) 8117**], NH. . On presentation to the ICU, he continued to complain of abdominal pain which he says was only improved with dilaudid but returns to the same baseline pain in between doses. He was immediately taken for ERCP where stone fragments with frank pus were drained. Past Medical History: Atrial fibrillation off coumadin [**3-18**] GIB CHF AAA s/p remote repair COPD emphysema on Home O2 2L Bladder CA s/p surgery and BCG PVD s/p fem-[**Doctor Last Name **] Cholecystitis Gallstone pancreatitis CAD Duodenal AVM s/p large bleed Spinal stenosis Prinzmetal angina Sleep apnea Urosepsis Social History: Lives at home w/ wife and oldest daughter. Quit smoking in [**2152**] but had smoked 52yrs x 2.5PPD. Previous heavy ETOH, but only occasional now. Family History: Father died of CAD at age 47 Mother had breast CA Physical Exam: VS - Temp 96.6F, BP 104/81, HR 117, R 20, O2-sat 94% 4l GENERAL - well-appearing man in NAD, comfortable, appropriate HEENT - sclerae anicteric, MM dry NECK - JVD to Ear lobe LUNGS - Decreased breath sounds diffusely. Crackles half way up the back. HEART - Irregular rhythm, II/VI systolic murmur ABDOMEN - BS+, soft, moderately tender in LUQ and LLQ but not in RUQ. Midline well healed laparotomy scar. EXTREMITIES - DP and PT pulses not palpable, warm/WP, 1+ pedal edema SKIN - no rashes or lesions NEURO - awake, A&Ox3, appropriately conversant Pertinent Results: [**2165-5-24**] ERCP Normal major papilla Cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique Contrast medium was injected resulting in complete opacification of the biliary tree. There were few filling defects that appeared like sludge at the lower third of the common bile duct. A sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire Sludge, few small stone fragments, and purulent bile in small amount were extracted successfully using a 8.5 mm balloon. Successful placement of a 10Fr 9cm biliary stent. Otherwise, the caliber and course of the the common bile duct, common hepatic duct, right and left hepatic ducts, and intrahepatic bile ducts were normal. Normal limited pancreatogram [**2165-5-24**] AP CXR: IMPRESSION: AP chest reviewed in the absence of prior chest radiographs: Lungs are clear, heart top normal size, and pulmonary mediastinal vasculature engorged. Pleural effusion is minimal if any. No pneumothorax. [**2165-5-24**] 05:52PM GLUCOSE-72 UREA N-21* CREAT-1.3* SODIUM-139 POTASSIUM-4.4 CHLORIDE-109* TOTAL CO2-22 ANION GAP-12 ALT(SGPT)-132* AST(SGOT)-81* LD(LDH)-163 ALK PHOS-247* AMYLASE-447* TOT BILI-2.0* LIPASE-773* ALBUMIN-3.0* CALCIUM-7.7* PHOSPHATE-3.0 MAGNESIUM-2.2 NEUTS-84.6* LYMPHS-7.8* MONOS-2.5 EOS-5.0* BASOS-0.1PLT COUNT-226 PT-17.4* PTT-37.2* INR(PT)-1.6* Brief Hospital Course: 84 yo M w/ CHF, Afib not anticoagulated, known cholelithiasis, presents from OSH with gallstone pancreatitis and pansensitive E.coli bactermia for ERCP. #. E.coli bacteremia: Patient remained hemodynamically stable throughout hospital course with good urine output. Given history of known CHF he was carefully given IV fluid support and his home lasix dose was initially held. OSH cultures from blood grew E.coli pan sensative and he was switched from Zosyn to ciprofloxacin on hospital day #2. He will finish a 14-day course (last day [**6-5**]). Surveillance blood cultures were negative as of day of discharge. He will follow up with ERCP in 6 weeks for stent removal. The recommendation of the ERCP team that he be considered for early cholecystectomy was discussed with the PCP by both the [**Hospital Unit Name 153**] team and hospitalist, and the PCP prefers to hold off for now given his significant cardiovascular and pulmonary comorbidities. #Gallstone pancreatitis s/p ERCP: Pus drained from bile ducts with sphincterotomy and stent placement. Patient improved clinically and was advanced to regular diet without difficulty. He will follow up with the ERCP team in 6 weeks for stent removal. #. Hx of GIB: Hct stable on admission but then began to trend downward after recieving fluids, did not have any s/s of GIB and his Hct eventually trended back towards the value at admission. #. CHF/CAD: Appeared mildly volume overloaded on admission, but given borderline BP in setting known bacteremia home lasix was held and IVF given prn. As he recovered, spironolactone, then lasix were resumed. Given brisk diuresis on home lasix and increased dose of metoprolol, Lasix was decreased to 20mg daily to allow blood pressure room. Continued on BB, imdur, statin, not on aspirin at home [**3-18**] GI bleed; restarting coumadin as below but would observe on this before adding ASA (can be done as outpatient). . #. Afib: Afib: Presented from OSH in RVR. Controlled with one dose of IV metoprolol 5mg. He was continued on PO metoprolol for rate control and increased on hospital day #3 due to persistent heart rate in the 130s, likely related to increased activity on transfer to the medical floor (now walking independently, out of bed). His metoprolol was titrated up to 75mg [**Hospital1 **] with good effect. He remained asymptomatic throughout all tachycardic episodes. His PCP has been holding coumadin given recent GI bleed but had planned to restart this on [**5-27**], so he was started on 2mg warfarin daily, to be followed by his PCP (discussed with PCP) Medications on Admission: Home ocuvite 2tabs daily Omeprazole 20mg daily isosorbide dinitrate 20mg [**Hospital1 **] Simvastatin 40mg daily doxazosin 2mg QHS Metoprolol tartrate 25mg [**Hospital1 **] Furosemide 40mg daily spironolactone 25mg Daily nitroquick 0.4mg PRN . On transfer Pip/tazo 2.25g Q6hours day 1=[**5-23**] Pantoprazole 40mg IV daily ondansetron 4mg Q6 PRN Hydromorphone 0.5-1mg Q4PRN Metoprolol 2.5mg IV Q8hours Metronidazole 500mg Q12 hours Heparin SC Q12 Discharge Medications: 1. Outpatient Lab Work INR check on [**2165-5-29**], please fax results to Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) **] office (phone # [**Telephone/Fax (1) 82541**]) per standing order. 2. Ocuvite 1,000-60-2 unit-unit-mg Tablet Sig: Two (2) Tablet PO once a day. 3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 4. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 7. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*2* 8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. NitroQuick 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual q5min up to three times. 11. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO once a day. Disp:*60 Tablet(s)* Refills:*2* 12. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 8 days. Disp:*16 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 8117**] Home Health and Hospice Discharge Diagnosis: Primary: gallstone pancreatitis, atrial fibrillation Secondary: coronary artery disease, chronic systolic heart failure Discharge Condition: good, stable, ambulating independently Discharge Instructions: You were transferred for an ERCP for gallstone pancreatitis and your abdominal pain improved. You should continue to take antibiotics as directed. You had a very fast heart rate afterwards that may have been partially due to the infection, and your metoprolol dose was increased. If you have lightheadedness, chest pain, shortness of breath, episodes of loss of consciousness, fevers, chills, abdominal pain, or any other concerning symptoms, call your doctor or seek medical attention immediately. Followup Instructions: Dr.[**Name (NI) 2798**] office will call you to schedule a follow up ERCP for stent removal in [**5-20**] weeks. If you do not hear from them, you can call them at ([**Telephone/Fax (1) 10532**]. You should follow up with your primary care physician [**Name Initial (PRE) 176**] 1 week; call Dr.[**Name (NI) 82542**] office at [**Telephone/Fax (1) 82541**] to make an appointment. You should have your INR checked tomorrow. Have your labs drawn as per your prior routine and Dr.[**Name (NI) 82542**] office will call you with any changes to your coumadin dose. ICD9 Codes: 7907, 4280, 412
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Medical Text: Admission Date: [**2152-6-7**] Discharge Date: [**2152-6-23**] Date of Birth: [**2077-8-11**] Sex: M Service: CARDIOTHORACIC Allergies: Dilaudid Attending:[**First Name3 (LF) 1505**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: [**2152-6-7**] Cardiac Catheterization [**2152-6-14**] Mitral Valve Repair(28mm Csgrove Annuloplasty Band) and Four Vessel Coronary Artery Bypass Grafting(Left internal mammary artery to left anterior descending, saphenous vein grafts to diagonal, ramus, and posterior descending artery). History of Present Illness: This is a 74 year old male with a six month history of worsening dyspnea on exertion. Several weeks prior to admission, he admitted to rapid decrease in exercise capacity. For several years, he had used two pillows for sleep. He has no history of chest pain or PND. On [**6-6**], he presented to his cardiologist with the above complaints. Office echocardiogram showed an LVEF of 15-20%. He was subsequently admitted to [**Hospital 6451**] with congestive heart failure. BNP on admission was 1400. He was diuresed with IV Lasix with improvement in his shortness of breath. He was stabilized on medical therapy and transferred to the [**Hospital1 18**] for further evaluation and treatment. Past Medical History: Congestive Heart Failure, Hypertension, Hyperlipidemia, Type II Diabetes Mellitus, Pulmonary Hypertension, Chronic Renal Insufficiency, History of Atrial Fibrillation, GERD, History of Urinary Sludge, Prior Tonsillectomy, Hidradenitis Suppurative s/p Surgery Social History: 15 pack year history of tobacco. Quit smoking over 25 years ago. Admits to 3 ETOH drinks per month. Married, lives with spouse. Family History: Denies premature coronary disease. Physical Exam: PREOP EXAM - Vitals: 137/64, 79, 18, 95% RA General: WDWN male in no acute distress HEENT: Oropharynx benign, EOMI Neck: Supple, no JVD Lungs: CTA bilaterally Heart: Regular rate and rhythm, normal s1s2, soft systolic murmur Abdomen: Soft, nontender with normoactive bowel sounds Ext: Warm, no edema Pulses: 2+ distally Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal deficits noted Pertinent Results: [**2152-6-7**] 10:20AM BLOOD WBC-6.8 RBC-3.99* Hgb-12.5* Hct-36.9* MCV-93 MCH-31.5 MCHC-34.0 RDW-14.6 Plt Ct-264 [**2152-6-7**] 10:20AM BLOOD PT-13.9* PTT-28.4 INR(PT)-1.2* [**2152-6-7**] 10:20AM BLOOD Glucose-147* UreaN-20 Creat-1.3* Na-140 K-3.6 Cl-105 HCO3-23 AnGap-16 [**2152-6-7**] 10:20AM BLOOD ALT-18 AST-19 AlkPhos-84 TotBili-0.9 [**2152-6-7**] 10:20AM BLOOD Albumin-4.3 Cholest-133 [**2152-6-7**] 10:20AM BLOOD %HbA1c-6.2* [**2152-6-7**] 10:20AM BLOOD Triglyc-115 HDL-31 CHOL/HD-4.3 LDLcalc-79 [**2152-6-7**] Cardiac Catheterization 1. Coronary angiography in this right-dominant system revealed three-vessel disease: --the LMCA had no angiographically apparent disease. --the LAD had diffuse 80% stenosis in its mid-portion. D1 was a very large vessel wrapping around the lateral wall, with an ostial 80% stenosis. --the LCX had an 80% proximal stenosis --the RCA was occluded in its mid-portion and fills by right-to-right and left-to-right collaterals. 2. Resting hemodynamics revealed elevated right- and left-sided filling pressures with RVEDP 10 mmHg and LVEDP 26 mmHg. There was moderate pulmonary arterial hypertension with PASP 59 mmHg. The cardiac output was low-normal with CI 2.1 L/min/m2. The PCWP was elevated at 26 mmHg. There was mild systemic arterial systolic hypertension with SBP 145 mmHg. There was no gradient across the aortic valve upon pullback of the angled pigtail catheter from LV to ascending aorta. [**2152-6-8**] Carotid Ultrasound: Bilateral less than 40% carotid stenosis. [**2152-6-8**] Echocardiogram: Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. There is severe regional left ventricular systolic dysfunction with near-akinesis of the inferior/inferolateral walls. There is moderate-to-severe hypokinesis of the remaining segments (LVEF = 20%). No masses or thrombi are seen in the left ventricle. 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 pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. Brief Hospital Course: Mr. [**Known lastname **] was admitted under cardiology and [**Known lastname 1834**] cardiac catheterization which revealed severe three vessel coronary artery disease with moderate to severe pulmonary hypertension(see result section). Cardiac surgery was consulted and further evaluation was performed. Carotid ultrasound found no significant disease of the internal carotid arteries. Repeat echocardiogram was notable for an LVEF of 20% with mild mitral regurgitation(see result section). Post catheterization, he had a slight decline in renal function and his ACE inhibitor was discontinued. His preoperative creatinine peaked to 1.7. Creatinine just prior to surgery was 1.5. Preoperative course was also notable for bouts of paroxysmal atrial fibrillation/flutter for which he was maintained on intravenous Heparin. On [**6-14**], Mr. [**Known lastname **] [**Last Name (Titles) 1834**] coronary artery bypass grafting and a mitral valve repair by Dr. [**Last Name (STitle) **]. For surgical details, please see separate dictated operative note. Following the operation, he was brought to the CVICU for invasive monitoring. On postoperative day one, sedation was weaned and he was extubated. However, due to severe agitation and confusion associated with atrial fibrillation and low mixed venous saturations, he was electively reintubated. While intubated and sedated, cardioversion was performed but unsuccessful. He was also given several units of PRBCs. On postoperative day three, he self-extubated. He did not required reintubation but was initially maintained on 100% shovel mask. Despite medical therapy and multiple cardioversions, he continued to experience atrial fibrillation. Given atrial fibrillation, he was eventually started on Amiodarone and Warfarin. He temporarily required a Heparin bridge. Postoperative renal function remained relatively stable. His confusion and agitation gradually improved with use of haldol. On [**2152-6-20**], Mr. [**Known lastname **] was transferred to the step down unit for further recovery. He continued to be gently diuresed towards his preoperative weight. The physical therapy service worked with him daily to increase his strength and mobility. Keflex was started for mild incisional erythema. An ace inhibitor was started given his low preoperative ejection fraction. Mr. [**Known lastname **] continued to make steady progress and was discharged to Baypoint of [**Hospital1 1474**]. Dr. [**Name (NI) 38327**] coumadin clinic will assume management of his coumadin dosing after discharge from rehabilitation. His goal INR is 2.0-2.5. He will also follow-up with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (un) **]. Amiodarone will be tapered to 200mg once daily. Medications on Admission: Aspirin 325 qd, Zestril 20 qd, Toprol XL 50 qd, Lasix, KCL, Nexium 40 qd, Plavix Load of 600mg Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: One (1) Tablet 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. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice a day. 5. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours) for 5 days. 6. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO once a day. 7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 8. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Warfarin 1 mg Tablet Sig: Adjust for goal INR 2.0-2.5 Tablets PO DAILY (Daily): Adjust dose for goal INR of 2.0-2.5. 10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 10 days. 11. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO once a day for 10 days: Take with lasix and stop when/if lasix stopped. 12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): Take amiodarone 400mg twice daily for 2 more days. Starting [**2152-6-26**], take 400mg once daily for 7 days and then decrease to 200mg once daily therafter until seen by Dr. [**Last Name (STitle) 7047**]. . 13. Senna Lax 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as needed for constipation. 14. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 15. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 16. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: Baypointe - [**Hospital1 1474**] Discharge Diagnosis: Primary: Coronary Artery Disease, Mitral Regurgitation, Acute on Chronic Systolic Heart Failure - s/p CABG and MV Repair Secondary: Postoperative Atrial Fibrillation, Postoperative Agitation, Hypertension, Hyperlipidemia, Type II Diabetes Mellitus, Pulmonary Hypertension, Chronic Renal Insufficiency Discharge Condition: Stable 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. 6) No driving for 1 month. 7) You are taking coumadin (a blood thinner) for atrial fibrillation. You goal INR is 2.0-2.5. You coumadin dosing will be managed by Dr. [**Last Name (STitle) 7047**] and you will need an appointment for blood draw (PT/INR) when discharged from rhab for coumadin management. [**Telephone/Fax (1) 8725**] 8) Take amiodarone 400mg twice daily for 2 more days. Starting [**2152-6-26**], take 400mg once daily for 7 days and then (Starting [**7-3**])decrease to 200mg once daily therafter until seen by Dr. [**Last Name (STitle) 7047**]. 9) Take lasix and potassium once daily for 10 days. Monitor electrolytes and replete as needed. Monitor daily weights. Preop weight 150lbs. You may need continued treatment with lasix but will be determined per cardiologist or rehab physician. 10) Take Keflex for 5 days for sternal wound erythema. 11) Monitor renal function (BUN/CREAT)given history of chronic renal insufficieny and currently on Ace and lasix. Preop Creat 1.3. [**6-23**] Creat 1.4. 12) Call with any questions or concerns. Followup Instructions: Dr. [**Last Name (STitle) **] in [**5-13**] weeks, call [**Telephone/Fax (1) 170**] for appt Dr. [**Last Name (STitle) 7047**] in [**3-12**] weeks, call [**Telephone/Fax (1) 8725**] for appt Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 15369**] in [**3-12**] weeks, call [**Telephone/Fax (1) 6699**] for appt ****Coumadin management with Dr. [**Last Name (STitle) 7047**] via his coumadin clinic. They are aware of patient (contact[**Name (NI) **] [**2152-6-23**]). Please contact his office when discharged from rehab to schedule PT/INR draw and appointment for coumadin management.**** Completed by:[**2152-6-23**] ICD9 Codes: 4240, 2930, 4271, 5849, 4280, 4168, 5859, 2449
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 6799 }
Medical Text: Admission Date: [**2110-1-13**] Discharge Date: [**2110-1-24**] Date of Birth: [**2056-3-11**] Sex: F Service: OME HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname 63364**] is a 53-year-old female with history of stage IIIA and IB melanoma with new retroperitoneal, pelvic and inguinal lymphadenopathy. She underwent excisional biopsy of a 2.1-mm thick melanoma from her right ankle in the spring of [**2105**]. She underwent wide local excision, skin flap and right inguinal sentinel lymph node biopsy without residual melanoma at the primary site. Two sentinel lymph nodes showed evidence of microscopic involvement with melanoma. Her postoperative course was complicated by failure of the flap to take. Dr. [**Last Name (STitle) **] performed a right superficial inguinal femoral lymphadenectomy with right sartorius rotation flap on [**2106-7-16**] with pathology showing microscopic melanoma in [**12-22**] residual lymph nodes. She began adjuvant interferon in [**2106-10-12**], undergoing 2 dose reductions due to peripheral neuropathy and persistent back pain. She completed 39 weeks of interferon. She underwent skin biopsy of a left posterior thigh lesion in [**2107-1-12**] revealing a 0.62-mm thick superficial spreading melanoma, [**Doctor Last Name 10834**] level IV without ulceration for which she underwent re-excision on [**2107-2-2**] without residual melanoma noted. She developed worsening right lower extremity edema in late [**2109-10-12**] with abdominal pelvic CT revealing retroperitoneal and pelvic lymphadenopathy. She underwent CT-guided biopsy of a pelvic node revealing metastatic melanoma. She was screened for high- dose IL-2 therapy and underwent prescreening testing. She now is admitted to begin cycle 1 week on high-dose IL-2 therapy. PAST MEDICAL HISTORY: Cervical dysplasia treated with colonoscopy, cervical neck disk disease treated with surgery, lumbar spine disk herniation, a history of depression. ALLERGIES: No known drug allergies. SOCIAL HISTORY: Lives with significant other, smokes, currently on disability, no EtOH. MEDICATIONS ON ADMISSION: Wellbutrin SR 200 mg daily, Klonopin 0.5 mg at bedtime, 0.25 mg t.i.d. p.r.n., Premarin 0.625 mg cream, Lexapro 20 mg daily, Nexium 40 mg p.o. daily, lorazepam 1 mg t.i.d. p.r.n., Percocet 1-2 tablets every 4 hours p.r.n. pain, calcium 500 mg daily, multivitamin 1 tablet daily. PHYSICAL EXAMINATION: GENERAL: Well-appearing female in no acute distress. Vital signs: Stable. HEENT: Clear. Heart: Regular rate and rhythm. Chest: Clear bilaterally. Abdomen: Palpable lower abdominal masses. Extremities: 3+ right lower extremity edema. LABS ON ADMISSION: WBC 11.2, hemoglobin 10.9, hematocrit 31.6, platelet count 496,000, BUN 17, creatinine 0.8, sodium 137, potassium 3.9, chloride 99, CO2 30, glucose 86 INR 1.1, ALT 10, AST 16, albumin 3.8. HOSPITAL COURSE: Ms. [**Known lastname 63364**] was admitted and underwent central line placement to begin therapy. Her admission weight was 68 kg and she received interleukin II 600,000 international units per kilo equaling 40.8 million units IV every 8 hours times 14 potential doses. During this week she received [**11-24**] doses with 2 doses held related to shortness of breath on treatment day #5. She stabilized on treatment day #6 but that evening developed increasing shortness of breath associated with hypoxia requiring 100% non-rebreather with O2 sats in the mid 90s consistent with acute pulmonary edema. Chest x-ray was consistent with that and she was treated with Lasix with good urine output. That night on treatment day #7 she desatted to 80% on a non-rebreather and was transferred to the ICU where continued diuresis was carried out. ____________ edema. She was tried on CPAP which she did not tolerate well and was placed back on 100% non- rebreather. She did not require intubation. She slowly improved with diuresis and was transferred back to 7 [**Hospital Ward Name 1950**] on [**1-22**] where she continued to improve with eventual discharge on [**2110-1-24**]. Other side effects during IL-2 therapy included rigors improved with Demerol; development of an erythematous pruritic skin rash; mild nausea improved with antiemetic therapy; and diarrhea improved with Lomotil therapy. During this week she had no acute renal failure noted. She developed transaminitis with a peak ALT of 87 and peak AST of 99, both improved at the time of discharge. She developed hyperbilirubinemia with peak bilirubin of 4 improved to 1 at the time of discharge. She was anemic without need for packed red blood cell transfusion. She developed thrombocytopenia with a platelet count low of 11,000, improved to 111,000 at the time of discharge. She had no coagulopathy or myocarditis noted. By [**2110-1-24**] she had recovered from side effects to allow for discharge to home. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: To home with her significant other. DISCHARGE DIAGNOSES: Metastatic melanoma status post cycle 1 week on high-dose IL-2 therapy complicated by acute pulmonary edema. DISCHARGE MEDICATIONS: Wellbutrin 200 mg p.o. daily, Nexium 40 mg p.o. daily, Lexapro 20 mg p.o. daily, Percocet 1-2 tablets every 4 hours p.r.n. pain, Ativan 1 mg every 6 hours p.r.n. anxiety. Outpatient physical therapy. FOLLOW-UP PLANS: Ms. [**Known lastname 63364**] will recover from her complicated first week of high-dose IL-2 therapy. Week 2 of therapy will not be administered at this time but we will plan to follow up with CT scans at week 7 to assess disease response to determine whether treatment again would be warranted. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 19077**] Dictated By:[**Last Name (NamePattern1) 18853**] MEDQUIST36 D: [**2110-4-4**] 11:12:09 T: [**2110-4-4**] 14:08:25 Job#: [**Job Number 63365**] cc:[**Location (un) 63366**] ICD9 Codes: 2768