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{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7100 }
Medical Text: Admission Date: [**2121-3-19**] Discharge Date: [**2121-4-3**] Date of Birth: [**2043-6-24**] Sex: M Service: EMERGENCY Allergies: Amiodarone Attending:[**First Name3 (LF) 2565**] Chief Complaint: Respiratory distress. Major Surgical or Invasive Procedure: Intubation with mechanical ventilation Central line placement Tracheostomy Placement of Percutaneous Gastrostomy Tube History of Present Illness: Mr. [**Known lastname **] is a 77 yo M with PMH of CAD/CABG, DM, CRI, AAA/TAA repair, multiple CVA, seizure d/o who presented to the ED w/ respiratory distress. Son reports 4 days of lethargy, decreased POs, 'not walking at all,' and wet, non-productive cough. He also reports subjective fever the morning of admission. His son states that his father did not complain of any chest pain, abdominal pain or dysuria. He has had normal bowel movements. He lives at home with wife and was seen there today by NP who referred him to the ED. He denied abdominal pain/nausea/vomiting/diarrhea/CP/SOB. On arrival to [**Name (NI) **] pt was tachypneic w/ RR 35, BP 198/122, T 101.2 rectally, sats 70s on RA, 85 on NRB, RLL crackles and rhonchi. He had a CXR that showed multilobar pneumonia. He was intubated for respiratory distress with VBG showing 7.28/50/56. Other significant labs were; BNP 2458, Trop 0.06, Lactate 3.4. His blood pressure had been in the high 100's systolic and dropped initially to 90's then to 54/33 after receiving propofol. He then received 6L NS and peripheral dopa was started. A RIJ placed and started on central levophed and dopamine per sepsis protocol (on low dose for both (124/70). He received Levaquin 750mg IV and Ceftriaxone 1gm and was consented for sepsis research study. On arrival to floor, ABG was 7.32/45/327 on AC @100% w/ PEEP 10 and FiO2 was decreased to 60. He was started on fentanyl/versed gtt for sedation, and dopa and levo for BP support. Past Medical History: CAD CABG X 3 VD (70% distal LMCA, 100% PDA/PLV) HTN CHF LEVF 50% ([**11-1**]) MR, TR Anemia (baseline 28.2-33.8) AFib s/p pacer, D/C cardioversion, on Warfarin SDH ([**11-1**]): 3 mm L frontoparietal SDH 12 strokes since [**2105**] DM CRI (baseline Cr 1.5-1.7) LLE cellulitis Surgical History: AAA repair '[**08**] w/ redo in '[**09**] TAA repair '95CAD Social History: Married, lives in [**Location (un) 538**]. Spanish speaking only . He is currently retired, was an independent truck driver. Tobacco remote history, quit over 10 years ago. Alcohol use is rare Family History: Non-contributory Physical Exam: VS: Temp: 100 BP: 155/83 HR:79 RR:19 O2sat100% on AC FiO2 100, PEEP 10 GEN: elderly man, lying in bed, intubated HEENT: PERRL, EOMI, anicteric, MMM, op without lesions NECK: no jvd 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, warm, good pulses SKIN: no rashes/no jaundice NEURO: sedated . on discharge pertinent changes: NECK: trach collar in place ABD: PEG in place, wound c/d/i Pertinent Results: LABORATORY STUDIES [**2121-3-19**] BLOOD WBC-10.6 RBC-5.47# Hgb-15.7# Hct-48.6# MCV-89 MCH-28.7 MCHC-32.3 RDW-13.9 Plt Ct-308# [**2121-3-20**] BLOOD Hct-27.7* [**2121-4-3**] BLOOD WBC-10.0 RBC-3.71* Hgb-10.5* Hct-32.6* MCV-88 MCH-28.2 MCHC-32.0 RDW-14.8 Plt Ct-524* [**2121-4-3**] BLOOD Glucose-147* UreaN-14 Creat-1.3* Na-141 K-3.9 Cl-104 HCO3-30 AnGap-11 MICROBIOLOGY 2/2O URINE - NEGATIVE SPUTUM - NEGATIVE BLOOD - Coag Neg Staph, Neg FLU - Negative Legionella UA Negative [**Date range (1) 101379**] Sputum growing Yeast Blood Cx [**3-20**], [**3-22**] Negative REPORTS AND STUDIES ECHO [**3-21**]: The left atrium is mildly dilated. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity is unusually small. Overall left ventricular ejection fraction is normal (LVEF 60-70%); however, the basal segments of the inferior septum, inferior free wall, and posterior wall are hypokinetic. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The descending thoracic aorta is moderately dilated. The aortic valve is not well seen. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the findings of the prior study (images reviewed) of [**2119-5-6**], the mitral regurgitation appears reduced; however, this suboptimal study may have underestimated the mitral regurgitation. CXR [**2121-4-1**] In comparison with the study of [**3-31**], there is little overall change. Tubes remain in place in this patient with median sternotomy and pacemaker leads. Hazy opacification of the lower half of the right hemithorax is again seen, consistent with pleural fluid. Some asymmetric pulmonary edema, worse on the right, is suggested. CXR [**2121-4-2**]: IMPRESSION: Uncomplicated ultrasound and fluoroscopically guided single lumen PICC line placement via the right basilic venous approach. Final internal length is 43 cm, with the tip positioned in SVC. The line is ready to use. Brief Hospital Course: A/P: 77 yo M with PMH of CAD/CABG, DM, CRI, AAA/TAA repair, multiple CVA who presented initially with RLL pneumonia, admitted to the MICU intubated [**3-1**] to respiratory distress and hypotension, extubated briefly, then reintubated secondary to increased secretions. . #) Pneumonia/Respiratory Failure: Upon initial presentation, the patient had had 4 days of lethargy, and increased cough with inability to clear sputum. The patient was intubated initially and started on levofloxacin and ceftriaxone. Flagyl was additionally added; The patient's vent was titrated according to ABGs. Ceftriaxone was discontinued on [**3-25**]. The patient was extubated on [**3-26**], but required reintubation the subsequent day for respiratory distress, presumed secondary to thick secretions. A pneumonia was seen on CXR, and the patient was started on zosyn and vancomycin. The patient had a trach, PEG and central line placed on [**2-/2042**]. Pressure support was weaned as tolerated, but he may require more ventilator support for transport. Zosyn and vancomycin are to be continued for an 8 day course for PNA. Zosyn and vanc are to be given via PICC for 1 more days for 8 days total. PICC lines was placed on [**2118-4-2**] and is ok for use. Last day of vancomycin and zosyn will be [**2121-4-4**]. . #) Hypotension/Sepsis: On initial presentation, pt was hypertensive to 200s/100s, but BP began to drop after intubation. IV dopamine and fluids were started, BP increased. The patient was pan-cultured. The patient's pressors were weaned and fluid boluses were given as necessary. Resolved. . #) Hypernatremia: Initial sodium was 160. The patient did not appear volume-overloaded on arrival to the medical floor despite receiving 6 L NS. Most likely cause was thought to be dehydration from not drinking water. The free water deficit was calculated and the patient was given free water to bring his sodium down. His electrolytes were closely monitored. He can continue to get free water with his tube feeds as needed. . #) A-fib/A-flutter: pt has a history of this, controlled on sotolol and metoprolol. During admission, he went into a-fib with rvr and a-flutter but this wsa controlled with uptitration of medications including calcium channel blocker & beta blocker. - Continue lopressor and diltiazam for control (can titrate up if needed) . #) Renal Failure: Cr 1.8 on admission, elevated BUN/Cr ratio suggests at least partial pre-renal etiology although pt has chronic renal insufficiency with baseline Cr of 1.6. Currently, creatinine stable and at baseline, creatinine 1.3 at discharge. . #) Mental Status - Pt still remains largely unarousable despite being off of sedating medications. Per discussion with family, his baseline is poor to start. - continue to hold sedating medications. . #.) Anemia-Pt received 1 U PRBC on [**3-31**] for a Hct of 24.9, with an apppropriate hematocrit elevation. Hematocrit 32.6 at time of discharge. . #) CAD: h/o CAD s/p CABG X 3 VD (70% distal LMCA, 100% PDA/PLV) - continue ASA, statin . #) Pump: last ECHO [**5-4**] = LEVF 50%, no signs of volume overload at present. . #) Hyperlipidemia: continue statin . #) DM: Continue glargine 20 U hs and insulin per sliding scale. . #) F/E/N: IVF prn. Replete lytes PRN. TF at goal. . #) PPx: Bowel regimen, PPI, pneumoboots, heparin SC TID while nonambulatory. . #) Access: PICC . #) Code Status: DNR. Patient would like no CPR, no shock, but vasopressors okay. . #) Communication: [**Name (NI) **] [**Name (NI) **] (wife) [**Telephone/Fax (1) 104708**] Medications on Admission: Amlodipine 10mg QD Aspirin 325mg QD Citalopram 10mg QD Docusate 200mg [**Hospital1 **] Glipizide 5mg QD Keppra 500mg TID Lipitor 20mg QD Lisinopril 5mg QD Metoprolol 100mg QD Senna 187mg tab QD Sotalol AF 80mg [**Hospital1 **] Zyprexa 5mg QD @ 5pm . Allergies: Amiodarone (neurotoxicity), Codeine, PCN Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed: per tube. 2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed: per tube. 3. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) mL PO BID (2 times a day): per tube. mL 4. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day): per tube. 5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): per tube. 6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed: per tube. 7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 9. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) 5,000 unit injection Injection TID (3 times a day): while nonambulatory. 10. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day): hold for sbp <100, hr <55 per tube. 11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed. 12. Heparin Flush CVL (100 units/ml) 1 ml IV DAILY:PRN 10ml NS followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen QD and PRN. Inspect site every shift 13. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale Subcutaneous four times a day: humalog insulin sliding scale.* * Refills:*2* 14. Insulin Glargine 100 unit/mL Cartridge Sig: Twenty (20) units Subcutaneous at bedtime. 15. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): at 5pm. 16. Citalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Diltiazem HCl 90 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). 18. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 19. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1) g Intravenous Q 12H (Every 12 Hours) for 3 doses: To end after PM dose on [**2121-4-4**]. 20. Zosyn 4.5 gram Recon Soln Sig: 4.5 g Intravenous every eight (8) hours for 1 days: To end after PM dose on [**2121-4-4**]. Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 86**] Discharge Diagnosis: PRIMARY Sepsis Pneumonia Atrial Fibrillation Acute Renal Failure SECONDARY Chronic Kidney Disease Stage II Chronic Diastolic Congestive Heart Failure Anemia h/o Subdural Hemorrhage h/o stroke x12 Diabetes Dementia Discharge Condition: afebrile, normotensive, comfortable on trach mask Discharge Instructions: You were admitted to the hospital with respiratory distress and found to have a pneumonia. You were on the ventilator to assist with your breathing while you were treated with antibiotics. Because of your condition, you were not able to be off of the ventilator initially, and underwent a tracheostomy to help with secretions and aspiration. Your medications have changed. Please review your current medication list. You are being discharged to a rehab/skilled nursing facility. If you develop fevers, chills, respiratory difficulty, shortness of breath, or other concerning symptoms, please return to the hospital. Followup Instructions: Please follow-up with your primary care physician [**Name Initial (PRE) 176**] 2 weeks of leaving the hospital. Completed by:[**2121-4-3**] ICD9 Codes: 0389, 486, 2760, 5849, 5070, 4280
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Medical Text: Admission Date: [**2104-12-31**] Discharge Date: [**2105-1-6**] Date of Birth: [**2050-12-10**] Sex: F CHIEF COMPLAINT: Chest pain. HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname 40865**] is a 56-year-old woman with a history of coronary artery disease, status post [**2102**], also longstanding type 1 diabetes, who was in her usual state of poor health in which she generally just stays in bed or sits in a chair until two weeks prior to presentation when she began experiencing chest pain. The patient experienced frequent episodes of chest pressure up to several times a week lasting up to 10-15 minutes, but resolving with nitroglycerin. usual angina, which she describes as a "pressure in the middle of her chest, at rest". She took one sublingual nitroglycerin which relieved the pressure. However, the patient's chest pressure returned 30 minutes later, but was again relieved with one sublingual nitroglycerin. The discomfort appeared for a third time, at this time it was a sharp and sternal chest pain not relieved with nitroglycerin and then she presented to the [**Hospital1 1474**] Emergency Department. At no point did she experience any shortness of breath, nausea, vomiting, diaphoresis, or palpitations. In the [**Hospital1 1474**] Emergency Department, she was found to have ST elevations in lead III, [**Street Address(2) 4793**] depression in aVL, 0.[**Street Address(2) 1755**] depression in V3 and V4. She also had Q waves in V1 and V2 and slight prolonged Q-T interval. At the outside hospital, she was treated with 50 mg of Lopressor intravenously, and made pain free with 10 mg of morphine sulfate. She was then treated with aspirin, Aggrastat, nitroglycerin drip, and Heparin drip. She remained pain free and was transferred to [**Hospital1 346**] for cardiac catheterization. PAST MEDICAL HISTORY: 1. Coronary artery disease status post angioplasty in [**2097**], myocardial infarction in [**2097**] and [**2102**]. 2. Renal insufficiency, baseline creatinine uncertain. 3. Diabetes mellitus type 1 x47 years complicated by retinopathy, nephropathy, and neuropathy. 4. Depression. 5. Toe amputations of all five digits on the left. 6. Chronic anemia uncertain hematocrit at baseline. 7. Essential tremor. HOME MEDICATIONS: 1. Lopressor 75 mg [**Hospital1 **]. 2. Insulin 10 units of regular q am, 20 units of NPH q am, 24 units of N q pm. She is on a regular sliding scale at dinner. 3. Lasix 80 mg po q day. 4. Zoloft 50 mg po q day. 5. Lipitor 50 mg po q day. 6. Sublingual nitroglycerin prn. 7. Aspirin 325 mg po q day. 8. Iron sulfate 325 mg po q day. 9. Vitamin C. ALLERGIES: Bactrim and Biaxin. She becomes nauseous to both of those drugs. REVIEW OF SYSTEMS: Of note, the patient spends most of her time in bed, though will transfer to a chair. She is unable to walk secondary to weakness and shortness of breath with minimal exertion. PHYSICAL EXAMINATION: Upon presentation to the Cardiac Intensive Care Unit, the patient had the following vital signs: Her temperature is 97.8, blood pressure 107/55, heart rate 76 and regular. She is breathing 16. Sating 88% on room air, 100% on nonrebreather at 10 liters. GENERAL: She is lying in bed with a nonrebreather. She can speak in full sentences in no acute distress. She has a resting tremor of her right foot and left hand. HEENT: She has no vision in her right eye. Her left eye has decreased vision with surgical pupils. She is anicteric. Her oropharynx is clear and dry. NECK: No bruits, no jugular venous distention appreciated at 45 degrees. CARDIOVASCULAR: Regular, rate, and rhythm, normal S1, S2, no murmurs, rubs, or gallops. LUNGS: Respiratory crackles bilaterally to 1/3 up on the right, 1/2 up on the left. No wheezes or rhonchi. ABDOMEN: Soft, nontender, and nondistended, positive bowel sounds. EXTREMITIES: Five toe amputee on the left, no edema. She had Doppler DP pulses bilaterally and 1+ femoral pulses bilaterally. NEUROLOGICAL: She is alert and oriented times three. She is moving all extremities symmetrically despite the tremor. She has this resting tremor in the right foot and left hand. She has decreased sensation of both feet to 2 cm above the ankle to light touch. LABORATORIES ON PRESENTATION: The patient had the following laboratories at the outside hospital: She had a complete blood count which had a white blood cell count of 10.1, hematocrit of 32.2, MCV of 90, and platelets of 248. She had 74% polys, 21% lymphocytes, 3% monocytes. PT 12.2, PTT 20.6, an INR of 1.0. Her chemistry is as follows: She had a sodium of 133, potassium of 5.1, chloride 98, bicarb 22, BUN 51, creatinine 2.0, baseline not certain, and a glucose of 513. Her enzymes at the outside hospital were as follows: She had a CK of 149, CK MB of 4.7, index of 3.2, and troponin less than 0.3. She had a chest x-ray which showed bibasilar opacities. Heart size within normal limits. Of note, she had cardiac catheterization in [**2103-6-8**] at [**Hospital3 **], which showed three-vessel disease. She had diffuse disease in the proximal right coronary artery with a 90% mid right coronary artery lesion and diffuse disease in the other vessels. She had an echocardiogram in [**6-7**] which showed an ejection fraction of 45-50%. Upon arrival here, her laboratories were as follows: She had a white blood cell count of 11.3, hematocrit of 27.9, platelets of 241. PT 15.3, PTT 140.9, INR 1.5. Sodium 141, potassium 4.7, chloride 106, bicarb 22, BUN 51, and creatinine of 1.7, and glucose was 343, calcium 7.8, magnesium 2.1, phosphorus 4.3. Her CK had risen to 377. CK MB to 44. Her index showed 11.7 and troponin increased to 37.8. Her hemoglobin was 7.4. She had a urinalysis which showed trace blood, negative nitrates, traced glucose, negative protein, negative ketones, and trace leukocyte esterase, [**3-11**] red blood cells, and [**6-16**] white blood cells, many bacteria, and 0-2 epi's. Her urine electrolytes showed a sodium of 88, creatinine of 49, potassium of 36, and osms of 410. Of note, she had a peak CK of 1,112, which declined to 692. Her electrocardiogram was notable for resolution of the ST elevation in III the day after admission. She underwent cardiac catheterization which shows the following: She had severe three vessel coronary artery disease, severe left ventricular diastolic dysfunction. Her left main was diffusely diseased. The left anterior descending artery was diffusely diseased throughout with 90% lesion at D2. She had diffusely diseased proximal left circumflex lesion and a subtotal occlusion of the right coronary artery at the mid vessel with left to right collaterals. She in addition, she had a transthoracic echocardiogram during this admission which demonstrated the following: She had anterior akinesis with inferobasilar and inferolateral hypokinesis. Her left ventricular ejection fraction was likely unchanged from her [**2102**] study which demonstrated an ejection fraction of 45-50%. Of note, she had a normal TSH in addition, and she grew Gram-negative rods, Klebsiella pansensitive from her urine cultures greater than 100,000 colonies. HOSPITAL COURSE: 1. Cardiovascular: The patient from a pump standpoint, had severe left ventricular diastolic dysfunction with an estimated ejection fraction of 45-50%. She remained slightly fluid overloaded during her hospital stay and was gently diuresed. This was done carefully given the patient's tenuous blood sugar control and her tendency to tip into diabetic ketoacidosis very easily. Otherwise, her blood pressure remained systolic between 90-130 during her hospital stay. She was started on a beta blocker and ACE inhibitor, and tolerated both of these medications well. From a rhythm standpoint, the patient remained in normal sinus rhythm following her transfer from Cardiac Intensive Care Unit to the floor. She had a known artifact on her Telemetry which mimicked monomorphic V-tach with an essence of an artifact from her essential tremor. She had no other arrhythmias. Coronary artery disease: As mentioned previously, the patient had a catheterization which showed triple vessel disease and mid right coronary artery lesion that was complex in nature and extended for several cm and is deemed not amenable to stenting due to high risk of reocclusion. The patient was scheduled for a Persantine thal stress test to further elucidate the extent of the ischemia. This was scheduled for [**2105-1-5**]. The plan was if that the ischemia was extensive, that they would consider placing a stent regardless of the risk of restenosis. If the ischemia was mild-to-moderate, the plan was to medically manage the patient with beta blockers, ACE inhibitors, aspirin, Plavix, and HMG coA reductase inhibitor until she can be bridged to a drug eluting stent with the much less likelihood of restenosis. 2. Endocrinology: During her hospital stay, the patient had blood sugars that were very difficult to control. She initially had a blood sugar of 513 at the outside hospital and likely was in diabetic ketoacidosis at that time. She was initially controlled with an insulin drip, and then transitioned to subQ insulin. She was initially tried on doses of Lantus with a Humalog sliding scale tid, however, in light of this failed to be controlled with blood sugars, and on the 29th, she was switched back to her outpatient regimen with 20 units of N in the morning and 24 units of N in the evening with tid Humalog sliding scale. She will require close endocrinologic followup, although the patient states that her insurance will not allow her to go to [**Last Name (un) **]. This remains an unresolved issue, and the patient needs to find an endocrinologist closer to home covered by insurance to manage her sugars better as her hemoglobin A1C was 7.4 contributing to her cardiovascular disease. In addition, she is at high risks for persistent diabetic ketoacidosis. Her TSH was within normal limits. 3. Hematology: Following her admission, the patient had a slight drop in her hematocrit from 34 to 27, and then to 25. The patient has known chronic anemia of uncertain etiology likely secondary to chronic renal insufficiency and iron deficiency. She showed no evidence of active bleed and had a small ecchymosis at her catheterization site, however, there is no evidence that she bled during her hospitalization. She was transfused 1 unit of packed red blood cells and her hematocrit rose appropriately, and there was no further evidence of hematocrit drops or active bleed during her stay. 4. Infectious Disease: The patient was noted to have white blood cells in her urine and grew greater than 100,000 colonies of Klebsiella that was sensitive to levofloxacin. She was treated with five day courses of ciprofloxacin and remained afebrile with a high normal white count during her hospital stay and no urinary symptoms. CONDITION ON DISCHARGE: Patient's condition was fair. DISCHARGE STATUS: Likely to home. DISCHARGE DIAGNOSES: 1. Coronary artery disease status post inferior myocardial infarction with ST elevation and right coronary artery mid lesion. 2. Type 1 diabetes with difficult to control blood sugars. 3. Urinary tract infection with Klebsiella. 4. Chronic renal insufficiency. 5. Chronic anemia. 6. Gastroparesis. 7. Postprandial nausea and vomiting. DISCHARGE MEDICATIONS: The discharge medications will be completed at discharge summary addendum. FOLLOW-UP PLAN: Follow-up plans will be completed at discharge summary addendum. [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3812**] Dictated By:[**Last Name (NamePattern1) 11801**] MEDQUIST36 D: [**2105-1-5**] 07:46 T: [**2105-1-9**] 04:52 JOB#: [**Job Number 37961**] ICD9 Codes: 5990, 3572
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7102 }
Medical Text: Admission Date: [**2162-7-5**] Discharge Date: [**2162-7-11**] Date of Birth: [**2103-3-2**] Sex: F Service: ORTHOPAEDICS Allergies: Sulfa (Sulfonamides) / Methadone Attending:[**First Name3 (LF) 64**] Chief Complaint: airway observation s/p RTKA Major Surgical or Invasive Procedure: R TKR History of Present Illness: This is a 59 yo F with a past medical history significant for OSA, morbid obesity, COPD and hypogammaglobulinemia who was admitted today for right total knee replacement. This morning, she received a dose of IVIG, did well intra and postoperatively, however, she is admitted to the [**Hospital Unit Name 153**] for observation of her airway postoperatively given her history of angioedema in [**10-22**]. This was of unclear etiology but thought due to medications and did not require intubation. . In the PACU, her vitals were T 97.6, BP 120/70, HR 50's, RR 10-15 satting in the mid 90's on 2L by NC. On arrival to the [**Hospital Unit Name 153**], she is on a ketamine gtt, she is alert and communicative and complains of very mild pain in her right knee. As indicated above; pt was admitted to orthopaedic surgery for R TKA. She was admitted one day early for her extensive PMH including infusion of IVIG. Past Medical History: PMH: Hypogammaglobulinemia and chronic severe urticaria treated with IVIG infusions OSA Morbid Obesity- BMI of 43 NIDDM COPD Autoimmune Hypothyroidism s/p gastric bypass prolonged QT interval and possibly with syncopal episodes migraines history of angioedema - autoimmune urticaria/angioedema syndrome GERD fibromyalgia Hypercholesterolemia h/o recurrent pneumonias DJD back . PSH: s/p TKR on the left Social History: no tobacco, etoh, illicits Family History: Father died of "blocked arteries. No family history of sudden death. Physical Exam: Vitals: 97.8 134/82 67 23 100%2L NC General: Obese 59 yo F, alert, NAD HEENT: EOMI, PERRL, anicteric. OP clear, MM dry, edentulous. Unable to assess JVP given habitus. Chest: Distant heart sounds, RRR no m/r/g Lungs: Small lung volumes, clear to auscultation anteriorly/laterally Abd: obese, soft, NT/ND +BS Ext: no e/c/c, wwp Skin: warm and dry, no rashes Neuro: CN II-XII in tact bilaterally, sensation to LT in tact bilaterally, motor [**4-19**] on upper and LLE, can wiggle toes on RLE. RLE in CPM. Ortho Exam: Wound c/d/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 938**]/TA/GS intact minimal SSD minimal ecchymosis Pertinent Results: [**2162-7-5**] 02:50PM WBC-11.5* RBC-4.33 HGB-12.9 HCT-38.4 MCV-89 MCH-29.8 MCHC-33.6 RDW-13.8 [**2162-7-5**] 02:50PM GLUCOSE-144* UREA N-7 CREAT-0.7 SODIUM-141 POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-24 ANION GAP-19 COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2162-7-7**] 03:25AM 7.1 3.04*# 9.0*# 27.1*# 89 29.8 33.4 13.6 152 RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2162-7-7**] 03:25AM 100 6 0.5 140 3.2*1 109* 22 12 [**2162-7-8**] 06:30AM BLOOD WBC-8.2 RBC-3.16* Hgb-9.3* Hct-27.7* MCV-88 MCH-29.6 MCHC-33.8 RDW-13.5 Plt Ct-152 [**2162-7-7**] 03:25AM BLOOD WBC-7.1 RBC-3.04*# Hgb-9.0*# Hct-27.1*# MCV-89 MCH-29.8 MCHC-33.4 RDW-13.6 Plt Ct-152 [**2162-7-5**] 02:50PM BLOOD WBC-11.5* RBC-4.33 Hgb-12.9 Hct-38.4 MCV-89 MCH-29.8 MCHC-33.6 RDW-13.8 Plt Ct-236 [**2162-7-5**] 02:50PM BLOOD Neuts-85.5* Lymphs-11.5* Monos-2.6 Eos-0.3 Baso-0.1 [**2162-7-8**] 06:30AM BLOOD Plt Ct-152 [**2162-7-7**] 03:25AM BLOOD Plt Ct-152 [**2162-7-8**] 06:30AM BLOOD Glucose-124* UreaN-8 Creat-0.7 Na-139 K-4.1 Cl-101 HCO3-33* AnGap-9 [**2162-7-7**] 03:25AM BLOOD Glucose-100 UreaN-6 Creat-0.5 Na-140 K-3.2* Cl-109* HCO3-22 AnGap-12 [**2162-7-7**] 03:25AM BLOOD Calcium-6.8* Phos-3.3 Mg-1.4* [**2162-7-5**] 02:50PM BLOOD Calcium-9.3 Phos-3.9 Mg-1.5* Brief Hospital Course: 59 y/o F with MMP including hypogammaglobulinemia, prolonged QT syndrome, OSA and morbid obesity admitted for airway observation s/p right TKR in light of past h/o angioedema. . # Airway mgmt ?????? No s/sx airway compromise, edema post-op; patient is comfortable with minimal O2 requirement. Stable for transfer out of ICU. -cont. outpatient dose of prednisone . # s/p right TKR: Pain well controlled -plan per surgical team ?????? ketamine gtt, dilaudid PCA . # prolonged QT ?????? EKG on admission QTc 469, borderline; no arrhythmias on tele -repleted K, Mg PRN . # COPD: continue albuterol, singulair, prednisone. . #. Hypogammaglobulinemia: Received IVIG the morning prior to surgery. No acute issues. . #. NIDDM: Continue metformin, insulin sliding scale. Diabetic diet. . #. Hypothyroidism: continue levothyroxine. . #. GERD: omeprazole. . #. F/E/N: Diabetic diet. Euvolemic. ADDENDUM. The patient was admitted on [**2162-7-5**] for preop optimization and IVIG infusion and taken to the operating room by Dr. [**Last Name (STitle) **] where the patient underwent R TKA. The procedure was well tolerated and there were no complications. Please see the separately dictated operative report for details regarding the surgery. The patient was subsequently transferred to the post-anesthesia care unit in stable condition and transferred to the [**Hospital Unit Name 153**] later that day for observation of her airway given he hx of angioedema and complicated medical hx. Overnight, the patient was placed on a PCA for pain control w/ ketamin drip as per the pain service. IV antibiotics were continued for 24 hours postoperatively as per routine. Lovenox was started the morning of postop day 1 for DVT prophylaxis. The patient was placed in a CPM machine with range of motion set at 0-45 degrees of flexion up to 90 degrees as tolerated. The drain was removed without incident. The patient was weaned off of the PCA and ketamin onto oral pain medications. The Foley catheter was removed without incident. The surgical dressing was also removed, and the surgical incision was found to be clean, dry, and intact without erythema nor purulent drainage. During the hospital course the patient was seen daily by physical therapy. Labs were checked both post-operatively and throughout the hospital course and repleted accordingly. The patient was tolerating regular diet and otherwise feeling well. Prior to discharge the patient was afebrile with stable vital signs. Hematocrit was stable and pain was adequately controlled on a PO regimen. The operative extremity was neurovascularly intact and the wound was benign. The patient was discharged to home with service or rehabilitation in a stable condition. Medications on Admission: singulair 10 amlodipine 5 propanolol 80 cyclobenzaprine 20 qhs lunesta 2 qhs hydroxyzine 25 1-2q4-6prn darvocet prn Potassium Chloride 10 meq daily bumex 1 simvastatin 20 zyrtec prn prednisone 20 zantac prn cellcept [**Pager number **] metformin 500 neurontin 300 levothyroxine 88 rhinoocort prn prilosec 20 amerge 2.5 prn for headache proventil Discharge Medications: 1. Budesonide 32 mcg/Actuation Aerosol Sig: One (1) Nasal prn (). 2. Naratriptan 2.5 mg Tablet Sig: One (1) Tablet PO prn (). 3. Lovenox 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous once a day for 3 weeks. 4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily) for 2 weeks. 7. Multivitamin,Tx-Minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Prednisolone Oral 9. Prilosec OTC 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 10. Cyclobenzaprine 10 mg Tablet Sig: Two (2) Tablet PO QHS (once a day (at bedtime)). 11. Hydroxyzine HCl Oral 12. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as needed for allergy symptoms. 13. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Proventil HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: [**12-16**] Inhalation Q4H (every 4 hours) as needed for for SOB or wheezing. 15. Darvocet-N 100 Oral 16. Simvastatin Oral 17. Propranolol Oral 18. CellCept Oral 19. Potassium Chloride Oral 20. Metformin Oral 21. Amlodipine Oral 22. Singulair Oral 23. Lunesta Oral 24. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO QID (4 times a day). 25. Bumetanide Oral 26. Zantac Maximum Strength Oral 27. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for contipation. 28. Hydromorphone 2 mg Tablet Sig: 2-3 Tablets PO Q3H (every 3 hours) as needed for pain. MEDICATIONS: VERY IMPORTANT - pt has extensive list of medications and she likes to take her own medications. She is responsible and knowledgeable about her condition. We gave her the permission to take her own meds while she is here at the hospital. From orthopaedic perspective, she should take her daily dilaudid (4-6mg q3h prn) pain medication prn along with darvocet (2 tabs) as long as she tolerates both. Dilaudid should be weaned off as pain improves. She must also take lovenox injections (40mg SC) x 4 wks for DVT px. Calcium, and vitamin D supplements were given along with Iron pills (x2 weeks) to stimulate blood production. While these supplements are recommended, they are not absolutely necessary. Pt should go back on all her home medication. At the time of this review, pt was tolerating all medication as listed on this d/c summary. Discharge Disposition: Extended Care Facility: Rehab Hospital Of [**Doctor Last Name **] Discharge Diagnosis: OA Discharge Condition: stable Discharge Instructions: should experience: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers >101.5, shaking chills, redness or drainage at the incision site, chest pain, shortness of breath or any other concerns. 2. Please follow up with your PCP regarding this admission and any new medications and refills. 3. Resume your home medications unless otherwise instructed. 4. You have been given medications for your pain control. Please do not operate heavy machinery or drink alcohol when taking these medications. As your pain improves, please decrease the amount of pain medication. This medication can cause constipation, so you should drink plenty of water daily and take a stool softener as needed to prevent this side effect. 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 can get the wound wet or take a shower starting 5 days after surgery, but no baths or swimming for at least 4 weeks. No dressing is needed if wound continued to be non-draining. Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment, by your PCP or at rehab. 7. Please call your surgeons/doctors office to [**Name5 (PTitle) **] or confirm your follow-up appointment. 8. Please DO NOT take any NSAIDs (i.e. celebrex, ibuprofen, advil, motrin, etc). ANTICOAGULATION: Please take lovenox injections (40mg) once a day x 4 weeks. WOUND CARE: Keep your incision clean and dry. Okay to shower after POD#5 but do not tub-bath or submerge your incision. Please place a dry sterile dressing to the wound each day if there is drainage, leave it open to air. Check wound regularly for signs of infection such as redness or thick yellow drainage. Staples will be removed by VNA in 2 weeks. If you are going to rehab, then rehab can remove staples at 2 weeks. ACTIVITY: Weight bearing as tolerated to operative leg, and CPM machine advance as tolerated. No strenuous exercise or heavy lifting until follow up appointment, at least. VNA (after home): Home PT/OT, dressing changes as instructed, and wound checks, staple removal in 2 weeks after surgery. MEDICATIONS: VERY IMPORTANT - pt has extensive list of medications and she likes to take her own medications. She is responsible and knowledgeable about her condition. We gave her the permission to take her own meds while she is here at the hospital. From orthopaedic perspective, she should take her daily dilaudid (4-6mg q3h prn) pain medication prn along with darvocet (2 tabs) as long as she tolerates both. Dilaudid should be weaned off as pain improves. She must also take lovenox injections (40mg SC) x 4 wks for DVT px. Calcium, and vitamin D supplements were given along with Iron pills (x2 weeks) to stimulate blood production. While these supplements are recommended, they are not absolutely necessary. Pt should go back on all her home medication. At the time of this review, pt was tolerating all medication as listed on this d/c summary. Physical Therapy: WBAT. Treatments Frequency: should experience: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers >101.5, shaking chills, redness or drainage at the incision site, chest pain, shortness of breath or any other concerns. 2. Please follow up with your PCP regarding this admission and any new medications and refills. 3. Resume your home medications unless otherwise instructed. 4. You have been given medications for your pain control. Please do not operate heavy machinery or drink alcohol when taking these medications. As your pain improves, please decrease the amount of pain medication. This medication can cause constipation, so you should drink plenty of water daily and take a stool softener as needed to prevent this side effect. 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 can get the wound wet or take a shower starting 5 days after surgery, but no baths or swimming for at least 4 weeks. No dressing is needed if wound continued to be non-draining. Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment, by your PCP or at rehab. 7. Please call your surgeons/doctors office to [**Name5 (PTitle) **] or confirm your follow-up appointment. 8. Please DO NOT take any NSAIDs (i.e. celebrex, ibuprofen, advil, motrin, etc). ANTICOAGULATION: Please take lovenox injections (40mg) once a day x 4 weeks. WOUND CARE: Keep your incision clean and dry. Okay to shower after POD#5 but do not tub-bath or submerge your incision. Please place a dry sterile dressing to the wound each day if there is drainage, leave it open to air. Check wound regularly for signs of infection such as redness or thick yellow drainage. Staples will be removed by VNA in 2 weeks. If you are going to rehab, then rehab can remove staples at 2 weeks. ACTIVITY: Weight bearing as tolerated to operative leg, and CPM machine advance as tolerated. No strenuous exercise or heavy lifting until follow up appointment, at least. VNA (after home): Home PT/OT, dressing changes as instructed, and wound checks, staple removal in 2 weeks after surgery. MEDICATIONS: VERY IMPORTANT - pt has extensive list of medications and she likes to take her own medications. She is responsible and knowledgeable about her condition. We gave her the permission to take her own meds while she is here at the hospital. From orthopaedic perspective, she should take her daily dilaudid (2-4mg q3h prn) pain medication prn along with darvocet as long as she tolerates both. Dilaudid should be weaned off as pain improves. She must also take lovenox injections (40mg SC) x 4 wks for DVT px. Calcium, and vitamin D supplements were given along with Iron pills (x2 weeks) to stimulate blood production. While these supplements are recommended, they are not absolutely necessary. Pt should go back on all her home medication. At the time of this review, pt was tolerating all medication as listed on this d/c summary. Followup Instructions: Provider: [**First Name8 (NamePattern2) 4599**] [**Last Name (NamePattern1) 9856**], [**MD Number(3) 3261**]:[**Telephone/Fax (1) 1228**] Date/Time:[**2162-8-6**] 11:40 ICD9 Codes: 496, 2449, 2720
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Medical Text: Admission Date: [**2154-9-9**] Discharge Date: [**2154-9-14**] Date of Birth: [**2085-7-20**] Sex: M Service: SURGERY Allergies: Ceftriaxone / Cartia Xt / Hydroxyzine Attending:[**First Name3 (LF) 2597**] Chief Complaint: Left infected Charcot foot Major Surgical or Invasive Procedure: [**2154-9-10**] Left Below the knee amputation History of Present Illness: This 69-year-old gentleman with dialysis dependent renal failure, longstanding diabetes mellitus, and peripheral neuropathy, has bilateral Charcot foot deformity. He has had a Charcot foot reconstruction on the left. This became unstable again, chronically infected from osteomyelitis and he now has a flail ankle which is non- salvageable. He was advised to have a below-the-knee amputation. Past Medical History: 1. DM2 complicated by retinopathy, nephropathy, neuropathy 2. ESRD (recent baseline Cr 7-7.5). HD M/W/F. 3. HTN 4. Hyperlipidemia 5. Paralyzed right hemidiaphragm s/p MVA [**2135**] 6. OSA on CPAP 11, secondary to #5 per pt 7. h/o syncope, has implanted event recorder x2yrs. 8. Glaucoma Social History: Lives at home with wife on [**Hospital3 **]. Owns a construction company. Denies EtOH/TOB/IVDU. Family History: Mom died from DM complications. Has 1 sister and 3 children - healthy. Physical Exam: Afebrile/VSS Gen: no distress, alert and oriented x 3 HEENT: PERLA, EOMI, anicteric Neck: no bruits heard Chest: RRR, lungs clear Abdomen: soft, nontender, nondistended Ext: rigth foot warm well perfused, left BKA stump incision clean and dry, no erythema, there is minimal ecchymoses, minimal edema . Pulses: palpable femorals bilaterally, doppler signals in right foot Pertinent Results: [**2154-9-13**] 08:15AM BLOOD WBC-11.2* RBC-3.99* Hgb-10.2* Hct-32.8* MCV-82 MCH-25.6* MCHC-31.2 RDW-16.4* Plt Ct-332 [**2154-9-12**] 06:25AM BLOOD WBC-9.6 RBC-4.01* Hgb-10.4* Hct-33.5* MCV-84 MCH-26.0* MCHC-31.1 RDW-16.4* Plt Ct-311 [**2154-9-9**] 05:30PM BLOOD Neuts-82.0* Lymphs-9.3* Monos-5.8 Eos-2.6 Baso-0.3 [**2154-9-13**] 08:15AM BLOOD Plt Ct-332 [**2154-9-13**] 08:15AM BLOOD Glucose-143* UreaN-51* Creat-7.1*# Na-136 K-4.2 Cl-93* HCO3-33* AnGap-14 [**2154-9-11**] 10:00AM BLOOD CK(CPK)-63 [**2154-9-11**] 03:15AM BLOOD ALT-52* AST-60* AlkPhos-192* TotBili-0.6 [**2154-9-13**] 08:15AM BLOOD Calcium-8.1* Phos-5.6* Mg-2.3 [**2154-9-13**] 08:15AM BLOOD Vanco-21.7* [**2154-9-11**] 10:10AM BLOOD Type-ART pO2-100 pCO2-57* pH-7.33* calTCO2-31* Base XS-1 Intubat-NOT INTUBA [**2154-9-11**] 06:39AM BLOOD O2 Sat-98 [**2154-9-11**] 01:35AM BLOOD freeCa-1.04* CXR [**2154-9-10**] 6:33 PM IMPRESSION: Mild dependent pulmonary edema changed in distribution but not in overall severity since [**9-9**]. Greater opacification in the left lower lobe could be atelectasis, with likely persistence of at least a small left pleural effusion. Heart size normal. Mediastinal contours are unremarkable. ET tube ends at the thoracic inlet. The caliber of the endotracheal tube may be small, since the diameter, 12 mm, is less than a half the coronal diameter of the trachea, 26 mm. Clinical assessment is indicated. Brief Hospital Course: Mr. [**Known lastname **] was admitted on [**9-9**] after his normal dialysis session for preoperative preparation for a left BKA. He underwent a successful Left BKA on [**2154-9-10**]. While still in the OR during emergence from anesthesia, he developed profound bradycardia and lost his blood pressure. Chest compressions were initiated. After a minute of compressions and a dose of atropine, his blood pressure returned to 120 systolic. Postoperatively the patient was kept intubated and transferred to the cardiovascular intensive care unit where he required Neosynephrine to maintain his blood pressure. He was quickly weaned off the Neo and extubated on POD1. His cardiac arrest was attributed to hypercarbia. The rest of the work up was normal. He underwent HD on POD1 and tolerated it well. He was then transferred to the VICU. On the floor, he remained hemodynamically stable with his pain controlled. He progressed with physical therapy to improve his strength and mobility. He continues to make steady progress without any incidents. He was discharged to a rehabilitation facility in stable condition. Medications on Admission: novolog SSI, nephrocap daily, asa 81mg daily, crestor 5mg daily, norvasc 2.5mg on non-HD days, lasix 80mg Fri/Sat/Sun, cosop 1 gtt ou [**Hospital1 **], alphagan 1 gtt os [**Hospital1 **], renvela 3200mg tid w/ meals, zoloft 100mg 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. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for sleep. 3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 4. Amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO 4X/WEEK ([**Doctor First Name **],TU,TH,SA). 5. Furosemide 80 mg Tablet Sig: One (1) Tablet PO 3X/WEEK ([**Doctor First Name **],FR,SA). 6. Sevelamer Carbonate 800 mg Tablet Sig: Four (4) Tablet PO EACH MEAL (). 7. Ranitidine HCl 150 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 8. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 11. Rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 13. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q4H (every 4 hours). 14. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 15. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 16. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day): take while not ambulatory and decreased mobility. 17. Ondansetron 4 mg IV Q8H:PRN nausea 18. Lantus 100 unit/mL Cartridge Sig: Five (5) units Subcutaneous once a day. 19. Insulin sliding scale Insulin SC Sliding Scale Breakfast Lunch Dinner Bedtime Humalog Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose 0-55 mg/dL 4 oz. Juice 4 oz. Juice 4 oz. Juice 4 oz. Juice 56-70 mg/dL 0 Units 0 Units 0 Units 0 Units 71-100 mg/dL 7 Units 5 Units 8 Units 0 Units 101-150 mg/dL 8 Units 6 Units 9 Units 0 Units 151-200 mg/dL 9 Units 7 Units 10 Units 0 Units 201-250 mg/dL 10 Units 8 Units 11 Units 0 Units 251-300 mg/dL 11 Units 9 Units 12 Units 2 Units 301-350 mg/dL 12 Units 10 Units 13 Units 4 Units 351-400 mg/dL 13 Units 11 Units 14 Units 5 Units >401 mg/dL 14 Units 12 Units 15 Units 6 Units 20. Amoxicillin/Clavulanate Sig: One (1) 500mg twice a day for 1 weeks. Discharge Disposition: Extended Care Facility: Rehab.hosp. of [**Location (un) **] & Islands-[**Location (un) 6251**] Discharge Diagnosis: Left non-healing charcole foot DM2 ESRD Hypertension Hyperlipidemia Glaucoma Discharge Condition: Stable Discharge Instructions: DISCHARGE INSTRUCTIONS FOLLOWING BELOW OR ABOVE KNEE AMPUTATION . This information is designed as a guideline to assist you in a speedy recovery from your surgery. Please follow these guidelines unless your physician has specifically instructed you otherwise. Please call our office nurse if you have any questions. Dial 911 if you have any medical emergency. . ACTIVITY: There are restrictions on activity. On the side of your amputation you are non weight bearing until cleared by your Surgeon. You should keep this amputation site elevated when ever possible. . You may use the other leg to assist in transferring and pivots. But try not to exert to much pressure on the amputation site when transferring and or pivoting. Please keep knee immobilizer on at all times to help keep the amputation site straight. . No driving until cleared by your Surgeon. . PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS: . Redness in or drainage from your leg wound(s) . . Watch for signs and symptoms of infection. These are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. If you experience any of these or bleeding at the incision site, CALL THE DOCTOR. . Exercise: . Limit strenuous activity for 6 weeks. Do not drive a car unless cleared by your Surgeon. Try to keep leg elevated when able. . BATHING/SHOWERING: . You may shower immediately upon coming home. No bathing. A dressing may cover you??????re amputation site and this should be left in place for three (3) days. Remove it after this time and wash your incision(s) gently with soap and water. You will have sutures, which are usually removed in 4 weeks. This will be done by the Surgeon on your follow-up appointment. . WOUND CARE: . Sutures / Staples may be removed before discharge. If they are not, an appointment will be made for you to return for staple removal. . When the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. These will stay on about a week and you may shower with them on. If these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. . Avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . MEDICATIONS: . Unless told otherwise you should resume taking all of the medications you were taking before surgery. You will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. . Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day. . Continue taking the antibiotic Augmentin for 1 week. . CAUTIONS: . NO SMOKING! We know you've heard this before, but it really is an important step to your recovery. Smoking causes narrowing of your blood vessels which in turn decreases circulation. If you smoke you will need to stop as soon as possible. Ask your nurse or doctor for information on smoking cessation. . Avoid pressure to your amputation site. No strenuous activity for 6 weeks after surgery. . DIET : . There are no special restrictions on your diet postoperatively. Poor appetite is expected for several weeks and small, frequent meals may be preferred. . For people with vascular problems we would recommend a cholesterol lowering diet: Follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. Additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. Since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and LDL (Low Density Lipoprotein-the bad cholesterol). Exercise will increase your HDL (High Density Lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. You may be self-referred or get a referral from your doctor. . If you are overweight, you need to think about starting a weight management program. Your health and its improvement depend on it. We know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. If interested you can may be self-referred or can get a referral from your doctor. . If you have diabetes and would like additional guidance, you may request a referral from your doctor. . FOLLOW-UP APPOINTMENT: . Be sure to keep your medical appointments. The key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. Things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. Don't let them go untreated! . Please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. This should be scheduled on the calendar for seven to fourteen days after discharge. Normal office hours are 8:30-5:30 Monday through Friday. . PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE Followup Instructions: Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2154-10-14**] 1:20 ICD9 Codes: 5856, 9971, 4275, 2724
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Medical Text: Admission Date: [**2171-9-19**] Discharge Date: [**2171-10-22**] Date of Birth: [**2106-9-24**] Sex: M CHIEF COMPLAINT: Decreased p.o. intake and refusing to eat. HISTORY OF PRESENT ILLNESS: The patient is a 65-year-old male resident of [**Hospital3 **] Home who has had a history several week history of refusal to eat, refusal to take after hydration, the patient was discharged to [**Hospital 48910**] Hospital inpatient Psychiatry. The patient was recently discharged from [**Hospital 48910**] Hospital and presented to [**Hospital3 36255**] Home on [**2171-9-16**]. The patient was again refusing to eat and take medications. The patient also the patient with poor effort. The patient also complained of "paralysis." Apparently, the patient lost function of his MRI revealed white matter changes in the frontal lobe at [**Hospital 48910**] Hospital. The patient denies fever. Occasional diffuse abdominal pain. The patient does not recall last bowel movement. The patient denies headache or chest pain. The patient complains of being very thirsty. The patient has a longstanding psychiatry history labeled as psychotic depression, schizoaffective disorder, with a long history of resistance and refusal of medical care. He was referred to [**Hospital1 69**] on [**8-7**] for refusal to eat or drink and take medications at his previous nursing home, Sun Bridge [**Location (un) **]. He was rehydrated and after two days was transferred to [**Hospital 48910**] Hospital for inpatient psychiatry. They reported that he began to eat more, and a guardian was obtained. The patient was found to be incompetent by the courts, and when guardianship was obtained the patient's son [**First Name8 (NamePattern2) **] [**Name (NI) **]) was not available at that time. The patient was then transferred to [**Hospital3 **] Home on [**9-16**], but since arrival had refused to eat or take medications. He was only taking sips of fluid. Of note, has had loss of function of his lower extremities for unclear reasons. MRI of the head at [**Hospital 48910**] Hospital revealed small vessel disease and white matter changes predominantly in the front lobe. There was a question of whether multiple sclerosis could be involved in this patient, but the patient refused further workup. PAST MEDICAL HISTORY: 1. Depression with psychotic features. 2. Questionable parkinsonian feature; it was thought that perhaps patient's neurodegenerative disease may be related to antipsychotic medication. The patient did not respond to a trial of Sinemet. 3. Osteoarthritis. 4. Stage I decubitus ulcer in coccyx. MEDICATIONS ON ADMISSION: Zyprexa 2.5 mg p.o. q.d., Haldol 0.5 mg intramuscularly, zinc sulfate 220 mg p.o. q.d., vitamin C 500 mg p.o. q.d., Klonopin 0.25 mg q.8.h., multivitamin, Colace. Of note, the patient is refusing to take all of these medications. ALLERGIES: No known drug allergies. SOCIAL HISTORY: The patient's guardian is [**Name (NI) **] [**Name (NI) 36260**] (telephone number [**Telephone/Fax (1) 36257**]). The patient's son is not the patient's decision maker. The patient's estranged wife ha s again reentered the picture. CODE STATUS: The patient has variably requested to be DNR, bu t the guardian is not comfortable with agreeing to a DNR/DNI status without it being court mandated because of the son does not agree with the DNR. The patient also has [**Doctor Last Name 7474**] treatment plan. PHYSICAL EXAMINATION ON ADMISSION: In general, the patient is a cachectic elderly man lying in bed with a flat affect. He was contracted in his lower extremities. Vitals were temperature of 100, heart rate of 100, blood pressure 120/70, oxygen saturation 95% on room air. HEENT revealed oropharynx was very dry. Pupils were equal, round, and reactive to light and accommodation. Neck was thin. No cervical lymphadenopathy. Chest was a poor anterior examination, positive rhonchi anteriorly. Cardiovascular had a regular rate and rhythm. Normal S1 and S2 and tachycardic. Abdomen had hypoactive bowel sounds, soft, nontender, and nondistended, scaphoid. Extremities were extremely cachectic, early ulcers over heels. Neurologically, the patient was alert and oriented times three, answered questions appropriately. Cranial nerves II through XII were grossly intact, uncooperative with examination. Rigid upper extremity and lower extremity, would not spontaneously move upper or lower extremities. LABORATORY DATA ON ADMISSION: White blood cell count 19.1, hematocrit 38, platelets 87, MCV 84, 87% neutrophils, 6% lymphocytes, 5% monocytes. INR 1.3, PT 13.9, PTT 25.5. Sodium 144, potassium 3.7, chloride 103, bicarbonate 24, BUN 22, creatinine 0.5, glucose 112. Blood cultures times two were negative. RPR negative. TSH 1.4. Albumin 3.3. B12 1076, folate 11.8. RADIOLOGY/IMAGING: X-ray revealed left retrocardiac opacity suggestive of aspiration pneumonia. Electrocardiogram revealed Q waves inferiorly, T wave inversions in II, III, aVF, V3 through V6. ST elevations in V2 of 2 mm, poor R wave progression. HOSPITAL COURSE: In summary, this is a 65-year-old male with psychotic depression and schizoaffective disorder, who presented with decreased oral intake and aspiration pneumonia. 1. ASPIRATION PNEUMONIA: The patient was treated with 14 days of intravenous levofloxacin and Flagyl. The patient had intermittent episodes of desaturations to the 70% and 80%. These desaturations were thought to be due to aspirations because they resolved with aggressive suctioning. The patient is currently on 3 liters of nasal cannula, but most likely will be weaned down to room air. 2. NUTRITION: The patient has been refusing p.o. intake since hospitalization. Partial parenteral nutrition was considered; however, it would not contribute to the patient's comfort and would only provide at the maximum of 25% of the patient's daily needs. Since the patient was refusing laboratory draws, it was also thought unwise to start partial parenteral nutrition without being able to monitor the patient for refeeding syndrome. The patient is being maintained with D-5 normal saline with 40 mEq of [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] at 100 cc per hour. The patient has largely been refusing p.o. intake but has on occasion taken sips of Boost. 3. PSYCHOTIC DEPRESSION: The patient was evaluated by Psychiatry on admission. Since he was refusing all medications it was thought that the patient could be a candidate for electroconvulsive therapy treatment. The patient was evaluated by anesthesia who felt that the patient could not undergo electroconvulsive therapy without being intubated. It was thought, however, that if the patient was intubated he may not be able to be weaned off of the ventilator. Also, since electroconvulsive therapy treatment requires multiple treatments over several days, it was felt that intubating the patient for this period of time would be unsafe. It was then suggested that the patient Zyprexa dissolvable wafer; however the patient still refused to take the Zyprexa. 4. NEUROLOGY: It was clear that the patient was suffering from a neurodegenerative disease, but at this point it appears that it is end-stage. The patient had refused MRI, and although the guardian had given approval for a MRI, the MRI was not able to be performed because the patient's son had interfered. It was also felt that the patient would have to be sedated to under MRI, and it was felt that considering the patient's tenuous pulmonary status that he would not be able to be sedated safely. Neurology suggested prescribing Sinemet. The patient has been refusing Sinemet during this hospitalization. They also suggested a voiding antipsychotic such as Haldol which may causes exacerbation of the patient's contracted state. The patient has been refusing further workup of his neurodegenerative disease. During this entire hospitalization, the patient has been refusing the majority of care. The patient is at times verbally abusive. An court decision regarding DNR/DNI comfort measures was pursued. The end result was that the patient died in the hospital, due to inanition and respiratory failure. DISCHARGE DIAGNOSES: 1. Psychotic depression. 2. Neurodegenerative disease of unclear etiology. CONDITION AT DISCHARGE: Deceased DISCHARGE STATUS: deceased [**Last Name (LF) **],[**First Name3 (LF) 2671**] E. M.D. [**MD Number(1) 2673**] Dictated By:[**Last Name (NamePattern1) 218**] MEDQUIST36 D: [**2171-10-8**] 18:44 T: [**2171-10-10**] 19:20 JOB#: [**Job Number 93466**] 1 1 1 R ICD9 Codes: 5070, 2765, 2761, 2875
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7105 }
Medical Text: Admission Date: [**2199-7-4**] Discharge Date: [**2199-7-24**] Date of Birth: [**2125-4-12**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 759**] Chief Complaint: Cellulitis Major Surgical or Invasive Procedure: Intubation PICC line placed on [**7-8**] History of Present Illness: This is a 74 y.o. female with diabetic neuropathy and chronic lower extremity edema who was evaluated and treated in the ER on [**6-26**] for lower extremity cellulitis. At that time she was discharged on 2 week regimen of PO Augmentin. She was readmitted today since her symptoms did not improve on this regimen. She denies any fevers or chills. She reports ulceration and purulent drainage from ulcers. She denies any pain but reports that her sensation is markedly decreased in her lower extremities due to neuropathy. She denies any nausea, vomitting, diarrhea, abdominal pain, chest pain or shortness of breath. Past Medical History: Chronic atrial fibrillation. Colon cancer [**2187**] s/p colectomy, treatment with 5-FU, in remission since. DM-II x 10 years, has peripheral neuropathy, microalbuminuria. Most recent Hgb A1c 6.2 in [**10-6**]. HTN Hyperlipidemia PVD s/p bilateral fem [**Doctor Last Name **] bypasses Bilateral cataracts Obstructive sleep apnea Urge incontinence Social History: Patient is retired and formerly worked at [**Location (un) 8599**]Hospital in computers. She has never married and currently lives alone in senior housing in [**Location (un) 686**]. She has several close friends that help her with her shopping and getting to appointments. She has a remote smoking and alcohol history (puffed an occasional cigarette in social gatherings 50 years ago) denies any illict drug use. Family History: Brother - liver cancer. Sister - colon cancer. Physical Exam: Vitals:BP:160/64 HR:86 RR:20 Tc:98.8 O2Sat:98.8 General:A&O x3, NAD HEENT:EOMI, Sclera anicteric, MMM, no rhinorrhea or epistaxis, clear oropharynx. Neck:Supple, no JVD Chest: Lungs CTAB, no wheezes, rales or rhonchi Cardiovascular: RRR, nl S1 and S2, no M/G/R Abdomen: Soft, NT, ND, +BS, no HSM Extremities: +1 pitting edema bilaterally. Sensation decreased bilaterally. Bilateral lower extremity stasis changes and erythema/warmth overlying anterior legs bilaterally. Ulcerations present between 1st and 2nd interdigital spaces and on anterior shin. Pertinent Results: [**2199-7-8**] 05:35AM BLOOD WBC-12.8* RBC-3.12* Hgb-8.1* Hct-24.0* MCV-77* MCH-25.8* MCHC-33.5 RDW-15.4 Plt Ct-276 [**2199-7-9**] 01:00AM BLOOD PT-14.1* PTT-117.7* INR(PT)-1.3* [**2199-7-8**] 05:35AM BLOOD Glucose-83 UreaN-36* Creat-1.5* Na-139 K-4.1 Cl-102 HCO3-28 AnGap-13 [**2199-7-8**] 05:35AM BLOOD Calcium-8.8 Phos-5.2* Mg-2.3 [**2199-7-7**] 05:35AM BLOOD TSH-2.5 [**2199-7-7**] 05:35AM BLOOD Free T4-1.2 [**2199-7-8**] 05:35AM BLOOD Digoxin-1.2 . Echo: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The right ventricular cavity is dilated. Right ventricular systolic function is normal. [Intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation.] The aortic valve leaflets (3) are mildly thickened. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is severe pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the prior study (images reviewed) of [**2198-1-4**] estimated pulmonary artery systolic pressure is now higher. . CXR [**7-19**]: 1. Increased interstitial markings, nonspecific in appearance. Differential diagnosis includes CHF or other interstitial processes. The appearance is likely accentuated by low inspiratory volumes. 2. Bibasilar atelectasis and small effusions. An early infiltrate would be difficult to exclude in this setting. 3. There has been some interval clearing of the left base compared with [**2199-7-17**]. Otherwise, no significant change is identified. 4. PICC line tip difficult to visualize. 3. ET tube and NG tube removed compared with [**2199-7-17**]. Brief Hospital Course: 74 yo F with DM, HTN, AFib presents with LLE cellulitis, refractory to oral Abx. . #. Respiratory distress/decreased oxygen saturation: Pt noted to have decreased oxygendation saturations on HD #[**1-5**], dropping into the 70s while on RA with improvement to the 90s on oxygen. On HD #6, pt was sent to the ICU for hypoxia and for initiation of BiPAP with the thought that OSA was contributing to the hypoxia. During her ICU stay, pt developed worsening hypoxia. She was initially treated empirically for a PE with a heparin drip but this was stopped after a VQ scan was low probability. Due to increasing hypoxia and resp distress, she was intubated. due to CHF, aspiration pneumonia and OSA. She was diuresed with a lasix drip, treated with cipro and vancomycin for possible aspiration pneumonia and she was successfully extubated on HD#14 after eight days. She did well and was sent to the floor. On the floor, she still required 6L of O2 to maintain sats in the low 90s. She continued to be diuresed with 80mg of IV lasix [**Hospital1 **] but when her urine output dropped, Diuril was added to the lasix, 30 minutes before. Her BP was controlled as below. She diuresed 1-1.5L per day and her creatinine remained stable at her baseline of 1.5-1.7. She should continue to be diuresed with lasix and diuril to maintain goal of 1L negative per day. She was treated with 14 days of vanc and 10 days of cipro for her aspiration PNA. . # Obstructive Sleep apnea: Pt had been on CPAP 3 years ago but discontinued due to repeatedly having to take the mask off at night due to urinary incontinence and repeated trips to the bathroom. As above, it was thought that OSA was contributing to her hypoxia but she was not tried on BiPAP while in ICU. We attempted to try mask on the floor but she did not tolerate. Pt would benefit from additional sleep study testing as an outpatient. . # Hypertension: Pt's BP was difficult to control in the hospital. She cannot tolerate beta blockers due to bradycardia. She was continued on diltiazem, norvasc, lisinopril and hydralazine. Her hydralazine was discontinued due to poor outpatient choice for BP control and clonidine patch was started. Due to bradycardia, her diltiazem was decreased to 60mg qid and clonidine patch increased. She tolerated these adjustments well and her BP was stable in the 130s/80s. . # Afib: Pt is chronically in afib but has refused anticoagulation. She is very well rate controlled on calcium channle blocker. Her digoxin was stopped as it was thought that is was not needed for rate control and is not indicated for her diastolic heart failure. . # Cellulitis: Cellulitis not resolving with outpatient PO amoxicillin/clavulanate. Pt. is afebrile, hemodynamically stable, with white count trending upwards. Wound Cx positive for and treated for Pseudomonas sensitive to Ciprofloxacin. Bilateral LE US to r/o DVT was negative. She was treated for 10 days with ciprofloxacin. Podiatry followed patient while in house. . #. Acute on chronic renal failure: On admission, creatinine increased to 1.5 from baseline of 1.3-1.4. This increased to 2.0 and her lasix was held due to thought of volume depletion. With some fluids and holding renally cleared meds, creatinine stabilized to 1.5-1.6. This remained stable even with reinitiation of lasix and ACE. She likely requires a higher creatinine to maintain euvolemic state. . # DM: Pt with some episodes of asymptomatic hypoglycemia while in house. Her 70/30 was titrated to decrease hypoglycemia. . #. Urinary incontinence: Foley was kept in to watch I2 and Os carefully. Oxybutynin was stopped due to foley and incidence of orthostatic hypotension. . # Diarrhea: cdiff negative. Likely due to antibiotic associated diarrhea. . #. Anemia: Stable at 27-28. . # Acccess: PICC placed on [**2199-7-8**] . Code status: Full Code Medications on Admission: ASPIRIN 81MG daily COLACE 100MG daily DIGOXIN 250MCG daily DITROPAN XL 15MG daily GLIPIZIDE 2.5 mg daily LASIX 20 mg daily LIPITOR 10 mg daily LISINOPRIL 40MG daily MULTIVITAMIN daily NORVASC 10 mg NOVOLIN 70/30 30u am, 24u pm NOVOPEN 3 Discharge Medications: 1. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Clotrimazole 1 % Solution Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q4H (every 4 hours) as needed. 6. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q4H PRN (). 7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Chlorothiazide 250 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): give 30 minutes prior to lasix. 11. Clonidine 0.2 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly Transdermal QMON (every Monday). 12. Diltiazem HCl 240 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO once a day. 13. Insulin NPH-Regular Human Rec 100 unit/mL (70-30) Cartridge Sig: as directed units Subcutaneous twice a day: 20U qam, 15U qpm. 14. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: as directed units Subcutaneous four times a day: per sliding scale. 15. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) injection Injection TID (3 times a day). 16. Furosemide 10 mg/mL Solution Sig: Eighty (80) mg Injection [**Hospital1 **] (2 times a day). Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: Primary Diagnosis: 1. diastolic heart failure 2. aspiration pneumonia 3. Pseudomonas cellulitis 4. Acute on chronic renal failure 5. Obstructive sleep apnea 6. Antibiotic associated diarrhea 7. Anemia of chronic disease 8. Hypertension Discharge Condition: Stable, afebrile, tolerating po, satting 100% on 6L Discharge Instructions: You were admitted with cellulitis and had several problems with your breathing due to fluid in the lungs and pneumonia. Please watch your salt intake and weight yourself every day. Call your physician if your weight increased by more than 2lbs in one day. Please contact your physician or return to the Emergency Department if you notice fevers > 101.5, chest pain, shortness of breath, worsening of the leg rash, or any other worrisome symptoms. Followup Instructions: Please follow up with your primary care provider [**Name Initial (PRE) 176**] 1 week. Provider: [**First Name4 (NamePattern1) 247**] [**Last Name (NamePattern1) 248**], MD Phone:[**Telephone/Fax (1) 250**] Completed by:[**2199-7-24**] ICD9 Codes: 5070, 5849, 3572, 4439
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Medical Text: Admission Date: [**2161-1-29**] Discharge Date: [**2161-2-7**] Date of Birth: [**2076-8-2**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: Mitral valve replacement with a [**Street Address(2) 12523**]. [**Hospital 923**] Medical Biocor Epic tissue valve. History of Present Illness: 83 year old male with recent dyspnea with exertion and edema lower extremities that has improved with lasix. Referred for cardiac catheterization due to mitral regurgitation found on echocardiogram, in preparation for cardiac surgery. Past Medical History: Hypertension Hyperlipidemia Severe mitral regurgitation/prolapse Atrial fibrillation, on Coumadin; last dose WED [**12-31**] Diabetes type II Prostate cancer- elevated PSA (not treated) Colon polyps s/p polypectomy Bilateral Inguinal hernia repair remote trauma to leg involving pitchfork Social History: Last Dental Exam: > 1 year Lives with:alone Occupation:retired mechanic shop owner Tobacco:denies ETOH:denies Family History: non contributory Physical Exam: Pulse: 78 Resp: 18 O2 sat: 100% B/P Right: 133/59 Left: 156/80 Height: 6' Weight: 160# General: no acute distress Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [] Full ROM [] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur: systolic ejection murmur best heart at the left sternal border radiating to both carotids. Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [] Extremities: Warm [x], well-perfused [x] no Edema; has bilateral varicosities Neuro: Grossly intact Pulses: Femoral Right: 2+ Left:2+ DP Right: 1+ Left: 1+ PT [**Name (NI) 167**]: 0 Left: 0 Radial Right: 2+ Left: + Carotid Bruit: left/right: referred cardiac murmur Pertinent Results: [**2161-2-7**] 06:40AM BLOOD WBC-6.2 RBC-4.18* Hgb-13.7* Hct-40.1 MCV-96 MCH-32.7* MCHC-34.0 RDW-14.6 Plt Ct-134* [**2161-2-7**] 06:40AM BLOOD PT-19.1* PTT-38.3* INR(PT)-1.7* [**2161-1-29**] 04:13PM BLOOD PT-15.5* PTT-28.9 INR(PT)-1.4* [**2161-2-7**] 06:40AM BLOOD Glucose-98 UreaN-31* Creat-1.0 Na-135 K-4.6 Cl-96 HCO3-31 AnGap-13 [**2161-1-29**] 04:13PM BLOOD Glucose-294* UreaN-33* Creat-1.1 Na-138 K-5.0 Cl-104 HCO3-27 AnGap-12 [**2161-1-29**] 04:13PM BLOOD ALT-17 AST-31 LD(LDH)-224 AlkPhos-112 Amylase-41 TotBili-1.0 Pulse: 78 Resp: 18 O2 sat: 100% B/P Right: 133/59 Left: 156/80 Height: 6' Weight: 160# General: no acute distress Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [] Full ROM [] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur: systolic ejection murmur best heart at the left sternal border radiating to both carotids. Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [] Extremities: Warm [x], well-perfused [x] no Edema; has bilateral varicosities Neuro: Grossly intact Pulses: Femoral Right: 2+ Left:2+ DP Right: 1+ Left: 1+ PT [**Name (NI) 167**]: 0 Left: 0 Radial Right: 2+ Left: + Carotid Bruit: left/right: referred cardiac murmur [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 89503**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 89504**] (Complete) Done [**2161-2-2**] at 1:19:08 PM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) **] R. [**Hospital1 18**], Division of Cardiothorac [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2076-8-2**] Age (years): 84 M Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: Intraoperative TEE for MV Repair vs replacement ICD-9 Codes: 428.0, 427.31, 424.0, 424.2 Test Information Date/Time: [**2161-2-2**] at 13:19 Interpret MD: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Name Initial (MD) **] [**Name8 (MD) 4901**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2011AW4-: Machine: U/S 3 Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Inferolateral Thickness: 1.0 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: *5.8 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 40% to 45% >= 55% Aorta - Annulus: 2.2 cm <= 3.0 cm Aorta - Ascending: 3.2 cm <= 3.4 cm Aorta - Descending Thoracic: 2.3 cm <= 2.5 cm Aortic Valve - LVOT diam: 2.2 cm Findings LEFT ATRIUM: Dilated LA. No spontaneous echo contrast in the body of the LA. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Mild spontaneous echo contrast in the LAA. Depressed LAA emptying velocity (<0.2m/s) All four pulmonary veins identified and enter the left atrium. RIGHT ATRIUM/INTERATRIAL SEPTUM: Dilated RA. 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. Normal LV wall thickness. Mildly dilated LV cavity. Normal regional LV systolic function. Mildly depressed LVEF. [Intrinsic LV systolic function likely depressed given the severity of valvular regurgitation.] RIGHT VENTRICLE: Dilated RV cavity. Moderate global RV free wall hypokinesis. AORTA: Focal calcifications in aortic root. Normal ascending aorta diameter. Focal calcifications in ascending aorta. Simple atheroma in aortic arch. Focal calcifications in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. Trace AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. Myxomatous mitral valve leaflets. Moderate/severe MVP. Partial mitral leaflet flail. Moderate mitral annular calcification. Calcified tips of papillary muscles. No MS. Eccentric MR jet. Severe (4+) MR. TRICUSPID VALVE: Tricuspid valve not well visualized. Mild to moderate [[**11-23**]+] TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. 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. No TEE related complications. The rhythm appears to be atrial fibrillation. Results were personally reviewed with the MD caring for the patient. Bilateral pleural effusions. Conclusions PRE BYPASS The left atrium is dilated. No spontaneous echo contrast is seen in the body of the left atrium. No mass/thrombus is seen in the left atrium or left atrial appendage. Mild spontaneous echo contrast is present in the left atrial appendage. The left atrial appendage emptying velocity is depressed (<0.2m/s). The right atrium is dilated. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is mildly depressed (LVEF= 40-45 %). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] The right ventricular cavity is dilated with moderate global free wall hypokinesis. There are simple atheroma in the aortic arch. There are focal calcifications 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. Trace aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. The mitral valve leaflets are myxomatous. There is bileaflet prolapse with a flail P2 segment and potentislly some A2 partial flail. An eccentric, anteriorly directed jet of severe (4+) 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 receiving milrinone and norepinephrine by infusion. The right ventricle displays normal systolic function. The left ventricle displays septal dyskinesis versus severe dysynchronous contraction which is new from the pre-bypass study. The rest of the LV segments are glbally, moderately depressed. Overall left ventricular ejection fraction is approximately 35%. There is a bioprosthesis located in the mitral position. It appears well seated. The leaflets have normal motion. There is trace valvular mitral regurgitation. The maximum gradient through the valve was 6 mmHg with a mean of 2 mmHg at a cardiac output of 3.5 liters/minute. The thoracic aorta is intact after decannulation. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2161-2-2**] 16:09 ?????? [**2152**] CareGroup IS. All rights reserved. Brief Hospital Course: 83 year old with worsening symptoms of heart failure and found to have severe mitral regurgitation presenting for mitral valve replacement. His preoperative work up consisted of dental consult and OMFS for root extraction. [**2161-2-1**] Mr. [**Known lastname **] was taken to the operating room and underwent Mitral valve replacement with a [**Street Address(2) 89505**]. [**Hospital 923**] Medical Biocor Epic tissue valve with Dr.[**Last Name (STitle) **]. Please refer to operative note for further surgical details. He tolerated the procedure well and was transferred to the CVICU in critical but stable condition. He awoke neurologically intact, although slow to wake and was extubated on POD#2. He was weaned off inotropes and pressors and was started on Beta-blocker/Statin/Aspirin and diuresis. All lines and drains were discontinued in a timely fashion. Mr.[**Known lastname **] was confused on POD#2 and narcotics were discontinued. His mental status improved to baseline. He continued to progress and was transferred to the step down unit for further monitoring. Physical Therapy was consulted for evaluation of strength and mobility. On POD# 4 an unwitnessed slip vs.fall occurred and Mr. [**Known lastname **] was not able to fully weight bare immediately thereafter. Orthpeadics was consulted and a CT scan was performed. Per Ortho Mr.[**Known lastname **] was cleared for discharge with partial weight baring on his left lower extremity until follow up in [**11-23**] weeks with Dr.[**First Name (STitle) 4223**] in orthopeadic oncology. On POD# 5 Mr.[**Known lastname **] was cleared for discharge to [**Hospital 1514**] Health Care Center in Ma. All follow up appointments were advised. Medications on Admission: FUROSEMIDE - (Prescribed by Other Provider) - 20 mg Tablet - 1 Tablet(s) by mouth once a day GLYBURIDE - (Prescribed by Other Provider) - 2.5 mg Tablet - 1 Tablet(s) by mouth twice a day LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - 1 Tablet(s) by mouth daily SIMVASTATIN [ZOCOR] - (Prescribed by Other Provider) - 20 mg Tablet - 1 Tablet(s) by mouth daily WARFARIN - (Prescribed by Other Provider) - 1 mg Tablet - 3 Tablet(s) by mouth once a day as directed per coumadin clinic Medications - OTC ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet, Chewable - 1 Tablet(s) by mouth daliy GLUCOSAMINE SULFATE [GLUCOSAMINE] - (Prescribed by Other Provider) - Dosage uncertain MULTIVITAMIN - (OTC) - Tablet - 1 Tablet(s) by mouth once a day Discharge Medications: 1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet 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. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. warfarin 1 mg Tablet Sig: [**Name8 (MD) **] MD Tablet PO DAILY (Daily): INR goal=>2, indication; Atrial Fibrillation. 6. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO Q12H (every 12 hours). 10. insulin regular human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain, fever. 12. warfarin 3 mg Tablet Sig: One (1) Tablet PO once for 1 doses. Discharge Disposition: Extended Care Facility: tba Discharge Diagnosis: Mitral valve replacement with a [**Street Address(2) 12523**]. [**Hospital 923**] Medical Biocor Epic tissue valve. Secondary: Hypertension Hyperlipidemia Severe mitral regurgitation/prolapse Atrial fibrillation, on Coumadin; last dose WED [**12-31**] Diabetes type II Prostate cancer- elevated PSA (not treated) Colon polyps s/p polypectomy Bilateral Inguinal hernia repair remote trauma to leg involving pitchfork Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Groin pain managed with tylenol Left groin - no erythema or drainage Right groin - no erythema or drainage Bilateral Lower extremity with no/trace edema Discharge Instructions: Please shower daily including washing puncture sites in groins with mild soap, no baths or swimming for 1 week until groin sites are healed. Please NO lotions, cream, powder, or ointments to puncture sites in your groins 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 one month, will be discussed at follow up appointment No lifting or pulling more than 10 pounds for 1 week, and then continue to take it easy for 1 month Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call Integrated Aortic valve clinic in 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.[**Last Name (STitle) **] #[**Telephone/Fax (1) 170**] on [**2-26**] at 1:15pm Cardiologist:Dr [**Last Name (STitle) 7526**] on [**3-4**] at 11am. Please call to schedule appointments with your Primary Care Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] S. # [**Telephone/Fax (1) 28262**] in [**11-23**] weeks **Please call Integrated Aortic valve clinic in 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 First draw:[**2161-2-8**] Completed by:[**2161-2-7**] ICD9 Codes: 4240, 4280, 4019, 2724, 2859
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Medical Text: Admission Date: [**2190-10-8**] Discharge Date: [**2190-10-10**] Date of Birth: [**2123-7-4**] Sex: F Service: MEDICINE Allergies: Paxil / Benadryl / Buspar / Levaquin / Adhesive Tape Attending:[**First Name3 (LF) 425**] Chief Complaint: Pericardial effusion s/p SVT ablation Major Surgical or Invasive Procedure: electrophysiology study with incomplete ablation History of Present Illness: 66-year-old lady with history of breast and bladder cancers was admitted for elective EPS with ablation for SVT. She first noted palpitations approximately 16 years ago in the setting of high emotional distress when her son was killed while in the service. Since then, she has had palpitations in the setting of chemotherapy, and over the past years has had no more than [**3-2**] episodes per year. However, on the day of her most recent cystoscopy on [**3-5**] at [**Hospital1 69**], she experienced a tachycardia, which was terminated after she received intravenous Lopressor. The same tachycardia occurred on [**3-9**] for which she presented to [**Hospital6 17032**] Emergency Room, where the tachycardia was terminated with intravenous adenosine. The tracings of the tachycardia were reviewed by her Electrophysiologist, Dr.[**Last Name (STitle) 1911**], and thought be a narrow complex tachycardia at 150 beats/minute with an RP interval of 100-120 msec. However, immediately post adenosine, there was evidence of sinus rhythm with a fully pre-excited QRS complex consistent with a left lateral bypass tract. Since the Emergency Room visit, she has been on low-dose atenolol without further recurrences of the arrhythmia. Dr.[**Last Name (STitle) 26676**] recommended EPS with ablation and the patient was admitted today for the procedure. . During the procedure she developed hypotension to SBP of 77 mm HG. This responded to IVF and dopamine infusion to SBP of 130s. Patient was mentating appropriately. Focal views of TTE showed noncircumferential pericardial effusion with mild RA collapse without RV collapse. Her heparin was reversed with protamine. PA catheterization showed preserved CO, no equalization of filling pressures, and preserved Y descent on RA tracing. This suggested nonhemodynamically significant effusion. Patient was admitted to CCU with PA catheter for close hemodynamic monitoring. . On arrival patient complained of stable pleuritic chest pain which she had since the cath lab. She denied any shortness of breath. No other complaints. . Past Medical History: 1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: -CABG: N/A -PERCUTANEOUS CORONARY INTERVENTIONS: N/A -PACING/ICD: N/A 3. OTHER PAST MEDICAL HISTORY: - Total abdominal hysterectomy and salpingoophrectomy [**2164**] r/t endometriosis - Left breast cancer diagnosed [**2180**] s/p Left lumpectomy and radiation therapy - Papillary bladder cancer diagnosed [**2180**] s/p multiple resections and chemotherapy, finished [**2190-4-28**] - [**2190-3-5**] s/p right ureteral stent, ? transitional cell cancer of the right ureteral orifice - Anxiety . Social History: Lives with: husband Occupation: retired ETOH: no Tobacco: 35 years/ 1ppd, quit in [**2180**] Contact person upon discharge: Husband and son: [**Telephone/Fax (1) 29176**] Home Services: NO . Family History: Unremarkable for any cardiac disease . Physical Exam: VS: T=96 BP=103/58 HR=97 RR=17O2 sat= 98% 2LNC GENERAL: Pleasant lady, in NAD. Lying down flat, Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Unable to assess JVP appropriately given the patient's position. CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: Resp were unlabored, no accessory muscle use. CTAB in anterior lung fields, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis. PULSES: Right: DP 2+ Left: DP 2+ . Pertinent Results: [**2190-10-10**] 08:50AM BLOOD WBC-14.1* RBC-3.54* Hgb-9.5* Hct-30.5* MCV-86 MCH-27.0 MCHC-31.3 RDW-14.7 Plt Ct-156 [**2190-10-10**] 08:50AM BLOOD Glucose-120* UreaN-11 Creat-0.8 Na-135 K-4.3 Cl-101 HCO3-26 AnGap-12 [**2190-10-10**] 08:50AM BLOOD Calcium-8.6 Phos-1.6* Mg-2.5 . ECG: [**2190-10-8**] at 7:23 AM NSR, rate in 70s, nl axis, early R wave transition in precordial leads, no acute ST-T changes compared to . ECG: [**2190-10-8**] at 11:58 AM Narrow complex tachycardia, rate in 140s, early R wave transition. No acute ST-T wave changes. . 2D-ECHOCARDIOGRAM [**2190-10-8**] Focused Views: 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. There is a small to moderate sized pericardial effusion primarily around the right atrium and right ventricle with minimal around the apex and inferolateral wall. There is mild right ventricular diastolic collapse. IMPRESSION: Mild-moderate loculated anterior pericardial effusion with echocardiographic evidence for increased pericardial pressure. . 2D-ECHOCARDIOGRAM [**2190-10-9**] The left ventricular cavity is unusually small. The inferior and posterior walls are hypokinetic. The rest of the left ventricle is hyperdynamic. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. There is a small to moderate sized pericardial effusion. The effusion appears circumferential. There are no echocardiographic signs of tamponade. No right atrial or right ventricular diastolic collapse is seen. Compared with the findings of the prior study (images reviewed) of [**2190-10-8**], the pericardial effusion appears similar in size. . HEMODYNAMICS: RAP 20, PCWP 17, Arterial oxygen 98%, RV oxygen sat 71% . EPS [**2190-10-8**]: Left lateral ventricular pre-excitation. Retrograde VA block via BT at 350 msec. Anterograde BT block at 300 msec. Atypical Induced orthodromic AVRT, CL 400 msec via left lateral BT. Difficulty crossing AV. Ablations were performed primarily at the entrent atrial acitivation site during Vpacing. Also slow pathway ablation were performed to prevent initiation of the AVRT. Ablation procedure was incomplete given hypotension as above. . CT ABDOMEN/PELVIS [**2190-10-9**]: 1. No retroperitoneal bleed. 2. Mild to moderate sized pericardial effusion with indeterminate density measurements suggesting proteinaceous fluid or blood. No obvious right atrial compression. Recommend echocardiogram 3. Right femoral line with tip located at the cavoatrial junction. 4. Left lobe hepatic cyst; could consider outpatient ultrasound for further characterization. 5. No large hematoma at right femoral entry site. 6. Stranding in mesentery, nonspecific finding. Brief Hospital Course: 66 y/o lady with history of SVT now with pericardial effusion s/p attempted EP ablation. . # Pericardial Effusion/PUMP: Patient was found to have a 1.4 cm anterior pericardial effusion after she became hypotensive during SVT ablation procedure on [**2190-10-8**]. TTE also showed mild RA collapse without any RV collapse. Emergently, patient received a right heart cath that was consistent with a non-hemodynamically signicant effusion w/o tamponade physiology, so pericardiocentesis was not felt to be indicated. (Cardiac output was preserved and there was no equalization of filling pressures.) Swan-ganz was initially left in place to monitor for development of tamponade physiology. Arterial line was also placed for blood pressure monitoring. Patient was initially hypotensive, but her blood pressure was responsive to IV fluid hydration and dopamine. Her blood pressure remained stable over the next 24 hours, and a repeat TTE on [**10-9**] did not show worsening of the pericardial effusion. Chest pain secondary to the pericardial effusion was well-controlled with Toradol and patient was discharged on ibuprofen prn for pain. . # RHYTHM: Prior to admission, SVT was thought be a narrow complex tachycardia at 150 beats/minute with an RP interval of 100-120 msec. However, immediately post adenosine, there was evidence of sinus rhythm with a fully pre-excited QRS complex consistent with a left lateral bypass tract. In EP lab, monitors showed left lateral ventricular pre-excitation, retrograde VA block via BT at 350 msec, anterograde BT block at 300 msec, and atypical induced orthodromic AVRT, CL 400 msec via left lateral BT. During the procedure, it was difficult crossing the AV, and ablations were performed primarily at the entrent atrial acitivation site during Vpacing. Also slow pathway ablation was performed to prevent initiation of the AVRT. The ablation procedure was incomplete given hypotension as above. Rhythm was monitored on telemetry and showed predominantly sinus rhythm. . # CORONARIES: Patient has no known CAD. Chest pain while inpatient was pleuritic in nature and attributed to hemopericardium. ASA was continued. . # Extensive groin manipulation: Due to extensive groin manipulation during cardiac procedures on [**2190-10-8**], patient was monitored closely for evidence of retroperitoneal bleed. In the cath lab, heparin was reversed with protamine, post cath checks were unremarkable, and a CT scan of abdomen and pelvis was negative for a retroperitoneal bleed. Hemoglobin and hematocrit remained stable throughout hospital stay. . # H/o breast CA and papillary bladder CA: Stable. Patient advised to continue outpatient follow-up per primary oncologist. . FEN: Patient was maintained on cardiac prudent diet. Electrolytes were repleted as necessary. . PROPHYLAXIS: SCD's were used for DVT prophylaxis. . CODE: FULL Medications on Admission: Atenolol 25mg daily, last dose [**2190-10-3**] Lunesta 2mg qhs Alprazolam 0.25mg daily in the am, [**1-29**] tablet at noon, 1 tablet at night PRN Simvastatin 30mg daily MVI daily Vitamin D daily Vitamin B12 500mcg daily Calcium, magnesium daily Fish oil 1000mg daily Asa 81mg daily . Discharge Medications: 1. Simvastatin 10 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 2. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day. 4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. Omega-3 Fatty Acids Capsule Sig: One (1) Capsule PO DAILY (Daily). 7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 8. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO once a day. 9. Ibuprofen 400 mg Tablet Sig: 1-2 Tablets PO three times a day as needed for pain: please take with food. 10. Lunesta 2 mg Tablet Sig: One (1) Tablet PO at bedtime. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Supraventricular tachycardia, AVRT Pericardial effusion Secondary Diagnoses: 1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: -CABG: N/A -PERCUTANEOUS CORONARY INTERVENTIONS: N/A -PACING/ICD: N/A 3. OTHER PAST MEDICAL HISTORY: - Total abdominal hysterectomy and salpingoophrectomy [**2164**] r/t endometriosis - Left breast cancer diagnosed [**2180**] s/p Left lumpectomy and radiation therapy - Papillary bladder cancer diagnosed [**2180**] s/p multiple resections and chemotherapy, finished [**2190-4-28**] - [**2190-3-5**] s/p right ureteral stent, ? transitional cell cancer of the right ureteral orifice - Anxiety Discharge Condition: stable and improved Discharge Instructions: You were admitted to the hospital for a procedure to fix an abnormal rhythm in your heart. The procedure was unable to be finished because of concern for build up of fluid around your heart. Ultrasounds of your heart showed that the fluid around your heart was not getting worse. You were discharged on [**2190-10-10**], and will have close follow up with Dr. [**Last Name (STitle) **]. Please follow up in 6 weeks for liver ultrasound to follow up liver cyst. No changes were made to your medications. Please see below for your follow up appointment with Dr. [**Last Name (STitle) 1911**]. Please call your physician [**Last Name (NamePattern4) **] 911 if you develop chest pain, shortness of breath, worsening palpitations, dizziness/lightheadedness, fevers, chills, or any other concerning medical symptoms. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 1911**] tomorrow, [**2190-10-11**]. Please call [**Telephone/Fax (1) 11767**]. You have another appointment with Dr. [**Last Name (STitle) 11649**] on [**2190-10-26**], see below. [**Last Name (un) 1918**] [**Doctor Last Name **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2190-10-26**] 10:40 ICD9 Codes: 9971, 2724
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Medical Text: Admission Date: [**2178-4-13**] Discharge Date: [**2178-4-29**] Service: HISTORY OF PRESENT ILLNESS: Patient is an unfortunate 80-year-old female with a prior medical history of hypertension, osteoporosis, prior left carotid stenosis, and had subsequent left carotid endarterectomy as well as history of polymyalgia rheumatica, who was involved in a motor vehicle accident as an unrestrained driver with possible loss of consciousness. She was initially seen at an outside facility on [**4-13**], the date of her accident. She was doing well, hemodynamically stable, however, she was complaining of left-sided chest pain. She was diagnosed with multiple left sided rib fractures and evidence of crepitus. Her saturations were okay. However, she was quite tachypneic. She additionally had dropped her systolic blood pressure into the 90s at the outside facility from an admission blood pressure in the 130s, and was found to have a hematocrit of 22. She was given 2 units of packed cells, and transferred here. Presentation to the Trauma Bay showed her to have extensive work of breathing requiring subsequent intubation. Initial trauma survey revealed crepitus in the left chest and decreased breath sounds necessitating insertion of a left chest tube. Chest x-ray had confirmed that she had a large left-sided effusion and multiple rib fractures with no obvious pneumothorax. Subsequent to this, the patient was stabilized and received her protocol imaging. Her CT of the head was otherwise unremarkable. Her CT of the chest revealed a large left hemothorax with no evidence of pneumothorax. A large left pulmonary contusion. Additionally, the scan of the chest revealed a right distal clavicular fracture and left scapular fracture. Her CT of the neck was unremarkable. Her CT of the head was negative. CT of abdomen with intravenous contrast on initial survey additionally showed no evidence of parenchymal or abdominal visceral injury. She was admitted to the Trauma Critical Care Unit for further resuscitation. Her admission examination was notable for a temperature of 95.3 rectally, heart rate of 107, sinus tachycardia. Her blood pressure is 104/39, the respiratory rate of 14, and saturating 100% and vented. She was intubated, however, she was awake and following commands. She had coarse breath sounds bilaterally. On the left, she was markedly diminished. She was tachycardic, but had no murmurs, rubs, or gallops. Her left chest had some mild crepitus, but there was no evidence of instability or flail segment. Her abdomen was soft and nontender. There was no ecchymosis or abrasion. Her pelvis was stable. The rectal examination had loose tone, guaiac negative, no masses. Her flanks and back were otherwise normal without obvious deformity or injury. Her extremities showed no obvious deformity. There was some minor cuts and scrapes over the knees and right elbow. She was able to move all extremities. Her right upper extremity and left upper extremity were somewhat limited by pain, however. Over the ensuing hours of her admission, however, she became hemodynamically unstable despite being aggressively resuscitated. The patient was profoundly acidotic and dropped her hematocrit to 26. Her abdomen became progressively more distended and had hemodynamic instability requiring high dose of dopamine and Levophed. Upright chest x-ray had been repeated showing no evidence of intraabdominal free air. She had a transthoracic echocardiogram by the oncall Cardiology fellow that night of injury revealing a hyperdynamic left ventricular function with an EF greater than 75%, a normal RV systolic function, no mitral regurgitation, no evidence of pericardial effusion. There was spontaneous collapse of the inferior vena cava and the mechanically ventilated patient, which suggested profound hypovolemia, and her tachycardia precluded adequate evaluation of any wall motion abnormalities. Due to the fact that the patient had initial survey on abdominal CT showing no evidence of visceral injury and the rapidly progressing abdominal distention with acidosis and somewhat collapsed IVC, it was thought that the patient may in fact be suffering from an abdominal compartment syndrome. She was thereafter sent to the operating room on the early morning hours of [**2178-4-14**]. Dr. [**Last Name (STitle) 519**] took her to the OR, performed a trauma laparotomy. There was no obvious injury to the viscera. However, after opening the abdomen, the patient profoundly improved confirming the likely diagnosis of abdominal compartment syndrome. She only had 100 cc estimated blood loss during this procedure. Received 1200 cc of intravenous fluids and urine output was 700 cc for the case. Patient left the operating room intubated, sedated. Over the ensuing days, the patient progressed into acute respiratory distress syndrome as defined by her PAO2:FIO2 ratio being less than 200 with bilateral infiltrates particularly worse on the left side, where she had a confirmed contusion and left hemothorax. There was no obvious persistent pneumothorax, however, as her daily chest x-ray evaluation confirmed this with a left chest tube being repositioned. She was given maximal lung protective ventilation strategy including paralysis, low tidal ventilation, and permissive hypercapnia and permission hypoxia. Over the ensuing days she improved. Her tube feed regimen was serially increased. She had a pulmonary artery catheter that had been placed during her postoperative course for guidance of her fluid and electrolyte therapy. Ultimately, the patient actually somewhat rallied and improved. We were able to dial back her intravenous fluids, titrate up her tube feedings to a goal. Ultimately, her ARDS seemed to improve and she was actually switched from an assist control setting into a pressure support ventilatory mode. Her pain control was a [**Last Name **] problem. We had attempted an epidural twice, were unsuccessful at placement. She did receive a left-sided rib block several times during her ICU course to enhance her pain control and to give her an opportunity to participate in her pulmonary rehab and vent wean. We utilized a variety of agents including NSAID therapy with Vioxx as well as Roxicet elixir to control her pain. However, there was a significant component of pain and overall deconditioning that made her ventilatory wean prolonged. She ultimately necessitated placement of an open tracheostomy tube, which was performed on [**2178-4-27**] under the care of Dr. [**Last Name (STitle) **]. Therefore the patient had a speech and swallow evaluation, and at the time of this discharge summary, the final report of the speech and swallow evaluation was indeterminate. The plan was to place a discharge summary addendum with the results of this were back if she were able to pass her speech and swallow evaluation, she will be titrated on an oral regimen and serially advanced accordingly with tube feeds being cycled at night and dialed back as needed as she took adequate p.o. intake. However, if she failed her speech and swallow evaluation, she will likely need a percutaneous endoscopic gastrostomy tube for feeding access and then a repeat speech and swallow evaluation as an outpatient can be performed in a couple of weeks when her aspiration risk was reduced, and that her mental status has improved. FOLLOW-UP PLANS BY SYSTEM: Neurologically: She had a negative head CT and negative CT C spine. No MR films were done. She wore the collar for more than two weeks. This was ultimately removed. She was able to interact, although not at a very robust fashion, but could certainly localize her gaze to the examiner, able to move her upper extremities with limited range of motion. Able to make weak grasp with bilateral upper extremities. Able to wiggle toes and intermittently move her legs. Therefore, she was following simple commands. She appeared to have somewhat blunted affect despite being on a ventilator, the assessment was whether she may or may not have been suffering from a mild degree of depression as well as some intermittent waxing and [**Doctor Last Name 688**] consciousness confirming the likely low grade delirium. However, this was florid and did not necessitate antipsychotic regimen or one-to-one sitter or any restraining mechanism. Pulmonary wise: The patient was on pressure support ventilation approximately anywhere from 18 to 20 mmHg being utilized. She will continue prolong ventilatory wean. Chest x-ray showed no evidence pneumothorax. She had mild cephalization and evidence of mild overload, and she had bilateral effusions left greater than right, but nothing that seemed to be tapable at this time. She had multiple left sided rib fractures, left scapular fracture, and right distal clavicular fracture, and her analgesic regimen will be key to control so that she can participate in her ventilatory wean and have adequate strength and analgesia to pull an adequate tidal volume to allow appropriate weaning as needed. She will receive standard trach care as needed. She had a #6 Shiley trach tube placed at the time of surgery on [**2178-4-27**]. Cardiovascular wise: The patient was stable on a beta-blocker 25 mg p.o. b.i.d. This can be titrated as needed to control her blood pressure and heart rate. She did not have any specific parameters, however, it would be nice to keep her systolic pressures at least under 160 with a heart rate in the 70-80 range. Her transthoracic echocardiogram results were stated on the night of admission. Her baseline cardiac medications included a beta-blocker and aspirin. Aspirin can be added back as needed on an outpatient basis in the vent rehab facility. FEN and GI: Patient had speech and swallow evaluation pending at the time of this dismissal. If she were to fail this evaluation, she will get a PEG tube placed, and continued on Impact with fiber full strength at 60 cc per hour. This can be cycled serially at night as needed. Ultimately, she can be reassessed for possible swallowing function in the rehab setting so that she can ultimately hopefully be weaned off a tube feeding regimen. She was not receiving any additional motility agents such as Reglan at the time of this dismissal note. Her electrolytes were otherwise stable. Heme/ID: She had no infectious issues. She had some yeast that had grown out from a sputum sample at the end of [**Month (only) 958**], however, she did not have any florid infiltrate on chest x-ray. Her sputum was somewhat tan colored in nature, but ultimately it was not felt that she was suffering from a ventilator-associated pneumonia. At this time, she was not on any antibiotics. She had a hematocrit of 28.6 and a white count was 7.8 on [**2178-4-29**] with a normal platelet count of 407. For Endocrine: She should be on a sliding scale regimen. She should be placed on a NPH regimen and tighten her sliding scales for normoglycemia with goal blood sugars of 120-140 can be achieved. This should be continued indefinitely. The patient almost certainly has some component of insulin resistance or perhaps undiagnosed type 2 diabetes mellitus. GU/renal: She had a Foley catheter for urine output monitoring. She had no significant urinary cultures. Her creatinine was 0.5 on [**2178-4-29**] with a BUN of 23. She was making approximately 1-1.5 liters of urine per day. Tubes, lines, and drains: At the time of this dismissal, discharge summary, she did have a left subclavian, which was a triple lumen catheter, which had been in place for 15 days as well as a left radial A line. Ultimately on dismissal, she likely will not have her radial arterial line unless deemed appropriate by the ventilatory rehab facility. Additionally, she was receiving feedings through a nasogastric tube pending the speech and swallow evaluation. She may not end up with a PEG tube, thereby removing that nasogastric tube accordingly. Prophylaxis: She should continue on Prevacid 30 mg/NG q.d. or per PEG as needed if she ends up with a PEG. She can be on Lovenox 30 mg subq b.i.d. for DVT prophylaxis, Lopressor 25 mg p.o. b.i.d., aspirin 81 mg p.o. q.d., Roxicet elixir as needed, Vioxx 12.5 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Dulcolax suppository 10 mg p.o./p.r. one tablet q.d. prn. Her followup plans will be to see Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 1022**] in approximately one month from time of dismissal. Call this clinic for this follow-up appointment. Additionally, she should follow up in the Trauma Clinic in approximately 3-4 weeks from time of dismissal if she has been appropriately weaned from the ventilator. If she is still vent dependent, then she will stay at the [**Hospital 5442**] Rehab until which time, she has been weaned from the ventilator and then she may follow up on a prn basis to the Trauma Clinic. TREATMENTS AND FREQUENCIES: She will continue on aggressive enteral feeding regimen her speech and swallow evaluation will proceed. If her swallowing is poor, then she will receive a PEG tube for enteral access and feeding, and this can be reassessed as an outpatient in the ventilatory rehab setting to see if she can ultimately be started on an oral regimen. She was not requiring any motility agents at this time to assist her with her tube feeding tolerance. She should be on aggressive bowel regimen. Her blood pressure control is as stated above. She will need aggressive Physical Therapy. She can be full weightbearing on her lower extremities as tolerated despite the pelvic fracture as previously noted. Additionally, she should continue aggressive Physical Therapy, be out of bed, get a chest physiotherapy and incentive spirometry, and trach care as standard fashion. DISCHARGE DIAGNOSES: 1. Status post motor vehicle crash with multiple injuries including multiple left-sided rib fractures, left hemothorax, left sided pulmonary contusion, right distal clavicular fracture, left scapular fracture, left superior and inferior pubic rami fracture. 2. Abdominal compartment syndrome resolved. 3. Status post exploratory laparotomy. Negative for any visceral injury, however, patient was profoundly improved after her abdomen was opened. 4. Status post acute respiratory distress syndrome now resolved. 5. Respiratory failure with failure to wean from ventilator. 6. Status post tracheostomy. OTHER DIAGNOSES: 1. Hypertension. 2. Peripheral vascular disease. 3. Status post left carotid endarterectomy. 4. Osteoporosis. 5. Polymyalgia rheumatica. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D. [**MD Number(1) 10637**] Dictated By:[**Last Name (NamePattern4) 3204**] MEDQUIST36 D: [**2178-4-29**] 12:26 T: [**2178-4-29**] 12:50 JOB#: [**Job Number 52915**] ICD9 Codes: 5180, 2762, 2765
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Medical Text: Admission Date: [**2153-4-30**] Discharge Date: [**2153-5-8**] Date of Birth: [**2091-5-14**] Sex: M Service: MEDICINE Allergies: Demerol / Benadryl Attending:[**First Name3 (LF) 2698**] Chief Complaint: Headache Major Surgical or Invasive Procedure: Cardiac angiography History of Present Illness: HPI: [**Known firstname **] [**Known lastname **] is a 61-year-old gentleman with history of HTN, IDDM, hypercholesterolemia, DVT, who was brought to the ED per EMS after he developed vomiting and nausea and was off balance following a headache that he has been having for 6 days. He initially presented to the Emergency Department on [**2153-4-30**] for headache and mental status changes. He was intubated for ? airway protection and admitted to the TSICU, where he was extubated fairly rapidly. Initial concern was for a CVA, but head CT and MRI/MRA were unremarkable. While on the floor, patient had several episodes of hypertensive urgency, with systolics reaching 220. Cardiology team was consulted, who recommended labetolol with goal SBPs 150-160, stress results from [**Hospital1 112**], MRI and 24 hour urine to eval for pheochromocytoma. . While in the ICU he was evaluated with MRI/CT/MRA which did not show any abnormalities. Additionally an LP was done which did not show any signs of infection though was not sent for viral PCR (likely suspicion was low). He was empirically treated with vancomycin, ceftriaxone and acyclovir (vanc, ceftriaxone stopped [**5-1**], acyclovir stopped [**5-2**]). For BP control the patient was on Nicardipine, then labetolol and briefly a nitroglycerin drip. He also was given IVF and showed signs of volume overload and was diuresed. Past Medical History: - HTN - IDDM - hypercholesterolemia - history of DVT in R-leg - cataract, s/p surgery - headaches, no migraine headaches per wife - rosacea Social History: Occupation: accountant from [**Month (only) **] to [**Month (only) 547**] (works 7 days a week during this period; very sedentary) No illicit drugs, occ alcohol, smoking Walks without assistance Married, 2 children. Family History: -DM, HTN, breastca mom, no migraine headaches Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension Physical Exam: Blood pressure was 175/82 mm Hg while seated. Pulse was 95 beats/min and regular, respiratory rate was 24 breaths/min. 02 sat 97% 4L t 99.9 Generally the patient was well developed, well nourished and well groomed. The patient was oriented to person, place and time. The patient's mood and affect were not inappropriate. . There was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. The neck was supple with JVP of 10 cm, though difficult to assess secondary to obesity. The carotid waveform was normal. The were no chest wall deformities, scoliosis or kyphosis. The respirations were not labored and there were no use of accessory muscles. The lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. Palpation of the heart revealed the PMI to be located in the 5th intercostal space, mid clavicular line. There were no thrills, lifts or palpable S3 or S4. The heart sounds revealed a normal S1 and the S2 was normal. There were no rubs, murmurs, clicks or gallops. The abdominal aorta was not enlarged by palpation. There was no hepatosplenomegaly or tenderness. The abdomen was soft nontender and nondistended. The extremities had no pallor, cyanosis, clubbing or edema. There were no abdominal, femoral or carotid bruits. Inspection and/or palpation of skin and subcutaneous tissue showed 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+ . Skin: erythematous cheeks/nose Neuro: PERRL, EOMI, CN II-XII intact, strength 5/5 UE, sensation intact UE, decreased secondary to neuropathy or LE. Alert and oriented x 3. able to remeber building ([**Hospital Ward Name **]) and do serial 7's without difficulty Pertinent Results: [**2153-4-30**] 03:45PM BLOOD WBC-11.8*# RBC-5.26 Hgb-15.6 Hct-44.9 MCV-86 MCH-29.6 MCHC-34.6 RDW-14.2 Plt Ct-275 [**2153-5-8**] 07:02AM BLOOD WBC-9.0 RBC-4.54* Hgb-12.9* Hct-39.5* MCV-87 MCH-28.4 MCHC-32.7 RDW-14.4 Plt Ct-327 [**2153-4-30**] 03:45PM BLOOD Neuts-83.6* Lymphs-10.6* Monos-4.4 Eos-1.2 Baso-0.2 [**2153-5-4**] 06:10AM BLOOD Neuts-73.9* Lymphs-14.2* Monos-7.1 Eos-4.3* Baso-0.6 [**2153-5-6**] 07:08AM BLOOD PT-12.7 PTT-71.0* INR(PT)-1.1 [**2153-5-7**] 06:40AM BLOOD PT-12.9 PTT-84.2* INR(PT)-1.1 [**2153-5-1**] 02:20AM BLOOD ESR-15 [**2153-5-1**] 12:59PM BLOOD ESR-22* [**2153-5-8**] 07:02AM BLOOD UreaN-24* Creat-1.2 K-4.1 [**2153-4-30**] 03:45PM BLOOD Glucose-152* UreaN-19 Creat-1.1 Na-142 K-4.2 Cl-103 HCO3-27 AnGap-16 [**2153-5-2**] 04:20AM BLOOD CK(CPK)-1778* [**2153-5-2**] 12:11PM BLOOD CK(CPK)-[**2075**]* [**2153-5-3**] 12:02AM BLOOD CK(CPK)-[**2072**]* [**2153-5-7**] 06:40AM BLOOD CK(CPK)-136 [**2153-5-1**] 02:20AM BLOOD CK-MB-7 cTropnT-<0.01 [**2153-5-2**] 04:20AM BLOOD CK-MB-23* MB Indx-1.3 cTropnT-0.23* [**2153-5-2**] 12:11PM BLOOD CK-MB-22* MB Indx-1.1 cTropnT-0.33* [**2153-5-5**] 06:35AM BLOOD CK-MB-5 cTropnT-0.45* [**2153-5-6**] 12:35AM BLOOD CK-MB-5 cTropnT-0.38* [**2153-5-7**] 06:40AM BLOOD CK-MB-4 cTropnT-0.23* [**2153-4-30**] 03:45PM BLOOD Calcium-9.6 Phos-2.2* Mg-2.0 [**2153-5-8**] 07:02AM BLOOD Calcium-8.8 Mg-2.3 [**2153-5-1**] 02:20AM BLOOD %HbA1c-8.1* [Hgb]-DONE [A1c]-DONE [**2153-5-1**] 02:20AM BLOOD Triglyc-272* HDL-30 CHOL/HD-5.7 LDLcalc-86 [**2153-5-1**] 02:20AM BLOOD TSH-0.49 [**2153-4-30**] 03:45PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG . . . . . . . ................................................................ MRI head on admission: MRI HEAD WITHOUT CONTRAST: The diffusion-weighted imaging is unremarkable without evidence of acute infarction. There are scattered tiny foci of T2/FLAIR hyperintensity within the subcortical white matter bilaterally, which are non-specific and likely represent chronic small vessel ischemic changes. The signal intensity of the brain parenchyma otherwise throughout is unremarkable. There is no evidence of mass, edema, or shift of normally midline structures. MRA OF THE CIRCLE OF [**Location (un) **]: The vertebral arteries, basilar artery, and right posterior cerebral artery are well identified. However, there is a sharp cutoff of the P1 segment of the left posterior cerebral artery which is not clearly delineated on the source images. However, there is evidence of artifact on the source images at this level and the apparent cutoff of the artery may be secondary to artifact. The rest of the major tributaries of the circle of [**Location (un) 431**] are patent. There is no evidence of aneurysm or arteriovenous malformation. IMPRESSION: 1. No evidence of acute intracranial ischemia. No mass lesions identified. 2. Abrupt cutoff of the left posterior cerebral artery, which may be secondary to artifact as there is signal drop out on this level and the source images. However, further evaluation with a repeat MRA or CT angiogram is recommended to exclude abnormality involving the left posterior cerebral artery. . . . . . . . ................................................................ NON-CONTRAST CT OF THE HEAD: No acute intracranial hemorrhage, shift of normally midline structures, or major vascular territorial infarct. Periventricular hypoattenuation is consistent with chronic microvascular ischemic changes. [**Doctor Last Name **]-white matter differentiation is preserved. The visualized paranasal sinuses and osseous structures are unremarkable. IMPRESSION: No acute intracranial process. . . . . . . . . ................................................................ MRA head : FINDINGS: There is fetal origin to the left posterior cerebral artery. The left posterior cerebral artery also appears to take a slightly inferior course from its usual location. There is no evidence of loss of the normal flow signal. The circle of [**Location (un) 431**] is otherwise normal with no evidence of aneurysms or stenoses. IMPRESSION: A fetal left posterior cerebral artery with no evidence of loss off the normal flow signal. . . . . . . . . ................................................................ EEG done while with MS changes: IMPRESSION: This is a mildly abnormal EEG in the primarily sleeping state due to the excessive sleep with a 6 Hz background rhythm. This suggests either excessive drowsiness and sleppr or a mild encephalopathy, which may be seen with infections, toxic metabolic abnormalities or medication effect. A repeat EEG with waking state recorded may better differentiate between sleep and a mild encephalopathy. . . . . . . . . ................................................................ BILATERAL LOWER EXTREMITY ULTRASOUND: Compared to [**2147-5-26**]. Bilateral grayscale and color Doppler ultrasound performed of the common femoral, superficial femoral, and popliteal veins. Venous structures demonstrate normal compressibility, flow, waveforms, and augmentation without intraluminal thrombus. IMPRESSION: No evidence of DVT. . . . . . . . . ................................................................ ECHO: Conclusions: The left atrium is mildly dilated. The estimated right atrial pressure is 0-5mmHg. 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) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. There is a small pericardial effusion posterior to the atria. IMPRESSION: Preserved regional/global biventricular systolic function. Mild mitral regurgitation. Impaired left ventricular relaxation pattern. Small loculated pericardial effusion. . . . . . . . . ................................................................ Cardiac Catherization: COMMENTS: 1. Selective coronary angiography of this left dominant system revealed two vessel disease. The LMCA was free of critical stenoses. The LAD was a small vessel with a proximal ulcerated 70% stenosis. The D1 branch was also small with 80% ostial lesion. The LCx was the dominant vessel and free of critical lesions; there was a 40% stenosis at the origin of the LPDA. The RCA was a small nondominant and occluded at the mid-vessel. 2. Non-selective renal angiography revealed bilateral single renal arteries without angiographically apparent lesions. 3. Limited resting hemodynamics revealed mildly elevated left sided filling pressures with an LVEDP of 15mmHg and moderate systemic arterial hypertension with an aortic SBP of 158mmHg. 4. Successful PTCA was performed of the D1 with a 2.0 mm balloon. Successful PTCA and stenting was performed of the proximal LAD with a 2.5 mm Cypher drug eluting stent. Final angiography revealed 10% residual stenosis in the LAD, 30% residual stenosis in the D1, no dissection, and normal flow. (see PTCA comments) FINAL DIAGNOSIS: 1. Two vessel coronary artery disease. 2. No angiographic evidence of renal artery stenosis. 3. Mild left ventricular diastolic dysfunction. 4. Successful PTCA of the D1. 5. Successful PTCA and stenting of the proximal LAD with a drug eluting stent. ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. CARDIOLOGY FELLOW: [**Last Name (LF) **],[**First Name3 (LF) **] M. [**Last Name (LF) **],[**First Name3 (LF) **] ATTENDING STAFF: [**Last Name (LF) **],[**First Name3 (LF) **] A. Brief Hospital Course: Patient is a 62 yo man admitted from the ED with severe hypertension and mental status changes. Patient was transferred to the ICU and was briefly intubated for airway protectioin. While in the NeuroICU, the patient was evaluated with MRI, MRI/A, CT head and LP all of which did not show signs of either infection or acute change to explain mental status changes. However, however he did have very elevated blood pressure and cardiology consultation felt the clinical picture was consistent with hypertensive encephalopathy. With improved blood pressure control, mental status cleared and patient was mentating well on admission to the floor. . While on the inpatient floor issues were: . # Hypertension- Patient was restarted on his home medications and then increased as needed to maximize metoprolol, losartan. HCTZ and amlodipine were added and patient's blood pressure was eventually improved to normotensive. (Was decreased slowly by approx 30 mmHg/day). Patient counselled at time of discharge on necessity of taking all meds and checking blood pressure daily. . # NSTEMI/CAD: Initial Troponin leak was thought to be secondary to cardiac stress given that the patient has had significantly elevated BPs. However, it continued to rise and eventually peaked at .45. Given his clinical history of uncontrolled diabetes and hypertension, it was very concerning for CAD. Therefore, a cardiac catherization was performed that showed 2 vessel disease and had stenting of the proximal LAD and the first diagonal artery. Additionally the renal artery angiography was normal. . # Mental status- Was significantly improved from admission. Mentating well without difficulty. Likely hypertensive encephalopathy given that patient now improved in the setting of negative workup otherwise. . # Diabetes- Per patient he was on NPH and humalog at home given only every 12 hours. He was continued on NPH while here and was also started on a humalog QID sliding scale. Glucose control improved, but was not optimal. At time of discharge, it became apparent that the patient had not been tightly following his glucose level and a VNA was arranged for follow up of his use of NPH [**Hospital1 **] as well as humalog sliding scale. Further management will need to be done as an outpatient. . Medications on Admission: - insulin Humulin N 60 [**Hospital1 **], Humalog 30 [**Hospital1 **]? - lipitor 20 mg - cozaar 100mg qd - Zoloft 100 mg QD - Atenolol 100mg QD Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Sertraline 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*60 Tablet(s)* Refills:*0* 4. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 5. Atenolol 100 mg Tablet Sig: Two (2) Tablet PO once a day. Disp:*60 Tablet(s)* Refills:*0* 6. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 7. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 9. Humulin N 100 unit/mL Suspension Sig: Forty (40) Subcutaneous twice a day: and increase to your home scale gradually. 10. Humalog 100 unit/mL Solution Sig: per sliding scale Subcutaneous four times a day: Check your glucose dialy at breakfast, lunch and dinner and at bedtime and use the sliding scale. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Hypertensive Encephalopathy Coronary artery disease . Diabetes Discharge Condition: stable Discharge Instructions: You were admitted with very severe hypertension and trouble thinking as a result. You MUST take your medications as prescribed and stick to a low salt low sugar diet. . Please call your doctor or go to the ER if you have any chest pain, shortness of breath, nausea, vomiting, fever, chills, headaches, trouble with your vision. . Please take all medications as prescribed. Followup Instructions: Please call Dr. [**Last Name (STitle) 105190**] and make a follow up appointment in [**2-6**] weeks. Additionally if you would like to have a PCP in our system, the number to set up the appointment is [**Telephone/Fax (1) 250**]. . You also have the following appointments: Provider: [**First Name11 (Name Pattern1) 1730**] [**Last Name (NamePattern4) 2301**], M.D. Date/Time:[**2153-6-4**] 11:45 Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM Phone:[**Telephone/Fax (1) 543**] Date/Time:[**2153-5-29**] 1:20 ICD9 Codes: 4019, 2720
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Medical Text: Admission Date: [**2113-12-27**] Discharge Date: [**2114-1-3**] Date of Birth: [**2077-5-4**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 905**] Chief Complaint: Headache Major Surgical or Invasive Procedure: CT scans History of Present Illness: 36 year old male with a prior hx of 4+ AI and ascending aortic aneur s/p Bental and St. [**Male First Name (un) 923**] aortic valve replacement [**11-28**] , AF (post-op)on amio, HTn, hyper chol, (clean cor on pre-op cath) presents with subacute SDH and INR 5.9 (now 3.5). He developed intermittent HA on [**12-21**] in the occipal region radiating down the R arm. A CT done by his pcp showed [**Name Initial (PRE) **] parietal subdural. Patient was sent to the ER and admitted no neurosurg. Patient's coumadin recently was decreased for high INR. Recently started abx for wound infection. . On admission, INR 3.5. Per report INR was 5.9 at osh. Cardiology consult felt INR likely high dei to recent abx as well as amiodarone acting as warfarin potentiator. Goal INR is 2.5. Coumadin was held upon admission. CT surgery evaluated. Patient was followed by CT, bleed appears stable. Felt safe for transfer to medicine. Did have elevation of INR to 4.8 today, got additional Vitamin K this afternoon. Past Medical History: s/p AVR [**11-4**] aa repair as above htn hyperhol a fib Social History: Married, currently in school at [**Hospital3 12678**] and works nights at a mental health center. Has 2 children, ages 4 and 23months. Family History: Noncontributory Physical Exam: 97.7, HR 68, 105/36 ( 104-131/36-62), 16 99% RA I/O 2540/3000 LOS in ICU negative 290cc Gen: Pleasant, laying in bed, a/ox3 NAD HEENT: Pulils 2-3mm, RRLA, EOMI, OP clear, MMM, neck supple, face symmetric CV: S1 mechanical S2, regular Pulm: CTAb Chest: wound well healed, no erythema, no warmth, no discharge Abd: soft, NT/ND, NABS Ext: no edema noted Pertinent Results: CT head [**12-28**]: No acute intracranial hemorrhage. There is a chronic appearing right cerebral hemispheric subdural hematoma. Direct comparison with the patient's outside study after it has been scanned into PACS would enable a meaningful comparison. [**2113-12-27**] 06:44PM BLOOD WBC-4.6 RBC-4.18* Hgb-12.4* Hct-38.2* MCV-91 MCH-29.5 MCHC-32.3 RDW-13.1 Plt Ct-294 [**2113-12-27**] 06:44PM BLOOD Neuts-42.4* Lymphs-42.7* Monos-3.6 Eos-10.8* Baso-0.4 [**2113-12-27**] 06:44PM BLOOD Hypochr-1+ [**2113-12-27**] 06:44PM BLOOD Plt Ct-294 [**2113-12-27**] 06:44PM BLOOD PT-23.6* PTT-46.5* INR(PT)-3.5 [**2113-12-27**] 06:44PM BLOOD Glucose-87 UreaN-11 Creat-1.1 Na-140 K-3.8 Cl-105 HCO3-29 AnGap-10 [**2114-1-3**] 06:40AM BLOOD WBC-4.8 RBC-4.21* Hgb-12.3* Hct-37.9* MCV-90 MCH-29.2 MCHC-32.4 RDW-13.1 Plt Ct-291 [**2114-1-3**] 06:40AM BLOOD Plt Ct-291 [**2114-1-3**] 06:40AM BLOOD PT-20.0* PTT-52.1* INR(PT)-2.5 [**2114-1-3**] 06:40AM BLOOD Glucose-88 UreaN-8 Creat-1.1 Na-144 K-3.7 Cl-106 HCO3-29 AnGap-13 [**2114-1-3**] 06:40AM BLOOD Calcium-9.5 Phos-4.2 Mg-1.9 Brief Hospital Course: 36 y/o man with PMH significant for AVR with mechanical valve placement on [**2113-11-28**] admitted with a headache in the setting of supratherapeutic INR. Found to have a subacute R frontal-parietal SDH. Anticoagulation was reversed but pt became subtherapeutic so he was started on IV heparin and coumadin. Goal INR is 2.0-2.5 per neurosurgery and 2.5 to 3.5 per CT surgery given mechanical valve. At this time, plan to keep it between 2.5 and 3.0 if possible. 1. [**Name (NI) 44061**] Pt was initially supratherapeutic on admission. His anticoagulation was reversed but pt then became subtherapeutic. At that time, he was started on a heparin bridge with coumadin as his subdural hematoma was stable. He was continued on this regimen until his INR was 2.5. At that time, the heparin was discontinued. The pt's INR goal will be between 2.5 and 3.0 given his valve replacement in addition to his atrial fibrillation. He will follow up with his cardiologist on [**1-5**] for evaluation of his coags and adjustment of his coumadin dosage as needed. 2. Subdural hematoma- Pt was initially admitted to and evaluated by neurosurgery. The subdural hematoma was stable in appearance throughout the admission with normal neuro function. The pt was sufferring from a fairly severe headache on admission but this resolved over the course of the admission. The pt will need repeat head CT in 2 weeks time which was scheduled prior to his discharge. He will then follow up with neurosurgery in outpatient clinic. 3. [**Name (NI) 12329**] Pt with good BP control. He was initially on IV hydralazine in addition to his oral meds but this was changed to an oral formulation on [**1-2**] with continued good blood pressure control. On discharge, pt was continued on his beta blocker, [**Last Name (un) **], and hydralazine. 4. Atrial fibrillation- Pt was continued on amiodarone throughout admission. His anticoagulation was managed as above and his INR was therapeutic on discharge. 5. [**Name (NI) 14983**] Pt was continued famotadine. 6. FEN- Low Na diet. Electrolytes were replaced as needed. 7. Code- Full Medications on Admission: Aspirin 81 mg Tablet; Amiodarone HCl 400 mg Tablet Sig: One (1) Tablet PO once a day for 3 months: continue until after postop visit with Dr [**Last Name (STitle) **].;Valsartan 80 mg Tablet Sig: One (1) Tablet PO once a day.; Atenolol 75mg qd;Ibuprofen 600 ; Warfarin Sodium Discharge Medications: 1. Amiodarone HCl 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 2. Valsartan 80 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*30 Capsule(s)* Refills:*2* 3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 6. Atenolol 25 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO at bedtime: Take 5 mg on the evening of [**1-3**] and 2.5 mg on the evening of [**1-4**]. You will have your blood checked on Fri and your dose should be adjusted as needed at that time. . Disp:*60 Tablet(s)* Refills:*2* 8. Hydralazine HCl 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). Disp:*120 Tablet(s)* Refills:*2* 9. Outpatient Lab Work Please have a PT, PTT, and INR checked on Friday [**2114-1-5**]. Your PCP will need to follow up on the results and adjust your coumadin level as needed. Discharge Disposition: Home Discharge Diagnosis: Stable Subdural Hematoma Supertheraputic INR Hypertension s/p AVR Discharge Condition: Stable. INR is in target range 2.5-3 Discharge Instructions: Follow up with your cardiologist for close follow up of your INR and coumadin dosing. If you have increased headaches, change in mental status, feelings of confusion, bleeding, or any falls or trauma call your doctor or go to the ED. No lifting greater than 10 pounds or driving for 1 month after your surgery. You may shower. No bathing or swimming for 1 month after your surgery. It is very important that you get your follow up head CT. Please keep this appointment. Followup Instructions: 1. Follow up at Dr.[**Name (NI) 44062**] office to have your labs checked on Fri at your convenience. You will need a PT, PTT, and INR check and then advice on how to change your coumadin. In addition, you also have an appointment with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Name (STitle) 766**] [**1-8**] at 4:00. 2. Dr. [**Last Name (STitle) **] (electrophysiology)in 2 months. 3. Please follow up with your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 44063**] within one week of discharge. He needs to put in a referral for the CT of your head that has already been scheduled so that it is covered by your insurance. 4. You are scheduled for a repeat head CT (to see if bleeding in brain has changed) on Wed [**1-17**] at 10:30. Please go to the fourth floor of the [**Hospital Ward Name 23**] Clinical building for this study. Do not eat or drink for three hours before the study. 5. Please follow up with neurosurgery on Friday [**1-19**] at 10:00. Their office is located in the [**Last Name (un) 2577**] building [**Hospital Unit Name **]. [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**] ICD9 Codes: 5849, 2720, 4019
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Medical Text: Admission Date: [**2199-6-27**] Discharge Date: [**2199-7-2**] Date of Birth: [**2147-3-9**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1990**] Chief Complaint: etoh withdrawl Major Surgical or Invasive Procedure: sutures in ED History of Present Illness: 52 yo M with a history of EtOH abuse presented to ED after a fall onto face day prior to admission. He notes that he had been clean and sober for 17 months, though "fell off the wagon" and went into a 3 week drinking "bender". He sat at home on couch for two days straight with only minimal movement, noting that he soiled himself to avoid having to get up. He finally did arise from the couch the evening prior to admission and fell forward into his TV stand, hitting his left brow and ear. He notes that his last drink of EtOH was on the evening prior to presentation. . Past Medical History: # Alcohol abuse: Binges, no hx of DTs or seizures # Depression # R wrist fracture ([**7-/2196**]) # Acute pancreatitis s/p drinking binge # Hemorrhoids Social History: # Personal: Lives alone, recently divorced # Professional: Real estate developer for [**Hospital3 **] communities # Alcohol: Began drinking in college on weekends. Moderate social drinking after college. Binge-drinking began in mid-[**2179**], during a period of high work stress. Longest period of sobriety lasted 18 months; longest binge lasted three weeks. Pt had Alcoholics Anonymous sponsor, and had undergone "self-detox" previously by himself, as well as inpatient alcohol rehabilitation. # Tobacco: Social smoking, quit in ~[**2186**]. # Recreational drugs: Experimental marijuana in youth. Family History: # M a: Dementia # F: Prostate CA # Siblings (1 brother, 1 sister): No known illnesses Physical Exam: Physical Exam On Admission: VS: T afebrile, BP 123/88, P 65, R 18, 98% on RA GEN: NAD HEENT: PERRL, oral mucosa slightly dry, oropharynx benign, multiple facial abrasions and large left brow laceration with sutures, ecchymotic and tender left ear NECK: Supple PULM: CTAB CARD: RR, nl S1, nl S2, no M/R/G ABD: BS+, soft, NT, ND EXT: no C/C/E Skin: shallow sacral ulcerations covered with a dry dressing NEURO: Oriented x 3, slight resting tremor that attenuates with distraction, tounge wag present Pertinent Results: Labs on Discharge: CBC WBC-4.4 RBC-3.13* Hgb-10.2* Hct-31.4* MCV-101* MCH-32.7* MCHC-32.6 RDW-14.3 Plt Ct-281 Coags: BLOOD PT-11.6 PTT-28.8 INR(PT)-1.0 Panel 10 Glucose-103* UreaN-12 Creat-0.7 Na-139 K-4.2 Cl-104 HCO3-25 AnGap-14 Calcium-9.0 Phos-4.6* Mg-2.0 [**2199-6-27**] BLOOD ALT-88* AST-146* CK(CPK)-475* AlkPhos-77 TotBili-1.1 [**2199-6-29**] BLOOD ALT-87* AST-136* CK(CPK)-148 AlkPhos-83 TotBili-0.7 [**2199-6-30**] BLOOD ALT-84* AST-103* AlkPhos-82 TotBili-0.4 [**2199-6-27**] BLOOD calTIBC-204* VitB12-1475* Folate-GREATER TH Ferritn-611* TRF-157* Brief Hospital Course: Pt is 52yo male with hx of alcohol abuse, but sober for 17 months, who went on a 3-week binge. He was brought into the hospital for head trauma after fall (no acute intracranial or cervical process), and was subsequently found to have Stage 1 pressure ulcer in buttocks region. Pt was started on Valium overnight, and received a total (inc standing orders and PRN CIWA>10) of 120mg. Pt was given thiamine, folate, multivitamin, and SW consult. Iron panel was also checked, and revealed Ferritin 611, Fe 46, TIBC 204. B12 and folate wnl. Pt was transferred to floor when valium needs decreased. Dry dressings and frequent positional changes for buttock ulcer. He received a total of 160+mg of Valium during his hospital stay. At the time of discharge he was not tremulous or anxious, was able to ambulate well and his ulcer on his buttock region was healing well. Medications on Admission: None Discharge Medications: 1. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). 5. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for pain. 6. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for sacral decubitus wound. Disp:*1 tube* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Laceration to head Pressure wounds ETOH withdrawl Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted for withdrawing for alcohol. It was from drinking too much the last few weeks. You also had sores on your bottom from sitting in one place too long. You should stop drinking and seek help as social work has directed. You have been to treatment programs before and should start going back again. As for your wounds, we recommend an antifungal cream for a short period of time while it heals. If it gets worse, you have fevers or chills, or other concerns about it, you should seek medical treatment because you're at a higher risk of infection. And as for your stitches, you should see a doctor in our [**Hospital 1944**] clinic to have them removed as outlined below. Please take a multivitamin, thiamine and folate supplements after leaving. Please DO NOT drive for at least 48 hours. Followup Instructions: To remove your stitches please go to the following appointment: Department: [**Hospital3 249**] When: WEDNESDAY [**2199-7-10**] at 8:30 AM With: [**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 Please schedule an appointment to follow up with your PCP in the next week. ICD9 Codes: 2761, 2875, 311
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Medical Text: Admission Date: [**2113-4-5**] Discharge Date: [**2113-4-11**] Date of Birth: [**2034-4-4**] Sex: F Service: SURGERY Allergies: Ciprofloxacin / Vancomycin / Bactrim Ds Attending:[**First Name3 (LF) 5547**] Chief Complaint: FEVER;HYPOTENSION Major Surgical or Invasive Procedure: none History of Present Illness: Ms. [**Known lastname 80843**] is a 79 year old female with past medical history of perforated duodenal ulcer, complicated recovery with several infections, presents from rehabilitation with fevers, vomiting, and leukocytosis. . Ms. [**Known lastname 80843**] experienced a perforation of her duodenum in [**12/2112**], which required urgent surgery at an outside hospital. Her course since that time has been complicated by a number of infections of fluid collections and indwelling lines, with several admissions here at [**Hospital1 18**] for sepsis-like physiology. She has been followed closely by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 111**] in the department of infectious disease, and has continued on linezolid and fluconazole since her discharge on [**2113-3-24**]. During her last stay, studies of her duodenum revealed normal passage of contrast without obstruction or leakage, but she continues to be limited in her ability to take PO's. She has been followed closely by Dr. [**Last Name (STitle) 1924**] in surgery as well. . She was brought to the emergency room today from rehabilitation after she experienced fevers, abdominal pain, nausea, as well as worsening renal function and leukocytosis and diarrhea. She also reports that she has noted a diffuse red rash over her whole body that started one or two days prior to admission. She had been started on Bactrim [**2113-4-4**] for fevers and increasing WBC (noted to be 18.3 as compared to 12.1 on [**3-29**]). She had had a CT of her abdomen and pelvis completed as an outpatient on [**4-4**] that demonstrated a slight increase in right upper abdominal fluid collection as compared to [**3-19**], as well as persistent inflammatory stranding adjacent to the duodenum and stable narrowing of her superior mesenteric vein. . Her initial vital signs revealed a temperature of 98.3, blood pressure of 70/54 right arm and 97/73 in left arm, heart rate of 94, respiratory rate of 18, 97% on 2 liters nasal cannula. . She recieved 5 liters of intravenous fluids. ID was contact[**Name (NI) **] in the emergency room, and recommended linezolid and zosyn which she received. She also received 50 mg of benadryl for a diffuse red rash. She was noted to be guaiac negative. Surgery was consulted and evaluated the patient in the ED. Past Medical History: Duodenal perforation Intra-abdominal abscess Staph coag negative sepsis Iron deficiency anemia Depression Diarrhea Hypertension Hypercholesterolemia GERD Recurrent low back pain s/p disc operation ~ 20 years ago Social History: Does not smoke cigarettes. Does drink alcohol. Lives independently. Does not smoke cigarettes. Does drink alcohol. Lives independently. Family History: Noncontributory. Physical Exam: At discharge: A&Ox3. Appropriate, Listens and responds to questions appropriately, pleasant V.S 98.5, 86, 142/72, 18, 99 Ra Gen: no acute distress CV: RRR, S1, S2. No murmurs ascultated LUNGS: CTA, BS BL, No W/R/C ABD: Soft, nontender. G tube also in place, c/d/i EXT: 2+ pitting edema. 2+ DP pulses BL Pertinent Results: [**2113-4-11**] 04:45AM BLOOD WBC-11.4* RBC-2.84* Hgb-8.4* Hct-25.9* MCV-91 MCH-29.7 MCHC-32.6 RDW-17.5* Plt Ct-401 [**2113-4-5**] 02:00PM BLOOD WBC-15.7*# RBC-3.18* Hgb-9.7* Hct-28.3* MCV-89 MCH-30.6 MCHC-34.4 RDW-17.6* Plt Ct-502* [**2113-4-7**] 04:52AM BLOOD Neuts-55.5 Lymphs-18.4 Monos-4.6 Eos-21.1* Baso-0.3 [**2113-4-11**] 04:45AM BLOOD Plt Ct-401 [**2113-4-11**] 04:45AM BLOOD Glucose-126* UreaN-7 Creat-0.7 Na-146* K-4.2 Cl-112* HCO3-25 AnGap-13 [**2113-4-5**] 02:00PM BLOOD ALT-12 AST-16 AlkPhos-73 TotBili-0.1 [**2113-4-11**] 04:45AM BLOOD Calcium-8.2* Phos-2.9 Mg-1.8 . BCX negative x 2. . UCX negative. . STUDIES [**4-5**] CT Abd/Pelvis: Limited evaluation without contrast. No free air. No apparent change in size of upper abdominal fluid collection with adjacent inflammatory change since [**4-4**]. No new collection. Micro: [**2113-3-18**] Blood VRE [**2113-2-8**] Fluid MRSA, [**Female First Name (un) 564**] Brief Hospital Course: The patient was brought to the emergency room from rehabilitation after she experienced fevers, abdominal pain, nausea, as well as worsening renal function and leukocytosis and diarrhea. She also reports that she has noted a diffuse red rash over her whole body that started one or two days prior to admission. She had been started on Bactrim [**2113-4-4**] for fevers and increasing WBC (noted to be 18.3 as compared to 12.1 on [**3-29**]). She had had a CT of her abdomen and pelvis completed as an outpatient on [**4-4**] that demonstrated a slight increase in right upper abdominal fluid collection as compared to [**3-19**], as well as persistent inflammatory stranding adjacent to the duodenum and stable narrowing of her superior mesenteric vein. . Her initial vital signs revealed a temperature of 98.3, blood pressure of 70/54 right arm and 97/73 in left arm, heart rate of 94, respiratory rate of 18, 97% on 2 liters nasal cannula. . She recieved 5 liters of intravenous fluids. ID was contact[**Name (NI) **] in the emergency room, and recommended linezolid and zosyn which she received. She also received 50 mg of benadryl for a diffuse red rash. She was noted to be guaiac negative. Surgery was consulted and evaluated the patient in the ED. . Upon arrival to the [**Hospital Unit Name 153**], she is no distress and has no complaints. Her BP is 110/70, with heart rate in the 70's. . IMAGING: [**2113-4-5**] CT Abdomen and Pelvis without contrast Limited evaluation without contrast. No free air. No apparent change in size of upper abdominal fluid collection with adjacent inflammatory change since yesterday. No new collection. . [**2113-4-5**] Chest x-ray The lungs are of low volume. There is stable appearance to the scattered tiny calcific densities, which may be related to a prior granulomatous infection. There is subtle added density at the left costophrenic angle suggestive of infective change. Cardiomediastinal silhouette is stable. Right lung is clear. . CONCLUSION: Subtle added density at the left lung base, may represent infective change. Please ensure followup to clearance. . #) Fevers, leukocytosis: Sources of potential infection include abdominal fluid collection, pneumonia (given appearance of CXR, though no cough or sputum reported), or urinary source given urine analysis. Most likely is abdominal in setting of abdominal discomfort and emesis, however after discussion with surgery team, this has been an ongoing unexplained problem for her (inability to take good PO's), and the fluid collection is not significantly changed from prior scans. Also possible is drug reaction in setting of rash and elevated eosinophils, though leukocytosis and hypotension are more consistent with infection as etiology. She has no RUQ tenderness to suggest cholecysitis, with benign LFT's. No significant findings on CT, but c. difficile infection is possibility given diarrhea and leukocytosis. Relatively recent echocardiogram from [**2113-3-22**] was without vegetations, and she has no stigma of endocarditis, but this is also a possible source of recurrent infections. - Per ID team who was contact[**Name (NI) **] in [**Name (NI) **], [**First Name3 (LF) **] continue linezolid, zosyn, and fluconazole. The referral sheet indicated that she completed fluconazole on [**4-2**] and Zyrox 600 mg on [**2113-4-2**] as well. . #) Hypotension: Suspect secondary to sepsis in setting of fevers, leukocytosis. Other possible (and likely) contributing etiology is volume depletion in setting of poor PO intake while at rehabilitation and concurrent administration of usual blood pressure medications. Given diffuse red rash after initiation of Bactrim and history of similiar rash with ciprofloxacin, allergic reaction (not anaphylactoid) is another possibility. Her hypotension has responded well to IVF while in the ED. BP on prior admission was systolic of 110's. - IVF boluses for goal MAP >55, will need to consider placement of central line should she continue to require boluses beyond those given in ED, also would then be able to measure CVP . #) Acute renal failure: Baseline creatinine is 0.9-1.1. Suspect pre-renal etiology in setting of concurrently elevated BUN, fevers, and emesis contributing to significant insensible losses. Component of ATN is also possible given hypotension and continued administration of anti-hypertensives. Urine output has picked up to over 50cc/hour with IVF resuscitation. - Hydration, follow up trend - Urine electrolytes, urine sediment - Should his renal function not improve, will consider renal ultrasound or additional work-up . #) Rash: Patient noted diffuse erythema yesterday, at which time she was also started on Bactrim for increasing leukocytosis. She has a history of a similar rash which was ultimately felt to likely be secondary to mediations (ciprofloxacin) in the setting of eosinophila. She again today has a marked eosinophila, and given temporal association to new medication, this is highest on the differential. No mucosal involvement noted, no pruritis or new peeling or blistering. - Patient received benadryl 50 mg once in the [**Last Name (LF) **], [**First Name3 (LF) **] continue to treat should she be symptomatic, though this would make mental status more difficult to assess. . #) Eosinophila: As noted above in discussion of rash. - Will follow trend, also check stool O&P - negative . #) Anemia: Patient's HCT today on admission is 28, which is up from her baseline prior to discharge (25-27), likely representing some degree of hemoconcentration. No history of bleeding. Guaiac negative in ED. Has history of iron deficiency. - Monitor trend, guaiac stools. . #) Duodenal performation: Patient has had difficulty with PO's since her surgery and complicated recovery. During last stay she had studies demonstrating patent duodenum without obstruction, but she may need further intervention to improve ability to take PO's and assist with chronic nausea and vomiting. . #) Mental status: Unknown baseline at this time, though she is on remeron as outpatient. She is currently oriented, though has poor recall of recent events. Per surgery team, this is close to her baseline. - Continue to monitor, obtain further information from family in AM. - Resume remeron once taking PO's. . #)ID was consulted and they recommended Daptomycin 450 mg IV Q24H fir a total of 4 weeks. laboratory monitoring required: -weekly CBC/diff, BUN/Cr, LFT, CK All laboratory results should be faxed to Infectious disease R.Ns. at ([**Telephone/Fax (1) 6313**] . #) Psych agrees pt depressed, but do not recommend SSRI while on Linezolid, nor Remeron, and to check TSH (3.9) . The patient was transfered to [**Hospital Ward Name **] 5. She was placed on telemetry secondary to prior sepsis. She was made NPO and tube feeds were administered via GJ tube at a goal rate of 40, which she tolerated well. A PICC line was placed for long term ABX per ID. The patient has a history of chronic loose stools, she was started on imodium 2 mg [**Hospital1 **] PRN with good effect. . Physical therapy also worked with patient and [**Hospital 80844**] rehab. Please see physical therapy note. . The patient will follow up with ID on [**2113-4-14**] and Dr. [**Last Name (STitle) 1924**] in 2 weeks. Medications on Admission: Vancomycin 750mg IV daily, Flucanazole 200mg daily, Lisinopril 10mg twice daily, Metoprolol 12.5 mg twice daily, Remeron 15mg nightly, Prevacid 30mg twice daily, Tylenol, Senna, Maalox, Lactulose PRN, Prochlorperazine 10mg q6h PRN nausea, dulcolax PR PRN, Benadryl cream, Dorzolamide-timolol 2-0.5% drps twice daily both eyes, Florastor II cabs twice daily, MVI, combivent, insulin Discharge Medications: 1. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization [**Last Name (STitle) **]: One (1) Inhalation Q6H (every 6 hours) as needed. 2. Dorzolamide-Timolol 2-0.5 % Drops [**Last Name (STitle) **]: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 3. Camphor-Menthol 0.5-0.5 % Lotion [**Hospital1 **]: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for pruritus. 4. Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day). 5. Lisinopril 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day). 6. Daptomycin 500 mg Recon Soln [**Hospital1 **]: One (1) Recon Soln Intravenous Q24H (every 24 hours) for 4 weeks: last dose [**2113-5-5**]. 7. Heparin, Porcine (PF) 10 unit/mL Syringe [**Month/Day/Year **]: Two (2) ML Intravenous PRN (as needed) as needed for line flush. 8. Sodium Chloride 0.9 % 0.9 % Syringe [**Month/Day/Year **]: Three (3) ML Injection Q8H (every 8 hours) as needed for line flush. 9. Prevacid 30 mg Capsule, Delayed Release(E.C.) [**Month/Day/Year **]: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 10. Florastor 250 mg Capsule [**Month/Day/Year **]: Two (2) Capsule PO twice a day. 11. Insulin Breakfast Lunch Dinner Bedtime Regular Regular Regular Regular Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose 0-60 mg/dL [**1-13**] amp D50 [**1-13**] amp D50 [**1-13**] amp D50 [**1-13**] amp D50 61-120 mg/dL 0 Units 0 Units 0 Units 0 Units 121-160 mg/dL 2 Units 2 Units 2 Units 2 Units 161-200 mg/dL 4 Units 4 Units 4 Units 4 Units 201-240 mg/dL 6 Units 6 Units 6 Units 6 Units 241-280 mg/dL 8 Units 8 Units 8 Units 8 Units 12. Prochlorperazine Maleate 10 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO every six (6) hours as needed for nausea. 13. Loperamide 2 mg Capsule [**Month/Day (2) **]: One (1) Capsule PO BID (2 times a day) as needed for loose stool. 14. Mirtazapine 15 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO QHS PRN. Discharge Disposition: Extended Care Facility: life care center of [**Location (un) **] Discharge Diagnosis: Primary: FEVER HYPOTENSION leukocytosis Acute renal failure Anemia Duodenal performation . Secondary: Duodenal perforation and repair [**12/2112**] - Intra-abdominal abscess - Staph coagase negative sepsis - Iron deficiency anemia - Depression - Diarrhea - Hypertension - Hypercholesterolemia - GERD - Recurrent low back pain s/p disc operation ~ 20 years ago Discharge Condition: Stable. Tolerating tube feeds at goal rate. Please cycle and encourage PO intake during day. Pain well controlled. Discharge Instructions: Rehab: 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 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. . GJ Tube: -Please continue to assess GJ tube site for s/s of infection -Please change dressing QD and PRN -Please cycle tube feeds: Peptamen 1.5 Full strength; Goal rate: 40 ml/hr Residual Check: q4h Hold feeding for residual >= : 100 ml Flush w/ 30 ml water q8h . Please check weekly labs CBC/Diff/BUN/Cr/AST/ALT/CK and fax to Dr. [**First Name (STitle) **] at [**Telephone/Fax (1) 432**]. . Please continue with Daptomycin 450 mg IV Q24H until [**5-5**]. Followup Instructions: 1. Please call Dr.[**Name (NI) 12822**] office, [**Telephone/Fax (1) 7508**], to make a follow up appointment in 2 weeks. . Scheduled Appointments : Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2113-4-14**] 10:30 Completed by:[**2113-4-11**] ICD9 Codes: 0389, 2930, 2720, 4019, 311
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Medical Text: Admission Date: [**2189-1-29**] Discharge Date: [**2189-2-2**] Date of Birth: [**2116-1-21**] Sex: F Service: CARDIOTHORACIC Allergies: Iodine; Iodine Containing / Lipitor / Codeine Attending:[**First Name3 (LF) 165**] Chief Complaint: superficial sternal wound infection Major Surgical or Invasive Procedure: none History of Present Illness: Ms. [**Known lastname 67738**] is a 73 year old woman who [**Known lastname 1834**] a coronary artery bypass grafting times four and mitral valve repair on [**2189-1-14**]. She subsequently was discharged to a rehab facility. Once home, her visiting nurse described her sternal wound to be erythematous with foul smelling eschar. She was admitted to [**Hospital1 69**] for debridement and intravenous antibiotics. Past Medical History: s/p CABG x4/MVr (on [**2189-1-14**]) Coronary artery disease with unstable angina chronic systolic heart failure mitral regurgitatiuon obesity insulin dependent diabetes mellitus s/p coronary angioplasty pulmonary hypertension hypertension peripheral vascular disease-s/p stenting lower extremities s/p cholecystectomy s/p appendectomy s/p psoas abcess gastritis Social History: Heavy smoker up to 2 PPD for 50 years, quit in [**10-25**]. Denies etOH or IVDU. Pt is a retired x-ray technician. She lives with her husband and two grandchildren in [**Name (NI) 67740**], She is the caregiver for her sister with [**Name (NI) 309**] body dementia and her husband as well as her two grandchildren. Family History: No family history of CAD or premature death, DM, HTN, HLD. Mother with PD. Sister with [**Name (NI) 309**] body dementia. Sister with lung CA. Physical Exam: At admission Ms. [**Known lastname 67738**] was noted to be in no acute distress. She was hemodynamically stable and afebrile. Her lungs were clear to auscultation bilaterally and her heart was of regular rate and rhythm. Her abdomen was soft, non-tender, and non-distended. Her mediastinal incision was intact at the superior pole, but inferiorly a 3 cm long by 2 cm wide area of eschar. Pertinent Results: [**2189-1-30**] 04:19PM BLOOD WBC-10.2 RBC-3.77* Hgb-11.2* Hct-34.2* MCV-91 MCH-29.7 MCHC-32.7 RDW-13.5 Plt Ct-495*# [**2189-2-2**] 05:59AM BLOOD WBC-10.4 [**2189-1-30**] 04:19PM BLOOD Glucose-338* UreaN-40* Creat-1.5* Na-133 K-6.0* Cl-94* HCO3-31 AnGap-14 [**2189-2-2**] 05:59AM BLOOD UreaN-31* Creat-1.1 [**2189-1-29**] 6:22 pm SWAB Source: mediastinum. GRAM STAIN (Final [**2189-1-29**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI IN PAIRS. 1+ (<1 per 1000X FIELD): GRAM POSITIVE ROD(S). WOUND CULTURE (Final [**2189-2-1**]): 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.. ANAEROBIC CULTURE (Preliminary): RESULTS PENDING. Brief Hospital Course: Ms. [**Known lastname 67738**] was admitted and her wound cultured. She was placed on Vancomycin and her wound was debrided. Superficial eschar was removed and vascularized healthy tissue was discovered just below it. No pus was expressed. A peripherally inserted central catheter was placed for access. She remained afebrile with a normal white blood cell count. Her wound on discharge was superficial without erythema or drainage. Her sternum was stable with no [**Doctor Last Name **] or click. Wound swab culture from [**1-29**] showed mixed bacteria. As per Dr.[**Last Name (STitle) **], Vanco and Cipro was discontinued and Ms.[**Known lastname 67738**] was placed on oral antibiotic course: Keflex 500 mg every 6 hours x ten days. A visiting nurse has been arranged for wound checks at home and Ms.[**Known lastname 67738**] has been instructed on dressing changes as well so that the wound can be dressd twice daily. She was advised to call with any signs or symptoms of worsening infection, and to follow up with Dr.[**First Name8 (NamePattern2) **] [**Name (STitle) **] for wound visit in 1 week. Medications on Admission: plavix 75mg omeprazole 20mg [**Hospital1 **] Insulin NPH 36 units in the morning and evening Insulin Lispro 4 units in the morning and evening atrovent xenopex [**Hospital1 21177**] 10mg metolazone 5mg [**Hospital1 **] colace zocor 40mg aspirin 81mg percocet amiodarone 400mg lopressor 75mg Discharge Medications: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). Disp:*60 Capsule, Delayed Release(E.C.)(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. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*60 Tablet, Chewable(s)* Refills:*0* 5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed. Disp:*40 Tablet(s)* Refills:*0* 6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily). Disp:*180 Tablet Sustained Release 24 hr(s)* Refills:*0* 7. Rosuvastatin 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 8. [**Hospital1 **] 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 9. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**1-21**] Puffs Inhalation Q6H (every 6 hours). Disp:*1 * Refills:*0* 10. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours): x 10 days. Disp:*40 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 **] VNA, [**Hospital1 1559**] Discharge Diagnosis: superficial sternal wound infection Discharge Condition: good Discharge Instructions: Please shower daily including washing incisions, no baths or swimming Monitor wounds for infection - redness, drainage, or increased pain Report any fever greater than 101 No creams, lotions, powders, or ointments to incisions **Wound dressing changes, wet to dry, twice daily Followup Instructions: See Dr. [**Last Name (STitle) **] in 1week Call for appointment [**Telephone/Fax (1) **] [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2189-2-2**] ICD9 Codes: 4280, 4019, 4240, 4439
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Medical Text: Admission Date: [**2188-4-8**] Discharge Date: Date of Birth: [**2130-3-24**] Sex: F Service: NOTE: This is an interim Discharge Summary through today ([**2188-4-18**]), and there will be a further Discharge Summary required. CHIEF COMPLAINT: This is a 58-year-old Caucasian female who presents with hypoxia, and mental status changes, and hypercapnia. HISTORY OF PRESENT ILLNESS: This is a 58-year-old female with a history of morbid obesity, obstructive sleep apnea, and chronic obstructive pulmonary disease who presents with hypoxia, per [**Hospital6 407**]. The patient had been found by [**Hospital6 407**] on the morning of admission confused, with shortness of breath, and an oxygen saturation of 79% on room air. The patient initially reported a sore throat, tightness, and chest pain which was not reported by the patient on presentation to the Emergency Department. Ms. [**Known lastname **] had recently been admitted to [**Hospital1 346**] a few days before with a workup for subacute renal failure. At that time, it was decided that Ms. [**Known lastname 34727**] renal failure was likely secondary to hypovolemia. She was given intravenous fluids, and her usual dose of 80 mg p.o. of Lasix b.i.d. was held. The patient's creatinine peaked around 4.1, and at discharge was 2.9. Currently, the patient is disoriented, awake, and alert. She has no complaints of chest pain, nausea, vomiting, diaphoresis, sore throat or shortness of breath. In the Emergency Department, she was given Levaquin 500 mg p.o. q.d., Lasix 40 mg intravenously times one, Solu-Medrol 120 mg times one, albuterol nebulizers, bicarbonate, D-50, and intravenous insulin. This was in response to a white blood cell count of 8.4, potassium of 6.1, and a blood urea nitrogen of 54, and creatinine of 2.6. PAST MEDICAL HISTORY: 1. Morbid obesity, weight of greater than 400 pounds. 2. Obstructive sleep apnea. 3. Cor pulmonale; echocardiogram in [**2188-1-12**] showed an ejection fraction of greater than 50%. There was also right atrial and ventricular dilatation, and severe global right ventricular hypokinesis. There was also abnormal right ventricular wall motion abnormalities. There was 4+ tricuspid regurgitation. Dobutamine MIBI on [**2187-3-30**] showed no defects. 4. Osteoarthritis/rheumatoid arthritis. 5. Hypertension. 6. Peptic ulcer disease. 7. Chronic obstructive pulmonary disease. The patient has a 72-pack-year smoking history, but no pulmonary function tests in the record. There is a history of intubation in the past, and she requires home oxygen of 2 liters to 3 liters. Her baseline bicarbonate was noted to be 48 to 50. 8. Renal insufficiency with a creatinine of 0.7 up until [**2187-9-12**], and since then has been 2 to 4. ALLERGIES: DEMEROL and CASHEWS. MEDICATIONS ON ADMISSION: Medications at home include Flovent 4 puffs b.i.d., Combivent 2 puffs q.i.d., albuterol 2 puffs q.i.d., Vioxx 25 mg p.o. q.d., trazodone 100 mg p.o. q.d., Prozac 20 mg p.o. q.d., Plaquenil 200 mg p.o. q.d., Protonix 40 mg p.o. q.d., Detrol 2 mg p.o. b.i.d., glucosamine 100 mg p.o. q.d., Neurontin 300 mg p.o. q.d., Norvasc 2.5 mg p.o. q.d., digoxin 0.125 mg p.o. q.d., Lasix 20 mg p.o. q.d., and K-Dur 20 mg p.o. q.d. PHYSICAL EXAMINATION ON PRESENTATION: Physical examination on admission revealed a temperature of 98, pulse of 100, blood pressure of 164/90, respiratory rate of 20, satting 96% on 50% face mask. In general, she was a very morbidly obese Caucasian female in moderate respiratory distress. Skin was pink. On neck examination unable to assess. On cardiovascular examination difficult to hear heart sounds. Second heart sound and second heart sound, tachycardic. Lungs were clear to auscultation anteriorly and laterally. The abdomen was obese, nontender and nondistended, positive bowel sounds. Extremities revealed some breakdown of the skin at the ankles. Pretibial edema was present. Neurologically, cranial nerves II through XII were intact bilaterally. Moved all four extremities and followed commands. Thought that the year was 200; had no response to date. She noted location was the hospital, but not that it was [**Hospital1 69**]. Otherwise, there were no focal neurologic deficits. PERTINENT LABORATORY DATA ON PRESENTATION: Laboratories on admission with a complete blood count that showed a white blood cell count of 8.4, hematocrit of 31.2, platelets of 187 (with 78% neutrophils, 1% basophils, 12% lymphocytes, 3% monocytes, and 5% eosinophils). Chem-7 revealed the following: Sodium of 143, potassium of 6.1, chloride of 105, bicarbonate of 30, blood urea nitrogen of 64, creatinine of 2.6, blood sugar of 95. Digoxin level of 2.3. Urinalysis showed the following: Specific gravity of 1.025, large blood, 30 protein, moderate leukocyte esterase, negative nitrites, 6 to 10 white blood cells, many bacteria. Lactate of 1.1, A-gradient of 15.5. Arterial blood gas on 50% face mask was the following: pH of 7.18, PCO2 of 88, PO2 of 231. Urine culture from [**2188-4-4**] showed Klebsiella sensitive only to imipenem with 10,000 colony-forming units. Urine culture from [**4-8**] was pending. Sputum from [**3-29**] showed methicillin-resistant Staphylococcus aureus in rare colonies. RADIOLOGY/IMAGING: Chest x-ray was limited, but no definite congestive heart failure or pneumonia. Electrocardiogram showed low voltages, rate of 110, with atrial abnormalities, far right axis deviation. No acute ST-T wave changes. No sign of Q waves. This was compared to an electrocardiogram from [**2188-3-23**]. CT of the abdomen and pelvis in [**3-15**] showed moderate ascites. She underwent paracentesis on [**2188-3-25**] which showed no spontaneous bacterial peritonitis by white blood cells or culture. Hospital course prior to being transferred to the [**Hospital1 **] Service, Ms. [**Known lastname **] was admitted to the Medical Intensive Care Unit Service for further management of her respiratory distress. She was placed on BiPAP and did not tolerate this well overnight. However, she maintained her oxygenation and was switched to nasal cannula during the day on the following morning. It was uncertain in the beginning as to whether her respiratory distress was secondary to congestive heart failure versus pneumonia/chronic obstructive pulmonary disease. Chest x-ray, lack of fever, and lack of leukocytosis suggested that there was not an infectious component. Thus, Solu-Medrol was discontinued at this time as well as Levaquin for pneumonia. She was diuresed in the intervening days with good response. Since then she has been able to maintain herself off of BiPAP and only on 3 liters to 4 liters nasal cannula. During her Medical Intensive Care Unit stay, Mr. [**Known lastname **] also converted to new atrial flutter with transient hypotension. At that time DC cardioversion was considered, but Ms. [**Known lastname 34727**] blood pressure improved. She was also tried on ibutilide drip without affect. She was anticoagulated initially with heparin and then converted to Coumadin and started on amiodarone while in the unit. MEDICATIONS ON TRANSFER: 1. Flovent 4 puffs inhaled b.i.d. 2. Albuterol and Atrovent nebulizers q.6h. 3. Imipenem 500 mg q.6h. intravenously. 4. Protonix 40 mg p.o. q.d. 5. Lasix 40 mg p.o. b.i.d. 6. Amiodarone 400 mg p.o. t.i.d. 7. Heparin drip. 8. Combivent 2 puffs q.4-6h. PERTINENT LABORATORY DATA ON TRANSFER: Complete blood count showed a white blood cell count of 6.5, hematocrit of 28.7, platelets of 171. Chem-7 showed the following: Sodium of 142, potassium of 5.2, chloride of 103, bicarbonate of 30, blood urea nitrogen of 67, creatinine of 2.7, blood sugar of 110. Calcium of 8.3, phosphate of 5.8, magnesium of 1.9. Urine culture from [**4-9**] did eventually grow out 100,000 Klebsiella pneumoniae which was sensitive only to imipenem. Nasal swab from [**2188-3-25**], showed positive methicillin-resistant Staphylococcus aureus. PHYSICAL EXAMINATION ON TRANSFER: Temperature of 96.3, pulse of 89 (in atrial flutter), blood pressure of 104/62, respiratory rate of 27, satting 88% to 97% on 4 liters nasal cannula. In general, this was an extremely obese Caucasian female lying in bed, in no acute distress. Nasal cannula was in place. Head, eyes, ears, nose, and throat revealed pupils were equal, round, and reactive to light. Extraocular movements were intact. Poor attention span. The oropharynx was clear. Poor dentition. Cardiovascular examination showed a regular rate, irregularly rhythm. No murmurs, rubs or gallops could be assessed. Lungs revealed poor inspiratory effort, otherwise clear. The abdomen revealed normal active bowel sounds, nontender, and nondistended. No masses could be palpated. An extremely obese abdomen. Extremities were clean, dry, and intact. There was brawny induration with 3+ pitting edema up to her lower thighs. Neurologically, alert and oriented times three. Able to move all four extremities against gravity and pressure. Light touch was intact bilaterally; grossly nonfocal. HOSPITAL COURSE: (After being transferred to the [**Hospital1 **] Medicine team) 1. CARDIOVASCULAR: (a) Arrhythmia: Ms. [**Known lastname **] was noted to be in new atrial fibrillation/atrial flutter but was not considered a candidate for electrocardioversion. She had been attempted previously for chemical cardioversion with ibutilide drip without success. She was started on amiodarone on [**2188-4-11**] and also anticoagulated with a heparin drip with Coumadin. The goal at that time was for an INR of greater than 2. Digoxin was discontinued secondary to its effect on both amiodarone and Coumadin. Thyroid-stimulating hormone and liver function tests were recently checked and were within normal limits with the exception of a subclinical hypothyroidism. Ms. [**Known lastname 34727**] INR did finally reach a therapeutic range but had to be reversed with vitamin K secondary to need for new line placement. (b) Coronary artery disease: Ms. [**Known lastname **] was ruled out for myocardial infarction during her Medical Intensive Care Unit course. Electrocardiograms were followed every few days. (c) Congestive heart failure: Ms. [**Known lastname **] has known right-sided heart failure secondary to extreme obesity, chronic obstructive pulmonary disease, and obstructive sleep apnea. Cardiology was consulted who recommended holding off on Swan-Ganz catheter and suggested possible right heart catheterization at a later time. 2. RESPIRATORY: Ms. [**Known lastname 34727**] respiratory distress responded well to diuresis with Lasix up to 80 mg intravenously b.i.d. At the time of transfer from the Medical Intensive Care Unit, this had been changed to p.o. Lasix at 40 mg p.o. b.i.d. Strict ins-and-outs were requested, and oxygen was weaned as tolerated. Ms. [**Known lastname **] continued to refuse BiPAP as well as nebulizers while on the Medicine floor. 3. RENAL: Ms. [**Known lastname **] was known to have recent acute renal failure with chronic renal insufficiency, likely secondary to hypovolemia. In the intervening days after being transferred from the Medical Intensive Care Unit, her creatinine and blood urea nitrogen continued to rise; likely secondary to prerenal picture including hypovolemia and possible congestive heart failure. Renal was consulted. Urine electrolytes had been obtained prior to a Renal consultation which showed a urea of 26, which likely indicated prerenal state. Urinalysis was also obtained which showed many bloody/brown casts. However, Renal was consulted and thought that only granular casts could be visualized on the urinalysis. FENa was repeated and found to be 0.17%, likely indicating prerenal. Ms. [**Known lastname **] is not a candidate for dialysis at this time secondary to her preload dependence and poor blood pressure. However, they believed that she was a candidate for continuous venovenous hemofiltration to help remove approximately 120 pounds of fluid. She will require placement of a hemodialysis catheter and transfer to the Medical Intensive Care Unit for hemodynamic monitoring and continuous venovenous hemofiltration. In light of her renal failure, all medications are now renally dosed, and all nephrotoxins have been discontinued. 4. FLUIDS/ELECTROLYTES/NUTRITION: Ms. [**Known lastname **] had been on a regular diet except for nuts. However, in the intervening days she began to have decreased oral intake. Albumin was checked and was found to be 3.4. Intravenous fluids had been avoided at this time secondary to whole body anasarca. Ms. [**Known lastname **] was treated for hyperkalemia on admission with a potassium of 6.1. Potassium was carefully monitored over the next few days. On [**2188-4-17**], potassium was found to be 5.5, and she was given Kayexalate 30 g with good affect. 5. HEMATOLOGY: Ms. [**Known lastname 34727**] hematocrit on admission was 30.2, and trended down to 28.7. This was likely secondary to chronic renal insufficiency and poor Epogen production. Transfusion parameters were for a hematocrit of less than 27. 6. INFECTIOUS DISEASE: Ms. [**Known lastname **] has had a chronic indwelling Foley for greater than two years. Cultures from [**2188-4-4**] and [**2188-4-9**] showed two strains of Klebsiella which were imipenem sensitive. She was treated with seven days of imipenem which was discontinued on [**2188-4-15**]. Foley was changed on [**2188-4-11**]. She continued on methicillin-resistant Staphylococcus aureus and contact precautions. 7. LINES: Ms. [**Known lastname **] has a left subclavian line which was placed in the unit on admission on [**2188-4-8**]. This will be changed when transferred to the Medical Intensive Care Unit on [**2188-4-21**]. 8. DISPOSITION: Ms. [**Known lastname **] is do not resuscitate but NOT do not intubate. She will be transferred at this time to the Medical Intensive Care Unit for further monitoring and continuous venovenous hemofiltration/hemodialysis. Ms. [**Known lastname **] understands that continuous venovenous hemofiltration does have risks involved including possible renal failure, heart failure, and other kinds of morbidities. She is willing to take these risks including possibly requiring hemodialysis for the rest of her life. As stated before, this is an interim Discharge Summary. A discharge addendum will be needed later. [**First Name11 (Name Pattern1) 312**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 313**], M.D. [**MD Number(1) 314**] Dictated By:[**Name8 (MD) 8073**] MEDQUIST36 D: [**2188-4-18**] 14:05 T: [**2188-4-18**] 17:58 JOB#: [**Job Number 34728**] ICD9 Codes: 4280, 4168, 5849, 5990
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Medical Text: Admission Date: [**2143-6-18**] Discharge Date: [**2143-6-26**] Date of Birth: [**2067-3-27**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: SOB and chest pain Major Surgical or Invasive Procedure: CABGx4 (LIMA>LAD, SVG>Diag, SVG>Ramus, SVG>OM) [**2143-6-21**] History of Present Illness: 76 yo M who fell and fractured hip, had ORIF at [**Hospital3 **] [**2143-6-9**]. He developed chest pain on POD #2, had +ETT and cardiac cath which showed multivessel CAD. He was transferred for surgery. Past Medical History: PMH: CAD, HTN, DM, BPH, peripheral neuropathy, L [**Doctor Last Name **] DVT PSH: Rt hip ORIF, Spinal [**Doctor First Name **] x2(15yrs ago) Social History: retired mechanic quit tobacco 20 years ago denies etoh Family History: mother died of ischemic heart disease at age 42 Physical Exam: HR 63 RR 18 BP 136/76 98% on 2L NAD, pain free muliple scratched on arms/legs Lungs CTAB Heart RRR no M/R/G Abdomen benign Extrem warm, no edema Neuro non-focal but poor historian, forgetful Pertinent Results: [**2143-6-25**] 05:35AM BLOOD Hct-28.9* [**2143-6-24**] 01:40AM BLOOD WBC-13.5* RBC-3.42* Hgb-10.1* Hct-29.3* MCV-86 MCH-29.6 MCHC-34.5 RDW-14.6 Plt Ct-295 [**2143-6-25**] 05:35AM BLOOD PT-14.1* INR(PT)-1.2* [**2143-6-25**] 05:35AM BLOOD K-4.4 [**2143-6-24**] 01:40AM BLOOD Glucose-182* UreaN-22* Creat-0.8 Na-132* K-4.3 Cl-98 HCO3-28 AnGap-10 PORTABLE CHEST, [**2143-6-23**]. COMPARISON: [**2143-6-21**]. INDICATION: Tube removal. Various indwelling devices have been removed, with no evidence of pneumothorax. Cardiomediastinal contours are within normal limits for postoperative status. Patchy and linear areas of atelectasis are present in both lung bases, slightly worse in the interval, and there are also very small bilateral pleural effusions. Calcified pleural plaques are present consistent with prior asbestos exposure. [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 78541**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 78542**] (Complete) Done [**2143-6-21**] at 12:59:43 PM FINAL 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: [**2067-3-27**] Age (years): 76 M Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: cabg ICD-9 Codes: 786.05, 786.51, 799.02, 440.0, 424.1, 424.0 Test Information Date/Time: [**2143-6-21**] at 12:59 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: aw2 Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: 1.0 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: 1.0 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 5.0 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 50% to 55% >= 55% Aorta - Ascending: *3.5 cm <= 3.4 cm Aorta - Descending Thoracic: 2.5 cm <= 2.5 cm Findings LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal ascending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Moderately thickened aortic valve leaflets. Mild (1+) AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild (1+) 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. Right ventricular chamber size and free wall motion are normal. LV systolic fxn is good, with an EF of 50 - 55%. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets are moderately thickened. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. An epi-aortic scan was done to aid placement of aortic cannula and cross-clamp. Post-CPB: Preserved biventricular systolic fxn. AI and MR remain 1+. Aorta intact. Brief Hospital Course: He was admitted to cardiac surgery. He continued on heparin and nitroglycerine drips and he remained chest pain free. He was taken to the operating room on [**6-21**] where he underwent a CABG x 4. He was transferred to the ICU in stable condition. He was extubated post op. He was transferred to the floor on POD #2. He was started on coumadin for his recent hip surgery. Chest tubes and wires were pulled without incident. Foley was reinserted for urinary retention and he was restarted on his flomax and proscar. Foley was again removed on [**6-25**] and he voided successfully. He was ready for discharge to rehab on POD #5. His right leg remains ecchymotic secondary to recent trauma. He will need lovenox until his INR is 2.0 or greater, he has received 3 doses of 5 mg of coumadin so far. Medications on Admission: Novalin, Procrit, Proscar 5', Flomax 0.4', Colace 100", Pepcid 20', MOM 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. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 4. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 7. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Twenty (20) units Subcutaneous with breakfast. 8. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Fifteen (15) units Subcutaneous with dinner. 9. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: sliding scale units Subcutaneous four times a day. 10. Lovenox 80 mg/0.8 mL Syringe Sig: Seventy (70) mg Subcutaneous twice a day: please check inr daily, when 2.0 or greater discontinue lovenox. 11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. 13. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 14. Warfarin 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily): Check INR daily, continue lovenox until INR >= 2. Has received 3 doses of 5 mg. Discharge Disposition: Extended Care Facility: Berkeley Retirement Home Discharge Diagnosis: CAD s/p CABG PMH: CAD, HTN, DM, BPH, peripheral neuropathy, L [**Doctor Last Name **] DVT PSH: Rt hip ORIF, Spinal [**Doctor First Name **] x2(15yrs ago) 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 for 10 weeks. No driving until follow up with surgeon. Followup Instructions: CT scan in 3 months to follow-up left upper lobe lung nodule. Dr. [**Last Name (STitle) 28745**] 2 weeks Dr. [**First Name (STitle) 3646**] 2 weeks Dr. [**Last Name (STitle) 914**] 4 weeks Completed by:[**2143-6-26**] ICD9 Codes: 4111, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7116 }
Medical Text: Admission Date: [**2177-4-14**] Discharge Date: [**2177-4-18**] Date of Birth: [**2098-11-22**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 4095**] Chief Complaint: Hypoxia Posterior hip dislocation Major Surgical or Invasive Procedure: Reduction of left posterior hip dislocation PICC line insertion History of Present Illness: 78M with hx of CABG in [**2168**], CAD, DM hx of hip frequent dislocation of artificial L hip, tripped over rug in apartment and fell, no Head strike or LOc. He felt hip [**Doctor Last Name **] out. In the ED, initial VS were:97.3 108 144/75 16, no O2 sat recorded, 3L NC(recorded).However resident noted patient to be tachypneic at 35 hypoxic to 50. Patient did note several hours of shortness of breath today upon further questioning. CXR showed R pulmonary edema vs infiltrate, placed on NRB, then sats to mid90s-100. A CT scan was negative for PE, but did show right sided pneumonia, possible aspiration. Patient noted to have elevated lactate 4.4. WBC 2.8 with N:59.5 L:33.2 M:5.4 E:0.9 Bas:1.0. Vanc/Zosyn/Levoflox given. Trop of 0.05. EKG: sinus 92 NA, IV conduction delay ST depression I and aVL. . In ED, Ortho consulted and patient had procedural sedation with with fent (100)/versed (4) hip successfully reduced in ED. Reversed sedation with flumazenil (0.2)/narcan (2), Got 2L IV fluids for the lactate. . On arrival to the MICU, patient's VS. 97.7/ 81/112/69/13 100% NRB. On recheck 91% on RA. 97% on 2L. patient denied any Chest pain/SOB. Feels very well and is surprised to be admitted. Past Medical History: Coronary artery disease status post CABG, [**2168**] Diabetes recently stopped glyburide and metformin per his doctor [**First Name (Titles) **] [**Last Name (Titles) 6093**], muscle weakness, NOS spinal stenosis, lumbar MITRAL INSUF/AORT STENOS PVD, NOS HL Social History: Social History: Lives by himself. Has a home care nurse [**First Name (Titles) **] [**Last Name (Titles) 6094**]s every 2 weeks. Uses a walker or cane and scooter when out of apartment. No smoking, no alcohol, no rec drugs. has a Niece [**Name (NI) **] [**Name (NI) **] who lives in [**Hospital1 1474**] [**Telephone/Fax (1) 6095**] (cell) [**Telephone/Fax (1) 6096**] (work) is HCP according to patient. Family History: Family History: Father with MI in 50s. Brother with MI in 50s. No history of cancer Physical Exam: Vitals: 97.7/ 81/112/69/13 100% NRB General: Alert, oriented x3, no acute distress, NRB in place HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, holosystolic murmur radiates to both axilla and carotids, rubs, gallops Lungs:rales in bilateral lung bases R>L., no wheezes, occasional ronchi Abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. Left leg in knee immobilizer Pertinent Results: ADMISSION [**2177-4-14**] 09:45AM BLOOD WBC-2.8* RBC-3.81* Hgb-10.3* Hct-35.3* MCV-93 MCH-27.2# MCHC-29.3*# RDW-14.1 Plt Ct-144* [**2177-4-15**] 07:36AM BLOOD Hct-28.4* [**2177-4-15**] 12:05PM BLOOD Hct-29.7* [**2177-4-14**] 09:45AM BLOOD PT-10.4 PTT-25.9 INR(PT)-1.0 [**2177-4-15**] 04:24AM BLOOD Plt Ct-100* [**2177-4-14**] 09:45AM BLOOD Neuts-59.5 Lymphs-33.2 Monos-5.4 Eos-0.9 Baso-1.0 [**2177-4-15**] 04:24AM BLOOD Ret Aut-2.4 [**2177-4-14**] 09:45AM BLOOD Glucose-322* UreaN-23* Creat-0.6 Na-139 K-4.0 Cl-98 HCO3-29 AnGap-16 [**2177-4-15**] 04:24AM BLOOD Glucose-113* UreaN-14 Creat-0.4* Na-138 K-4.0 Cl-104 HCO3-30 AnGap-8 [**2177-4-14**] 09:45AM BLOOD CK(CPK)-216 [**2177-4-14**] 03:57PM BLOOD ALT-29 AST-46* LD(LDH)-225 CK(CPK)-482* AlkPhos-51 TotBili-0.3 [**2177-4-14**] 08:54PM BLOOD CK(CPK)-516* [**2177-4-15**] 04:24AM BLOOD LD(LDH)-214 CK(CPK)-395* TotBili-0.3 [**2177-4-15**] 12:05PM BLOOD CK(CPK)-379* [**2177-4-14**] 09:45AM BLOOD CK-MB-8 [**2177-4-14**] 09:45AM BLOOD cTropnT-0.05* [**2177-4-14**] 03:57PM BLOOD CK-MB-15* MB Indx-3.1 cTropnT-0.34* [**2177-4-14**] 08:54PM BLOOD CK-MB-15* MB Indx-2.9 cTropnT-0.37* [**2177-4-15**] 04:24AM BLOOD CK-MB-11* MB Indx-2.8 cTropnT-0.25* [**2177-4-15**] 12:05PM BLOOD CK-MB-10 MB Indx-2.6 cTropnT-0.19* [**2177-4-15**] 04:24AM BLOOD Calcium-8.3* Phos-3.0 Mg-2.0 [**2177-4-15**] 04:24AM BLOOD Hapto-48 [**2177-4-14**] 04:18PM BLOOD Type-[**Last Name (un) **] pH-7.29* Comment-GREEN TOP [**2177-4-14**] 04:18PM BLOOD Lactate-0.9 [**2177-4-14**] 09:56AM BLOOD Lactate-4.4* [**2177-4-14**] 04:18PM BLOOD freeCa-1.02* [**2177-4-14**] 11:45AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.029 [**2177-4-14**] 11:45AM URINE Blood-NEG Nitrite-NEG Protein-30 Glucose-1000 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG [**2177-4-14**] 11:45AM URINE RBC-3* WBC-1 Bacteri-NONE Yeast-NONE Epi-0 [**2177-4-14**] 11:45AM URINE CastHy-1* [**2177-4-14**] 11:45AM URINE Mucous-RARE DISCHARGE [**2177-4-18**] 06:15AM BLOOD WBC-1.9* RBC-3.33* Hgb-8.9* Hct-29.1* MCV-87 MCH-26.8* MCHC-30.6* RDW-13.9 Plt Ct-125* [**2177-4-17**] 06:05AM BLOOD Neuts-58.9 Lymphs-29.5 Monos-9.1 Eos-2.2 Baso-0.4 [**2177-4-18**] 06:15AM BLOOD ESR-15 [**2177-4-18**] 06:15AM BLOOD Glucose-126* UreaN-11 Creat-0.5 Na-141 K-3.6 Cl-99 HCO3-33* AnGap-13 [**2177-4-17**] 06:05AM BLOOD ALT-23 AST-28 LD(LDH)-225 AlkPhos-63 TotBili-0.3 [**2177-4-18**] 06:15AM BLOOD Calcium-8.8 Phos-3.8 Mg-2.3 [**2177-4-18**] 06:15AM BLOOD CRP-5.8* MICRO Blood Culture, Routine (Preliminary): SENSITIVITIES REQUESTED BY DR.[**Last Name (STitle) **] ([**Numeric Identifier 6097**]) ON [**2177-4-18**]. VIRIDANS STREPTOCOCCI. OF TWO COLONIAL MORPHOLOGIES. Isolated from only one set in the previous five days. Anaerobic Bottle Gram Stain (Final [**2177-4-15**]): Reported to and read back by DR. [**Last Name (STitle) **]. ROSE ON [**2177-4-15**] AT 0145. GRAM POSITIVE COCCI IN PAIRS AND CHAINS. -[**Date range (1) 6098**] blood cxs are no growth to date CHEST (PORTABLE AP) Study Date of [**2177-4-14**] 9:47 AM IMPRESSION: Increased hazy opacity in the right lung, predominantly in the right greater than left base, which could represent asymmetric edema versus aspiration or infection. No pneumothorax. No laboratory data is available at the time of interpretation, which should be correlated as well as with clinical presentation. HIP UNILAT MIN 2 VIEWS LEFT PORT Study Date of [**2177-4-14**] 10:13 AM IMPRESSION: Findings consistent with posterior dislocation of the prosthetic femoral head from the acetabular cup. CTA CHEST W&W/O C&RECONS, NON-CORONARY Study Date of [**2177-4-14**] 11:04 AM IMPRESSION: 1. Bilateral lower lobe consolidations, likely reflecting pneumonia and/or aspiration, worse on the right. 2. Right upper lobe and left apical ground-glass opacities, with neighboring smooth septal wall thickening, likely reflecting combination of inflammation/infection and mild edema. 3. No pulmonary embolus detected to the subsegmental levels. No acute dissection. 4. Mildly prominent left para-aortic lymph node/ Portable TTE (Complete) Done [**2177-4-15**] at 9:53:07 AM Conclusions The left atrium is mildly dilated. There is moderate 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. Overall left ventricular systolic function is probably normal (LVEF~55%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The ascending aorta is mildly dilated. The aortic valve leaflets are severely thickened/deformed. There is moderate to severe aortic valve stenosis (valve area ~1.0cm2). Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The left ventricular inflow pattern suggests impaired relaxation. There is no pericardial effusion. CHEST (PORTABLE AP) Study Date of [**2177-4-15**] 7:59 AM FINDINGS: As compared to the previous radiograph, there is marked improvement of the pre-existing right parenchymal opacity. On the left, there is unchanged evidence of moderate retrocardiac atelectasis, potentially combined to a minimal left pleural effusion. Unchanged status post CABG with stable size of the cardiac silhouette and stable sternal wires. PELVIS AP [**4-15**] There is some relocation of the left total hip arthroplasty. There is some asymmetric positioning of the femoral head suggestive of polyethylene liner wear with the femoral head positioned slightly more superolaterally within the center. No periprosthetic fractures are seen. Vascular calcifications are present. Brief Hospital Course: 78M with hx of CAD s/p CABG, L THA with Left hip dislocation s/p reduction, here with hypoxia in setting of likely pneumonia/aspiration. . ACTIVE ISSUES . #Aspiration Pneumonia with Strep Viridans Bacteremia. Patient presented with dyspnea, elevated lactate, hypoxia, and CXR/CT with evidence of pneumonia vs aspiration pneumonitis. Patient initially received vancomycin, levofloxacin, and ceftriaxone for likely community-acquired v aspiration PNA. He was initially admitted to the MICU as he required a non-rebreather but he was quickly transitioned to nasal cannula and sent to the floor. He continued to improve clinically, remaining afebrile and without leukocytosis or an oxygen requirement. One of 4 blood cultures was postive for gram positive cocci, so vancomycin was also started. When the blood culture speciated to Streptococcus viridans, vancomycin was discontinued and he was kept on ceftriaxone and levofloxacin. TEE could not be performed to rule out endocarditis due to his tenuous aortic valve but as patient appeared clinically well and had a very low-grade bacteremia (only one positive culture out of many bottles), CRP/ESR were low and TTE was negative for vegetations, there was a low suspicion for endocarditis so ID recommended he be treated for two weeks of IV antibiotics for his bacteremia until [**4-28**]. Patient was discharged on oral levofloxacin as well to cover for atypical organisms. . #Elevated Troponin. Presented with troponin of 0.05 that peaked at 0.37. Cardiology was consulted who felt this was due to demand ischemia in the setting of his fall. Patient was without chest pain throughout his stay. EKG showed no acute changes only borderline ST depressions in I and aVL. He was placed on ASA, metoprolol 12.5mg [**Hospital1 **], and continued on his statin. Cardiology agreed with plan, and recommended considering an ACE-I, however his outpatient cardiologist did not want to start it. Patient remained chest pain free with stable EKGs throughout his stay. . #Left hip dislocation. Patient with total hip arthroplasty of left hip many years ago and has had multiple dislocations in past, this presentation is similar to his previous. It was reduced successfully in the ED. Patient was initially placed in a lower lumbar to hip brace by orthopedics with restrictions on movement that were gradually loosened. At the time of discharge they recommended keeping him in the brace when out of bed only and with a maximum of 70 degrees hip flexion. At night, he should wear an abduction pillow. They recommended he continue in these braces until his hip can be evaluated for surgical repair. . CHRONIC ISSUES . #Aortic Stenosis: TTE on this admission showed severe AS (valve area 1.0cm2) with otherwise preserved EF. . #DM. Maintained on insulin sliding scale in house. Diet-controlled. . #HTN. Continued lasix 20mg daily, switched atenolol 12.5mg daily to metop 12.5 [**Hospital1 **]. . #HL. Continued rosuvastatin 5mg daily . #GERD. Continued omeprazole 20mg daily. . # Melanoma: Followed at VA. Was scheduled for biopsy this week which he missed due to this hospitalization. He is to follow-up with dermatology next week here at [**Hospital1 18**] for an urgent appointment. . TRANSITIONAL ISSUES - Given his severe aortic stenosis, patient will likely require cardiac evaluation to determine whether he is a candidate for hip surgery - Patient will need follow-up for his melanoma. We have arranged an appointment for him at [**Hospital1 18**] for next week for biopsy. - Patient will require repeat blood cultures two weeks after he has completed his antibiotic course to make sure his infection has cleared Medications on Admission: Lasix 20mg qday multivitamin qday omeprazole 20mg qday atenolol 12.5mg qday Calcarb 600 With Vitamin D 1tab qday lactulose 10g/15mL 1tblespoon as needed for constipation Ecotrin 81mg qday tylenol 650 qday rosuvastatin 5mg qday Discharge Medications: 1. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain/fever. 6. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 3 days. 7. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 8. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 10. lactulose 10 gram/15 mL Solution Sig: One (1) PO once a day as needed for constipation. 11. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 12. ceftriaxone in dextrose,iso-os 1 gram/50 mL Piggyback Sig: One (1) unit Intravenous Q24H (every 24 hours) for 10 days. Discharge Disposition: Extended Care Facility: Newbridge on the [**Doctor Last Name **] - [**Location (un) 1411**] Discharge Diagnosis: PRIMARY Hip dislocation Aspiration Pneumonia Demand ischemia . SECONDARY HTN HL Aortic stenosis Coronary artery disease 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: Dear Mr. [**Known lastname 6099**], You were admitted to [**Hospital1 18**] because you fell, dislocated your hip, and were found to have trouble breathing. Your hip was put back into place by our orthopedic surgeons who felt you should wear a brace to help keep your joint in place. You will likely require surgery to repair this hip. We have scheduled appointments with an orthopedic surgeon to evaluate your hip. You will need to talk to your cardiologist to determine whether you are a good candidate for surgery given your narrow aortic valve. Your shortness of breath was thought to be due to some accidental swallowing of your stomach contents during your fall. We treated you with antibiotics and your breathing improved quickly. However, some bacteria was found in your blood, likely coming from this infection in your lungs. As a result you will need to be on intravenous antibiotics to make sure that all the bacteria in your blood is gone. For the lesions on your nose, we have arranged for the [**Hospital1 18**] dermatologists to see you next week to determine whether it is melanoma. Please bring your records from the VA with you to this appointment. The following medications were changed during this hospitalization: START ceftriaxone intravenously for a total of two weeks to end on [**4-28**] START levofloxacin until [**4-20**] STOP atenolol and START metoprolol 12.5mg twice a day . Please continue your other medications as previously prescribed Followup Instructions: The doctor at rehab will follow-up this hospitalization. They will schedule you for an appointment with your PCP upon discharge. Department: ORTHOPEDICS When: THURSDAY [**2177-4-24**] at 11:10 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: THURSDAY [**2177-4-24**] at 11:30 AM With: [**First Name4 (NamePattern1) 6100**] [**Last Name (NamePattern1) **], MD [**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: DERMATOLOGY When: THURSDAY [**2177-4-24**] at 2:00 PM With: [**Name6 (MD) 1037**] [**Name8 (MD) 5647**], MD [**Telephone/Fax (1) 1971**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Please bring your dermatologic records from the VA to this appointment if possible. ICD9 Codes: 5070, 7907, 4019, 4241, 2724, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7117 }
Medical Text: Admission Date: [**2168-3-2**] Discharge Date: [**2168-3-16**] Date of Birth: [**2091-9-21**] Sex: F Service: PLASTIC Allergies: Bactrim / ciprofloxacin / Codeine / Penicillins / Thiazides / sulfa Attending:[**First Name3 (LF) 36263**] Chief Complaint: Right hand pain, swelling s/p fall with fever, ? of necrotizing fasciitis. Major Surgical or Invasive Procedure: [**2168-3-2**] Incision and debridement and carpal tunnel release right hand and forearm. . [**2168-3-3**] Debridement of skin, subcutaneous tissue, tendons of right upper extremity (measuring 25 x 15 cm). . [**2168-3-6**] Irrigation and debridement of skin, subcutaneous tissue, fascia. . [**2168-3-8**] 1. Irrigation and debridement of skin, subcutaneous tissue, and fascia. 2. Neurorrhaphy of the lateral antebrachial cutaneous nerve. . [**2168-3-10**] Placement of 'Integra' dressing to right hand wound defect and application of wound VAC dressing. History of Present Illness: 76 year old female transferred from [**Hospital3 26615**] for ? necrotizing fasciitis to her Right hand sustained from fall this weekend. Pt denies any other pain, complaints at this time. Of note, prior to transfer her temp was 104.2, she was subsequently given 1 gram vancomycin, clindamycin 900mg, gentamycin 120mg IV at OSH. On presentation to [**Hospital1 18**] ED her temp was 99. However, she did trigger in the room (low BP). She is a poor historian. Lives alone in [**Hospital3 4634**] and is seen 3x per week by VNA for BLE wounds (vasculopathy) and at the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] wound clinic. Past Medical History: Hypothyroidism Depresion Skin ulcers vasculopath double bypass previous blood clots Known MRSA cellulitis to RLE Social History: Lives alone in [**Hospital3 4634**] and VNA comes three times per week to treat BLE ulcers. Uses walker and ambulates about her unit. Does not drive. Her brother lives in the south and is 84 years old. She has no family nearby. Does not smoke or drink. Physical Exam: 99.2 94 114/92 18 93% 4L Appearance: complaining of R hand pain, AAOx3 VASCULAR R Radial Pulse: dopplerable R hand red, hot, swollen with ascending cellulitis and areas of ischemia. Notable blistering, areas of fibro-eschar along anatomical snuff box, fluid filled bulla up volar forearm NEUROLOGICAL: Sensation: [x] Intact - painful to touch [] Absent INTEGUMENT: Ulceration(s): [] Full thickness [x] Partial thickness [] Pre/Post-ulcerative [] Absent Pertinent Results: [**2168-3-2**] 09:00PM URINE MUCOUS-OCC [**2168-3-2**] 09:00PM URINE AMORPH-MOD [**2168-3-2**] 09:00PM URINE HYALINE-10* [**2168-3-2**] 09:00PM URINE RBC-0 WBC-26* BACTERIA-FEW YEAST-NONE EPI-3 [**2168-3-2**] 09:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN->600 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-9.0* LEUK-LG [**2168-3-2**] 09:00PM URINE COLOR-Red APPEAR-Cloudy SP [**Last Name (un) 155**]-1.019 [**2168-3-2**] 09:00PM PLT SMR-NORMAL PLT COUNT-220 [**2168-3-2**] 09:00PM NEUTS-67 BANDS-10* LYMPHS-19 MONOS-4 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2168-3-2**] 09:00PM WBC-3.0* RBC-3.58* HGB-11.0* HCT-33.9* MCV-95 MCH-30.7 MCHC-32.4 RDW-13.7 [**2168-3-2**] 09:00PM CALCIUM-8.3* PHOSPHATE-1.7* MAGNESIUM-1.5* [**2168-3-2**] 09:00PM estGFR-Using this [**2168-3-2**] 09:00PM GLUCOSE-134* UREA N-39* CREAT-1.9* SODIUM-134 POTASSIUM-3.3 CHLORIDE-102 TOTAL CO2-21* ANION GAP-14 [**2168-3-2**] 09:21PM LACTATE-2.4* [**2168-3-2**] 09:40PM PT-19.9* PTT-25.1 INR(PT)-1.9* . MICROBIOLOGY: [**2168-3-2**] 9:00 pm BLOOD CULTURE #1. **FINAL REPORT [**2168-3-8**]** Blood Culture, Routine (Final [**2168-3-8**]): NO GROWTH. . [**2168-3-2**] 10:40 pm BLOOD CULTURE **FINAL REPORT [**2168-3-8**]** Blood Culture, Routine (Final [**2168-3-8**]): NO GROWTH. . [**2168-3-2**] 11:35 pm SWAB Site: HAND RIGHT. GRAM STAIN (Final [**2168-3-3**]): Reported to and read back by DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 39755**] ON [**2168-3-3**] AT 0105. 3+ (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CHAINS. WOUND CULTURE (Final [**2168-3-5**]): BETA STREPTOCOCCUS GROUP A. MODERATE GROWTH. ANAEROBIC CULTURE (Final [**2168-3-7**]): NO ANAEROBES ISOLATED. ACID FAST CULTURE (Preliminary): A swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. A negative result should be interpreted with caution. Whenever possible tissue biopsy or aspirated fluid should be submitted. NO MYCOBACTERIA ISOLATED. ACID FAST SMEAR (Final [**2168-3-3**]): NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR. FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. A swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. A negative result should be interpreted with caution. Whenever possible tissue biopsy or aspirated fluid should be submitted. . [**2168-3-3**] 2:36 am MRSA SCREEN Source: Nasal swab. **FINAL REPORT [**2168-3-4**]** MRSA SCREEN (Final [**2168-3-4**]): POSITIVE FOR METHICILLIN RESISTANT STAPH AUREUS. . RADIOLOGY: Cardiovascular Report ECG Study Date of [**2168-3-2**] 10:43:28 PM Sinus rhythm. Inferior wall myocardial infarction of indeterminate age. Possible anterior wall myocardial infarction of indeterminate age. Diffuse non-diagnostic repolarization abnormalities. No previous tracing available for comparison. . Radiology Report CHEST (PORTABLE AP) Study Date of [**2168-3-2**] 9:13 PM IMPRESSION:Lung volumes with vascular crowding. . Radiology Report HAND, AP & LAT. VIEWS RIGHT PORT Study Date of [**2168-3-2**] 9:48 PM FINDINGS: There are severe degenerative changes at the DIP and PIP joints and at the CMC and triscaphe joint of the right hand. No evidence of fractures, foreign bodies or soft tissue gas. There is prominent soft tissue swelling, most pronounced at the dorsum of the hand. . Brief Hospital Course: On presentation to [**Hospital1 18**] ED on [**2168-3-2**], patient's temp was 99. She became hypotensive and confused shortly after arrival. She was placed on levophed and a central line was placed. Blood cultures were obtained and sent. She arrived with foley catheter in place for chronic retention. A urinalysis was sent and showed few bacteria, 26k WBC with hyaline casts. Her right hand was erythematous, swollen and hot with obvious areas of blistering and ischemia. She had received vancomycin, gentamicin, clindamycin IV at an OSH. Due to her overall clinical picture, there was a high suspicion for necrotizing fasciitis and patient was taken to the OR for emergent exploration of the right hand. She underwent incision and debridement and carpal tunnel release right hand and forearm. Cultures were obtained and sent in the OR. The patient was kept intubated and transferred to the ICU post surgery. . Upon admission to the ICU, a second pressor was added (Norepinephrine) for persistent hypotension and she was given a dose of azithromycin and ceftriaxone intravenously. Overnight, she was commenced on meropenem, clindamycin and linezolid IV and Infectious Disease was consulted in the morning. Her postoperative course was notable for increasing pressor requirement and hemodynamic lability. As a result, she was emergently taken back to the operating room on [**2168-3-3**] for a repeat I&D. . Once back in ICU, the patient was maintained on contact precautions for a reported history of MRSA and follow up MRSA nasal swab confirmed this. ID recommended discontinuing meropenem and linezolid and maintaining the patient on ceftriaxone and clindamycin. Right hand/forearm debrided areas were treated with TID dressing changes of wet to dry and right forearm/hand maintained in a splint. A wound care consult was requested for care of chronic left lower extremity ulcers and wounds were treated daily, per their recommendations. Electrolytes were repleated PRN and a NG tube was inserted for purposes of medication administration. Patient was commenced on heparin subcutaneous for DVT prophylaxis and her foley catheter was changed. . Patient was able to wean off of pressors within 24-hours post ICU arrival. She was successfully extubated on [**2168-3-4**] and she was started on regular diet. Her temporary central access was discontinued and a left arm PICC line was placed on [**2168-3-5**] and she was transferred to the floor in stable condition. By this time her OR wound cultures from [**2168-3-2**] confirmed 'Beta group A streptococcus' and she continued on her course of ceftriaxone and clindamycin IV per ID recommendations. Her blood cultures from [**2168-3-2**] remained negative. Electrolytes were repleted PRN. Patient was noted to have a significant drop in hematocrit from 29.7 on [**2168-3-4**] to 23.8 on [**2168-3-5**] and was treated with 2 units of PRBCs with lasix given in between units. Hematocrit corrected to 29.5. . On [**2168-3-6**], patient was taken back to the OR for further debridment of right hand and forearm wounds which she tolerated well. She remained stable and afebrile. On [**2168-3-8**] patient went back to OR for further debridement with wound VAC placement to right arm/hand wounds which she tolerated well. Patient developed a left upper extremity thrombophlebitis just above PICC line which was treated with warm compresses and ibuprofen, as needed. . On [**2168-3-9**], Clindamycin was discontinued per ID recommendations. On the eve of [**2168-3-9**], patient's urinary output had a significant drop to <20cc an hour. She was given a liter of NS with an improved urine output and she was placed back on maintenance IV fluids. On the morning of [**2168-3-10**], patient spiked a fever to 101.2 and was somewhat somnolent. Patient was pancultured, stool for C.diff was sent due to reported 'loose stools' and labs were reviewed and essentially benign. We attempted to remove the right hand/forearm wound VAC dressing at bedside to examine the wound for possible source of fever and patient immediately responded to this stimulus and began protesting. As patient had returned to her baseline mental state within an hour she was again returned to the OR. There she underwent irrigation and debridement of skin and subcutaneous tissue of the right forearm with application of Integra skin substitute followed by wound VAC application. Patient tolerated the procedure well. All results from [**3-10**] panculture returned negative for infection and patient remained afebrile. . Vac dressing was changed prior to discharge to rehab facility (dressing change on [**2168-3-15**]) and patient has a follow up appointment in Hand Clinic in 1 week to remove Vac dressing and evaluate status of Integra. At the time of discharge on [**2168-3-16**], the patient was doing well, afebrile with stable vital signs, and tolerating a regular diet. Medications on Admission: Librium 20 TID to QID Synthroid 25 mcg' Neurontin 300 QAM ASA EC 81' Celexa 200' Vit D 1000 IU' Procardia XL 30' Celebrex 200' Hyoscamine 1mg TID to QID Culturelle 1 cap" Discharge Medications: 1. heparin, porcine (PF) 10 unit/mL Syringe Sig: Two (2) ML Intravenous PRN (as needed) as needed for line flush: PICC, heparin dependent: Flush with 10mL Normal Saline followed by Heparin as above daily and PRN per lumen. 2. ceftriaxone in dextrose,iso-os 2 gram/50 mL Piggyback Sig: Two (2) grams Intravenous Q24H (every 24 hours): D/C [**3-24**] (14 days post last surgery). 3. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for pain: For LUE pain from thrombophlebitis . 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 5. nifedipine 30 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO DAILY (Daily). 6. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO HS (at bedtime). 7. gabapentin 300 mg Capsule Sig: One (1) Capsule PO QAM (once a day (in the morning)). 8. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain, fever. 10. chlordiazepoxide HCl 5 mg Capsule Sig: Four (4) Capsule PO QID (4 times a day). 11. levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 13. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ML Injection TID (3 times a day). 14. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 15. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 16. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day. 17. multivitamin,tx-minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 18. sliding scale Regular insulin sliding scale Discharge Disposition: Extended Care Facility: [**Hospital6 1293**] - [**Location (un) 8957**] Discharge Diagnosis: Necrotizing fasciitis of right hand/forearm Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Prior to admission she lived independently (with VNA visits) and ambulated her apartment with a walker. Discharge Instructions: Personal Care: 1. You will have a wound VAC dressing with a wound vac machine in place for discharge. This VAC dressing will remain in place and not be changed as it is applying pressure to your recently placed Integra dressing. 2. While VAC is in place, please clean around the VAC site and monitor for air leaks of the VAC 3. You may continue to wash up daily using a basin and soapy water. 4. No baths/showers until after directed by your surgeon. 5. LLE wound care as ordered. 6. Foley care as ordered. . Activity: 1. Avoid strenous activity with wound vac in place. 2. Do not lift anything heavy with right hand/arm. . Medications: 1. Take medications as directed on your medication sheet. . Call the office IMMEDIATELY if you have any of the following: 1. Signs of infection: fever with chills, increased redness, swelling, warmth or tenderness around the surgical site, or unusual drainage in the collection container. 2. Fever greater than 101.5 oF 3. Severe pain NOT relieved by your medication. . Return to the ER if: * If you are vomiting and cannot keep in fluids or your medications. * If you have shaking chills, fever greater than 101.5 (F) degrees or 38 (C) degrees, increased redness,swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. * Any serious change in your symptoms, or any new symptoms that concern you. Followup Instructions: Hand Clinic: ([**Telephone/Fax (1) 2007**] [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Building, [**Location (un) 1385**] Please follow up in the Hand Clinic on Tuesday, [**2168-3-22**] at 9:30AM. The clinic is open from 8-12pm most Tuesdays. The clinic is located on the [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Building, [**Location (un) 1385**], Orthopedics. . Please bring a VAC sponge kit with you for dressing change in the clinic. Completed by:[**2168-3-16**] ICD9 Codes: 486, 0389, 2449, 311
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Medical Text: Admission Date: [**2170-1-15**] Discharge Date: [**2170-1-19**] Date of Birth: [**2091-10-23**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2170-1-15**] Coronary artery bypass graft x 4 (left internal mammary artery to left anterior descending, saphenous vein graft to diagonal, saphenous vein graft to obtuse marginal, saphenous vein graft to posterior descending artery) History of Present Illness: This 78 year old Spanish speaking male has a cardiac history that includes RCA stent, inferior STEMI with in-stent restenosis of RCA, s/p BMS pRCA. He reports right sided back pain that radiates to his chest which occurs with walking short distances. The pain resolves with rest and does not occur unrelated to activity. He reports he has been taking Oxycodone three times daily for this chest pain. He states this is the only medication that helps him. He was recently seen by Dr. [**Last Name (STitle) 171**] and referred for a stress test which was positive and was referred for cardiac catheterization. He was found to have multivessel disease upon cardiac catetherization and is now being referred to cardiac surgery for revascularization. Past Medical History: s/p inferior Myocardial infarction restenosis of the RCA s/p bare metal stent of pRCA [**2160**] RCA stent Hypertension Hyperlipidemia Chronic Chest Pain Hypothyroidism noninsulin dependent diabetes mellitus h/o Prostate cancer- s/p radiation treatment [**2164**] Social History: Race:Hispanic Last Dental Exam:2 months agp Lives with:Alone, children live out of state Contact:[**Name (NI) **] [**Name (NI) 67533**] (friend) Phone #[**Telephone/Fax (1) 67534**] Occupation:Retired Cigarettes: Smoked no [] yes [x] Hx: [**11-20**] ppd x 15 years quit >40 years ago Other Tobacco use:denies ETOH: < 1 drink/week [x] [**12-26**] drinks/week [] >8 drinks/week [] Illicit drug use:denies Family History: Premature coronary artery disease- Son had open heart surgery recently in [**State 108**]; age 54 Physical Exam: Pulse:58 Resp:12 O2 sat:100/RA B/P Right:169/77 Left:169/73 Height:5'6" Weight:150 lbs General: NAD 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 [] grade ______ Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] No Edema [] _____ Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral 2 Right: 2 Left: DP 2 Right: 2 Left: PT 2 Right: 2 Left: Radial 2 Right: 2 Left: Carotid Bruit Yes Right: No Left: Pertinent Results: [**2170-1-15**] Echo: PRE-BYPASS: No spontaneous echo contrast 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 size is normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). The right ventricular cavity is mildly dilated with normal free wall contractility. 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. 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. Trivial mitral regurgitation is seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results at time of surgery. POST-BYPASS: The patient is in sinus rhythm. Biventricular function is unchanged. Mitral regurgitation is unchanged. The aorta is intact post-decannulation. . [**2170-1-17**] 04:55AM BLOOD WBC-11.5* RBC-3.03* Hgb-10.2* Hct-28.1* MCV-93 MCH-33.6* MCHC-36.1* RDW-13.3 Plt Ct-113* [**2170-1-17**] 04:55AM BLOOD Glucose-110* UreaN-13 Creat-1.1 Na-129* K-4.2 Cl-94* HCO3-27 AnGap-12 [**2170-1-15**] 02:01PM BLOOD UreaN-14 Creat-0.9 Na-138 K-4.0 Cl-109* HCO3-20* AnGap-13 [**2170-1-19**] 06:10AM BLOOD WBC-7.2 RBC-3.21* Hgb-10.5* Hct-30.4* MCV-95 MCH-32.6* MCHC-34.5 RDW-12.7 Plt Ct-179# [**2170-1-19**] 06:10AM BLOOD Glucose-108* UreaN-17 Na-133 K-4.2 Cl-96 HCO3-32 AnGap-9 Brief Hospital Course: Mr. [**Known lastname **] was a same day admit and on [**1-15**] was brought directly to the Operating Room where he underwent coronary artery bypass grafts x 4. Please see operative note 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 he was started on beta-blockers and diuretics and gently diuresed towards his pre-op weight. Later on this day he was transferred to the step-down floor for further care. Chest tubes and epicardial pacing wires were removed per protocol. H edid experience some postoperative nausea and vomiting at POD 3. however, after moving his bowels this resolved and he felt well. Physical Therapy worked with him for strength and mobility. He was ready for transfer to a rehabilitation facility for further recovery prior to return home. He was discharged to [**First Name4 (NamePattern1) 730**] [**Last Name (NamePattern1) 731**] Rehab on [**1-19**]., Medications on Admission: Simvastatin 20mg (was instructed to stop and start Lipitor [**10-30**]- he is still currently taking simvasatin and no Lipitor) ATORVASTATIN (Not Taking as Prescribed) 80 mg Daily PLAVIX 75 mg Daily pt reports he does not take this consistently LISINOPRIL 40 mg daily METOPROLOL SUCCINATE 25 mg Daily OXYCODONE-ACETAMINOPHEN 5 mg/325 mg Tablet- takes 1 tablet 3 x day for chest pain RANITIDINE HCL 150 mg daily SIMVASTATIN 20 mg daily ASPIRIN 325 mg Daily MILK OF MAGNESIA Dosage uncertain Discharge Medications: Discharge Disposition: Extended Care Facility: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 731**] - [**Location 8391**] Discharge Diagnosis: Coronary artery disease s/p Corornary artery bypass graft x 4 s/p inferior Myocardial infarction s/p bare metal stent of pRCA [**2160**] RCA stent Hypertension Hyperlipidemia Chronic Chest Pain Hypothyroidism noninsulin dependent diabetes mellitus h/o Prostate cancer (s/p radiation treatment [**2164**]) Discharge Condition: Alert and oriented x3, nonfocal Ambulating with steady gait with assistance 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: 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**] **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. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) on [**2170-2-14**] at 1:45pm Cardiologist: Dr. [**Last Name (STitle) 171**] on [**2170-2-7**] at 10am Please call to schedule appointments with: Primary Care Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 14918**]) in [**2-22**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2170-1-19**] ICD9 Codes: 412, 4019, 2724, 2449
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Medical Text: Admission Date: [**2109-9-24**] Discharge Date: [**2109-10-17**] Date of Birth: [**2030-1-16**] Sex: F Service: SURGERY Allergies: Heparin Agents Attending:[**First Name3 (LF) 3376**] Chief Complaint: abdominal pain Major Surgical or Invasive Procedure: Acute perineal resection History of Present Illness: 79F with biopsy proven stage III T3N1 rectal cancer who recently finished XRT on [**2109-9-7**] presents with 2 weeks of nonspecific abdominal pain. The patient is a very poor historian, but per the daughter, she has had a very poor appetite with decreased PO intake over the past few days. She had been urged to be evaluated but has refused until today. She states that she has been having bowel movements but cannot remember when the last one was. She denies fever, chills, nausea, and emesis. Past Medical History: Dementia-presumed, undergoing w/u with Dr. [**Last Name (STitle) **] h/o ETOH abuse-pt denies Newly diagnosed rectal cancer Chronic intermittent diarrhea/fecal incontinence, being w/u urinary urge incontinence Anxiety/depression Cataracts, awaiting surgery Chronic multifactorial debility [**12-31**] arthritis, loss of function RUE after fall, back pain, balance issues-mostly wheelchair, but is able to ambulate Smoker s/p L ankle surgery s/p ovarian cyst removal s/p Appy Social History: Married. h/o ETOH abuse per family though pt denies, none recently as poor access to ETOH. Also h/o 50pack year, still occ smokes but unable to quantify. no illicits. Poor mobility, mostly wheelchair bound, but is able to walk if needed. Dependent on some ADLs and all IADLs. Family History: no family h/o GI malignancy, dementia, DM Physical Exam: 98.4, 82, 99/53, 18, 95% on room air Gen: no distress, alert, appears demented, poor historian HEENT: PERLA, EOMI, mucus membranes dry Neck: supple Chest: RRR, lungs clear Abd: soft, nondistended, diffusely tender to palpation, no rebound or guarding noted Rectal: patient refused Ext: trace edema, feet warm . At Discharge: Vitals:98.1, 91, 167/89, 18, 97% on 2L GEN: NAD, A/Ox3 CV: RRR, no m/r/g RESP: Coarse with bilateral rhonchi at bases, no SOB. ABD: soft, ND, appropriately TTP, +BS Incision: small abdomen OTA with dermabond, CDI. Old JP site, scant serous drainage. Intact with DSD. Perineal incision OTA with sutures, serosanguinous drainage. No exudate or purulent drainage noted. Surrounding skin with improved maceration and erythema. Ostomy: stoma dark red and viable, protruding out with blood clot at skin margin. Profusing well. Liquid brown effluence, +gas Coccyx: Stage II ulcer Extrem: LUE edema, CSM's intact. Mild pedal edema bilaterally. +pulses, brisk cap refill. Pertinent Results: Micro/Imaging: [**2109-10-16**] PICC line inserted in RUE via Interventional radiology [**2109-10-15**] RUE and B/L LE U/S negative [**2109-10-14**] LUE U/S occlusive thrombus of L subclv, axillary, brachialis, and basilic [**2109-10-10**] URINE URINE CULTURE-FINAL {YEAST} [**2109-10-6**] CXR no opacities. unchanged bibasilar atelctasis and pl. effusions [**2109-10-6**] CTchest mod b/l pl eff. loc eff on R. focal opacities RU+[**Doctor Last Name **] ?inf vs. atelec [**2109-10-3**] Cdif neg [**2109-10-1**] Bcx NGTD [**2109-9-30**] CXR worsening opacity, ?central obstruction, b/l effusions [**2109-9-30**] CT chest collapse of RML, known COPD, ?adrenal met b/l pl effusions [**2109-9-30**] Ucx no growth UA:sm leuks, neg nit no bact [**2109-9-30**] Bcx no growth [**2109-9-28**] Cdiff neg [**2109-9-27**] CXR RLL infiltrate [**2109-9-24**] Ucx neg UA: mod leuks, neg nit, rare bact [**2109-9-24**] Stool cx Neg [**2109-9-24**] Bcx NGTD [**2109-9-24**] CT rectal ca w/o mets, patent graft, pulmonary nodule, ?r asp PNA, DJD [**2109-9-24**] 10:40AM BLOOD WBC-7.4 RBC-4.21 Hgb-12.5 Hct-38.1 MCV-90 MCH-29.6 MCHC-32.8 RDW-14.8 Plt Ct-298 [**2109-9-25**] 03:44AM BLOOD WBC-7.5 RBC-3.93* Hgb-12.0 Hct-36.1 MCV-92 MCH-30.6 MCHC-33.3 RDW-14.2 Plt Ct-291 [**2109-9-30**] 06:50AM BLOOD WBC-15.9* RBC-4.01* Hgb-12.0 Hct-37.4 MCV-93 MCH-30.0 MCHC-32.2 RDW-14.7 Plt Ct-584* [**2109-10-10**] 01:30AM BLOOD WBC-26.0*# RBC-3.15* Hgb-9.4* Hct-29.4* MCV-93 MCH-29.7 MCHC-31.9 RDW-15.5 Plt Ct-75* [**2109-10-11**] 03:30AM BLOOD WBC-13.8* RBC-2.27*# Hgb-6.7*# Hct-21.5*# MCV-95 MCH-29.5 MCHC-31.0 RDW-16.1* Plt Ct-65* [**2109-10-14**] 06:10AM BLOOD WBC-14.8* RBC-3.38* Hgb-10.2* Hct-30.5* MCV-90 MCH-30.3 MCHC-33.6 RDW-15.7* Plt Ct-28* [**2109-10-15**] 05:55AM BLOOD WBC-12.3* RBC-3.47* Hgb-10.4* Hct-31.8* MCV-92 MCH-29.9 MCHC-32.5 RDW-15.4 Plt Ct-41* [**2109-10-16**] 05:25AM BLOOD WBC-12.4* RBC-3.27* Hgb-9.9* Hct-30.0* MCV-92 MCH-30.2 MCHC-33.0 RDW-15.3 Plt Ct-52* [**2109-10-15**] 05:55AM BLOOD PT-28.3* PTT-71.3* INR(PT)-2.8* [**2109-10-11**] 10:30PM BLOOD PT-16.4* PTT-31.5 INR(PT)-1.5* [**2109-9-27**] 07:45AM BLOOD PT-12.4 PTT-26.9 INR(PT)-1.0 [**2109-9-24**] 10:40AM BLOOD PT-11.6 PTT-28.0 INR(PT)-1.0 [**2109-10-11**] 10:36AM BLOOD Fibrino-176 [**2109-10-10**] 01:30PM BLOOD Fibrino-270 [**2109-10-11**] 10:36AM BLOOD FDP-0-10 [**2109-9-30**] 03:20PM BLOOD ESR-0 [**2109-10-15**] 05:55AM BLOOD Glucose-81 UreaN-17 Creat-0.9 Na-141 K-4.2 Cl-99 HCO3-31 AnGap-15 [**2109-10-14**] 06:10AM BLOOD Glucose-79 UreaN-15 Creat-0.9 Na-141 K-3.4 Cl-98 HCO3-34* AnGap-12 [**2109-10-13**] 05:54AM BLOOD Glucose-84 UreaN-12 Creat-0.7 Na-141 K-3.9 Cl-102 HCO3-31 AnGap-12 [**2109-10-12**] 12:49PM BLOOD Glucose-103 UreaN-12 Creat-0.7 Na-142 K-3.4 Cl-102 HCO3-31 AnGap-12 [**2109-10-11**] 03:30AM BLOOD Glucose-80 UreaN-13 Creat-0.8 Na-141 K-4.0 Cl-106 HCO3-25 AnGap-14 [**2109-9-29**] 05:00AM BLOOD Glucose-145* UreaN-11 Creat-0.9 Na-141 K-3.6 Cl-105 HCO3-24 AnGap-16 [**2109-9-27**] 07:45AM BLOOD Glucose-116* UreaN-8 Creat-0.4 Na-142 K-4.1 Cl-107 HCO3-30 AnGap-9 [**2109-9-25**] 03:44AM BLOOD Glucose-88 UreaN-9 Creat-0.4 Na-139 K-3.6 Cl-102 HCO3-22 AnGap-19 [**2109-9-24**] 10:40AM BLOOD Glucose-116* UreaN-12 Creat-0.4 Na-138 K-3.8 Cl-101 HCO3-28 AnGap-13 [**2109-9-29**] 05:00AM BLOOD CK(CPK)-28 [**2109-9-24**] 10:40AM BLOOD ALT-25 AST-19 AlkPhos-54 TotBili-0.6 [**2109-9-29**] 05:00AM BLOOD CK-MB-3 cTropnT-<0.01 [**2109-9-24**] 10:40AM BLOOD Lipase-10 [**2109-10-15**] 05:55AM BLOOD Calcium-7.6* Phos-3.0 Mg-2.4 [**2109-10-14**] 06:10AM BLOOD Calcium-7.4* Phos-3.6 Mg-1.7 [**2109-10-13**] 05:54AM BLOOD Calcium-7.6* Phos-3.4 Mg-2.2 [**2109-10-11**] 10:36AM BLOOD Albumin-2.7* [**2109-9-24**] 10:40AM BLOOD Albumin-3.1* Calcium-8.6 Phos-3.6 Mg-1.5* [**2109-9-25**] 03:44AM BLOOD Albumin-2.9* Calcium-8.3* Phos-3.6 Mg-1.4* Iron-18* [**2109-9-27**] 07:45AM BLOOD Calcium-8.5 Phos-2.5* Mg-2.1 [**2109-9-25**] 03:44AM BLOOD calTIBC-194* Ferritn-128 TRF-149* [**2109-9-25**] 03:44AM BLOOD Triglyc-109 Brief Hospital Course: [**Hospital Unit Name 153**] Course 79 yo female with mild dementia, recent HAP, pleural effusions with stage III rectal cancer now s/p perineal resection (including sigmoidectomy, protectomy, resection of portion of colon) with uncomplicated operative course who was admitted to [**Hospital Unit Name 153**] on [**2109-10-10**] for monitoring post-operatively. Onb admission, the patient was noted to marked leukocytosis, which was believed to be post-operative change. However, given recent history of HAP, the patient was pan-cultured. No antibiotics were initiated and WBC count trended down by ICU Day #2. The patient was given IV Morphine PRN for pain control. Nausea was controlled with IV Zofran PRN. The patient was noted to have significant drop in Hct from 29.4 to 20.0 on ICU day #2. She was transfused with 2 units of pRBCs with appropriate response. The patient also had significant thombocytopenia. Because of a concern for HIT due to long-term exposure to Heparin in this patient, Heparin was discontinued and the patient was switched to pneumoboots for DVT Prophylaxis. HIT Antibody Panel was sent and was positive. Serotonin Release Assay was sent out. The patient was also noted to have increasing INR to 1.8, without a significant change in PTT. This was believed to be due to a poor nutritional status in this patient, although DIC was considered as well. DIC labs were not conclusive. The patient also received 2 units FFP, Platelets. Albumin and prealbumin were sent out to assess nutritional status. COPD: The patient received albuterol/ipratropium nebs for her COPD. Anxiety/Depression: The patient was seen by Palliative colult team for help with anxiety/depression. The patient was called out to surgery service for further management. . Patient was admitted to the general surgery service for better control of her abdominal pain and management of her nutrition prior to her scheduled surgery. She was kept NPO and given IVF. Her pain was well controlled with Tylenol and Morphine as needed. Geriatics was consulted for assistance with medical management prior to surgery. They made recommendations for prevention of delirium, management of her COPD and pain. . She was scheduled for surgery on [**9-27**], for which she prepared with a bowel prep on the preceding day. Anesthesia was concerned about the patient's respiratory status. CXR in the holding area revealed an acute infilrate consistent with hospital-acquired pneumonia on top of her known severe COPD. The decision was made to delay surgery. She was started on a 5 day course of IV vancomycin and zosyn and returned to a regular diet. She continued to have multiple bowel movements after the bowel prep and was given several boluses (totaling 2L) for hypotension to SBPs of 60s. Her creatinine rose from 0.4 to 1.5 in this setting. Her FeNa was 2.1 and therefore her renal failure was thought to be from intrinisic renal failure, likely acute tubular necrosis. Geriatrics continued to follow her. . A repeat CXR on [**9-30**] showed persistent atelectasis with concern for central obstruction. A chest CT was recommended and preformed the same day. The CT revealed RML consolidation as well as known COPD and the question of an adrenal metastasis. Following this information, she was transferred to the medicine service for further management of her renal and pulmonary issues. Although the patient was not an optimal surgical candidate, surgery was thought to be delayed until another time rather than cancelled. . . During her medical admission, the patient did not demonstrate any subjective shortness of breath or chest pain. Her exam was remarkable for decreased lung sounds bilaterally, a heart murmur and right shoulder mass that have both been present for years. Her labs were remarkable for elevated renal function findings and leukocytosis. Over the next few days, the patient also complained of bilateral arm swelling and pain. The course of each issue progressed as follows: ?????? Lung infiltrates. The patient hardly complained of shortness of breath or other subjective respiratory distress. Over her stay, her oxygen saturation improved while on oxygen flow and peaked to 95-96% on 1-L, up to 99% after nebulizers. She never dipped below the 90s on room air. Her lung exam improved over several days, with increasingly louder respiratory sounds. One chest x-ray was suggestive of a loculated lesion that was then reassessed with a chest CT. It was decided that this did not merit any draining given her overall positive picture. ?????? COPD. The patient suffers from COPD which continued to benefit from her nebulizer regimen. She was maintained on ipratropium bromide (Q6H) and albuterol 0.083% Q6H. ?????? Renal function. The patient's creatinine decreased and stabilized within the range of 0.7-0.8. Her GFR continued to be impaired at 43 (nml for age group is 75), but it was similarly stable. Strict I/Os were difficult to maintain due to her baseline incontinence. ?????? Leukocytosis. The patient's WBC count was initially elevated (around 12) and then started to fall within normal levels (<10). No source of infection was identified; she was C. Diff negative. The only significant correlate of this laboratory finding is her recovering pneumonia and loculated infiltrate sequelae. ?????? Bilateral upper extremity swelling. The patient also complained of acute swelling of both of her arms. On exam, it was noted that the left arm appeared larger than the right, with some possible dependent edema on her abdomen. It was found that her albumin levels were below the normal range of variation (2.4). A nutrition consult was placed to improve her dietary input. Nutrition is currently following. ?????? Hypocalcemia/hypomagnesemia. On the second-to-last day before surgery, she patient was found to be hypomagnesemic and hypocalcemic. She received a magnesium citrate bowel prep the day before surgery. ?????? R shoulder mass - most likely a seroma. The patient reports it has been present for years. We monitored the mass and it did not change size or consistency. ?????? Diarrhea. The patient has baseline diarrhea given her rectal cancer. She was C. Diff negative and therefore was placed on her home regimen of loperamide. This alleviated her symptoms. ?????? Pain control. Over her stay, the patient complained of vague abdominal, R ankle/knee, L-thigh, back pain, bilateral arm pain, and R-shoulder pain. She did not consistently focus on any specific spot on a day-to-day basis. Her pain medication regimen was limited to acetaminophen, lidocaine patches and tramadol. ?????? Heart murmur. The patient has a chronic systolic heart murmur heard best in L sternal border, ([**3-4**]), mild thrill). The location was suggestive of a right-heart process, which could be as benign as flow murmur to more insidious etiologies like pulmonic valve stenosis or tricuspid insufficiency. Her EKG from [**10-1**] normal and a subsequent echocardiogram did not show any concerning abnormalities (R/L atria nml; mild L ventricle hypertrophy; aortic and mitral valve leaflets mildly thickened; no Ao. valve stenosis; no mitral regurg. Moderate pulmonary artery systolic hypertension; no pericardial effusion). ?????? Depression. The patient has endorsed suicidal ideation without active plans. Denies homicidal ideation. She is not on any antidepressants. Social work following. . . . . . . . . . . . . . . . . . . . . ................................................................ General Surgery: Operative course uncomplicated. Admitted to Stone 5 for post-op care. Pain controlled with PCA, quickly weaned due to cognitive status, and age. Patient continued to be followed by Geriatrics, Palliative Care, and Social Work post-op. Recommendations were instituted as needed. . Respiratory status stabilized post-op. Oxygen weaned. Continued with nebulizers and aggressive Chest PT. Completed full anitbiotic regimen for treatment of Pre-op pneumonia. . Upper extremity edema decreased as patient diuresed post-op. LUE remained edematous. U/S negative on [**10-10**]. Edema persisted. Patient also noted to have drop in platelets. Noted to be HIT positive. All heparin agents discontinued. Platelets monitored daily. Hematology/Oncology consulted. Patient started on an Argatroban drip. LUE re-scaned -extensive DVT noted. All other extremities underwent ultrasound, all negative. Heme/Onco advised continuing argatroban drip untile platelets above 100,000 for at least 48hours, then convert to PO Coumadin. Patient will require about 6 months of treatment. This will be monitored by patient's PCP once discharged back home from Rehab. . Abdominal incision intact with staples, CDI. Diet advanced gradually from sips to regular food as ostomy function and abdominal distention improved. IV fluid discontinued. Foley removed. Voided without issue. Medications switched to oral. Pain well controlled with oral Ultram. Activity returned to baseline. Continued to work with Physical Therapy. Patient deconditioned, and requires extensive Physical and Pulmonary REHAB. Medications on Admission: tylenol, nystatin powder, imodium, potassium supplement, vitamin Discharge Medications: 1. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical Q24 () as needed for pain. 2. Tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours) as needed for pain for 2 weeks: Hold for somnolence, RR<12. 3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: Two (2) Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 4. Ipratropium Bromide 0.02 % Solution Sig: Two (2) Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 5. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours) as needed for pain: Do not exceed 4000mg in 24hrs. 6. Fluconazole 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours) for 1 weeks. 7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed for fungal infection: apply under breasts & perineal area . 8. Argatroban 100 mg/mL Solution Sig: 0.5-2 mcg/kg/min Intravenous INFUSION (continuous infusion): Refer to attached protocol. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: stage III T3N1 rectal cancer completed XRT [**2109-9-7**] pre-op treatment of pneumonia post-op DVT-LUE post-op stage II ulcer of coccyx Positive for heparin induced thrombocytopenia Discharge Condition: Alert & oriented x3 Tolerating a regular diet with supplements Pain well controlled with oral Ultram and Tylenol Discharge Instructions: REHAB Instruction: Please call the 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: 1.Abdomen: open to air with Dermabond, clean & intact 2.Old JP drain site: Apply dry gauze dressing until serous drainage stops. Change at least twice a day & as needed. 3.Perineal: open to air with sutures, -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. 4. Ostomy-stoma protruding, dark red in color with clotted blood at skin level. Functioning well. No concerns for ischemia. Continue to monitor. Call Dr.[**Name (NI) 3377**] office with any concerns. . 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. -Try to maintain ostomy output between 1000mL to 1500mL per day. -If Ostomy output >1 liter, CALL Dr[**Doctor Last Name **] office. . Anticoagulation: -Continue Argatroban drip [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Hospital3 66399**] protocol and adhere to modifications per Hematology/Oncolgy specialists (see enclosed note & Instruction section). Followup Instructions: 1. Please follow-up with Dr. [**Last Name (STitle) 1120**] [**Telephone/Fax (1) 160**] [**2109-11-6**] 1:30pm in Multidisciplinary [**Hospital 7819**] Clinic. . 2. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 49562**], MD Phone:[**Telephone/Fax (1) 19886**] Date/Time:[**2109-11-6**] 1:30 . 3. Provider: [**First Name8 (NamePattern2) **] [**Name8 (MD) 4322**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2109-11-6**] 1:30 . 4. Please follow-up with PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], [**Telephone/Fax (1) 719**] once you are discharged from REHAB for long-term management of anticoagulation. Completed by:[**2109-10-16**] ICD9 Codes: 5845, 486, 5119, 2930, 4280
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Medical Text: Admission Date: [**2150-10-5**] Discharge Date: [**2150-10-11**] Date of Birth: [**2131-8-30**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3223**] Chief Complaint: GSW to Right posterior chest Major Surgical or Invasive Procedure: right chest tube placement Repair Right hemidiaphragm Endoscopy Exploratory laparatomy History of Present Illness: 19M s/p GSW to R flank, sustaining grade 3 liver laceration, R lung contusion and hemothorax, presumed diaphragmatic injury. Bullet fragments with RML and in esophoazygous recess. No pneumomediastinum to indicate esophageal injury and no extrav from azygous. Past Medical History: PMH: childhood asthma Social History: Lives at home with mother Family History: non contributory Physical Exam: On the day of discharge: 97.5 68 130/78 16 100% 2L NC General: NAD, A and O x3 Pulm: Lungs clear to auscultation bilaterally Cards: Regular rate and rhythm, + pericardial rub Abdomen: soft non-tender, non-distended Extremities: no clubbing, cyanosis or edema Neuro: Equal strength and sensation bilaterally. L pupil 6->4. R pupil 5->3 Pertinent Results: [**2150-10-5**] 05:33AM PT-14.6* PTT-28.6 INR(PT)-1.3* [**2150-10-5**] 05:33AM WBC-21.6* RBC-3.67* HGB-11.8* HCT-34.6* MCV-94 MCH-32.3* MCHC-34.2 RDW-12.7 [**2150-10-5**] 05:33AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2150-10-5**] 05:37AM HGB-13.1* calcHCT-39 O2 SAT-78 CARBOXYHB-2 MET HGB-0 [**2150-10-5**] 10:50AM GLUCOSE-155* UREA N-13 CREAT-0.9 SODIUM-141 POTASSIUM-4.8 CHLORIDE-109* TOTAL CO2-25 ANION GAP-12 [**2150-10-5**] 11:54PM HCT-31.3* Ct head [**10-5**]: No acute intracranial pathology. Ct spine [**10-5**]: No fracture or malalignment. an extramedullary hematoma [**10-7**] Esophagram: No evidence of esophageal perforation. Massively distended stomach filled with air. CXR [**10-7**]: With the chest tube on waterseal, there is evidence of a minimal lateral pneumothorax. The width of the pleural gap 2 to 3 mm. no tension. Ct spine: stable epidural hematoma C3-C6 CT head [**10-7**]: Normal head CT without evidence for hemorrhage or infarction. [**10-8**] cxr: no change in ptx. [**10-9**] echo: Small to moderate circumferential pericardial effusion most prominent anterior to the right ventricle (1.5cm) and <1cm elsewhere. No definite evidence of hemodynamic compromise. If clinically indicated, serial evaluation is suggested. Brief Hospital Course: Mr. [**Known lastname **] was admitted to the trauma surgery ICU after suffering a gunshot wound to the Right posterior chest. He had a chest tube placed in an outside hospital prior to his transfer to [**Hospital1 **]. On HD 1 the patient was taken to the OR for repair of a posterior diaphragmatic injury, esophagoscopy, and Right chest tube placement. He tolerated the procedure very well and was taken to the TSICU to recover. On HD 1, it was also discovered that the patient had a possible epidural hematoma of unknown etiology. On HD 3 the patient had a barium swallow which showed no acute esophageal injury. In addition, his hard collar was removed and replaced with a soft collar. The chest tube was removed on HD 3 and a f/u CXR showed a small apical pneumothorax. After removing the chest tube, the patient continued to improve and f/u CXR showed resolution of his PTX over the ensuing days. On HD 7 the patient was ambulating, tolerating a regular diet, and his pain was well controlled on an oral regimen. As a result it was felt that it would be appropriate to discharge him home with neurosurgery and trauma f/u. Medications on Admission: None Discharge Medications: 1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). Disp:*60 * Refills:*0* 2. Indomethacin 25 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*40 Capsule(s)* Refills:*0* 3. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for pain. Disp:*40 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: S/p right posterior chest gunshot wound Right liver laceration Right diaphragmatic injury Cervical Cord epidural hematoma Discharge Condition: hemodynamically stable, voiding without difficulty, pain controlled on an oral regimen, ambulating, tolerating normal diet. Discharge Instructions: Please return to the Emergency room for evaluation if you experience: fever>101.5, increasing shortness of breath, increasing chest pain or abdominal pain, uncontrollable nausea/vomiting, you have redness or increasing drainage from one of your surgical incisions, or other symptoms that are concerning to you. Surgical incision care: You may shower as you normally have in the past. if you have drainage at your abdominal incision or Chest tube site, you may put a clean dry gauze bandage over it. Do not swim or take a bath for 4 weeks. Neck: Continue to wear the soft collar until your followup with Dr. [**Last Name (STitle) 548**]. Medication: Take all medications as ordered. while taking narcotics for pain, do not operate heavy machinery or consume alcohol. Followup Instructions: Trauma: Please call Dr.[**Name (NI) 1863**] office on Monday at [**Telephone/Fax (1) 79670**] for a followup appointment in [**2-11**] weeks. Neurosurgery: Please call Dr.[**Name (NI) 2845**] office on Monday at ([**Telephone/Fax (1) 18865**] for a followup appointment in 6 wks. Prior to this appointment you will need to get a non-contrast CT of your C-spine (the scheduler will help you arrange this). [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**] Completed by:[**2151-2-17**] ICD9 Codes: 5185
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Medical Text: Admission Date: [**2190-8-4**] Discharge Date: [**2190-8-10**] Date of Birth: [**2143-6-14**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Attending Info 8238**] Chief Complaint: seizures Major Surgical or Invasive Procedure: none History of Present Illness: 47 yo M with a hx of EtOH abuse who presented to [**Hospital1 **] [**Location (un) 620**] today after 2 generalized seizures. Per report the patient stopped drinking abruptly yesterday, and had a seizure the morning of presentation for about 2 minutes. Prior to presenting to [**Hospital1 **] [**Location (un) 620**] he had another 20 minute seizure. Patient reportedly drinks 5 shots and 4 beers daily. Patient was complaining of nausea, mild epigastric pain, and emesis 2 days prior to presentation. Labs at [**Location (un) 620**] were concerning for cholecystits with wbc of 10, initial lactate 4.3 (repeat after 3L NS 2.3), TBili 6.6, DBili 4.4, and RUQ U/S concerning for acute cholecystitis. The patient was transferred to [**Hospital1 18**] for possible ERCP and further management of EtOH withdrawal. Prior to transfer he received 20 mg IV diazepam, 3L IVF, IV Zosyn and potassium. In the ED initial VS were T99 HR99 BP137/95 RR20 satting 96% on RA. Labs showed ALT 54, AST 160, Tbili 6.1, with normal alk phos and lipase. Serum tox screen was negative. Metabolic panel showed evidence of hypokalemia at 2.6, as well as hypocalcemia of 7.6, hypomagnesemia of 1.3, and phosphate of 1.5. CBC showed a macrocytic anemia with a HCT of 34.1 and thrombocytopenia of 88. WBC was 7.9 with 80.2% PMNs without bandemia. Lactate and urine tox screen were normal. UA showed moderate blood, bilirubin, and trace ketones without evidence of infection. EKG did not show any acute ischemic changes. Surgery was consulted who suggested to continue Zosyn and to defer CCY as patient is having withdrawal seizures. ERCP was also consulted who will follow along. Repleted with IV potassium and magnesium prior to transfer. Prior to admission patient received 2 mg lorazepam. VS prior to admission were HR 91, BP [**Numeric Identifier 112365**], RR 24, Sat 97%. On arrival to the MICU, pt was alert, oriented, and in no acute distress. Vitals: P: 93, BP: 135/89, R: 27, O2: 94% on 2L NC. Past Medical History: ETOH abuse, psoriasis, HTN (has not been taking anti-hypertensives for years) Medications HOME: none Allergies: NKDA Social History: Positive for Alcohol and Smoking Family History: no panc or GI CA hx Physical Exam: On admission: Vitals: P: 93, BP: 135/89, R: 27, O2: 94% on 2L NC Constitutional: ill appearing, tremulous HEENT: significant scleral icterus, mucosa dry Chest: diffuse wheezing, no distress Cardiovascular: regular tachycardia Abdominal: hepatomegaly with question ascites, non-tender GU/Flank: few bruises noted Extr/Back/Skin: venous incompetence with several bruises and plaques c/w psoriasis Neuro: Pt A+O times 3, CN II-XII intact, no asterixis On discharge: 98.8, P 84, BP 149/94 (today range 120-140/80-100s), 16, 98RA Gen- alert well appearing Psych- nl affect/mood, pleasant Skin- no pallor CV- RRR no m/g Lung- CTAB without wheeze Abd- soft, NT/ND Pertinent Results: [**2190-8-4**] 12:10AM BLOOD WBC-7.9 RBC-3.37* Hgb-11.7* Hct-34.1* MCV-101* MCH-34.7* MCHC-34.2 RDW-14.1 Plt Ct-88* [**2190-8-10**] 07:15AM BLOOD WBC-7.3 RBC-3.56* Hgb-12.4* Hct-37.5* MCV-105* MCH-34.9* MCHC-33.2 RDW-13.5 Plt Ct-286 [**2190-8-4**] 08:11AM BLOOD PT-13.5* PTT-33.1 INR(PT)-1.3* [**2190-8-6**] 04:49AM BLOOD PT-14.6* PTT-29.3 INR(PT)-1.4* [**2190-8-4**] 12:10AM BLOOD Glucose-90 UreaN-9 Creat-0.6 Na-139 K-2.6* Cl-102 HCO3-26 AnGap-14 [**2190-8-10**] 07:15AM BLOOD Glucose-105* UreaN-2* Creat-0.6 Na-137 K-4.0 Cl-105 HCO3-25 AnGap-11 [**2190-8-4**] 12:10AM BLOOD ALT-54* AST-160* AlkPhos-96 TotBili-6.1* [**2190-8-9**] 05:45AM BLOOD ALT-63* AST-98* AlkPhos-132* TotBili-2.6* [**2190-8-4**] 12:10AM BLOOD Lipase-53 [**2190-8-4**] 12:10AM BLOOD Albumin-3.4* Calcium-7.6* Phos-1.5* Mg-1.3* [**2190-8-10**] 07:15AM BLOOD Calcium-8.8 Phos-3.0 Mg-1.7 [**2190-8-4**] 08:11AM BLOOD VitB12-1238* [**2190-8-10**] 07:15AM BLOOD Folate-12.3 [**2190-8-4**] 08:11AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-NEGATIVE [**2190-8-4**] 12:10AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2190-8-4**] 08:11AM BLOOD HCV Ab-NEGATIVE Utox negative Liver US [**8-4**] 1. Asymmetric focal thickening of the gallbladder wall which may relate to underlying liver disease; however, cholecystitis cannot be excluded. A HIDA scan is recommended for further characterization of the gallbladder. 2. 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. HIDA [**8-4**] IMPRESSION: 1. Normal filling of the gallbladder with normal transit to the GI tract. 2. Mild persistent blood pool is suggestive of hepatic dysfunction, and compatible with abnormal LFTs. CT abd [**8-4**] 1. Free intraperitoneal air likely represents perforation from a duodenal ulcer; recommend endoscopy. 2. Evidence of diffuse hepatosteatosis with apparent areas of a nodular hepatic contour and early recanalization of the paraumbilical vein. Overall findings are suspicious for cirrhosis and early portal hypertension. Recommend correlation with liver function tests and nonemergent liver biopsy. Gallbladder wall edema may be secondary to hepatic dysfunction. 3. Subtle, peripheral wedge-shaped areas of hypodensity within both kidneys raise the possibility of small ischemic/inflammatory abnormalities which may be seen in the setting of certain medications, vasculitis or disseminated infection. 4. Gallbladder abnormality seen on US is not seen on CT and therefore very unlikely to be a mass. 5. Compression deformity of L1 vertebral body is of indeterminate chronicity. Brief Hospital Course: 47yoM with hx alcoholism, untreated HTN admitted for alcohol withdrawal, duodenal perforation, and new diagnosis cirrhosis. # Alcohol- admitted for withdrawal, initially to ICU. Managed on IV ativan. Psychiatry consulted. Recommended Ativan taper which patient finished uneventfully on [**2190-8-9**]. He appears motivated to achieve sobriety immediately. He met with social work. The patient is afraid that more alcohol will cause serious illness again. He is scared of temptation, and of having lack of structure in his day. He plans to attend AA meetings, and states his girlfriend has already removed all alcohol from his residence. # Duodenal perforation- seen on CT abdomen with evidence of free air. Probably from a perforated ulcer in setting of alcohol and NSAID use. H pylori serology negative. Surgery was consulted, patient did not require any operative intervention. Endoscopy also not done given danger of further worsening things. Was treated with antibiotics. Recommend continuing cipro/flagyl for total 10 days, started [**2190-8-4**], end date [**2190-8-13**]. He was also placed on IV PPI drip transitioned to oral twice daily PPI. He should continue this and have an EGD in ~8 wks to document healing. # Liver disease- transaminitis and hyperbilirubinemia along with thrombocytopenia. Possibly component of alcoholi hepatitis. Imaging was negative for acute cholecystitis (equivocal US but negative HIDA). His LFTs downtrended on their own; however, CT abdomen indicated cirrhosis which is a new diagnosis for the patient. Most likely due to alcohol. An MRCP was considered to look for other causes, but it was then decided this is not an urgent study and the LFTs were more attributable to cirrhosis/alcohol. He will follow up with liver clinic for ongoing management. The EGD recommended above should also assess for presence of varices. # Macrocytosis- probably due to alcohol and/or cirrhosis. B12 and folate normal. # HTN- reported hx of untreated elevated BP. Was elevated here intermittently but not to point of starting inpatient management. No BP meds. # Psoriasis- treated in house with topical steroid. Transitional Issues ======================= [ ] Antibiotics (Cipro + Flagyl) through [**2190-8-13**] [ ] Recommend repeat EGD in ~8 weeks for ulcer eval and variceal screening Medications on Admission: ibuprofen Discharge Medications: 1. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 2. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days end date [**2190-8-13**] RX *Cipro 500 mg 1 tablet(s) by mouth twice a day Disp #*6 Tablet Refills:*0 3. MetRONIDAZOLE (FLagyl) 500 mg PO TID Duration: 3 Days RX *Flagyl 500 mg 1 tablet(s) by mouth three times a day Disp #*9 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Alcohol withdrawal and alcoholism Perforated duodenal ulcer Cirrhosis 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 for alcohol withdrawal. You were found to have a small tear in the intestinal lining, possibly from an ulcer. You were also found to have findings concerning for likely liver cirrhosis. I recommend you stop drinking alcohol, and take your new medications as prescribed. Followup Instructions: Department: LIVER CENTER When: THURSDAY [**2190-8-19**] at 8:15 AM With: [**Name6 (MD) **] [**Last Name (NamePattern4) 2424**], MD [**Telephone/Fax (1) 2422**] Building: LM [**Hospital Unit Name **] [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Name: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 112366**], MD Specialty: Primary Care When Tuesday [**8-24**] at 11:15am Location: [**Hospital **] MEDICAL ASSOCIATES-[**Location (un) **] Address: [**Location (un) 11898**], [**Location (un) **],[**Numeric Identifier 9310**] Phone: [**Telephone/Fax (1) 8506**] ICD9 Codes: 5715, 2768, 2875, 2859, 4019
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Medical Text: Admission Date: [**2101-12-26**] Discharge Date: [**2102-1-2**] Date of Birth: [**2027-2-7**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2101-12-26**] - CABGx4 (left internal mammary->Left anterior descending artery, Saphenous vein graft(SVG)->Posterior descending artery, SVG->Obtuse marginal artery, SVG->Ramus artery). History of Present Illness: 74-year-old gentleman with a history of exertional chest tightness and abnormal stress test. He was recently hospitalized and underwent cardiac catheterization which revealed severe disease of the left anterior descending artery. His obtuse circumflex and right coronary arteries had mild luminal irregularities. Past Medical History: Dyslipidemia Diabetes Eczema Hx of herpes zoster Resection of adenomatous colon polyps Remote hernia repair Tonsillectomy Basal cell carcinoma of the face, s/p Mohs procedure Social History: Retired chemistry profesor. Lives with wife in [**Name (NI) 5087**]. Never smoked. Social alcohol use. Family History: Denies Physical Exam: Blood pressure 136/80, heart rate 69, and weight is 189 pounds. The patient is a reasonably fit-appearing man in no acute distress. He is well-developed and well-groomed, oriented to person, place, and time. He describes his symptoms eloquently. Mood and affect are appropriate. Pupils are equal. There is no icterus. There is mild arcus senilis bilaterally. Funduscopic exam reveals sharp optic disks without evidence of chronic hypertensive vascular disease. Neck is supple without lymphadenopathy, JVD, or thyromegaly. No chest wall deformity. His lungs are clear to auscultation bilaterally with normal respiratory effort. No abdominal aortic, femoral, or carotid bruits. Cardiac PMI is in the fifth ICS at MCL without a heave or palpable gallop. Normal S1, normally split S2, no S3, S4, rub, or click. There was no murmur. Pulses are 2+ and symmetric in carotid, radial, femoral, PT, and DP arteries. There was no HSM, abdominal mass, or tenderness. Extremities have no cyanosis, clubbing, or edema. Some spider varicosities below knee. Inspection and palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, or xanthomas. The gait and muscle tone are grossly normal. Pertinent Results: [**2101-12-26**] ECHO Pre Bypass: No mass/thrombus is seen in 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 size is normal. Regional left ventricular wall motion is normal. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. There are simple atheroma in the aortic arch. The descending thoracic aorta is mildly dilated. There are complex (>4mm) atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. Post Bypass: Patient is in sinus rhythmon phenylepherine gtt. Perserved biventricular function, LVEF >55%. MR remains mild. Aortic contour intact. Remaining exam is unchanged. All findings discussed with surgeons at the time of the exam. [**2101-12-31**] 07:05AM BLOOD WBC-4.3 RBC-2.72* Hgb-8.8* Hct-25.0* MCV-92 MCH-32.1* MCHC-35.0 RDW-13.5 Plt Ct-208 [**2102-1-1**] 08:55AM BLOOD UreaN-20 Creat-0.9 K-4.2 Brief Hospital Course: Mr. [**Known lastname 24110**] was admitted to the [**Hospital1 18**] on [**2101-12-26**] for surgical management of his coronary artery disease. He was taken directly to the operating room where he underwent coronary artery bypass grafting to four vessels. 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. Beta blockade, a statin and aspirn were resumed. On postoperative day one, he was transferred to the step down unit for further recovery. Mr. [**Known lastname 24110**] was gently diuresed towards his preoperative weight. The physical therapy service was consulted for assistance with his postoperative strength and mobility. Mr. [**Known lastname 24110**] failed to void after removal of his foley and thus had a new foley catheter reinserted. Urology was called and they stated he should go home with a foley and leg bag, follow up in urology clinic in 2 weeks. On the morning of POD 6 he experienced a brief episode of asymptomatic rapid atrial fibrillation that resolved with IV amiodarone bolus. He was maintained on oral amiodarone thereafter. On the day of discharge, the patient was found to have a urinary tract infection and was started on bactrim. The patient was discharged in good condition to home on POD 7, with VNA services. Medications on Admission: metformin 500', Zocor 20', ASA 81', Torpol xl 50', Preservision', Betamethasone 0.005% prn, NTG sl prn Discharge Medications: 1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 2 weeks. Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 2. Lasix 20 mg Tablet Sig: Two (2) Tablet PO twice a day for 2 weeks. Disp:*60 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:*2* 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:*2* 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed. 6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 7. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 8. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. 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* 10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day): 400mg [**Hospital1 **] x5 days then 400mg Qd x 5 days then 200mg QD. Disp:*60 Tablet(s)* Refills:*1* 11. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). Disp:*180 Tablet(s)* Refills:*2* 12. Metformin 500 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 13. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 1 months. Disp:*60 Tablet(s)* Refills:*0* 14. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO twice a day for 7 days. Disp:*14 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 2203**] VNA Discharge Diagnosis: CAD Dyslipidemia Diabetes mellitus H/O shingles Eczema Basal cell skin cancer 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 or while taking narcotics for pain. 7) Call with any questions or concerns. Followup Instructions: [**Hospital 409**] clinic in 2 weeks Please follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**] Please follow-up with Dr. [**Last Name (STitle) 171**] in [**1-17**] weeks. Please follow-up with Dr. [**Last Name (STitle) 5717**] in [**1-18**] weeks. [**Telephone/Fax (1) 250**] Please follow-up with [**Hospital 159**] Clinic in 2 weeks ([**Telephone/Fax (1) 772**] Completed by:[**2102-1-2**] ICD9 Codes: 5990
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Medical Text: Admission Date: [**2146-5-8**] Discharge Date: [**2146-5-13**] Date of Birth: [**2091-8-27**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 10293**] Chief Complaint: Recurrent altered mental status . Major Surgical or Invasive Procedure: Paracentesis . History of Present Illness: 54 year old man with history of ETOh induced cirrhosis with complications of esophageal varices, refractory ascites s/p TIPS and subsequent closure p/w altered mental status. Of note the patient was just discharged from [**Hospital1 18**] on [**2146-5-1**] for an admission for hepatic encephalopaty at which time he was found to have a UTI and he completed 7 days of antibiotics. He had his lactulose regimen titrated up during the admission. He had an outpatient liver u/s on [**5-6**] but the read is still pending. On the afternoon of the 24th his wife noted him to be less interactive and more somnolent. He was at home and leaned down onto floor from his recliner and did not get up. He had a small abrasion on his head. She gave him an additional dose of lactulose. However his somnolence persisted and she had him brought to [**Hospital3 3583**]. His vitals there were unremarkable and he was breathing comfortably on room air. He received an additional 20 gm of lactulose prior to transfer to [**Hospital1 18**]. . In the ED his initial vital signs were afebrile 110/79 90 19 97%RA. He received an additional dose of lactulose PO. A head CT was unremarkable for hemorrhage. He was transfered to the floor. . Past Medical History: 1. EtOH induced cirrhosis with portal HTN and esophageal varices, refractory ascites. h/o encephalopathy. previously not candidate for txp due to obesity, but lost 40 lbs and put on list in [**10-21**]. 2. s/p TIPS [**2137**] with frequent revisions, [**8-4**] and TIPS redo [**2145-11-19**], now s/p closure [**4-21**] 3. CKD with baseline Cr 1.6 4. DM2 5. s/p ccy for porcelain gallbladder in [**10/2145**] 6. neuroendocrine tumor in stomach 7. obesity 8. OSA on BiPAP at home c/b mild pulmonary hypertension 9. Squamous cell skin ca on left shoulder 10. s/p rhinoplasty after broken nose 11. s/p surgery for R cheek infection 12. s/p TIPS closure due to frequent encephalopathy [**4-/2146**] . Social History: Married to wife [**Name (NI) **] and living in [**Name (NI) 3320**]. 16 py h/o smoking, quit 27 years ago. H/O alcohol abuse, quit 10 yrs ago. Remote marijuana/cocaine use in the 60s-70s, no IVDU. Umemployed at present. He previously worked as the Director of food & beverage services on a cruisline in the Hawaiian islands. . Family History: # Mother, d 56: CVA # Father, d 84: Alzheimer's # Sister: DM2, seizures # Brother, older: [**Name2 (NI) 3495**] disease # Brother, younger: [**Name2 (NI) **] known disease . Physical Exam: VS: 97.5 94 129/93 15 97%2L GEN: minimally arousable to voice or noxious stimuli. HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, mild icteric, OP clear, MMM, Neck supple, no LAD, no carotid bruits CV: RRR, nl s1, s2, no m/r/g PULM: CTAB, no w/r/r with good air movement throughout ABD: [**Last Name (un) 25359**] open ccy scar, pendulous, NT, distended with ascites, + BS, no HSM. marked scrotal edema (inguinal hernia with ascites tracking down). non-visible urethral meatus. EXT: warm, dry, +2 distal pulses BL, no femoral bruits NEURO: awake. arousable to voice and noxious stimuli, not following commands, CN II-XII grossly intact, withdrawals all 4 ext symmetrically. No sensory deficits to light touch appreciated. +asterixis . Pertinent Results: CT head [**5-8**]: There is no hemorrhage, hydrocephalus, shift of normally midline structures, or evidence of major vascular territorial infarct. The [**Doctor Last Name 352**]-white matter differentiation is preserved. Hyperdensities are seen within the periventricular and subcortical white matter consistent with chronic microvascular ischemic disease. The visualized paranasal sinuses and mastoid air cells remain normally aerated. The surrounding soft tissue and osseous structures are within normal limits. . CXR [**5-8**] Portable radiograph of the lower lung and upper abdomen is demonstrated. The NG tube tip is in the stomach. The TIPS catheter is demonstrated in expected unchanged location. The limited evaluation of the upper abdomen is unremarkable. The evaluation of the lung bases demonstrates left pleural effusion and left lower lobe atelectasis. . RUQ US w/doppler [**5-9**]: Complete occlusion of the TIPS catheter compatible with recent TIPS closure procedure performed on [**4-14**], 08, no change from [**2146-4-27**]. . Brief Hospital Course: 54 year old man with history of alcoholic cirrhosis complicated by refractory ascites s/p TIPS c/b recurrent hepatic encephalopathy with TIPS closure, who presented to ICU from OSH for somnolence, now mental status improved with lactulose but still not at baseline. . # Recurrent hepatic encephalopathy: The patient presented with sudden decline in mental status and an unwitnessed fall at home. He was somnolent when he arrived from OSH so was admitted to ICU and improved with lactulose per NGT. Mental status slowly improved back to baseline. We will also evaluate whether the TIPS is still closed. No indication of infection - diagnostic para negative for SBP, UCx negative, CXR without evidence of infection. He was continued on lactulose and rifamixin. RUQ [**Month (only) 950**] with doppler confirmed TIPS is closed. . # Etoh cirrhosis: He is awaiting liver [**Month (only) **]. MELD on admission was 20. Patient has had issues with recurrent hepatice encephalopathy so TIPS was closed on [**2146-4-16**]. Patient also with h/o esophageal varices but Hct stable and no evidence of bleed. Lactulose and rifamixin were continued as above. Nadolol and diuretics were held initially and then re-started prior to discharge at his pre-admission doses. . # s/p unwitnessed fall: Patient has abrasions on forehead and knees bilaterally when he was encephalopathic prior to admission. CT head negative. Wounds all looked superficial and there was no evidence for more serious injury. . # s/p UTI: Patient finished 7 day course of amoxicillin for enterococcal UTI on [**2146-5-5**]. Patient had difficult foley placement by urology in ICU so started on a course of CTX but this was discontinued after 2 days as there was no evidence for UTI. Foley was discontinued when his mental status cleared. . #) Pancytopenia: This is chronic and likely [**1-15**] liver disease. He is known to be guaiac positive, presumed to be from his neuroendocrine tumor in his stomach. Hct at last discharge on [**5-6**] was 30.2, currently 27-28. . #) DM2: DM regimen at home is NPH 75 units qAM, 70. His regimen was decreased in the ICU as patient was NPO. Once he started eating, his NPH regimen was titrated up to his home doses. He was also covered with a humalog insulin sliding scale. . #) Neuroendocrine tumor: Patient has known 1.5cm mass in gastric cardia from [**12/2145**], not much increase in change from last EGDs in [**2144**]. Pathology consistent with carcinoid tumor. No evidence of flushing, increased urination. Patient can follow up as outpatient for further workup of carcinoid syndrome . #) Code status: FULL, confirmed with wife and patient at time of admission. . Medications on Admission: Pantoprazole 40 mg Q24H Magnesium Oxide 400 mg [**Hospital1 **] Spironolactone 100 mg [**Hospital1 **] Furosemide 100 mg DAILY Rifaximin 400 mg TID Nadolol 10 mg DAILY Lactulose 10 gram/15 mL Syrup Sig: One [**Age over 90 **]y (120) ML PO QAM (once a day (in the morning)). Lactulose 10 gram/15 mL Syrup Sig: Sixty (60) ML PO QNOON. Lactulose 10 gram/15 mL Syrup Sig: Fifteen (15) ML PO QPM (once a day (in the evening)). Insulin NPH 75U QAM;70U QPM Discharge Medications: 1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 2. Furosemide 20 mg Tablet Sig: Five (5) Tablet PO once a day. 3. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 6. Nadolol 20 mg Tablet Sig: 0.5 Tablet PO once a day. 7. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Seventy Five (75) units Subcutaneous qAM. 8. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Seventy (70) units Subcutaneous qPM. 9. Glucerna Shake Liquid Sig: One (1) bottle PO twice a day. Disp:*60 bottles* Refills:*2* . Discharge Disposition: Home With Service Facility: [**Age over 90 269**] Assoc. of [**Hospital3 **] Discharge Diagnosis: Final diagnosis: Hepatic encephalopathy . Secondary diagnosis: EtOH-induced cirrhosis CKD with baseline Cr 1.2-1.5 DM 2 Neuroendocrine tumor in stomach with chronic low grade GIB . Discharge Condition: Stable . Discharge Instructions: You were admitted for confusion and an unwitnessed fall at home due to your hepatic encephalopathy. Initially you were in the intensive care unit as you were very sleepy and required a nasogastric tube for lactulose. You improved with lactulose and were transferred to the medical floor. You had a paracentesis on the day of discharge for increasing ascites with 5L removed. . Please continue all your home medications and keep all scheduled follow-up appointments. . Please call your physician or return to the emergency room if you have any increased confusion, decreased bowel movements despite increased lactulose, fever, chills, pain on urination, or any other new or worrisome symptoms. . Followup Instructions: Provider [**Name9 (PRE) **],[**Name9 (PRE) 8754**] DERMATOLOGY GEN-[**Doctor First Name 8754**] (NHB) Date/Time:[**2146-5-11**] 10:00 . Provider [**Name9 (PRE) 1382**] [**Name9 (PRE) 1383**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2146-5-20**] 10:00 . Provider PULMONARY FUNCTION LAB Phone:[**Telephone/Fax (1) 609**] Date/Time:[**2146-7-19**] 11:10 . ICD9 Codes: 5849, 5990, 5859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7124 }
Medical Text: Admission Date: [**2159-2-1**] Discharge Date: [**2159-2-4**] Date of Birth: [**2097-8-21**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 668**] Chief Complaint: Small Bowel Obstruction Major Surgical or Invasive Procedure: None History of Present Illness: 61 year-old male with a history of a renal transplant on [**2137**] that has now failed, and also a history of multiple abdominal operations. He has a long history of small bowel obstructions and was recently hospitalized last week with an episode of small bowel obstruction. He reports last night had a similar episode of pain and presented to clinic. He denies nausea, vomiting, fevers, chills, chest pain, and shortness-of-breath. He was evaluated by Dr. [**First Name (STitle) **] in the clinic and was sent to the emergency room for further evaluation for a possible small bowel obstruction. Currently, he continues to have pain that has improved. He continues to have no nausea, vomiting, fevers, chills, chest pain, or shortness-of-breath. He continues to have high output from his ostomy with copious amounts of gas. He empties the ostomy approximately 7-8 times per day. Past Medical History: ESRD on HD (secondary to post-streptococcal glomerulonephritis, Renal transplant '[**37**] failed, transplant nephrectomy in [**2143**]), Hyperparathyroidism, Hypertension, Atrial fibrillation (started on warfarin [**Date range (1) 101024**]), CAD, Diastolic CHF with remote history of systolic CHF MSSA, Endocarditis w/ Aortic and Mitral valve involvement, Repeated episodes of pneumonia, VRE septic arthritis, L wrist MSSA infective arthritis, Right hip fracture s/p Right hip hemiarthroplasty, [**2157-1-11**], Right Prosthetic Hip infection s/p explantation [**2-18**], Ischemic colitis/ileitis s/p subtotal colectomy and terminal ileal resection, followed by ileocolonic anastomosis with diverting loop ileostomy and gastrostomy tube placement [**2156**] PAST SURGICAL HISTORY: [**2158-11-7**]: Aortic valve replacement(21 mm ON-X, Mitral valve replacement 25/33 On-X Conform-X mechanical valve) [**2158-10-5**]: Right heart catheterization [**2158-10-3**]: Paracentesis [**2158-7-13**]: Fistulogram, 6-mm balloon angioplasty of juxta-anastomotic segment [**2157-6-16**]: Washout and drainage right hip wound infection. [**2157-6-14**]: Revision left radiocephalic arteriovenous fistula, endarterectomy radial artery. [**2157-2-22**]: Evacuation drainage of right hip deep hematoma-abscess. [**2157-2-18**]: Removal right hip hemiarthroplasty. [**2157-2-3**]: Irrigation, debridement and evacuation of hematoma of right septic hemiarthroplasty. [**2157-1-26**]: Right hip revision of hemi arthroplasty due to dislocation. [**2157-1-15**]: Exploratory laparotomy, gastrostomy tube, ileocolonic anastomosis and diverting loop ileostomy. [**2157-1-14**]: Exploratory laparoscopy, subtotal colectomy. [**2157-1-13**]: Exploratory laparotomy, Subtotal colectomy, Resection of terminal ileum, Temporary abdominal closure. [**2157-1-11**]: Right hip hemiarthroplasty. [**2156-12-10**]: Left wrist incision and drainage. [**2156-2-17**]: Right ring finger closed reduction percutaneous pinning for mallet finger. Left index and long ring finger PIP joint manipulation under anesthesia. [**2155-12-16**]: Left carpal tunnel release and left index, long and ring finger trigger releases Social History: Owner of a clothing store in [**Location (un) 4398**]. No current tobacco and alcohol h/o intermittent tobacco use in the past (~3 pack-years). Denies illicit drug use. HIV negative [**2156-12-27**] Family History: Positive for cancer (father-prostate), [**Name (NI) 2481**] (mother). Father deceased. Brother has fibromyalgia. Daughter in good health Physical Exam: Gen: NAD HEENT: MMM no lesions CV: RRR no MRG RESP: CTAB no WRR ABD: soft, NT ND. Ostomy w stool and gas. G tube with drainage bag, thin gastric contents present. Ext: No LE edema Pertinent Results: [**2159-2-3**] 06:50AM BLOOD WBC-3.5* RBC-3.96* Hgb-11.9* Hct-36.7* MCV-93 MCH-30.1 MCHC-32.4 RDW-19.6* Plt Ct-75* [**2159-2-3**] 06:50AM BLOOD Glucose-65* UreaN-14 Creat-3.1* Na-138 K-4.2 Cl-96 HCO3-33* AnGap-13 [**2159-2-3**] 06:50AM BLOOD Calcium-9.4 Phos-4.4 Mg-1.7 [**2159-2-3**] 01:35PM BLOOD CK-MB-4 cTropnT-0.47* [**2159-2-3**] 06:50AM BLOOD CK-MB-4 cTropnT-0.48* [**2159-2-2**] 07:15PM BLOOD CK-MB-5 cTropnT-0.43* [**2159-2-2**] 02:00PM BLOOD cTropnT-0.41* [**2159-2-2**] 04:00AM BLOOD CK-MB-5 cTropnT-0.31* [**2159-2-1**] 08:15PM BLOOD CK-MB-4 cTropnT-0.28* KUB [**2-1**]: FINDINGS: Dilated small bowel in the lower abdomen measuring up to 4.3 cm in diameter containing air-fluid levels on the upright view. Findings concerning for small-bowel obstruction. Brief Hospital Course: Pt was admitted from ED in good condition with the diagnosis of small bowel obstruction. He was given hemodialysis for an elevated potassium. His small bowel obstruction was treated conservatively with IV hydration, PPI's, and nothing by mouth. On HD2, the patient's ostomy began to put out stool and gas. He was advanced to a clear, then regular diet on HD3. By HD 4 the patient was comfortable eating a regular diet, having stool and gas from his ostomy, without abdominal pain or distention. He was then deemed safe for discharge home. Of note, the patient had a set of troponins that were drawn in the ED for the symptom of epigastric pain. An EKG was normal, and the pt was hemodynamically stable. Thus his troponin elevation was thought to be due to his renal failure and not from cardiac ischemia. He was restarted kept on coumadin throughout his hospitalization and made sure his INR levels were therapeutic by his discharge, as he came with subtherapeutic levels. He was discharged on [**2-4**] with an INR of 3.0 and will closely follow-up his levels with the coumadin clinic from the labs drawn at [**Month/Year (2) 2286**]. Medications on Admission: atorvastatin 10mg daily, B complex-vitamin C-folic acid 1, cinacalcet 60, ciprofloxacin 500mg daily, epoetin alfa injection, pantoprazole 40mg daily, warfarin 2mg daily, aspirin 81 daily Discharge Medications: 1. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Cipro 500 mg Tablet Sig: One (1) Tablet PO once a day. 3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 4. Coumadin 2 mg Tablet Sig: please take according to levels Tablet PO once a day. 5. Aspir-81 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Discharge Disposition: Home Discharge Diagnosis: Small Bowel Obstruction Discharge Condition: Alert and Oriented to all spheres, ambulating and voiding without difficulty Discharge Instructions: You were admitted to the hospital with a small bowel obstruction. Your obstruction was relieved on hospital day 2, and you were then able to eat regular food without any problems. Make sure to monitor for symptoms of nausea, vomiting, or abdominal pain while eating. Keep track of your daily ostomy output, and whether or not you have gas and stool in the bag. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Please call and make an appointment with Dr. [**First Name (STitle) **] in 2 weeks [**Telephone/Fax (1) 673**] Provider: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3990**], [**First Name3 (LF) **] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2159-2-15**] 3:40 Please follow the coumadin levels and follow up with the coumadin clinic for dose tomorrow. Completed by:[**2159-2-6**] ICD9 Codes: 4280, 2767, 5856
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7125 }
Medical Text: Admission Date: [**2157-9-28**] Discharge Date: [**2157-9-30**] Date of Birth: [**2102-11-12**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 371**] Chief Complaint: Incarcerated hernia Major Surgical or Invasive Procedure: [**2157-9-28**] Left Inguinal hernia repair w/ mesh History of Present Illness: Pt is a 54 M w/ h/o L inguinal hernia repair by Dr. [**Last Name (STitle) **] in [**2151**]. He noticed a bulge in his left groin approximately 5 days, and has been having worsening nausea/vomiting for the last ~24 hrs, with approximately 11 episodes of emesis yesterday. His pain has been stable. He did have a subjective fever last night. Past Medical History: CAD s/p 3V CABG to LAD, OM1, PDA. HTN, controlled on meds Dyslipidemia Social History: No tobacco hx, very rare EtOH use, no IVDU. Pt is a MSM, lives with a steady male partner, currently sexually active, does not use protection, no hx of STDs in himself or partner. Employed in clothing design firm. Family History: Extensive family hx of CAD. F died of MI [**92**], Uncle died of MI [**83**]. GF died of MI. Physical Exam: Physical Exam upon admission: Vitals: GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: Soft. Minimally distended. Nontender. No guarding/Rebound. Palpable L inguinal Hernia Ext: No LE edema, LE warm and well perfused Physical Exam upon discharge: VS: 98.2, 119/57, 78, 16, 99/RA GEN: Resting in chair, NAD HEENT:No scleral icterus, mucus membranes moist CARDIAC: Normal S1, S2. RRR. No MRG PULM: Lungs CTAB ABDOMEN: obese, soft/nontender/mildly distended EXT: + pedal pulses. No CCE. NEURO: AAOx4 Skin: Left groin incision OTA, steri strips intact. Pertinent Results: Imaging: [**2157-9-28**] Radiology CT ABD & PELVIS WITH CO Left inguinal hernia containing sigmoid colon and causing large bowel obstruction. Minimal surrounding inflammation. No bowel wall enhancement abnormalities to suggest ischemia, though trace fluid is identified within the abdomen. No free air. [**2157-9-29**] 08:25AM BLOOD WBC-9.1 RBC-4.72 Hgb-14.9# Hct-41.3# MCV-88 MCH-31.5 MCHC-36.0* RDW-13.0 Plt Ct-173 [**2157-9-28**] 12:50PM BLOOD WBC-10.9# RBC-6.02 Hgb-18.7* Hct-51.8 MCV-86 MCH-31.1 MCHC-36.1* RDW-13.2 Plt Ct-245# [**2157-9-28**] 12:50PM BLOOD Neuts-82.9* Lymphs-11.5* Monos-5.1 Eos-0.1 Baso-0.3 [**2157-9-29**] 08:25AM BLOOD Glucose-103* UreaN-18 Creat-0.9 Na-136 K-3.9 Cl-103 HCO3-25 AnGap-12 [**2157-9-28**] 12:50PM BLOOD Glucose-118* UreaN-19 Creat-1.1 Na-132* K-3.6 Cl-95* HCO3-24 AnGap-17 [**2157-9-28**] 12:50PM BLOOD ALT-49* AST-31 AlkPhos-54 TotBili-1.3 [**2157-9-29**] 08:25AM BLOOD Calcium-8.1* Phos-3.9 Mg-2.0 [**2157-9-28**] 12:50PM BLOOD Albumin-5.3* [**2157-9-28**] 12:58PM BLOOD Lactate-2.5* Brief Hospital Course: The patient is with h/o L inguinal hernia repair by Dr. [**Last Name (STitle) **] in [**2151**]. He noticed a bulge in his left groin approximately 5 days, and has been having worsening nausea/vomiting for the last several hours. He was admitted to the Acute Care Service after a CT Scan revealed "Left inguinal hernia containing sigmoid colon and causing large bowel obstruction. Minimal surrounding inflammation." On [**2157-9-28**], the patient was taken to the operating room for repair of his incarcerated recurrent left inguinal hernia with mesh. Please see operative report for details of this procedure. He tolerated the procedure well and was extubated upon completion. He was subsequently taken to the PACU for recovery. He was transferred to the surgical floor hemodynamically stable. His vital signs were routinely monitored and he remained afebrile and hemodynamically stable. He was initially given IV fluids postoperatively, which were discontinued when he was tolerating PO's. His diet was advanced on the morning of [**2157-9-29**] to regular, which he tolerated without abdominal pain, nausea, or vomiting. He was voiding adequate amounts of urine without difficulty. He was encouraged to mobilize out of bed and ambulate as tolerated, which he was able to do independently. His pain level was routinely assessed and well controlled at discharge with an oral regimen as needed. His left groin incision was open to air with steri strips that were clean/dry/intact. On [**2157-9-30**], he was discharged home with scheduled follow up in [**Hospital 2536**] clinic. Medications on Admission: Metoprolol Tartrate 25 mg PO BID Lisinopril 5 mg PO DAILY Atorvastatin 20 mg PO DAILY Discharge Medications: 1. Metoprolol Tartrate 25 mg PO BID 2. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 3. Lisinopril 5 mg PO DAILY 4. Atorvastatin 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Incarcerated Inguinal Hernia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You came to the hospital complaining of nausea and abdominal pain. A CT scan revealed an left inguinal incracerated hernia . You were taken to the operating room for hernia repair. Your bowel function has returned and you have resumed a regular diet. Please follow up in [**Hospital 2536**] clinic at the appointment scheduled for you below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your [**Hospital 5059**] at your next visit. Don't lift more than 20-25 lbs for 4-6 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. HOW YOU [**Month (only) **] FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your [**Month (only) 5059**]. YOUR INCISION: Your incision may be slightly red around the staples. This is normal. You may gently wash away dried material around your incision. It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your [**Month (only) 5059**]. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next 6-12 months, your incision will fade and become less prominent. YOUR BOWELS: Constipation is a common side effect of medicine such as Percocet or codeine. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your [**Month (only) 5059**]. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your [**Name2 (NI) 5059**]. You will receive a prescription from your [**Name2 (NI) 5059**] for pain medicine to take by mouth. It is important to take this medicine as directied. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your [**Name2 (NI) 5059**] about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your [**Name2 (NI) 5059**] has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your [**Name2 (NI) 5059**]: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. In some cases you will have a prescription for antibiotics or other medication. If you have any questions about what medicine to take or not to take, please call your [**Name2 (NI) 5059**]. DANGER SIGNS: Please call your [**Name2 (NI) 5059**] if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound Followup Instructions: Name: [**Last Name (LF) **],[**First Name3 (LF) **] D. Location: [**Hospital1 **] [**Location (un) **] Address: [**Street Address(2) **], 2ND FL, [**Location (un) **],[**Numeric Identifier 2900**] Phone: [**Telephone/Fax (1) 5723**] Appt: [**10-5**] at 12:20pm Department: GENERAL SURGERY/[**Hospital Unit Name 2193**] When: THURSDAY [**2157-10-13**] at 3:00 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 Completed by:[**2157-9-30**] ICD9 Codes: 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7126 }
Medical Text: Admission Date: [**2125-10-14**] Discharge Date: [**2125-10-31**] Date of Birth: [**2063-4-4**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: unstable angina Major Surgical or Invasive Procedure: [**2125-10-14**] emergency CABG x3 with IABP (SVG to LAD, SVG to OM, SVG to PDA) Emergent left heart catheterization and coronary angiogram, placement of IABP [**10-14**] History of Present Illness: This 62 year old white male presented to ER with severe angina, shortness of breath, tingling down his left arm, and a new LBBB. He had a prior infarction with PTCA in [**2108**]. Acute coronary syndrome with shock was diagnosed and therefore, he went urgently to the catheterization lab. In the lab he developed acute respiratory distress requiring intubation. Critical left main, LAD and circumflex disease were found as well as occlusive RCA disease. An IABP was placed for cardiogenic shock and a decision was made to proceed with emergent coronary revascularization for myocardial salvage. Past Medical History: Myocardial infarction in [**2108**] coronary angioplasty [**2102**] Social History: lives with brother no tobacco or recreational drugs occasional ETOH Family History: unknown Physical Exam: Awake, alert and oriented. 2/4 strength left arm, 3/4 strength left leg. Full ROM sensation seems intact. There is some neglect of left side, unsteady gait when looks up while walking. Mild right facial weakness. Gag and swallowing intact. lungs- clear cor- SR 60-60 exts- without edema wounds- clean and dry. Stable sternum Pertinent Results: Conclusions 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 spontaneous echo contrast or thrombus is seen in the body of the right atrium or the right atrial appendage. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. There is severe regional left ventricular systolic dysfunction with complete akinesis of anteroseptal and anterior walls along with moderate depression of the entire lateral wall. The inferior and inferolateral walls are severely hypokinetic as well.. No masses or thrombi are seen in the left ventricle and the apex was not well visualized.. Overall left ventricular systolic function is severely depressed (LVEF= 10 to 15 %). RV has mild global free wall hypokinesis. There are simple 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 appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. IABP was initially 6cm below the Left SCA and was repositioned to 2cm below the Left SCA. Dr. [**Last Name (STitle) **] was notified in person of the results on Mr.[**Known lastname 80487**] immediately after anesthesia induction and TEEexam.. POST-BYPASS: Patient is on infusions milrinone, levophed and epinephrine and IABP Preserved RV systolic function. Mild improvement in septal wall motion abnormalities. LVEF 25%. Mild to Moderate MR (This was not seen in the preoperative or prebypass period) Intact thoracic aorta. Trivial TR. IABP is positoned well, I certify that I was present for this procedure in compliance with HCFA regulations. Interpretation assigned to [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting physician [**2125-10-29**] 05:25AM BLOOD Hct-35.1* [**2125-10-28**] 06:15AM BLOOD WBC-6.0 RBC-3.64* Hgb-11.4* Hct-33.6* MCV-92 MCH-31.3 MCHC-33.9 RDW-13.8 Plt Ct-332 [**2125-10-14**] 02:40AM BLOOD WBC-15.1* RBC-4.55* Hgb-14.5 Hct-41.2 MCV-91 MCH-31.9 MCHC-35.2* RDW-13.1 Plt Ct-287 [**2125-10-29**] 05:25AM BLOOD PT-24.3* INR(PT)-2.4* [**2125-10-28**] 06:15AM BLOOD Glucose-112* UreaN-10 Creat-1.1 Na-139 K-3.9 Cl-106 HCO3-23 AnGap-14 [**2125-10-14**] 02:40AM BLOOD Glucose-242* UreaN-13 Creat-1.2 Na-139 K-4.0 Cl-101 HCO3-21* AnGap-21* [**2125-10-25**] 02:48AM BLOOD ALT-26 AST-18 LD(LDH)-312* AlkPhos-100 Amylase-45 TotBili-0.4 [**2125-10-18**] 07:31PM BLOOD ALT-68* AST-69* LD(LDH)-636* AlkPhos-214* Amylase-35 TotBili-1.0 [**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG CSRU [**2125-10-24**] SCHED CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 80488**] Reason: r/o bleed into CVA [**Hospital 93**] MEDICAL CONDITION: 62 year old man with REASON FOR THIS EXAMINATION: r/o bleed into CVA CONTRAINDICATIONS FOR IV CONTRAST: None. Provisional Findings Impression: AJy WED [**2125-10-24**] 12:12 PM PFI: Right frontal lobe hypodensities consistent with evolution of known infarct. No evidence for hemorrhage, significant edema, or mass effect. Final Report HISTORY: 62-year-old male with recent CVA. Evaluate for hemorrhagic conversion. COMPARISON: CTA of the head from [**2125-10-21**] and MRI of the brain from [**2125-10-22**]. TECHNIQUE: Contiguous axial images were obtained through the brain without the administration of IV contrast. FINDINGS: There has been interval development of multiple partially confluent hypodense foci in the right frontal lobe, in territory consistent with known recent CVA. This is consistent with expected evolution of ischemic infarct. There is no evidence for hemorrhage, significant edema, mass effect, shift of midline structures, or effacement of cisterns. The osseous structures remain unremarkable without suspicious lytic or sclerotic lesions. Visualized paranasal sinuses and mastoid air cells remain clear. IMPRESSION: 1. New right frontal lobe subcortical hypodensities, consistent with expected evolution of ischemic infarction. 2. No evidence for hemorrhage, significant edema, or mass effect. The study and the report were reviewed by the staff radiologist. DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 7415**] Approved: WED [**2125-10-24**] 1:23 PM Imaging Lab Cardiology Report ECG Study Date of [**2125-10-26**] 5:29:56 AM Sinus rhythm. First degree A-V block. Long QTc interval. Poor R wave progression. Possible anterior myocardial infarction, age undetermined. Clinical correlation is suggested. Non-specific intraventricular conduction delay. Anterior T wave changes suggest myocardial ischemia. Low QRS voltage in the limb leads. Compared to the previous tracing of [**2125-10-15**] the ventricular rate is slower. The P-R interval is longer. Anterolateral T wave changes are more pronounced. Read by: [**Last Name (LF) 2889**],[**First Name3 (LF) 2890**] K. Brief Hospital Course: Mr. [**Known lastname 80487**] presented to the ED with an acute MI on [**10-14**], with cardiogenic shock and was taken to the cath lab where angiography revealed an 80% LM lesion and an occluded RCA. An IABP was placed in the cath lab where he was intubated due to respiratory distress and CHF. He received Plavix, Integrilin and Heparin and then was transferred to the OR emergently in cardiogenic shock for revascularization. His EF was noted to be 10-15% by echo in the OR with a large area of infarct. He weaned form bypass on epinephrine, levophed, milrinone, insulin, and propofol drips. He had a significant amount of ventricular ectopy post operatively and electrolytes were repleted.He received amiodarone as well. He subsequently remained stable postoperativley.Thge epinephrine then the Levophed were slowly weaned, keeping his MAP>65mmHg. The IABP was weaned to 1:2 and removed on POD 2. The amiodarone and Milrinone were continued and extubation occurred on POD 2. The Milrinone was weaned and discontinued as an ACEI was begun, and he remained stable. He was then transferred to the step down floor on POD 3. The chest tubes and wires were removed. He was seen in consultation by the physical therapist. He was noted to have bursts of atrial tachycardia and therefore was seen by electrophysiology who recommended continuation of the amiodarone and a repeat echocardiogram in a month. Due to PAF and the low LVEF he was anticoagulated with Coumadin. On the evening of POD 7 ([**10-21**]) he was noted to have an unsteady gait and felt exhausted. There was left sided weakness of the leg/arm with neglect. The stroke team was notified and an emergent CTA demonstrated occlusion of the right internal carotid extending to the right MCA with distal collateralization. No intervention was indicated beyond the ongoing anticoagulation and he was transferred to the ICU for monitoring. Carotid ultrasound on [**10-22**] confirmed no flow through the right internal carotid artery. There was no stenosis of the left internal carotid. Head CT/CTA on [**10-22**] demonstrated a right ICA occlusion with good collaterals and distal flow. He transiently required neosynephrine for BP support to maintain cerebral perfusion and all negative inotropes were discontinued. He remained stable from a cardiac standpoint throughout the remainder of his hospitalization.Physical therapy continued to work with the patient in the ICU and after his return to the floor. Family meeting with PT/OT cleared him for discharge to home with sister-in-law on [**2125-10-31**]. Medications on Admission: ASA 81 mg daily Discharge Disposition: Home with Service Discharge Diagnosis: coronary artery disease s/p emergency coronary artery bypass grafting acute myocardial infarction with shock s/p remote coronary angioplasty postoperative stroke occlusion of right carotid artery Discharge Condition: good Discharge Instructions: shower daily, no baths or swimming no lotion, creams, or powders on any incision no driving for one month and until off all narcotics no lifting greater than 10 pounds for 10 weeks call for fever greater than 100.5 report any redness or drainage of incisions take all medications as directed Followup Instructions: see Dr. [**Last Name (STitle) 8079**] in [**1-24**] weeks see Dr. [**Last Name (STitle) 911**] in [**2-25**] weeks see Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] Completed by:[**2125-10-31**] ICD9 Codes: 5185, 4271, 4280
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Medical Text: Admission Date: [**2190-7-21**] Discharge Date: [**2190-8-5**] Date of Birth: [**2113-11-16**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 30**] Chief Complaint: Abdominal Pain/ Nausea and Vomiting Major Surgical or Invasive Procedure: [**7-21**]- Cholangioscopy for CBD stone [**7-30**]- Cholangioscopy with Bx specimens History of Present Illness: 76yo woman with h/o dementia, s/p Billroth II and cholecystectomy, admitted for cholangioscopy and attempted biliary lithotripsy by IR [**2190-7-21**], transferred to MICU for hypotension. The patient was initially seen at [**Hospital 794**] Hospital three weeks ago after c/o several weeks of abdominal pain and nausea/vomiting. MRCP at that time showed a common biliary duct stone and dilated ducts, but ERCP failed to remove the stone. A temporary drain was placed and she was treated with Unasyn. The drain goes through the right biliary tree, into the common biliary duct, and ends in the duodenum. There is a stone in the cystic duct and stenosis of the common biliary duct. She was admitted to [**Hospital1 18**] [**Date range (1) 67837**]/06 and seen by the ERCP service, who deferred further treatment to IR. IR attempted stone retrieval but was unsuccessful. There was a 1cm mass seen near a biliary enteric anastomosis thought to be stenosis. She underwent MRCP and MRI. Her external drain was capped and she was changed to po levoflox for a 14 day course. She was discharged from [**Hospital1 18**] on [**7-10**] with plans for possible future lithotripsy. . She was readmitted [**2190-7-21**] and underwent cholangioscopy with attempted biliary lithotripsy by IR that was again unsuccessful. IR is attempting to delineate CBD stone vs. mass. Today, [**2190-7-22**], she was found hypotensive with SBP 60s, HR 70s. Tmax was 99.6 axillary at noon. 2L NS was bolused, and she was transferred to the MICU for further management. She c/o abdominal pain today. She does c/o nausea. She denies headache, dizziness, chest pain, or SOB. Pt does report that she sometimes has mild CP Past Medical History: Dementia billroth II Social History: lives with son, [**Name (NI) **] EtOH, no tobacco Family History: NC Physical Exam: PE- Gen: NAD CV: RRR no m/r/g Resp: CTAB Abd: soft, NT/ND c/o mild abdominal pain to palpation diffusely, no rebound or guarding Ext: no bruising or pitting edema, 2+ pulses Bilaterally x 4 Neuro: A&O x 1 (person only), demented w/o focal signs Pertinent Results: [**2190-7-21**] 10:13PM BLOOD WBC-8.0 RBC-3.67* Hgb-10.1*# Hct-28.9*# MCV-79* MCH-27.4 MCHC-34.9 RDW-15.4 Plt Ct-222 [**2190-7-31**] 03:41AM BLOOD WBC-6.9 RBC-3.50* Hgb-9.5* Hct-28.2* MCV-81* MCH-27.3 MCHC-33.8 RDW-16.3* Plt Ct-231 [**2190-7-21**] 10:13PM BLOOD PT-14.7* PTT-29.0 INR(PT)-1.3* [**2190-7-31**] 06:05PM BLOOD PT-15.2* PTT-30.9 INR(PT)-1.4* [**2190-7-21**] 10:13PM BLOOD Glucose-134* UreaN-9 Creat-0.5 Na-138 K-3.2* Cl-103 HCO3-28 AnGap-10 [**2190-8-2**] 06:28AM BLOOD Glucose-74 UreaN-11 Creat-2.0* Na-141 K-3.5 Cl-115* HCO3-18* AnGap-12 [**2190-7-21**] 10:13PM BLOOD ALT-14 AST-25 LD(LDH)-151 AlkPhos-73 TotBili-0.5 [**2190-7-30**] 03:50PM BLOOD ALT-33 AST-42* AlkPhos-66 TotBili-0.5 [**2190-7-21**] 10:13PM BLOOD Albumin-2.5* Calcium-7.8* Phos-3.6 Mg-1.5* [**2190-7-31**] 06:05PM BLOOD Mg-1.8 [**2190-7-29**] 01:23PM BLOOD calTIBC-212* VitB12-661 Folate-9.6 Hapto-116 Ferritn-35 TRF-163* Brief Hospital Course: After Cholangioscopy, patient transferred from floor to MICU HD#2 for hypotension which resolved with fluids. Not septic, Hct stable, no adrenal insuff. Moved back to floor HD#3 once stable. Patient again became hypotensive HD#5 and was transferred back to the MICU. Patient again responded to fluids. Unclear what cause of hypotension, but possibly from infection trending toward Sepsis. She remained stable in the MICU on ABX and was returned to the floor on HD#6 on Vanco and Zosyn for question of Biliary Sepsis. Biliary drain remained in place from procedure on. Once returning to the floor, patient maintained stable BP's and remained afebrile. She completed a 10 day course of Vancomycin and Zosyn at which time Abx were discontinued. She remained afebrile at discharge. Per IR, apparently patient has a cystic duct remnant with a stone that is not the source of obstruction. Her obstruction was caused by a mass vs. stricture distal to the stone which is causing obstruction. On HD#9 she again underwent cholangioscopy with stenting and Biopsy taken from stricture/mass to help deliniate. Pathology displayed inconclusive specimens. IR discussion on HD#15 drain drain was capped and they would like patient to follow-up next week for reevaluation. At follow-up it is likely that drain could be D/C completely. On HD# 10 Patient was found to have ARF with Cr 0.9-->1.9-->2.5. Renal was consulted and patient was believed to have ATN from a prerenal source of dehydration. Pt responded to IVF and her RF resolved. Urine Cx continued to be negative. Pt was found to have VRE and had to be placed on Contact Precautions. Pt was also chronically anemic during her hospitalization. Iron studies revealed some evidence of mixed iron deficiency and anemia of chronic disease. She was started on Ferrous Gluconate and her HCT was stable at D/C. Pt initially returned to the floor with low albumin and poor PO intake. She was given Boost supplementation, but was found to not be taking appropriate nutrition. On HD#14 nutrition felt that Tube Feeds would increase Patient's nutritional status. On discussion with the patient's son/Health Care Proxy, feeding tube was not something they wanted to pursue at this time. Pt's family feels that she will take more PO once she is in her home environment. They agree to keep up with her intake and continue supplementation with boost puddings. Pt's nutiritional status will be monitored by family and followed up with her PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 46**]. Pt was initially screened for rehabilitation vs. skilled nursing facilities. Her disposition was altered after discussion with her son who felt the patient would be bettere served at home with close supervision and VNA. He has changed around his work schedule to accomodate this care and has arranged with his brother to do the same. Pt was D/C home in stable condition and will F/U with her PCP and Interventional Radiology Medications on Admission: Protonix 40mg qday Hydromorphone 2 mg q2h prn Levofloxacin 500 qday Remeron 15 mg qhs Trazodone 50 mg qhs Risperdal 0.5 mg qam, 1mg qpm Discharge Medications: 1. Risperidone 0.25 mg Tablet Sig: Two (2) Tablet PO QAM (once a day (in the morning)). 2. Risperidone 1 mg Tablet Sig: One (1) Tablet PO QPM (once a day (in the evening)). 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*30 Tablet(s)* Refills:*0* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). Disp:*90 Tablet, Chewable(s)* Refills:*0* 7. Megestrol 40 mg/mL Suspension Sig: Eight Hundred (800) mg PO DAILY (Daily). Disp:*QS one month* Refills:*2* 8. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 10. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 11. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 12. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Discharge Disposition: Home With Service Facility: Bayada VNA Discharge Diagnosis: Primary: 1. Cholangitis and Sepsis. 2. Acute Renal Failure. 3. Cystic Duct Remnant with Retained Stone. 4. Common Bile Duct Stricture NOS. 5. Malnutrition - Moderate 6. Iron Deficiency Anemia. 7. VRE Colonization. Secondary: 1. Dementia. 2. S/P Bilroth II Roux-en-Y. 3. S/P Cholecystectomy. Discharge Condition: Good Discharge Instructions: You have been admitted to the hospital for Biliary Obstruction with superimposed infection. You should call your doctor or return to the hospital if you experience any of the following: Fever > 101 Severe Abdominal Pain Nausea and Vomiting Constipation or Diarrhea Bloody Stools Chest Pain Shortness of Breath Followup Instructions: Please follow-up with your primary care doctor Dr. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 46**] in [**12-28**] weeks. Please call [**Telephone/Fax (1) 67838**] and schedule an appointment. Please follow-up with Interventional Radiology in one week. You should call the office of Dr. [**Last Name (STitle) 4686**] ([**Telephone/Fax (1) 44617**] on Monday to schedule an appointment. Completed by:[**2190-8-5**] ICD9 Codes: 5849, 0389
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Medical Text: Admission Date: [**2131-3-31**] Discharge Date: [**2131-4-1**] Date of Birth: [**2073-9-26**] Sex: M Service: CSU DEATH SUMMARY: ADMISSION DIAGNOSES: 1. Acute myocardial infarction. 2. Diabetes mellitus type 2. 3. History of asbestosis. DISCHARGE DIAGNOSES: 1. Acute myocardial infarction. 2. Diabetes mellitus type 2. 3. History of asbestosis. 4. Cardiac arrest. 5. Ventricular fibrillation. 6. Status post insertion of right ventricular assist device. 7. Status post insertion of left ventricular assist device. 8. Status post placement on extracorporeal membrane oxygenation system. 9. Status post placement on continuous [**Last Name (un) **]-[**Last Name (un) **] hemodialysis. 10. Blood loss anemia. 11. Pulmonary edema/respiratory failure. 12. Multiple organ system failure. AD[**Last Name (STitle) **]N HISTORY AND PHYSICAL: Mr. [**Known lastname **] is a 57 year old gentleman with a history of type 2 diabetes mellitus and asbestosis who was diagnosed with an acute myocardial infarction at [**Hospital3 **] Hospital on [**2131-3-29**]. He was diagnosed after initially having about a one week history of intermittent fatigue and malaise, with one episode of chest pain and dyspnea. When he arrived to [**Hospital **] [**Hospital **] hospital, he was found to have elevated cardiac enzymes and EKG changes consistent with an inferior wall myocardial infarction. He was taken urgently to the cardiac catheterization laboratory, where he was found to have a thrombotic lesion of approximately 99 percent of the right coronary artery. Stenting was attempted, with placement of several stents, but, again, there was not good restoration of blood flow or return of good cardiac function. It was therefore felt that the patient would need a ventricular assist device for any chance at survival, and he was therefore emergently life- flighted to the [**Hospital1 69**] after a consultation with Dr. [**First Name (STitle) **] Dr. [**Last Name (Prefixes) **] of Cardiac Surgery. He arrived to the [**Hospital1 188**] on [**2131-3-31**] at approximately 2 p.m. and was taken directly from the helipad to the operating room. On arrival to the operating room, the patient was extremely pale and cool. He was noted on his telemetry strip to be in cardiac arrest and had in fact possibly had some episodes of possible cardiac arrest en route. He had been on large doses of epinephrine, bicarbonate, isoproterenol and dobutamine, with an aortic balloon pump in place. As noted, his cardiac rhythm was irregular. His lungs were coarse. His abdomen was distended, and his right lower extremity was quite cool and pale. Upon arrival to the operating room, the patient was placed on cardiopulmonary bypass within four minutes, and operation was undertaken. HOSPITAL COURSE: Due to the patient's cardiogenic shock, he underwent placement of right and left ventricular assist devices, along with closure of a patent foramen ovale. His femoral arteries were actually repaired bilaterally by the vascular surgery service (Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]) secondary to bilateral lower extremity ischemia which was evident on initial examination. The cardiopulmonary bypass time was 180 minutes. There was no cross clamp time. The patient was transferred to the intensive care unit on Levophed, vasopressin and insulin. Upon arrival in the CSRU, as noted, the patient was quite hypoxic, and he was placed on ECMO oxygenation circuit. During placement of the cannulas, it was noted that the patient may have had some increased degree of vascular insufficiency in his leg, as cannula placement was quite difficult. The vascular surgery service was again consulted, and they emergently re-explored the right groin and repaired his femoral artery, which was bleeding. Even after placement on the ECMO circuit, we had significant difficulty oxygenating the patient secondary to massive amounts of pulmonary edema, which manifested as copious frothy liquid emanating from the endotracheal tube. We evacuated approximately 3 to 4 liters of liquid from the endotracheal tube. In an effort to reduce the patient's volume overload, we placed him on continuous [**Last Name (un) **]-[**Last Name (un) **] hemodialysis after consultation with the nephrology service. None of these efforts allowed us to improve his oxygenation status. His ventricular assist device continued to maintain an adequate cardiac output, but there was growing concern of cerebral hypoxia in the setting of his diminished oxygen saturation. We continued our efforts, along with massive blood product transfusion, up until 0300 on [**2131-4-1**]. Notably, we attempted using IV steroids to improve his pulmonary status, but this did not improve this situation at all. As there was no improvement in his clinical status at this time, after discussion with the family and the attending surgeon, it was felt that resuscitative efforts should be withdrawn. He was pronounced dead on [**2131-4-1**] at 0300. The family was present. The patient's daughters were present at the time of expiration. The patient's primary care physician was [**Name (NI) 653**], and a message was left with the answering service. The patient's spouse was [**Name (NI) 653**] directly. RELEVANT LAB VALUES: The patient was quite acidotic throughout the course of his hospitalization, with pH's which has dropped to as low as 6.85, with a maximum of no more than 7.20. This was a combination of a respiratory and a metabolic acidosis, which we attempted to correct with manipulation of his ventilator and the ECMO circuit, along with the administration of bicarbonate, with little success. His hematocrit ranged between the 20-30's, and he had required massive amounts of blood transfusion. He was quite coagulopathic, with INR above 2, requiring multiple transfusions of fresh frozen plasma. [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**] Dictated By:[**Doctor Last Name 3763**] MEDQUIST36 D: [**2131-4-1**] 03:54:04 T: [**2131-4-1**] 05:15:06 Job#: [**Job Number 60626**] ICD9 Codes: 4280, 5185, 4275, 2851, 5849
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Medical Text: Admission Date: [**2139-2-1**] Discharge Date: [**2139-2-26**] Date of Birth: [**2074-5-16**] Sex: M Service: MEDICINE Allergies: Roxicet Attending:[**First Name3 (LF) 458**] Chief Complaint: Fevers, fatigue Major Surgical or Invasive Procedure: [**First Name3 (LF) **] implantation [**2139-2-13**] DDD [**Company 1543**] Electrophysiology study [**2139-2-5**] History of Present Illness: Mr. [**Known lastname 93612**] is a 64 yo man with history of bicuspid AV s/p [**Known lastname 1291**] and MSSA endocarditis and repeat [**Known lastname 1291**], AFib on coumadin and amiodaron, bronchiectasis and GIB who presented to [**Hospital1 18**] complaining of fatigue and fevers. He was recently admitted to [**Hospital1 18**] with a GIB in [**12/2138**] which resolved. He was in his usual state of health until about two days ago when he began feeling subjective fevers and weakness. Today he decided to call EMS because he could not walk more than 10 steps. In the ED, he was found to be febrile, to have a leukocytosis and hypotensive with a pulse in the 30's. EKG showed a sinus rate of 140 and 1:3 block. Levaquin, gentamycin and [**Year (4 digits) **] were given. a RIJ was placed despite an INR of >4. . On arrival to the CCU he was febrile, hypotensive, and bradycardic. Tele showed complete heart block. EP was consulted and a transvenous pacing wire was placed at the bedside with fluoroscopic guidance. Past Medical History: 1. Bicuspid AV-s/p [**First Name8 (NamePattern2) **] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 1291**] in 92, MSSA endocarditis and abscess- s/p redo in 5/00 2. Afib on amiodarone 3. Bronchomalecia and Bronchiectesis 4. Gastritis 5. CABG times 3- [**2132**] ([**2136**], LVEF>55%) 6. hypercholesterolemia 7. HTN 8. Diverticulosis and Lymphoid aggregates on Colonoscopy in [**2135**] 9. impotence 10. hernisted disc 11. STROKE ([**2137**]) ax 12. thoracic aneurysm Social History: Divorced, 2 sons, [**Name (NI) **] ETOH (per pt) but + h/o drinking 1 gallon of wine daily in [**2133**] that pt always denied, no current tobacco, 4ppd times 30 years and quit in 92, no IVDU, divorced, can do all ADLS. At baseline he walks a quarter of a mile every day. He will get short of breath on walking quickly [**2-28**] blocks. Family History: NC per patient Pertinent Results: [**2139-2-1**] 08:07PM PT-52.3* PTT-66.0* INR(PT)-6.2* [**2139-2-1**] 01:48PM GLUCOSE-102 UREA N-15 CREAT-1.0 SODIUM-139 POTASSIUM-4.3 CHLORIDE-109* TOTAL CO2-23 ANION GAP-11 [**2139-1-31**] 06:30PM WBC-23.0*# RBC-3.83* HGB-11.3* HCT-33.2* MCV-87 MCH-29.5 MCHC-34.0 RDW-15.2 [**2139-2-1**] 06:27AM GLUCOSE-92 UREA N-19 CREAT-1.4* SODIUM-141 POTASSIUM-4.0 CHLORIDE-111* TOTAL CO2-21* ANION GAP-13 RENAL U.S. [**2139-2-20**] 1:08 PM IMPRESSION: No masses, stones, or hydronephrosis present within the kidneys. CHEST (PORTABLE AP) [**2139-2-15**] 5:16 PM IMPRESSION: No significant interval change. ECG Study Date of [**2139-2-14**] 10:41:52 AM Regular ventricular pacing [**Date Range **] rhythm - no further analysis Since previous tracing, ventricular paced rhythm present UNILAT UP EXT VEINS US RIGHT PORT [**2139-2-12**] 12:59 PM IMPRESSION: 1) No evidence of deep venous thrombosis in the right upper extremity. 2) Large hetergenous round area within the right axilla, likely a hematoma. Right axillary vein was not visualized. ECHO Study Date of [**2139-2-2**] Conclusions: There are complex (>4mm) atheroma in the descending thoracic aorta. A well-seated bileaflet aortic valve prosthesis is present. The aortic prosthesis discs appear to move normally. There is a small 3mm fluttering echodensity is seen on the LVOT side of the valve consistent with vegetation/thrombus. No aortic valve abscess is seen. Mild (1+) aortic regurgitation is seen. Mild to moderate ([**1-27**]+) mitral regurgitation is seen. IMPRESSION: Small echodensity on the aortic valve disc consistent with a vegetation (or thrombus) as described above. Mild aortic regurgitation. Moderately dilated aortic arch and proximal descending aorta. CT ABDOMEN W/CONTRAST [**2139-2-2**] 2:06 PM IMPRESSION: 1. No evidence of abscess, as clinically questioned. 2. Gallstone. 3. Bilateral renal cysts. 4. Mild dependent atelectasis. CT HEAD W/O CONTRAST [**2139-2-1**] 10:06 AM IMPRESSION: No evidence of acute intracranial hemorrhage. No CT evidence of brain ischemia. Brief Hospital Course: A/P: 64M w/ CAD s/p CABG, [**Year/Month/Day 1291**], MSSA endocarditis, repeat [**Year/Month/Day 1291**] and bentall procedure, who presented with bradycardia, hypotension and fever/leukocytosis. Found to have a likely vegetation on his AV by TEE with CHB s/p PM on [**2139-2-13**]. . #)AV node dysfuction, complete heart block evolved back to type 2, then type 1 heart block. Pt required a temporary wire early in hospital course. Pt had EPS [**2-5**] which showed H-V interval in the 80's (prolonged) and on faster rhythm he went in 2:1 block. Had permanent [**Month/Year (2) 4448**] on [**2139-2-13**], heparin restarted. Also on coumadin. - in nsr on [**2-17**], intermittently v paced - Interrogated by EP on [**2-20**]. - Outpatient follow up. - Beta-blocker restarted without difficulty. In NSR on discharge. #) Hematoma right arm - The patient developed a spontaneous hematoma on heparin on [**2139-2-11**]. He was evaluated by vascular who recommended arm elevation and ACE wrap. His Hct dropped from 31 to 26 but has remained stable at 26. - An ultrasound was obtained on [**2-12**] which showed no clot. - Given his high risk of stroke with an [**Month/Year (2) 1291**], the heparin was restarted around [**2-28**] pm on [**2-12**]. - Improved on [**2139-2-13**] and resolved by the time of discharge. . #) AF: The patient had been on Amiodarone- this was DC'd on [**2-10**] as he developed 2nd degree AV block on tele but restarted on [**2139-2-14**] without event post [**Date Range 4448**]. He was discharged on coumadin. #) HTN: . His HCTZ and beta-blocker were restarted. ACE was held with acute renal failure. . #) ARF - Cr rose to 1.4 from 1.1 which was felt to be most likely from gentamycin toxicity. - His FENA was <1 with rare eos on UA. He was given IVF with no improvement of his kidney function. - We continue to hold his ACE. - Renal ultrasound on [**2139-2-20**] showed no acute abnormalities. - A Cr of 1.4 was deemed to be his new baseline. . #) Culture negative endocarditis: ID evaluated him inhouse and subsequently signed off. Vegetation seen on TEE. -The plan is for 6 weeks of Cefepime, Vanco, and initially 2 wks gentamycin. - No rifampin per ID given multiple drug interactions. - Had acute rise in Cr on [**2-9**], therefore DC'd gentamycin and he did not receive this for the remainder of his stay. - His vanco was dosed by level, trough <15 with results as an outpatient to be faxed to his ID specialist per their request. - Prior to DC, his level had been greater than 15 and was held two days prior to DC with permission to be restarted at 750 mg IV QD as an outpatient. -PICC placed on Tuesday in RUE. . #) CAD - Restarted ASA 81 mg on [**2-10**]. Resarted BB. Held ACE with ARF. Zetia, statin. . #) h/o GI bleed: The patient has known angioectasia and had GI bleed without multiple diverticula as well. Was to have outpt appointment with [**Doctor Last Name 519**] in surgery but missed it because of hospitalization. This was rescheduled prior to DC. - GI had seen the patient on [**2-4**] and felt no need for scope this admission. - - On [**2-9**], the patient noted black appearing stool (started iron day before). Guaiac negative, hemo stable. Hct stable and required no transfusions for this reason. - This was not an active issue for the remainder of his stay. . #) Mechanical AV valve: Required prolong hospitalization for heparin/coumadin bridge pre and post procedure. He required up to 10 mg of coumadin in-house to get a therapeutic INR, goal 2.5-3.5. - He formerly took 5 and 7.5 mg of coumadin at home. - He will have his INR checked in 2 days and have the results faxed to the coumadin clinic to adjust his coumadin dose accordingly. - Although coumadin 10 mg was required to achieve a therapeutic INR, he will be discharged on coumadin 7.5 mg. . #) Anemia - Concerning drop from 30->26 on [**2-13**] to 22 on [**2139-2-15**]. Guaiac negative. The hct drop was felt to be secondary to his right arm hematoma. - He was transfused 2 units from [**2-15**] to [**2138-2-16**]. His Hct remained stable thereafter and he required no further transfusions. . #) Code status: full code. . #) dispo: Home with VNA. Medications on Admission: amiodarone 200mg daily, dicloxacillin 25omg q8, HCTZ 25mg daily, lipitor 80mg, lisinopril 5mg daily, metoprolol XL 12.5mg daily, MVI, protonix, coumadin 2.5mg daily, zetia 10mg daily Discharge Medications: 1. Cefepime 2 g Recon Soln Sig: One (1) Intravenous twice a day for 3 weeks. Disp:*56 * Refills:*0* 2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Multivitamin,Tx-Minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 6. 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* 7. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1) ML Intravenous DAILY (Daily) as needed. Disp:*30 ML(s)* Refills:*3* 11. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1) ML Intravenous DAILY (Daily) as needed. 12. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: Five (5) ML PO Q6H (every 6 hours) as needed for 5 days. Disp:*50 ML(s)* Refills:*0* 13. Metoprolol Tartrate 25 mg Tablet Sig: 0.25 Tablet PO BID (2 times a day). Disp:*15 Tablet(s)* Refills:*2* 14. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for pain. 15. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4-6H (every 4 to 6 hours) as needed. Disp:*2 * Refills:*1* 16. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 17. Outpatient Lab Work INR check 2 days after discharge with results faxed to PCP. Vanco trough checked 2 days after discharge with results faxed to PCP. [**Name10 (NameIs) **] should continue for trough <15. 18. Sodium Chloride 0.9 % Parenteral Solution Sig: One (1) 3 cc Intravenous once a day. Disp:*30 * Refills:*3* 19. [**Name10 (NameIs) **] 500 mg Recon Soln Sig: 1.5 Intravenous once a day for 3 weeks: 750 mg IV QD. hold for trough >15. Disp:*30 * Refills:*3* 20. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 21. Warfarin 5 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Culture negative endocarditis Complete heart block with [**Hospital 4448**] implantation Paroxysmal atrial fibrillation Gentamicin-induced renal insufficiency Discharge Condition: stable Discharge Instructions: Please continue your antibiotics [**Hospital **] and Cefepime for a total of 6 weeks (last dose [**3-15**]). Please fax [**Month (only) **] troughs to Dr. [**First Name (STitle) **], your infectious disease specialist, weekly. Her fax is [**Telephone/Fax (1) 1419**]. The [**Telephone/Fax (1) 4448**] RN will call you at home [**2139-3-12**] to check PM (see below). Followup Instructions: Please follow up with the infection specialist - Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6400**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2139-3-12**] 9:00 Provider: [**Name10 (NameIs) **] CALL Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2139-3-12**] 11:30 You have an appointment with your cardiologist, Dr. [**First Name4 (NamePattern1) 919**] [**Last Name (NamePattern1) 911**], on [**6-8**] at 2:00pm. His office is located on the [**Location (un) 436**] of the [**Hospital Ward Name 23**] building. Please call ([**Telephone/Fax (1) 24798**] should you have any questions. You have an appointment with your electrophysiologist, Dr. [**Last Name (STitle) **] [**Name (STitle) 26676**], on ***. His office is located on the [**Location (un) 436**] of the [**Hospital Ward Name 23**] building. Please call ([**Telephone/Fax (1) 12468**] should you have any questions. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD Phone:[**Telephone/Fax (1) 34552**] Date/Time:[**2139-4-6**] 10:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. Phone:[**Telephone/Fax (1) 6554**] Date/Time:[**2139-3-9**] 8:30 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2139-3-5**] 2:30 ICD9 Codes: 5849, 4019, 4589
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7130 }
Medical Text: Admission Date: [**2130-3-30**] Discharge Date: [**2130-4-2**] Date of Birth: [**2100-4-7**] Sex: M Service: NEUROSURGERY Allergies: Cephalexin / Penicillins Attending:[**First Name3 (LF) 14802**] Chief Complaint: Headaches Major Surgical or Invasive Procedure: [**2130-3-30**]: suboccipital craniotomy and C1 laminectomy for chiari decompression History of Present Illness: This is a 29 year old male with occipital tussive headaches, dizziness and UE/LLE paresthesias. MRI imaging revealed a Chiari Malformation and he opted to procede for a decompression. Past Medical History: Asthma, Genital Herpes, Eczema, ADHD, allergic rhinitis, anxiety, asthma, LBP, prediabetes, PTSD Social History: He is a truck driver. He has two children. He has smokes [**11-28**] ppd since age 8. He denies ETOH use. Family History: NC Physical Exam: No apparent distress Alert and oriented x3 CN's intact PERRL CTAB RRR Normal bulk and tone 5/5 strength and sensation intact in all 4 extremities Ambulating on own No pronator drift Wound clean, dry and intact. No signs of infection. Brief Hospital Course: Mr. [**Known lastname **] was admitted to [**Hospital1 18**] on [**3-30**] and was taken to the OR with Dr. [**Last Name (STitle) **] for a suboccipital craniotomy and C1 laminectomy for decompression of a chiari malformtaion. He was extubated post-op and was taken to the SICU for close management. Post-op CT head showed good decompression. He remained stable in the SICU. His pain was initially controlled with a combination of IV and PO medications with a transition to only PO medications. He was able to void and ambulate independently. He progressed well and was transferred to the regular hospital floor on [**4-1**]. On the floor he remained stable, with stable vital signs, and was deemed ready for discharge on [**4-2**]. He was given the appropriate prescriptions and instructions for follow-up care. Medications on Admission: Valtrex, Cetirizine, Albuterol, Clobetasol, Fluticasone Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. diazepam 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for spasm: do not drive, drink alcohol or operate machinery/appliances while taking this medication. Disp:*40 Tablet(s)* Refills:*0* 3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 4. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain: do not drive, drink alcohol or operate machinery/appliances while taking this medication. Disp:*60 Tablet(s)* Refills:*0* 5. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). Disp:*14 Patch 24 hr(s)* Refills:*0* 6. cetirizine 10 mg Tablet Sig: One (1) Tablet PO QD (). 7. ipratropium-albuterol 18-103 mcg/actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours) as needed for sob/wheeze. 8. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day): resume home med. 9. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a day: resume home med. 10. Valtrex 500 mg Tablet Sig: One (1) Tablet PO once a day: resume home med. Discharge Disposition: Home Discharge Diagnosis: Chiari malformation Discharge Condition: Stable alert and oriented ambulating independently Discharge Instructions: General 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, unless you have been instructed not to. Followup Instructions: Follow-Up Appointment Instructions ??????Please return to the office in [**6-6**] days(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. ??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**Last Name (STitle) **], to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast at that time. ICD9 Codes: 3051
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7131 }
Medical Text: Admission Date: [**2135-12-2**] Discharge Date: [**2135-12-11**] Date of Birth: [**2076-8-3**] Sex: M Service: MEDICINE Allergies: Demerol / Zestril / adhesive tape Attending:[**First Name3 (LF) 2736**] Chief Complaint: Chest pain, melena, lightheadedness Major Surgical or Invasive Procedure: [**12-5**] Colonoscopy [**12-5**] Upper Endoscopy [**12-9**] Small capsule study History of Present Illness: This is a 59 year old male with multiple cardiac co-morbidities including CAD (s/p CABG abd multiple caths with PCIs), chronic angina on methadone for pain control, mechanical aortic valve on coumadin, who presents chest pain after 3 days of dark stools, weakness and lightheadedness. He had an INR elevated to 4.9 on [**11-29**] and held the dose. The next day he [**Last Name (un) 4996**] noticing dark stools and gradually became lightheaded and weak over the next 2 days. He also felt nauseous and had poor po intake. He denies abdominal pain. He denies any increase in his stools frequency or change in consistency. He has been having one well formed BM per day. He denies NSAID or steroid use. He has baseline chronic angina which he rates as [**1-27**] pain. This morning he began to have worsening chest pain, greater than baseline which began as a [**4-26**] pain and increased up to [**7-27**]. His current chest pain is associated with left arm pain as is his baseline chest pain. He called his PCP and was referred to the ED given the dark stools and chest pain he was sent to ED for evaluation. . In the ED, initial vs were: 6 T 98.0 P 75 BP 121/63 RR 18 O2 sat 100%. Labs were significant for hematocrit 19.1, INR 2.3, troponin <0.01. Melena was seen on rectal exam. EKG shows LBBB uchanged from prior. NG lavage showed flecks of blood but was otherwise non-bloody. Patient was given pantoprazole 80 mg bolus + drip, 2 units blood. For his pain he was given morphine, dilaudid 1 mg iv. His most recent vitals prior to transfer were: T: 99.3, P: 68, RR 12, 100/62. . On the floor, patient was initially complaining of [**7-27**] chest pain which improved to [**5-27**] after morphine 8 mg iv. Past Medical History: 1. CAD RISK FACTORS: known CAD, HTN, dyslipidemia, 2. CARDIAC HISTORY: -CABG: [**2119**] (LIMA to LAD) due to CCATH showing total occlusion of the RCA and circumflex arteries and an 80% left main stenosis. -CCATH/PCI: [**2121**], [**2123**], [**2126**] - PTCA and DES x2 of the LMCA bifurcation (LAD and ramus), [**2126**], [**2127**], [**2128**], [**2128**], [**2129**] - [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/Lcx, [**2130**], [**2130**] - [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **], [**2130**] - [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 22594**] anastomotic site of LIMA to LAD, [**2130**], [**2131**] -PACING/ICD: None 3. OTHER PAST MEDICAL HISTORY: -s/p St. [**Male First Name (un) 1525**] Aortic Valve Replacement [**2130**] - on coumadin -"intractable angina" on methadone -hypertension -dyslipidemia -h/o defibrillation in [**2121**] -nephrolithiasis -s/p lap cholecystectomy in [**2129**] -dCHF -Horner's syndrome - mild Social History: Married. on disability [**1-19**] chest pain. Quit tobacco in [**2119**] (25 pack-year history), no EtOH, never IVDA Family History: Brother died of MI at age 51. Father died of MI at age 72. sister died of uterine cancer at 58. His mother also had 'heart issues'. Physical Exam: Vitals: T: 99.1 BP: 122/35 P: 71 R: 16 O2: 98% on 3L NC General: overweight, Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: minimal bibasilar crackles, otherwise clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Regular rate and rhythm, normal S1, mechanical S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A&Ox3, CNII-XII intact, sensation and strength grossly intact in all extremities On discharge: VSS, satting 97-100% on RA, afebrile No change in physical exam except crackles gone. No signs of volume overload. Pertinent Results: [**2135-12-2**] 03:18PM BLOOD WBC-5.6 RBC-2.53* Hgb-6.9* Hct-20.7* MCV-82 MCH-27.2 MCHC-33.3 RDW-15.8* Plt Ct-153 [**2135-12-2**] 10:30PM BLOOD WBC-6.4 RBC-2.81* Hgb-8.0* Hct-23.0* MCV-82 MCH-28.5 MCHC-34.9 RDW-15.8* Plt Ct-158 [**2135-12-3**] 03:21AM BLOOD WBC-4.7 RBC-2.91* Hgb-8.2* Hct-24.0* MCV-82 MCH-28.2 MCHC-34.3 RDW-15.8* Plt Ct-153 [**2135-12-3**] 08:25AM BLOOD WBC-5.2 RBC-3.43* Hgb-9.4* Hct-28.5* MCV-83 MCH-27.4 MCHC-33.0 RDW-15.9* Plt Ct-168 [**2135-12-4**] 03:49AM BLOOD WBC-4.2 RBC-3.07* Hgb-8.4* Hct-25.1* MCV-82 MCH-27.4 MCHC-33.7 RDW-15.8* Plt Ct-151 [**2135-12-4**] 12:07PM BLOOD WBC-5.7 RBC-3.36* Hgb-9.3* Hct-28.3* MCV-84 MCH-27.6 MCHC-32.7 RDW-15.4 Plt Ct-164 [**2135-12-2**] 10:10AM BLOOD Neuts-79.0* Lymphs-13.9* Monos-5.6 Eos-1.2 Baso-0.5 [**2135-12-2**] 10:10AM BLOOD PT-24.5* PTT-40.4* INR(PT)-2.3* [**2135-12-2**] 03:18PM BLOOD PT-24.8* PTT-38.1* INR(PT)-2.4* [**2135-12-3**] 03:21AM BLOOD PT-23.6* PTT-40.9* INR(PT)-2.3* [**2135-12-4**] 03:49AM BLOOD PT-23.0* PTT-38.8* INR(PT)-2.2* [**2135-12-2**] 10:10AM BLOOD Glucose-125* UreaN-29* Creat-1.2 Na-136 K-3.8 Cl-99 HCO3-26 AnGap-15 [**2135-12-2**] 03:18PM BLOOD Glucose-88 UreaN-24* Creat-1.1 Na-139 K-3.5 Cl-107 HCO3-26 AnGap-10 [**2135-12-3**] 03:21AM BLOOD Glucose-92 UreaN-22* Creat-1.2 Na-138 K-3.6 Cl-107 HCO3-25 AnGap-10 [**2135-12-4**] 03:49AM BLOOD Glucose-91 UreaN-21* Creat-1.3* Na-137 K-3.8 Cl-103 HCO3-26 AnGap-12 [**2135-12-4**] 03:49AM BLOOD ALT-15 AST-29 CK(CPK)-197 AlkPhos-59 TotBili-2.1* Cardiac enzymes: [**2135-12-2**] 03:18PM BLOOD CK-MB-4 cTropnT-<0.01 [**2135-12-2**] 10:30PM BLOOD CK-MB-4 cTropnT-<0.01 [**2135-12-3**] 03:21AM BLOOD CK-MB-3 cTropnT-<0.01 [**2135-12-4**] 03:49AM BLOOD CK-MB-4 cTropnT-<0.01 Anemia workup: [**2135-12-2**] 10:10AM BLOOD Hypochr-3+ Anisocy-1+ Poiklo-2+ Macrocy-1+ Microcy-1+ Polychr-1+ Ovalocy-2+ Stipple-1+ Ellipto-1+ [**2135-12-2**] 10:10AM BLOOD Hapto-48 [**2135-12-2**] 03:18PM BLOOD calTIBC-398 Ferritn-15* TRF-306 Iron-32* [**2135-12-7**] 07:20AM BLOOD Hapto-60 [**2135-12-2**] 10:10AM BLOOD LD(LDH)-222 [**2135-12-4**] 03:49AM BLOOD ALT-15 AST-29 CK(CPK)-197 AlkPhos-59 TotBili-2.1* [**2135-12-6**] 07:20AM BLOOD ALT-21 AST-42* AlkPhos-69 TotBili-2.8* DirBili-0.3 IndBili-2.5 [**2135-12-6**] 01:00PM BLOOD Ret Man-6.4* [**2135-12-7**] 07:20AM BLOOD LD(LDH)-318* TotBili-3.1* DirBili-0.3 IndBili-2.8 [**2135-12-7**] 07:20AM BLOOD LD(LDH)-318* TotBili-3.1* DirBili-0.3 IndBili-2.8 Discharge Labs: [**2135-12-11**] 06:22AM BLOOD WBC-4.3 RBC-3.79* Hgb-10.2* Hct-30.6* MCV-81* MCH-26.8* MCHC-33.3 RDW-15.2 Plt Ct-175 [**2135-12-11**] 06:22AM BLOOD Neuts-65.5 Lymphs-21.2 Monos-8.1 Eos-4.4* Baso-0.8 [**2135-12-10**] 07:20AM BLOOD Hypochr-3+ Anisocy-1+ Poiklo-1+ Macrocy-1+ Microcy-1+ Polychr-1+ Ovalocy-1+ Schisto-OCCASIONAL Tear Dr[**Last Name (STitle) **]1+ [**2135-12-11**] 06:22AM BLOOD PT-28.4* INR(PT)-2.7* [**2135-12-11**] 06:22AM BLOOD Glucose-84 UreaN-20 Creat-1.2 Na-137 K-3.6 Cl-100 HCO3-28 AnGap-13 [**2135-12-7**] 10:07AM URINE Hemosid-NEGATIVE Microbiology: Urine culture x2= negative Blood culture x4= negative Studies: CXRay [**12-7**]: IMPRESSION: Left lung consolidation, compatible with pneumonia. CXray [**12-8**]: IMPRESSION: Left lower lobe pneumonia. Colonoscopy [**12-5**]: Impression: Normal colonoscopy to cecum Recommendations: Recommend capsule endoscopy for further evaluation of melena. Colonoscopy in 5 years Upper endoscopy [**12-5**]: Impression: Small hiatal hernia Erythema and erosion in the fundus Erythema in the antrum Otherwise normal EGD to third part of the duodenum Recommendations: Will proceed to colonoscopy for evaluation of melena. Continue PPI. Small capsule study: 1. Sub-optimal bowel prep with a moderate amount of food debris in the stomach and segments of the jejunum. 2. Erythema in the stomach (gastritis). 3. A few petechiae in the proximal jejunum . 4. Two angioectasias in the proximal jejunum. 5. No active bleeding site found. SUMMARY & RECOMMENDATIONS: Summary: Sub-optimal bowel prep with a moderate amount of food debris in the stomach and jejunum. Mild gastritis with two angioectasias in the proximal jejunum. No active bleeding site found. Recommendations: Follow up with the PCP (Dr. [**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 410**]) and consider a small bowel enteroscopy. Brief Hospital Course: Mr. [**Known lastname **] is a 59 year-old man with a PMH of CAD (s/p CABG and multiple PCIs) on aspirin, aortic valve replacement on coumadin, dCHF who presents with chest pain, lightheadedness and melena found to have HCT of 19.1 transferred to MICU for GI bleed. Pt was in stable condition so transferred to cardiology service where he underwent EGD, colonoscopy, and small capsule study without evidence of active bleed. Pt subsequently had fevers [**2047-12-7**] to 102 and evidence on CXray of LLL pna. Pt defervesced on antibiotics. . # GI Bleed/Anemia: Pt had lightheadedness, chest pain, melanotic stools, and a HCT of 19 on [**12-2**] admission with ED noting heme positive stool. Pt had a supratherapeutic INR to 4.9 on [**2135-11-29**]. He received 2 units of packed red blood cells in the ED and another 2 units in the MICU on [**2135-12-2**] before his transfer to cardiology service. EGD, colonoscopy, and small capsule study were negative for active bleeding source although small capsule study did reveal two angioectasias in the jejunum. Hypothetically, in the setting of an elevated INR while on aspirin and plavix, the patient may have bled from this site which resolved at the time of study. GI bleed likely resulted in iron deficiency anemia as the patient's labs were mostly consistent with this--a microcytic anemia with low ferritin, low iron, low % transferrin saturation, hypochromatic cells with the presence of ovalocytes. Although he was iron deficient, his marrow showed appropriate response with a retic index of 2.65%. Accordingly the patient was started on 325 mg FeSO4 [**Hospital1 **] which will need to be taken for greater than 2 years in order to replete the patient's iron stores. The patient can take TID if the constipating effects aren't limiting as patient does have history of constipation and is already taking opiates. Also of note, the patient had a mildly elevated indirect bilirubin, although it is unclear what the cause of this is--however, it was only found after transfusion as was the presence of schistocytes; thus there may have been some low level intravascular hemolysis present post-RBC transfusion. Notably, the patient's LDH and haptoglobin were normal on admission, making it extremely unlikely the patient was undergoing any sort of hemolysis at presentation. Furthermore, urine hemoglobin and hemosiderin were negative further aruging against intravascular hemolysis. Coombs test was negative strongly arguing against extravascular hemolysis. Pt was maintained and will remain on [**Hospital1 **] PPI for now, the duration of which can be determined by GI. Plavix was stopped since patient's last stent was placed in [**2130**] and risk of bleeding while also on coumadin and aspirin outweighs benefit of preventing stent thrombosis in someone with a stent placed four years ago. Dr. [**Last Name (STitle) **] was in agreement with this. Pt will be followed by GI as outpatient with potential small bowel enteroscopy. . # Pneumonia - Patient became febrile to 102 degrees on [**12-8**] and continued to spike on [**12-9**] with cxrays x2 demonstrating LLL pneumonia. The pt had no cough, adventitious sounds on physical exam, or elevated white count and his only symptom was fever. He otherwise felt extremely well. However, because blood and urine cultures were negative and cxray was suggestive of pna, the patient was initially started on HAP with vancomycin and cefepime before transitioning to PO levofloxacin, which he was discharged on after he was afebrile on this for >24 hours. He will complete a week long course of abx. . #Aortic Valve replacement: Pt had a mechanical aortic valve replacement in [**2130**]. Coumadin was held while pt had GI bleed and was restarted after EGD/Colonscopy and stabilization of HCT. The pt was bridged with heparin. Target INR is 2.0-3.0 . #Angina/ CAD: Patient has extensive cardiac history including prior CABG and multiple PCIs, aortic valve repair, last intervention in [**2130**] who now has chronic angina. The acute exacerbation of his angina on presentation was likely related to demand from anemia in the setting of his GI bleed. The patient ruled out for ACS. His chest pain diminished with an increased HCT. He remained on his "angina protocol" which is listed in OMR under problem list without issue. This consists of methadone, imdur, lorazepam prn, morphine prn. The patient otherwise maintained his home methadone, imdur, metoprolol, aspirin, and atorvastatin. Plavix was stopped since the patient's last stent was in [**2130**], his reocclusions with stents have been from restenosis (neointimal) and not actual thrombotic (platelet-driven) events, his CAD is stable, and the risk of bleeding is too great for the benefit offered by plavix in this setting. . # Chronic dCHF: Pt was mildly volume overloaded in the MICU and was restarted on his home diuretics with good effect. He was euvolemic on the floor. The pt will continue with his home diuresis regimen, consisting of torsemide [**Hospital1 **], spironolactone, and metolazone prn, as well as his other heart failure/blood pressure meds including metoprolol, amlodipine, and spironolactone. . # Hypertension: Pt was normotensive throughout his hospital course. He was maintained on his home regimen as stated above. He did have wide pulse pressures likely [**1-19**] to anemia. . # Dyslipidemia: He was continued on atorvastatin. . # Elevated indirect bili: Likely from low-level hemolysis, possibly intravascular given presence of schistiocytes post transfusion. Gilberts is another possibility although this wouldn't cause the presence of schistiocytes and would be unusual in someone with CAD. . # Mildly elevated AST: Only occurred x1. Can monitor for resolution. . # Code: Full (discussed with patient) . Transitional: Monitor hematocrit. Follow up with GI for possible push enteroscopy. Treat [**Doctor First Name **]. Make sure fevers resolve after pna treatment. Monitor pts INR as pt seems to have GI bleeding tendency when INR is supratherapeutic. Trend bilirubin. Monitor for resolution of elevated AST. Medications on Admission: Nitroglycerin 0.4 mg Sublingual Tab Sublingual prn Toprol XL 50 mg 24 hr Tab [**Hospital1 **] Aspirin 81 mg Tab Oral daily Folic acid 1 mg Tab daily Celexa 15 mg Tab daily Lipitor 80 mg Tab Daily Ativan 1 mg Tab Oral 1 - 2 Tablet(s) Twice daily prn Coumadin as directed Imdur 120 mg 24 hr Tab daily Amlodipine 6.25mg daily Plavix 75 mg Tab Oral daily Xanax 0.25 mg Tab Oral TID Methadone 15 mg Tab Oral TID torsemide 20 mg Tab Oral [**Hospital1 **] (twice weekly two pills in am) Miralax 17 gram Aldactone 25 mg Tab Oral daily Metolazone 2.5 mg Tab Oral daily Klor-Con M20 20 mEq Tab Oral daily Soma 250 mg Tab Oral TID Fluocinonide 0.05 % Topical Cream Topical [**Hospital1 **] prn Vicodin Discharge Medications: 1. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day for 6 days. [**Hospital1 **]:*6 Tablet(s)* Refills:*0* 2. Outpatient [**Hospital1 **] Work Please have your INR drawn on Monday [**12-12**] Please have your INR and HCT drawn on Wednesday [**12-14**] Please have these results faxed to Dr. [**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 410**] at [**Telephone/Fax (1) 18702**] 3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. [**Telephone/Fax (1) **]:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 4. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Sublingual once a day as needed for chest pain: can take up to 3 tabs in 15 minutes. 5. Toprol XL 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO twice a day. 6. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 7. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 9. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. 10. Ativan 1 mg Tablet Sig: 1-2 Tablets PO twice a day as needed for anxiety. 11. warfarin 7.5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM: Do not take a 10 mg dose while you are on levfloxacin unless directed by Dr. [**Last Name (STitle) **]. 12. Imdur 120 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 13. amlodipine 2.5 mg Tablet Sig: 2.5 Tablets PO DAILY (Daily). 14. methadone 5 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). 15. torsemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 16. Miralax 17 gram Powder in Packet Sig: One (1) PO once a day. 17. Aldactone 25 mg Tablet Sig: One (1) Tablet PO once a day. 18. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: One (1) Tablet, ER Particles/Crystals PO once a day. 19. metolazone 2.5 mg Tablet Sig: One (1) Tablet PO once a day as needed: take 1 tab 1/2 hour before torsemide. 20. ferrous sulfate 325 mg (65 mg iron) Capsule, Extended Release Sig: One (1) Capsule, Extended Release PO twice a day. 21. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for back pain. 22. Vitamin D 2,000 unit Capsule Sig: One (1) Capsule PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary: GI bleed, Pneumonia, Iron deficiency anemia, Acute on chronic diastolic CHF Secondary: CAD, [**First Name8 (NamePattern2) **] [**Male First Name (un) 1525**] aortic valve Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname **], It was a pleasure taking care of you at [**Hospital1 18**]. You were admitted for chest pain accompanied by black stools, weakness, and lightheadedness. Your HCT was 19 on admission and you were found to have a Gastrointestinal bleed. You were transfused a total of 5 units of PRBC with good response. A colonoscopy, upper endoscopy and small capsule study were conducted which revealed abnormal blood vessel dilations in the proximal jejunum but no sites of active bleeding. You developed fevers as high as 102 which resolved with antibiotics. The only source that we have found is a chest x ray concerning for left sided pneumonia. You will need to continue treatment with levofloxacin for 6 more days. Because you started levofloxacin, you need to closely monitor your INR as this drug can increase the effects of coumadin. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. The following changes were made to your medications: Started levofloxacin for pneumonia Started pantoprazole for GI bleed Started iron pills for anemia Stopped plavix Your Celexa was increased to 30mg daily Followup Instructions: Department: DIV. OF GASTROENTEROLOGY When: TUESDAY [**2135-12-20**] at 4:00 PM With: [**First Name8 (NamePattern2) 4503**] [**Last Name (NamePattern1) 4504**], MD [**Telephone/Fax (1) 463**] Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **] Campus: EAST Best Parking: Main Garage Completed by:[**2135-12-19**] ICD9 Codes: 486, 4111, 4280, 4019, 2724
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Medical Text: Admission Date: [**2115-6-18**] Discharge Date: [**2115-6-26**] Date of Birth: [**2060-7-26**] Sex: F Service: CARDIOTHORACIC Allergies: Demerol / Oxycontin / Morphine Sulfate / Darvocet-N 100 Attending:[**First Name3 (LF) 5790**] Chief Complaint: Recurrent right pleural effusion Major Surgical or Invasive Procedure: [**2115-6-20**] Right pleural effusion drainage with pigtail placement and talc pleurodesis History of Present Illness: [**Known lastname 34440**] is a 54 year-old woman whp is s/p R VATS decortication, mechanical pleurodesis, and doxycycline chemical pleurodesis for recurrent effusion/trapped lung on [**2115-6-7**]. The pathology was benign. I suspect the etiology of the effusion was cardiac (valvular) + previous chest radiation. Unfortunately she developed recurrent dry cough, chest pain, SOB 3 days ago. She has some wheezing. She denies fevers, chills, or sweats. Past Medical History: ALLERGIES: demorol, morphine, oxycontin (all cause dizziness, nausea, vomiting) Cardiac Risk Factors: +Diabetes, +Dyslipidemia, Hypertension Other Past History: - CHF diastolic : baseline BNP in 300s - Aortic stenosis - Mitral regurgitation - Pulmonary hypertension - DM2: on insulin since [**2112**] - Recurrent pleural effusions: Since [**2113**], s/p multiple thoracenteses. Pleurex cath inserted in [**3-/2115**] for drainage at home; averages 550cc every other day. Exudative but negative for infection and malignancy with negative bx from [**4-14**] thorascopy. - H/o Hodgkin's lymphoma: Dx [**2078**]. S/p thymectomy, splenectomy. S/p mantle, abdominal, and pelvis XRT. - H/o breast cancer: T1cNo ER+/PR+ invasive ductal carcinoma in left breast, s/p left mastectomy and chemo. On anastrozole. - H/o Hurtle cell thyroid nodule: s/p total thyroidectomy at [**Hospital1 2177**] followed by radioactive iodine. - Pericarditis and pleuritis: In [**2094**], s/p pleurocentesis and pericardiocentesis, rx'ed with abx - LUE tremor - S/p mutiple surgeries for basal cell carcinoma - Chronic leukocytosis/Thrombocytocis for past 2 years: JAK2 and MPLW 515 mutations drawn by her hematologist still pending - S/p TAHBSO for fibroids Social History: Pt lives with her husband and works as community developer for city of [**Hospital1 1474**] and a youth organizer in her church. Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. Drinks only occasionally. Family History: There is no family history of premature coronary artery disease or sudden death. Father died in 80s, had COPD and AFib. Mother living in 80s, has DM2. 10 siblings including an older brother s/p prosthetic valve replacement. Has 2 children including 35yo son with diverticulitis and 33yo daughter with Tetralogy of Fallot s/p 3 surgeries at CHB and s/p ICD placement. Physical Exam: 96.5 73 136/70 22 94RA WNWD NAD AAx3 Decreased BS R to halfway up chest RRR soft NT ND no LE edema Pertinent Results: Labs on Admission: [**2115-6-18**] 12:46PM BLOOD WBC-8.3 RBC-5.82* Hgb-9.8* Hct-34.8* MCV-60* MCH-16.9* MCHC-28.3* RDW-18.4* Plt Ct-728* [**2115-6-18**] 12:46PM BLOOD PT-27.3* PTT-29.6 INR(PT)-2.7* [**2115-6-18**] 12:46PM BLOOD Glucose-104 UreaN-14 Creat-0.6 Na-137 K-4.6 Cl-102 HCO3-26 AnGap-14 [**2115-6-18**] 12:46PM BLOOD Calcium-8.4 Phos-4.2 Mg-2.0 Labs prior to expiration: [**2115-6-25**] 09:09PM BLOOD WBC-21.6*# RBC-5.65* Hgb-9.6* Hct-34.9* MCV-62* MCH-16.9* MCHC-27.4* RDW-19.9* Plt Ct-475* [**2115-6-25**] 01:17AM BLOOD PT-18.3* PTT-29.1 INR(PT)-1.7* [**2115-6-24**] 02:35PM BLOOD Fibrino-778* [**2115-6-25**] 09:09PM BLOOD Glucose-108* UreaN-40* Creat-2.2* Na-136 K-6.2* Cl-93* HCO3-13* AnGap-36* [**2115-6-25**] 02:30PM BLOOD ALT-29 AST-66* CK(CPK)-10* AlkPhos-77 TotBili-0.7 [**2115-6-25**] 09:09PM BLOOD CK-MB-NotDone cTropnT-0.05* [**2115-6-25**] 02:30PM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2115-6-23**] 02:10PM BLOOD CK-MB-NotDone cTropnT-0.04* [**2115-6-22**] 07:59PM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2115-6-25**] 09:09PM BLOOD Calcium-9.1 Phos-8.8*# Mg-2.5 [**2115-6-26**] 01:58AM BLOOD Type-ART pO2-244* pCO2-36 pH-7.48* calTCO2-28 Base XS-4 [**2115-6-26**] 12:43AM BLOOD Type-ART pO2-88 pCO2-40 pH-7.18* calTCO2-16* Base XS--12 [**2115-6-25**] 11:12PM BLOOD Type-ART pO2-101 pCO2-43 pH-7.17* calTCO2-17* Base XS--12 [**2115-6-25**] 09:25PM BLOOD Type-ART pO2-175* pCO2-41 pH-7.09* calTCO2-13* Base XS--17 [**2115-6-26**] 12:43AM BLOOD Lactate-14.8* K-5.1 [**2115-6-25**] 11:12PM BLOOD Lactate-17.4* K-5.0 [**2115-6-25**] 09:25PM BLOOD Lactate-14.8* Imaging: CHEST (PORTABLE AP) Study Date of [**2115-6-25**] 8:26 PM: Small multiloculated right pleural effusion has increased over the course of the day, not as large as it was on [**6-23**]. Tiny volume of pleural air at the base of the right lung is stable. Basal and apical pleural tube are unchanged in their respective positions. There is appreciably greater congestion and possibly mild edema in the right lung now than earlier in the day. Moderate-to-severe cardiomegaly is stable. Minimal left perihilar edema has also developed. Tip of the new Swan-Ganz catheter projects over the bifurcation of the pulmonary arteries. ET tube in standard placement, transvenous right atrial and right ventricular pacer leads unchanged in standard placements as well. RUQ U/S: Normal son[**Name (NI) 493**] appearance of the kidneys bilaterally. Prominent fluid-containing structure with internal debris in the left upper quadrant may represent gastric contents versus pleural effusion with heterogeneous internal debris, incompletely evaluated. Further imaging can be performed if indicated. TTE [**2115-6-25**]: The left atrium is mildly dilated. Overall left ventricular systolic function is normal (LVEF>55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The right ventricular cavity is mildly dilated with borderline normal free wall function. There is abnormal septal motion/position. The aortic valve is abnormal. The aortic valve is not well seen. Moderate (2+) aortic regurgitation is seen. Mild to moderate ([**2-8**]+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. There are no echocardiographic signs of tamponade. CT CHEST W/CONTRAST Study Date of [**2115-6-21**] 4:18 PM 1. Persistent large multiloculated right pleural effusion. New loculated hydropneumothoraces are likely related to pleural catheter placement. 2. New high attenuation along diaphragmatic pleural region, probably representing talc deposition given history of interval talc treatment. 3. Improving left lower lobe opacity which may be due to resolving area of infection or inflammation. 4. Septal thickening, probably reflecting hydrostatic edema, but attention to this area on followup CT may be helpful to exclude lymphangitic carcinomatosis Brief Hospital Course: Mrs. [**Known lastname 34440**] was a very pleasant 54 year-old female who unfortunately was readmitted for recurrent right pleural effusion following a right VATS decortication, mechanical/doxycycline pleurodesis . Her chest CT showed an increase of the right-sided pleural effusion, partially divided/organized in two major compartments. Her coumadin was held on admission. . On [**6-20**]/009 she underwent placement of a pigtail catheter and talc pleurodesis by IR. She received 2u FFP periprocedure. Pigtail was inserted without complications, 1350cc of straw colored fluid was drained. Post-procedure CXRs showed continued right pleural effusion. Her WBC was elevated, which we attributed to the talc pleurodesis, as she was otherwise w/o signs or symptoms of infection. It quickly became evident that the pigtail placed was too small in diameter for adequate drainage of this multiloculated effusion and that she would need a repeat R VATS decortication with placement of a pleurx catheter. . On [**2115-6-22**] patient developed tachycardia with rates to the 150s and a drop in SBPs to 90-80s. The rhythm initially appeared to be sustained Vtach. However, on closer inspection of her rhythm strip and in consultation with cardiology, it was determined that she actually had afib RVR with aberrancy. She was immediately transferred to the unit and given IV lopressor. She later spontaneously converted to sinus rhythm without any further intervention. It also became quickly apparent to us that she was particularly preload dependent given her severe AS, which manifested as a prominent drop in SBPs with HRs >120s. Her urine output remained adequate before and after these episodes of afib. She was afebrile. Her electrolytes were closely monitored and repleted PRN. She remained in the unit until [**2115-6-24**] when she underwent a repeat R VATS decortication with placement of a pleurx catheter. Please see Dr. [**Name (NI) 5794**] operative note for details. She tolerated the procedure well and was transferred back to the SICU extubated. . In the early am of [**2115-6-25**] she again was in and out of afib with RVR. Her SBP was 70-80s requiring neosynephrine. She was given an amiodarone loading dose and then drip. She was also given 2 500 NS boluses for soft pressures. She never lost consciousness and had a strong peripheral pulse during these episodes. She also was found to have hyperkalemia, for which she received insulin, bicarb, and kayexylate. Repeat K 2 hours following treatment was 4.9. Her Cr was stable. Her urine output for most of the morning was adequate at ~25cc per hour. However, she suddenly became oliguric with outputs ~5cc/hr by 5:00am that morning. There was some debate at that point whether she was vol depleted or overloaded. Urine electrolytes were sent which showed a FENA of 3%, not c/w a prerenal state. Her creatinine bumped to 1.7. Ultimately it was decided that we should attempt diuresis, and she was given 10mg lasix. She did not respond, and became anuric. She again was intermittently in afib with RVR on an amio drip. Serial ABGs were obtained which showed a severe metabolic acidosis most likely caused by renal failure with a pH of 7.21, CO2 42 and HCO3 18. Subsequent ABGs showed worsening acidosis. Lactate was 13.8 and later trended upward to a max of 17. At this point, it became obvious that she was deteriorating fast and the etiology of this decline was unclear. Of note, her clinical exam was stable. She did not have abdominal pain or surgical abdomen and her chest tubes were adequately draining sersang fluid. . Renal and cardiology consults were immediately obtained. Renal thought she might have urosepsis given the presence of WBC casts. Again, she remained afebrile. She did have leukocytosis, although this temporally was consistent with her recent talc/doxy pleurodesis. A urinalysis taken on [**6-22**] showed 6-10 WBCs with mod bacteria, but was believed to be contaminated given the presence of [**7-17**] epi cells. Urine culture from that time eventually was negative. Urinalysis from [**2115-6-23**] was also negative for infection. Thus, there was few sxns and signs of urosepsis and was generally felt to be an unlikely cause of her sudden deterioration. Regardless, we immediately empirically started her on vanc/zosyn at that time. . Cardiology recommended stating a dilt drip and another amio load followed by drip for her continued intermittent afib with AVR. They were unsure if her metabolic acidosis and rising lactate was consistent with cardiogenic shock or sepsis physiology. We needed a swanz catheter. A TTE showed elevated PCWP with a preserved EF>55%. The aortic valve was not well visualized. There was moderate TR and mild MR. . On the evening of [**6-25**] patient was emergently intubated for worsening ABGs. A swanz catheter was inserted. Post swan CXR showed appropriate line placement without new PTX. The following plan for the evening was placed - obtain hemodynamic data, start CVVH to correct the metabolic acidosis, and cont vanc/zosyn. Her abdominal exam was stable. Serial ABGs were closely monitored. Bicarb was given for severe metabolic acidosis, which began to improve after CVVH was started. Hemodynamics were remarkable for a SVO2 60s, SVR >1300 (while on 3 of neo), PA pressures 60s/30s, wedge 28, mixed venous O2 50s, CO 2.4, fick CI 1.5. Cardiology believed the thermodilution was inaccurate given her severe valvular pathology and calculated the CI to be 2.3 (corrected for hemoglobin). They ultimately did not feel she was in cardiogenic shock and instead attributed the decline to peripheral vasodilation despite the high SVR and low SVO2. Thus, we still did not have an adequate explanation for the rising lactate and ARF. We contemplated the idea that she had thromboembolic acute mesenteric ischemia in the setting of intermittent afib, but ultimately felt this was extremely unlikely given the fact that she did not have abdominal pain or tenderness on exam. Again, urosepsis seemed an unlikely cause. Ultimately, we did not understand the exact cause of acute decline, but were actively managing here metabolic acidosis and renal failure by CVVH and bicarb drip. CVVH was started at 0000 [**2115-6-26**]. She was relatively rate controlled for most of the evening with HR in the 110s, and SBP by aline in the 100-110s (neo of 3). Her Hct was stable in the low 30s. . At approximately 1:45am, patient suddenly went into PEA arrest. She was without a pulse and unresponsive. ACLS protocol was immediately instituted. She was given CPR with approximately 6 rounds of epi/atropine. Multiple rds of CaCl and bicarb were given. At approximately 10 minutes into the code, she regained a pulse with a SBP to the 50s. However, this was temporary and then became asystolic. Bedside ultrasound was negative for a pericardial effusion. She did intermittently regain a rhythm, at times vfib, and was shocked as appropriate. But she never regained a sustainable rhythm and ultimately the code was called at 2:19am. Medical examiner declined the case and the death certificate was signed. Medications on Admission: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Enoxaparin 60 mg/0.6 mL Syringe Sig: One (1) Subcutaneous Q12H (every 12 hours): until INR 2.0 . 6. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed. 7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 8. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO once a day. 9. Anastrozole 1 mg Tablet Sig: One (1) Tablet PO once a day. 10. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day: Take as directed to maintain INR 2.0-3.0 for L DVT. 11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. 12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 13. Regular Insulin Sliding Scale Discharge Medications: NA Discharge Disposition: Expired Discharge Diagnosis: Expired Discharge Condition: Expried Discharge Instructions: NA Followup Instructions: NA Completed by:[**2115-7-1**] ICD9 Codes: 5119, 5849, 9971, 4271, 2762, 4275, 4280, 4241
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Medical Text: Admission Date: [**2120-10-24**] Discharge Date: [**2120-10-24**] Date of Birth: [**2120-10-24**] Sex: M Service: Neonatology HISTORY OF PRESENT ILLNESS: Baby boy [**Known lastname 3228**] is a newborn 37 week infant admitted to the NICU with respiratory distress and dysmorphic features. Infant was born at 5:54 a.m. this morning as the 2035 gram product of a 37 and [**2-19**] week gestation pregnancy to a 31 year- old G1 P0 to 1 mother with [**Name (NI) 37516**] [**2120-11-12**]. Prenatal labs including blood type O positive, antibody negative, RPR nonreactive, hep B surface antigen negative, rubella immune, GBS negative. Triple screen was not performed. Pregnancy was notable for normal 19 week ultrasound, a mildly elevated blood pressure with normal biophysical profile and upper normal AFI 2 weeks ago. Yesterday she was noted to have markedly elevated blood pressures as well as IUGR and elevated AFI. Because of these findings mother was admitted for labor and was induced. Antepartum course notable for vacuum assisted delivery with prolonged pushing. No fever was noted and spontaneous rupture of membrane occurred 5 hours prior to delivery. No antepartum antibiotics were administered. The infant was born vaginally with slightly meconium stained amniotic fluid. He was intubated with no meconium found below the cord. He was then stimulated with good response with Apgars of 7 and 8, increased work of breathing and increased secretions were noted and he was brought to the NICU. PHYSICAL EXAMINATION ON ADMISSION: Weight 2035, which is the 50th percentile. Head circumference 31 cm, which is the 10th percentile. Length of 43.5 cm, which is also the 10th percentile. Temperature 98.6. respiratory rate 40 to 50. Heart rate 150. Blood pressure 81/47 with a mean blood pressure of 54. O2 sat 99 to 100% on room air. In general, he is a small infant with mildly increase work of breathing, reduced activity. HEENT exam revealed molding with a caput. Fontanelles were soft and flat. Ears were posteriorly rotated and low. small palpebral fissures, small chin. He did have a positive red reflex. Pupils were equal and round and reactive to light. Nares were patent and palat was intact. Left side of the face was noted to have decrease movement or tone. Neck was supple with no lesions. Chest noted to have mild retractions, coarse, well aerated. Cardiac regular rate and rhythm. No murmur. Abdomen was soft with a 3 vessel cord. No masses. No hepatosplenomegaly and quiet bowel sounds. GU exam revealed a male with small genitalia. No testes palpable. Small scrotum and a patent anus. Extremities including hips and back were normal. Initially hypotonic, now improving. HOSPITAL COURSE: 1. Respiratory. Patient was noted to have increased work of breathing and therefore by 2.5 hours of life was intubated and placed on conventional mechanical ventilation. First blood gas 7.34/36/196 and weaned from 18/5 x 20 to 16/5 x 18. Repeat 7.44/33 and rate decreased to 15. 2. Cardiovascular. Patient has remained hemodynamically stable throughout his initial hospital course. 3. FEN/GI. Patient was noted to have copious amount of secretions after delivery that in concert with the polyhydramnios noted by the obstetrician prompted placement of an NG tube. Xrau showed an NG tube coiling in the esophagus. Of note, a small amount of air was observed most likely in the stomach--midline and above the diaphragm ??c/w hiatal hernia. Thus, fistula is possible. 4. CBC and blood culture were obtained, results of which are pending at this time. Patient has not been started on antibiotics. WBC=16.2, crit=42.6%, 48P4B36L2 metas, plt=312. 5. Neuro, patient is noted to have a left sided facial weakness as well as some hypotonia on exam. 6. Genetices: as stated above in physical examination, the patient does have some dysmorphic features including low set ears, hypotonia, left sided facial weakness as well as hypogonadism. Will meed to have further evaulation for possible CHARGE syndrome and requires genetics consultation. CONDITION ON DISCHARGE: Critical DISCHARGE DISPOSITION: [**Hospital3 1810**] NICU 7 North. NAME OF PRIMARY CARE PEDIATRICIAN: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 63290**], MD [**First Name (Titles) **] [**Last Name (Titles) 1426**] Pediatrics. CARE/RECOMMENDATIONS: Feeds, the patient is currently NPO on IV fluids at 80 cc per kilo per day. DISCHARGE DIAGNOSES: 1. Esophageal atresia with possible fistula 2. Possible hiatal hernia vs diaphragmatic hernia. 3. Respiratory distress due to multiple secretions, resolving 4. r/o syndrome. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 56662**] Dictated By:[**Last Name (NamePattern1) 58671**] MEDQUIST36 D: [**2120-10-24**] 08:09:41 T: [**2120-10-24**] 08:50:53 Job#: [**Job Number 63291**] ICD9 Codes: 769
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Medical Text: Admission Date: [**2168-4-9**] Discharge Date: [**2168-4-13**] Date of Birth: [**2115-7-6**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 293**] Chief Complaint: Hematemesis Major Surgical or Invasive Procedure: EGD and banding of 5 varices History of Present Illness: 52 year old man with h/o cirrhosis, etiology unknown, who presented to [**Hospital3 417**] Hospital on [**2168-4-9**] with an upper GI bleed from esophageal varices. He reports eating some acidic salad dressing on Friday, then developed burning abdominal pain and bloating afterwards. That evening, he then vomited ~800cc of blood and was taken to the hospital. One prior episode in [**1-7**], again assoc w/ acidic food. . At [**Hospital3 417**] Hospital, he was hemodynamically stable with HR 103 and BP 134/75. An NGT had approximately 800 ml of bloody output. His initial HCT was 37 but dropped to 32 on repeat check and he was given 1 unit PRBC. He was started on IV fluids and octreotide 100 mcg per hour. GI was consulted for urgent endoscopy which showed grade 4 esphageal varices without active bleeding. There was also pooling of blood in the fundus, but no other source of bleeding was noted. Given the severity of the varices, the pt was transferred to [**Hospital1 18**] for consideration for TIPS procedure. . MICU course was notable for: Pt was maintained on octreotide gtt. He was given levofloxacin for ppx as well as PPI [**Hospital1 **]. A R IJ was placed for access. He did not have any bleeding overnight. BP . Hct trended down to 26, 1 u PRBCs given. EGD performed on [**4-11**] and showed varices in the distal esophagus as well as erythema and congestion in the stomach body/fundus. 5 bands were placed. He was monitored in the MICU for the remainder of the day and was then tx out of the ICU for further monitoring/workup of his cirrhosis on the floor. Past Medical History: Liver cirrhosis of unclear etiology Previous GI bleed with varices identified in [**1-/2167**] Social History: Originally from [**Country 2045**], moved in [**2142**]'s. Unmarried, has girlfriend. [**Name (NI) 1403**] in water resources. No tobacco or IVDU. Drinks minimally, usually only when he goes to [**Country 2045**] (drinks the home-made rum). Does not drink EtOH here. Has had 5 sexual partners in his life, usually uses a condom for protection. Has never been told that he has hepatitis, HIV, or any other blood borne disease. No h/o transfusions or surgeries (though has undergone several attempted circumscisions in last several yrs). Family History: Mother died of asthma at 65, Father alive and well, no health concerns (age 72). No h/o CAD or MI. Physical Exam: VS: 98.8/98.9m BP 134/44 (92-150/38-60) P 71, 60-70 R19, 97-100 % 2L NC, I/O=-875 cc, -2.4 L LOS Gen: No apparent distress. Conversational, well appearing man. HEENT: sclera mildly icteric. Neck: no JVD Resp: crackles bilateral bases, clear with cough CV: RRR nl s1s2 no MGR Abd: soft, NT, obese, with normoactive bowel sounds and no hepatospenomegaly. Dull to percussion on flanks. Ext: no edema Neuro: A+Ox3, no asterixis. CN 2-12 intact. Strength 5/5 UE and LE. Skin: Dark without telangiectasias. Pertinent Results: LABS on admission: WBC 4.0, Hct 28.0, MCV 89, Plt 81* (DIFF: Neuts-59.5 Bands-0 Lymphs-28.0 Monos-10.1 Eos-1.7 Baso-0.7) PT 18.0*, PTT 29.9, INR(PT) 1.7* Na 141, K 4.0, Cl 108, HCO3 25, BUN 18, Cr 0.9, Glu 114 ALT 84, AST 106, LDH 197, AlkPhos 65, TBili 2.4 Albumin 3.3*, Calcium 7.8*, Phos 2.1*, Mg 1.8 calTIBC 296, Ferritin 82, TRF 228, TSH 0.30 . Urinalysis: [**2168-4-10**] 01:32AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015 Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG . LABS during hospitalization: [**2168-4-10**] ALPHA-1-ANTITRYPSIN-130 (within normal range) [**2168-4-10**] freeCa-1.11* [**2168-4-10**] HCV Ab-NEGATIVE [**2168-4-10**] IgG-1223 [**2168-4-10**] AFP-2.8 [**2168-4-10**] [**Doctor First Name **]-POSITIVE Titer-1:40 [**2168-4-10**] AMA-NEGATIVE [**2168-4-10**] HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-POSITIVE [**2168-4-11**] HAV Ab-POSITIVE [**2168-4-12**] IgM HBc-NEGATIVE [**2168-4-12**] IgM HBc-NEGATIVE [**2168-4-12**] Smooth-NEGATIVE [**2168-4-12**] HIV Ab-NEGATIVE [**2168-4-12**] HEPATITIS Be ANTIBODY-REACTIVE [**2168-4-12**] HEPATITIS Be ANTIGEN-NONREACTIVE [**2168-4-13**] HEPATITIS B VIRUS GENOTYPE-PND . LABS on discharge: WBC 4.1, Hct 30.9*, MCV 88, Plt 88* PT 15.2*, PTT 26.0, INR(PT) 1.4* Na 137, K 3.7, Cl 102, HCO3 27, BUN 13, Cr 1.2, Glu 104 ALT 115*, AST 111*, LDH 215, AlkPhos 64, TotBili 1.8* Calcium 8.2*, Phos 3.3, Mg 1.8 Cholest 163, Triglyc 74, HDL 45, CHOL/HDL 3.6, LDLcalc 103 . MICRO: [**2168-4-9**] - blood cx neg [**2168-4-10**] - urine cx neg [**2168-4-13**] - catheter tip cx neg [**2168-4-13**] - hep C viral load NEG . IMAGING: RUQ US [**4-10**]: 1. Heterogeneous-appearing liver consistent with cirrhosis. 2. Main portal vein, hepatic arteries, and hepatic veins appear patent with normal direction of flow. No drainable amount of ascites seen. . CXR [**4-10**]: The cardiomediastinal contours are unchanged. Lung volumes are low, but the lungs are clear. No effusion. There is no PTX. . EGD [**4-11**]: Varices at the mid to distal esophagus (ligation) Erythema and congestion in the stomach body and fundus compatible with portal HTN gastropathy Normal mucosa in the duodenum There was a malfunction of the first set of banding equipment and the plastic tip along with unapplied bands fell off the endoscope into the stomach. Otherwise normal EGD to second part of the duodenum . Brief Hospital Course: 52 year old man with history of cirrhosis of unclear [**Name2 (NI) 25100**] presents with GI bleed from grade 4 varices. . # UPPER GI BLEED - Mr. [**Name14 (STitle) 66577**] was found to have grade IV esophageal varices at OSH, w/ a question of large gastric varices as well. He was started on an octreotide gtt and tranferred to [**Hospital1 18**] for TIPS evaluation. On EGD here, he was found to have grade 3 varices and portal HTN gastropathy. He underwent banding to 5 esophageal varices on [**2168-4-11**] and has been stable since. He was monitored in the ICU for 24 hours. His Hct remained stable and he was transferred to the floor. He was continued on nadolol and protonix for his varices. He was also treated with levofloxacin for SBP prophylaxis, for a total of 7 days, to be completed as an outpatient. His diet was slowly advanced and by discharge, he was tolerating a soft diet without any complaints. . # CIRRHOSIS - Mr. [**Last Name (Titles) 66578**] laboratory evaluation revealed a pattern most consistent with cirrhosis, with elevated LFT's and compromised synthetic function. Imaging was also consistent with cirrhosis. However, his cirrhosis is of unclear etiology. From his history, he denies EtOH use, exposure to hepatitis B or hepatitis C. He also denies IVDU or tattoos. Hepatology/GI was consulted and recommended a laboratory workup which revealed that Mr. [**Name14 (STitle) 66577**] was hepB core Ab positive, likely representing a chronic hep B infection. He was given an appointment for outpatient follow-up in the Liver Clinic. He was continued on nadolol and protonix and completed a 7 day course of levofloxacin as an outpatient. . # PANCYTOPENIA - He was noted to be pancytopenic while hospitalized, with a decreased WBC, RBC and platelet count. Platelets could be low due to sequestration in spleen, but did not feel his spleen on exam. Hct likely low as well due to his GI bleeding. Most likely etiology was felt to be viral, likely his hepatitis. HIV was negative. . # PPX - Pneumoboots were given for DVT prophylaxis. He was given a PPI [**Hospital1 **] for his varices. No bowel regimen was needed. . # FEN - He was kept NPO, then advanced to clears, and finally to a soft diet. No IVF were needed after his transfusions. His electrolytes were checked daily and were repleted to keep K >4 and Mg >2. . # ACCESS - He had a R IJ, as well as peripheral IVs. . # CODE - FULL . # DISPO - To home, with follow-up in Liver Clinic. Medications on Admission: Pantoprazole Nadolol (? compliant) 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:*2* 2. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 3. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 5 days. Disp:*5 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Esophageal varices Esophageal variceal bleed Duodenal ulcer . Secondary diagnosis: Cirrhosis of unknown etiology Discharge Condition: Afebrile. BP 140/80, HR 60, RR 20, 98% on RA Discharge Instructions: Please call your PCP or go to the nearest ER if you develop any of the following symptoms: fever, chills, shortness of breath, chest pain, difficulty swallowing, nausea, vomiting, vomiting blood, bloody stools, dark or tarry stools, or any other worrisome symptoms. . Please take all your medications as prescribed. Please follow a soft, low residue diet for another 2 days. After that you may resume a normal diet. . Please keep all your follow-up appointments. Followup Instructions: Please follow-up with your PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) 2405**], as scheduled. . Please follow-up with the Liver Clinic (Dr. [**Last Name (STitle) **] on [**2168-5-3**] at 11:30am. Please call [**Telephone/Fax (1) 2422**] if you have any questions or need to reschedule your appointments. Their office is located in the [**Hospital Unit Name **], at [**Last Name (NamePattern1) **]., [**Location (un) **]. Please call their office upon discharge to update your demographic information in the computer. ICD9 Codes: 5715
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Medical Text: Admission Date: [**2150-5-23**] Discharge Date: [**2150-6-10**] Date of Birth: [**2082-2-28**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1384**] Chief Complaint: Fever, altered mental status, and RLQ pain at rehab facility. Major Surgical or Invasive Procedure: [**2150-6-1**] nephrostogram with dilatation [**2150-6-8**] nephrostogram History of Present Illness: Pt. is a 68 year-old male who presented to the ED with the aforementioned complaints. His potassium level in the ED was found to be 7.4 and his serum creatinine was 5.4 from a normal baseline. The patient was emergently dialyzed, and an obstruction was suspected. Prior to admission, the patient underwent cadaveric renal transplant in [**12-27**] that was complicated by proximal resection of the patient's ureter. A nephrostomy tube was placed in the donor ureter shortly after surgery and was removed on [**2150-5-21**]. Past Medical History: DM2 x32 years DM-associated retinopathy, nephropathy, and neuropathy. CAD ESRD HTN hypercholesterolemia PVD PSH: s/p R ORIF hip [**2150-2-13**] CRT [**2150-1-15**] evac hematoma [**2150-1-16**] nephrostomy tube [**2150-2-6**] for urinoma CABG [**2143**] Right fem-distal bypass s/p R BKA LUE AV fistula Social History: SOCIAL HISTORY: Significant for distant use of tobacco. He quit in [**2143**]. No history of alcohol use or IV drug abuse. His wife died of bone cancer. He has 6 children, all adults with an eldest son with a history of diabetes. He has supportive family in the area. He currently lives alone. Family History: Noncontributary Physical Exam: V/S: 98.9/P55/R20/BP137/53 Gen - cachectic male in NAD Skin - L heel decubitus ulcer with eschar, no rashes HEENT - NC/AT, EOMI, PERRL bilat., MMM, no palpable LAD Cardiac - RRR, palpable thrill from L brachial AV fistula Lungs - CTA bilat. [**Last Name (un) **] - bowel sounds present, soft, NT, ND, no organomegaly P.Vasc - 1/4 L d.p. and p.t. pulses, [**12-26**] palp. UE pulses bilat., no edema, no audible bruits Musc/Skel - s/p R BKA, full active and passive ROM at L lower extremity and upper extremities bilat. Neuro - Gen - A&Ox3, appropriate speech and affect CN - II-XII intact Reflexex - 1+ at patella bilat., 1+ at brachiorad and bicipital bilat. Sensory - intact to light touch and temp at UE bilat, LE bilat Motor - 5/5 strength throughout Cerebellar - + intention tremor Gait - not assessed - pt. is s/p R BKA and without prosthetic. Pertinent Results: [**2150-6-9**] 06:05AM BLOOD WBC-4.9 RBC-3.27* Hgb-9.0* Hct-28.1* MCV-86 MCH-27.7 MCHC-32.2 RDW-15.6* Plt Ct-341 [**2150-6-9**] 06:05AM BLOOD WBC-4.9 RBC-3.27* Hgb-9.0* Hct-28.1* MCV-86 MCH-27.7 MCHC-32.2 RDW-15.6* Plt Ct-341 [**2150-6-9**] 06:05AM BLOOD Glucose-97 UreaN-31* Creat-1.5* Na-139 K-5.8* Cl-111* HCO3-21* AnGap-13 [**2150-6-6**] 06:17AM BLOOD Glucose-71 UreaN-27* Creat-1.3* Na-140 K-4.9 Cl-110* HCO3-22 AnGap-13 [**2150-6-9**] 06:05AM BLOOD Albumin-3.0* Calcium-8.5 Phos-2.4* Mg-1.6 [**2150-6-9**] 06:05AM BLOOD FK506-7.4 Brief Hospital Course: Pt. was dialysed emergently upon arrival. His nephrostomy tube reopened and allowed to drain. Pt's creatinine gradually decreased to baseline levels over the course of admission with hydration. Pt's blood glucose levels were initially high, but were brought under good control with the help of the [**Last Name (un) **] center. At the time of discharge, pt's blood glucose levels were 116-130. [**5-29**]: Nutrition consult recommends Boost supplements [**5-30**]: TSH, folate, B12 normal, urine output via foley catheter and nephrostomy tube increased, creatinine continues to decrease [**6-1**]: Nephrostogram with stomal dilation, tube still open and draining well [**6-2**]: Nephrostomy tube closed for trial, foley catheter draining hematuria with clots. Foley removed. [**6-3**]: Pt. refused replacement of foley,urethral clots stopped. [**6-4**]: Urethral clots reappear,hematuria via nephro bag. [**6-7**]: Pt. started Zoloft, tolerated well. Pt. began eating well. [**6-8**]: Pt's Boost changed to Nepro supplements due to elevated potassium levels, kayexalate given for asymptomatic hyperkalemia. [**6-8**]: Nephrostogram --> no vasovesicular fistula present. [**6-9**]: Acute renal failure resolved, foley catheter draining more that neprhostomy tube; pt. tolerates nephrostomy tube capping. Pt. eating well. Pt.'s blood glucose levels in good control. Medications on Admission: tacrolimus 6 mg po bid amlodipine 5 mg po qd metoprolol 25mg po tid fluoxetine 20 mg po qd mycophenolate mofetil 1000mg po bid valgancyclovir 450mg po qd paantoprazole 40mg po qd isosorbide dinitrate 60mg po qd colace 100mg po bid bactrim ss i po qd CaCO3 100 mg po qid nystatin 5 ml po qid Discharge Medications: 1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 5. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day): apply to scrotum then apply aloe vesta. 8. Tacrolimus 1 mg Capsule Sig: Four (4) Capsule PO BID (2 times a day). 9. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Extended Care Facility: [**Hospital 20304**] Rehabilitation & Nursing Center - [**Location (un) 2498**] Discharge Diagnosis: hematoma/urinoma s/p cadaver kidney transplant complicated by nephrostomy tube DM type II hypertension depression peripheral vascular disease. Discharge Condition: stable Discharge Instructions: call if fevers, chills, nausea, vomiting, inability to take medications, inability to urinate, decreased urine output from nephrostomy tube or if nephrostomy tube urine becomes more bloody. Change Nephrostomy tube dressing every day. Labs once a week for cbc, chem 7, calcium, phosphorus, ast, t.bili, albumin, urinalysis and trough prograf level. Fax results to [**Hospital1 18**] [**Telephone/Fax (1) 697**] Followup Instructions: call [**Hospital1 18**] for follow up appointment in [**11-23**] weeks [**Telephone/Fax (1) 673**] Completed by:[**2150-6-9**] ICD9 Codes: 0389, 5990, 5849, 2767, 4439, 311, 4019, 3572, 2720
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Medical Text: Admission Date: [**2182-5-24**] Discharge Date: [**2182-6-3**] Date of Birth: [**2115-12-3**] Sex: F Service: MEDICINE Allergies: Motrin Attending:[**First Name3 (LF) 4891**] Chief Complaint: Hand pain Major Surgical or Invasive Procedure: I+D of the left hand History of Present Illness: 66 y/o with ESRD on HD M/W/F, CAD, PVD, DM, HTN presents with worsening pain and swelling left 3rd digit for 2-3 weeks. Pt had L UE AV fistula banded for vascular steal symptoms on [**2182-5-9**] by Dr. [**First Name (STitle) **]. Prior the operation the pt describes her had as black. Pt says the pain and swelling the the digits started within a few days of the operation. No F/C/S. The syptoms were progressively worsening of the last week. She went to see Dr. [**Last Name (STitle) **] (? transplant) today in clinic. There she had diminished L radial pulse with strong doppler signal. Ulnar pulse also has a strong doppler signal. There is good cap refill and was sent in to the ED for eval of possible infection. . In the ED, initial VS: T97.7, 61, 179/49, 18, 100%RA. Initial exam felt consistent with paronychia. I+D attempted without pus by ED resident. Hand was consulted and did a 2nd attempt of I+D was performed. Pt received ampicillin-Sulbactam and Vanco 1gm in the ED. No pus produced. Packed by hand team who argeed with treatment of vanco and unasyn (per ED). X ray performed and read as Soft tissue defect at the nail bad and osteomyelitis of the distal phalanx of the left 4th digit. Per ED report hand is less impressed with the idea of osteomyletis. Hand will continue to follow. Pt remained HD stable in ED. PIV in place. VS prior to transfer 98.5, 65, 180/64, 16, 100% RA. . ON arrival the pt complaints of severe left finger pain and her dressing has quickly soaked through. BP 201/60, but denies CP, HA, change in vision. . ROS: 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: PER [**Last Name (STitle) **]: PVD - s/p left SFA stent placement [**6-15**] CAD - 3VD per cath [**2179**], s/p stent to RCA in [**2177**] DM - on insulin, last A1C 8.9% in [**3-/2181**] ESRD - HD-M/W/F @ [**Location (un) **] (Dr. [**First Name (STitle) **] HTN hyperlipidemia hyperparathyroidism s/p hysterectomy h/o colonic polyps s/p phacoemulsification with posterior chamber lens implant left eye [**2181-6-14**]. Anemia Paroxysmal atrial fibrillation. Social History: Lives in [**Location 2268**] with daughter on [**Location (un) 448**] of her house, no history of tobacco, alcohol, drugs. Family History: Diabetes, hypertension in several family members Physical Exam: VS: T96.9, BP 201/60, 65, 22, 98% GENERAL: elderly appears AA female in moderate painful distress. HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. NECK: no JVD, HEART: RRR, no MRG, nl S1-S2. LUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding. EXTREMITIES: WWP, no c/c/e. Left 3rd digit with 1cm incision along radial aspect with wick exposed, ongoing bleeding. good cap refill in BL hands. Swelling of finger largely confined to distal to DIP. very TTP on the finger pad. Given pain flexsion PIP, DIP limited. No swelling appreicated proximal to PIP. no erythema. Radial and ulnar only appreciated by doppler. LUE fistula with good thrill. SKIN: dark nail changes in BL U and L ext which pt says is new since operation. No obvious splinter hemrhorages. muliple dark macules on palms / soles which appear chronic and nonblanching (therefore unlikely to be [**Last Name (un) **] lesions. NEURO: Awake, A&Ox3, CNs II-XII grossly intact, muscle strength and senstion grossly intact throughout. Pertinent Results: [**2182-5-24**] 04:33PM LACTATE-1.7 K+-5.3 [**2182-5-24**] 04:25PM GLUCOSE-237* UREA N-33* CREAT-5.2*# SODIUM-133 POTASSIUM-7.8* CHLORIDE-95* TOTAL CO2-31 ANION GAP-15 [**2182-5-24**] 04:25PM CALCIUM-9.3 PHOSPHATE-3.8 MAGNESIUM-2.1 [**2182-5-24**] 04:25PM WBC-3.6* RBC-3.58* HGB-11.4* HCT-35.1* MCV-98 MCH-31.9 MCHC-32.5 RDW-16.1* [**2182-5-24**] 04:25PM NEUTS-57.0 LYMPHS-29.5 MONOS-9.8 EOS-3.0 BASOS-0.8 [**2182-5-24**] 04:25PM [**Name (NI) 8255**] TO PTT-UNABLE TO INR(PT)-UNABLE TO [**2182-5-24**] 04:25PM PLT COUNT-107* MICROBIOLOGY: blood cult pending . STUDIES: X-ray left finger: Soft tissue defect at the nail bad and osteomyelitis of the distal phalanx of the left 4th digit. . ECG: [**2182-5-24**] 2251: NSR at 65, NANI. old TWF in lateral [**Location (un) 18187**]. No st changes. poor R wave progression. . MRI BRAIN: Multiple areas of high signal in subcortical and periventricular distribution are redemonstrated on FLAIR imaging, compatible with small vessel ischemic disease. Mild prominence of sulci and ventricles is again noted, suggestive of global atrophy. There is no evidence of acute infarction. On T2-weighted images, there is high signal intensity involving the left pons, compatible with remote infarction. MRA BRAIN: There is severe stenosis involving bilateral posterior cerebral arteries. Severe stenosis of the right distal M1 and M2 segments of the right middle cerebral artery are demonstrated. The left MCA is minimally narrowed. A supraclinoid segment of the left internal carotid artery appears markedly narrowed. These multiple foci of stenosis were not visualized on most recent CTA of [**2182-5-27**]. IMPRESSION: 1. Multiple severe stenoses involving posterior and anterior circulation, as detailed above. These findings appear new from [**2182-5-27**] CTA exam and are concerning for vasculitis or vasospasm due to meningitis. 2. Small vessel ischemic disease. 3. Old left pontine infarction. CTA HEAD [**2182-5-30**]: Preliminary Report !! WET READ !! 1. C-Head:1. no large acute major territorial infarction, intracranial hemorrhage or mass. Stable hyperdensity likely calcification in left frontal lobe (2,24) unchanged in size and appearance since [**2182-5-27**]. 4 2. CTA of the head: Reformats are pending . Within this limitation: a) Stable appearance of bilateral proximal cavernous ICA with e/o stenoses due to calcified atheromatous plaque with normal caliber and contrast enhancement distal to these segments. b) Calcified atheromatous plaque involving the intracranial vertebral arteries is noted with small area of focal stenosis of the right vertebral artery. c) Remaining vessels show no definite flow limiting stenosis, or aneurysm > 3mm. Brief Hospital Course: # Finger infection: Concerned initially for deep tissue infection, however I+D without pus x 2 in the ED. On admission the x-ray wet read osteomyelitis was a possiblility. Hand surgery was consulting on the patient and the patient was placed on vancomycin and ceftazidime with HD. The antibiotitcs were started on [**2182-5-24**] and will finish on [**2182-7-5**]. Blood cultures eventually grew multiple strains of bacteria including CONS and GNRs with high levels of resistence. ID was consulted and recommended vanc/meropenem for at least a 6 week course but they will tailor the antibiotics to her clinical status. She will need weekly safety labs while on the antibiotics. These will include cbc, chem 7 and lfts. These will be faxed to the [**Hospital 4898**] clinic at [**Hospital1 18**]. A PICC line was placed on [**2182-6-2**] for meropenem dosing. Hand surgery recommended [**Hospital1 **] dressing changes and [**Hospital1 **] soaks in betadyne/saline solution (a 1:1 ratio). They will follow up with the patient on the Tuesday after her discharge in hand clinic. If her appointment needs to be rescheduled the number is: [**Telephone/Fax (1) 3009**]. It is very important that she follow up with them as she may need an amputation of the finger if the infection does not clear up with antibiotics. Her pain was controlled with tylenol RTC. She was unable to tolerate oxycodone or morphine as they made her sleepy. # HTN: BP 201/60 in the setting of pain on admission. Chronic hypertensive on multiple agents. EKG without ischemic changes. Pt without chest pain, HA, vision changes, or abd pain suggestive of hypertensive emergency. Blood pressures were well-controlled after pain controlled on her home regimen. . # Toxic metabolic encephalopathy: Pt had acute altered mental status while on the medicine floors. Pt was aphasic with right sided weakness. CODE stroke was called, and pt had urgent CT head that demonstrated no ICH. She was transferred to the MICU for closer monitoring. Pt was evaluated by neuro, who thought most likely toxic metabolic given fevers. Given fevers, meningitis was considered; however, unable to perform LP given body habitus. MRI head was done which showed was concerning for possible MCA territory infarction but could also have been artifact that was not seen on the prior CTA Head. She underwent a repeat head CT which revealed no changes from the prior one. She was started on ASA 325mg daily per neuro recs. Her EEG revealed epileptiform waves on the right side consistent with seizures. Neurology recommended starting keppra. She remained stable and was transferred to the medical floor. On discharge she was alert and oriented X 3. # DM: continued home doses of NPH and HISS # CAD/PVD: continued statin, BB, imdur, ASA 81mg # ESRD on HD MWF: continued her regular dialysis sessions here and continued renal caps and calcium accetate. # Anemia: Patient's hematocrit down-trended while hospitalized. Her hematocrit at discharge was 26.5. # thrombocytopenia: at baseline. Defer to outpatient providers for followup. # CODE: confirmed full with pt. # CONTACT: [**First Name8 (NamePattern2) 1258**] [**Last Name (NamePattern1) 3234**], daughter, HCP, [**Telephone/Fax (1) 102079**], [**Telephone/Fax (1) 102080**] # Transitions of care: - Patient will need weekly labs drawn in HD and faxed to the [**Hospital 4898**] clinic to ensure she does not have toxicity from the vancomycin - Patient will need to follow up with hand clinic to ascertain whether she needs an amputation 7-10days after discharge - Patient has a PICC line in place (placed [**2182-6-2**]) which will need to be taken out when antibiotic course is completed Medications on Admission: MEDICATIONS per [**Name (NI) **], pt unable to confirm except for insulin: amlodipine 10mg PO daily Renal caps 1 PO daily calcium acetate 667 mg PO evenings w/ meals clonidine 0.1mg PO BID furosemide 20mg PO BID gabapentin 300mg PO qhs hydrocodone-acetaminophen 5/500mg [**2-10**] tab q4-6 hr prn pain imdur 30mg PO daily lidocaine 5% patch to lower back lisinopril 40mg PO daily metoprolol tartrate 200mg PO BID simvastatin 80mg PO daily acetaminophen 1000mg PO q6h prn ASA 81mg Po daily Carbamide peroxide 6.5% drops 2 drops daily prn earwax colace 100mg Po daily regular insulin 4 U qam and 2 units evening NPH 20 units qam, 10 u qpm senna PO daily Discharge Medications: 1. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 3. calcium acetate 667 mg Capsule Sig: One (1) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 4. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 7. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 8. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for pain. 9. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. metoprolol tartrate 50 mg Tablet Sig: Four (4) Tablet PO BID (2 times a day). 11. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 13. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 14. insulin lispro 100 unit/mL Solution Sig: Four (4) units Subcutaneous QAM. 15. NPH insulin human recomb 100 unit/mL Suspension Sig: Twenty (20) units Subcutaneous QAM. 16. NPH insulin human recomb 100 unit/mL Suspension Sig: Ten (10) units Subcutaneous QPM. 17. insulin lispro 100 unit/mL Solution Sig: Two (2) units Subcutaneous at bedtime. 18. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours). Disp:*30 Tablet(s)* Refills:*2* 19. Vancomycin 1000 mg IV HD PROTOCOL 20. Carbamoxide Ear Drops 6.5 % Drops Sig: 1-2 drops Otic once a day as needed for ear wax. 21. Outpatient Lab Work Please check weekly CBC, LFTs, Chem 7 and fax to [**Hospital 4898**] [**Hospital **] clinic. 22. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 23. levetiracetam 250 mg Tablet Sig: One (1) Tablet PO 3X/WEEK (MO,WE,FR). 24. Meropenem 500 mg IV Q24H please give AFTER HD on HD days 25. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - [**Location (un) 550**] Discharge Diagnosis: Osteomyelitis of left finger DM2 ESRD on HD Seizure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. You were admitted to the hospital with an infection of your hand. You had IV antibiotics (vancomycin, ceftazadine) to treat this. You were seen by the plastic surgeons who cleaned out your hand infection and recommend dressing changes and soaks (in a solution of betadyne and saline) twice a day. They want to see you within one week of discharge to see whether the infection is healing or whether you might need the tip of your finger removed. You should continue the antibiotics for 6 weeks with last dose on [**2182-7-5**]. You also had an event during which your brain did not seem to be functioning as well as it usually does. You had a ct scan and MRI of your head which did not reveal a stroke or mass or infection. You had an EEG which showed a seizure. The neurologists recommended starting an anti seizure medication called Keppra. You should continue this and follow up with the neurologists as an outpatient. You should also continue to take a full dose aspirin to prevent strokes. It was also thought that your pain medications may have contributed to this episode and these were discontinued. You should continue to take tylenol for your pain. Medication Changes: START: Vancomycin with HD for at least 6 weeks START: Meropenem IV for at least 6 weeks START: Acetominophen 1gm by mouth TID START: Keppra It was a pleasure taking part in your care. Followup Instructions: Department: [**Hospital3 249**] When: THURSDAY [**2182-6-27**] at 9:00 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**] Building: [**Hospital6 29**] [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: TRANSPLANT CENTER When: THURSDAY [**2182-6-27**] at 1 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD [**Telephone/Fax (1) 673**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: ORTHOPEDICS When: TUESDAY [**2182-6-4**] at 8:00 AM With: HAND CLINIC [**Telephone/Fax (1) 3009**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 249**] When: TUESDAY [**2182-6-4**] at 9:00 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**] Building: [**Hospital6 29**] [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Please follow-up with Hand Surgery Clinic, the office number is [**Telephone/Fax (1) 3009**] 7-10 days following discharge. ICD9 Codes: 5856, 2760, 2875, 4439, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7137 }
Medical Text: Admission Date: [**2119-10-20**] Discharge Date: [**2119-10-25**] Date of Birth: [**2044-8-14**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 12131**] Chief Complaint: Right leg weakness Major Surgical or Invasive Procedure: - OPERATIONS: 1. Fusion T2-T8. 2. Extra cavitary decompression T5. 3. Laminectomies T4, t6 4. Instrumentation T2-8. 5. Cage placement at T5. 6. Autograft. History of Present Illness: This is a 75 year old male with a history of metastatic renal cell carcinoma with metastasis to multiple ribs and lungs with associated pleural effusions s/p Genentech study drug who presents with right leg weakness, urinary retention, and constipation over the past several days. Ordinarily, Mr [**Known lastname 82579**] is able to ambulate with a walker without difficulty at home - he prepares meals for himself at his home he shares with his wife. Over the past few days, due to increasing weakness in his right leg, he has had difficulty with walking. He has also been constipated over this same time period, his last bowel movement 5 days ago. His PO intake has been diminished over the last several months, although he takes considerable fluids. He has also described urinary retention over the past three months. Otherwise, he denies any other extremity weakness, with no numbness or tingling. Back pain is minimal at rest, although coughing does make it worse. He recently had a pleurex catheter in place for pleural effusion during last admission. An MRI was performed on day of admission which reveals multiple spinal mets with significant collapse of the T5 vertebral body with epidural extension and marked canal narrowing with cord impingement at this level. The other areas of metastases are not associated with cord compression. For the MRI, the patient was intubated for claustrophobia and anxiety treatment - he was immediately extubated thereafter without need for supplemental O2. Neurosurgery saw the patient and plan on taking the patient to the OR assuming that this plan is acceptable per the Oncology team, based on their overall treatment plan. At time of transfer to floor, the patient was comfortable with no pain, but continued symptoms as described above. Past Medical History: PAST ONCOLOGIC HISTORY: -- On [**2117-7-22**], MRI revealed a 3.2 cm solid exophytic lesion arising from the lower pole of left kidney suspicious for clear cell renal cell carcinoma and a 1.6 cm solid lesion in the anterior left pole of the left kidney and a 2.4 cm lesion in the mid pole of the right kidney, both of which concerning for tumor cell carcinoma, papillary type. He was referred to Dr. [**Last Name (STitle) 3748**] on [**2117-4-13**]. Given its small size, he was recommended to have followup imaging ([**2117-7-22**] MRI at [**Hospital1 18**] compared to CT without contrast from [**2117-4-2**]). -- On [**2118-1-13**], he underwent repeat MRI, which showed no significant change and bilaterally no masses. -- On [**2118-9-28**], he underwent repeat MRI, which revealed significant interval increase in the lower pole of the left kidney obstructing mass, now measuring 4.9 x 3 cm from 3.1 x 2.7 cm and development of nodules in the perinephric fat, consistent with extrarenal spread suspicious for clear cell renal cell carcinoma, and there were also two other lesions that were minimally increased in size. On [**2118-11-15**], he underwent laparoscopic left radical nephrectomy, which revealed a 4.6 cm clear cell carcinoma and a 2.8 cm papillary renal cell carcinoma, grade 3 tumors with tumor extension into the perinephric tissue (T3a N0), 0/11. Of note, the clear cell renal cell carcinoma shows no areas of signaling, no definitive sarcomatoid differentiation. Renal cell carcinoma is diffusely positive CA9, negative for CK7 and patchy positivity for P504s. The papillary renal cell carcinoma is again diffusely positive for CK7 and P504s and focally positive for CA9. Packs two shows focal weak staining for both tumors with no after lymphovascular invasion as identified on CT31 staining. -- on [**2118-11-16**] Splenectomy showed vascular congestion with subcapsular hematoma. -- On [**2118-1-29**], the lesion in the pole of the right kidney most consistent with papillary renal cell carcinoma is unchanged, and fluid collection consistent with pseudocyst of one of the pancreas is noted. -- On [**2118-4-13**], he underwent partial right nephrectomy of the 2.6 cm papillary renal cell carcinoma, grade 2 (T1a Nx) with the size of the tumor measured as a solid part 2.6 cm, adjacent cyst continued minimal tumor. Specimen one in the belt of the cyst adjacent to the tumor, right margin with papillary carcinoma cauterized. --On [**2119-4-15**], post-nephrectomy period complicated by fever and treated for pneumonia. He was noted to have a low O2 and underwent a chest x-ray, which noted a 5 cm elliptical opacity in the left upper hemi collapse with apparent adjacent local destruction, new since [**18**]/[**2118**]. --On [**2119-4-17**], CT abdomen and pelvis revealed a 5.1 x 2.2 soft tissue density lesion with destruction of the third posterior lateral rib, fluid collection in the right partial nephrectomy bed with a seroma. Coronary and aortic valve calcifications, enlarged pulmonary artery, right lower lobe consolidation concerning for pneumonia. A 7-mm right lung nodule, nonspecific left upper lobe ground-glass opacity. --On [**2119-10-1**] admitted for pleural effusion which was tapped by IP. Interval need of supplemental O2. He was stopped on his experimental therapy. Past Medical History: PMH: HTN, bilateral renal masses, HLD PSH: splenectomy [**2118**], lap left radical nephrectomy [**2118**], R CEA ([**Doctor Last Name **]) [**2116**], hernia repair x 2 Social History: He is a senior project coordinator for the Department of Mental Health, specializes in [**Doctor First Name **] networks. He has a 50-pack-year smoking history, continues to smoke one pack per day, occasional alcohol, no drug use. He drinks rare alcohol. He is retired but still works two days a week. Family History: non-contributory Physical Exam: PHYSICAL EXAM ON DISCHARGE: Vitals - T: 97.6 BP: 118/52 HR: 65 RR: 18 02 sat: 96% 2L NC GENERAL: NAD, tired appearing HEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent nares, MMM, nontender supple neck, no LAD, no JVD CARDIAC: RRR, S1/S2, no murmers, gallops, or rubs LUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles BACK: Dressing c/d/i with drain in place ABDOMEN: nondistended, [**Month (only) **] BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly EXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities PULSES: 2+ DP pulses bilaterally NEURO: CN II-XII intact, strength 5/5 biceps and triceps bilaterally, left hip flexors, plantar and dorsiflexion; 4- R dorsiflexion, 4+ R hip flexors Pertinent Results: MR [**Name13 (STitle) 1093**] [**10-20**]: There are multiple vertebral body metastases demonstrated. These are identified at T1, T2, T4, T5, and sacrum. The largest of these lesions is at T5 where there is collapse of the vertebral body, to a considerably greater extent than present on the [**9-26**] CT scan. There is extensive soft tissue extending from the posterior vertebral body into the spinal canal producing severe spinal cord compression at T5. Tumor extends into the canal from the T2 body and just touches the left anterior surface of the spinal cord. Tumor also extends into the canal from the T4 body, again touching the anterior surface of the cord. There is no evidence of cord or cauda equina compromise at the other metastatic levels. At the level of most severe spinal compression, there is hyperintensity in the spinal cord on the long TR images, presumably edema related to severe compression. The metastases enhance after contrast administration. No intradural tumor is identified. Again noted are multiple other metastases in the chest wall, incompletely evaluated on this examination. Also again seen are bilateral pleural effusions, greater on the left than right. CONCLUSION: Multiple spinal vertebral metastases with collapse of the T5 vertebral body and a soft tissue extending into the canal at this level producing severe spinal cord compression. Soft tissue extends into the canal at T2 and T4 contacting the spinal cord but not producing cord compression. Brief Hospital Course: Mr. [**Name13 (STitle) 54864**] is a 75M with metastatic renal cell carcinoma with known malignant right sided pleural effusion s/p recent drainage who presented with several days of right sided leg weakness, urinary retention for several weeks/months and constipation, with radiographic evidence of cord compression at the level of T5 as above. 1) Cord compression - Upon admission, Mr. [**First Name (Titles) 82581**] [**Last Name (Titles) 23156**] clinical signs of cord compression, including right leg paralysis and radiographic evidence of T8 cord invasion. He underwent operative intervention on [**2119-10-22**] with decompression at the level of the T5 lesion, fusion T2-T8, laminectomies at T4 and T6, instrumentation T2-8, cage placement at T5, and autografting. Please see the operative report for complete details. Following this procedure, his strength improved. He was placed on a post-operative steroid taper, starting at dexamethasone 6mg IV q6hrs to be tapered down by 1mg q6hrs every other day. This regimen was converted to PO on the day of discharge. He was discharged taking 4mg PO q6hrs. His next adjustment was to be a decrease to 3mg PO q6hrs, to be initiated 48 hours after discharge. 2) Pleural Effusion - Patient was recently discharged after drainage of a recurrent malignant right pleural effusion and placement of Pleurx catheter. Admission CXR demonstrated a stable/slightly decreased effusion. He was saturating well on room air at time of discharge. This collection was drained every other day per his regular scheduled. 3) Hyponatremia - Stable sodium at 132 upon admission. Previously attributed to SIADH. Stable throughout this hospitalization; sodium equal to 133 on day of discharge. 4) Hypercalcemia - Calcium at admission 10.4. Previous admissions with suspicion of etiology secondary to combination of bony metastases and paraneoplastic hypercalcemia, though no definitive work-up for PTHrP performed. Managed well via intravenous fluids. Corrected calcium equal to 9.1 on day of discharge. 4) Leukocytosis - Patient with persistent leukocytosis of several years - attributed on previous admissions to be secondary to his renal cell carcinoma. Relatively stable througout admission, though did exhibit increase in WBC count status-post initiation of dexamethasone therapy. WBC count equal to 21.4 on day of discharge, comparable to previous values. Expected to trend downwards with tapering of steroids as above. 5) Thrombocytosis - Patient's thrombocytosis attributed to previous splenectomy/hyposplenism. 6) Metastatic renal cell carcinoma - Had been receiving Genetech study drug, but discontinued on recent admission secondary to dyspnea and progressive disease. Mr. [**Name13 (STitle) 54864**] is to follow-up as an outpatient for re-evaluation and initiation of chemotherapy. CHRONIC ISSUES: 7) Hyperlipidemia - continued simvastatin. 8) Hypertension - continued metoprolol. ========================================== TRANSITIONAL ISSUES: - Mr. [**Known lastname 82579**] remained full code throughout his hospitalization. - His HCP is [**Name (NI) 2411**] [**Name (NI) 44263**] (girlfriend of many years): [**Telephone/Fax (1) 82582**], Cell phone: [**Telephone/Fax (1) 82583**] - He will require outpatient follow-up with [**First Name8 (NamePattern2) 20062**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP [**Telephone/Fax (1) 63699**] after discharge. - He has an appointment with Dr. [**Last Name (STitle) **] (neurosurgery) on TUESDAY [**2119-10-31**] at 9:30 AM Medications on Admission: The Preadmission Medication list is accurate and complete. 1. Acetaminophen 500 mg PO Q6H:PRN pain 2. Docusate Sodium 100 mg PO BID 3. Metoprolol Tartrate 25 mg PO BID 4. Senna 1 TAB PO BID:PRN constipation 5. Simvastatin 10 mg PO DAILY 6. Tamsulosin 0.4 mg PO BID 7. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain Breakthrough pain. Hold for RR < 12. 8. Bisacodyl 10 mg PO DAILY 9. Morphine SR (MS Contin) 30 mg PO Q8H 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation Discharge Medications: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain/fever 2. Polyethylene Glycol 17 g PO DAILY constipation 3. Tamsulosin 0.4 mg PO BID 4. Simvastatin 10 mg PO DAILY 5. Dexamethasone 4 mg PO Q6H Duration: 48 Hours 6. Ondansetron 4 mg IV Q8H:PRN nausea 7. Pantoprazole 40 mg PO Q24H 8. Metoprolol Tartrate 25 mg PO BID 9. Morphine SR (MS Contin) 30 mg PO Q8H RX *morphine 30 mg 1 tablet(s) by mouth q8hrs Disp #*52 Tablet Refills:*0 10. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain Breakthrough pain. Hold for RR < 12. RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth q4hrs Disp #*80 Tablet Refills:*0 11. Senna 1 TAB PO BID:PRN constipation 12. Docusate Sodium 100 mg PO BID Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: PRIMARY: - metastatic renal cell carcinoma SECONDARY: - T5 cord compression - hypercalcemia 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: Dear Mr. [**Last Name (Titles) 54864**], Thank you for choosing [**Hospital1 18**] for your medical care. You were admitted to the hospital for compression of your spinal cord caused by a metastatic lesion from your renal cancer. You underwent surgery to relieve this compression. You did well. Upon discharge, please keep all of your scheduled appointments with your doctors. Please take all medications as prescribed. Refrain from driving while taking pain medication. Please return to the hospital or call Dr.[**Name (NI) 9034**] office at [**Telephone/Fax (1) 3231**] if you experience any of the following: fever, chills, night sweats, loss of conciousness, chest pain, trouble breathing, opening of your incision, foul smelling or pus-like discharge from your wound, worsening back pain, increasing weakness, or any other symptoms that concern you. Spine Surgery recommendations per Dr. [**Last Name (STitle) 14354**] [**Name (STitle) **]: ?????? Do not smoke. ?????? Keep your wound(s) clean and dry / No tub baths or pool swimming for two weeks from your date of surgery. ?????? Dressing may be removed on Day 2 after surgery. ?????? No pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? Limit your use of stairs to 2-3 times per day. ?????? Have a friend or family member check your incision daily for signs of infection. ?????? Take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? Do not take any medications such as Aspirin unless directed by your doctor. ?????? Increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. We recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Clearance to drive and return to work will be addressed at your post-operative office visit. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: ?????? Pain that is continually increasing or not relieved by pain medicine. ?????? Any weakness, numbness, tingling in your extremities. ?????? Any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? Fever greater than or equal to 101?????? F. ?????? Any change in your bowel or bladder habits (such as loss of bowl or urine control). Followup Instructions: You will have a follow-up appointment in approximately 2 weeks with Dr. [**Last Name (STitle) **] and [**First Name8 (NamePattern2) 622**] [**Last Name (NamePattern1) 17265**] to discuss chemotherapy options. They will call you with an appointment. Please call [**First Name8 (NamePattern2) 20062**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP [**Telephone/Fax (1) 63699**] if you have not heard from them within approximately one week. Neurosurgery Follow-up: Wound check w/ Nurse [**Month (only) **] Date: Tuesday, [**2119-10-31**] Time: 9:30am Location: [**Hospital Ward Name 517**], [**Hospital Unit Name **] ([**Hospital Unit Name 12193**]) [**Last Name (NamePattern1) 439**], [**Location (un) 86**], [**Numeric Identifier 718**] T-Spine CT scan **NPO 3 hrs prior to scan** Date: Tuesday, [**2120-1-30**] Time: 1:30pm Location: [**Hospital Ward Name 517**], Clinical Center ([**Location (un) 470**]) [**Hospital1 7768**], [**Location (un) 86**], [**Numeric Identifier 718**] [**First Name8 (NamePattern2) **] [**Doctor Last Name **], M.D, PhD Date: Tuesday, [**2120-1-30**] Time: 2:30pm Location: [**Hospital Ward Name 517**], [**Hospital Unit Name **] ([**Hospital Unit Name 12193**]) [**Last Name (NamePattern1) 439**], [**Location (un) 86**], [**Numeric Identifier 718**] If you know that you will not be able to keep your appointment, please give us a call and we will be happy to re-schedule your appointment for you. Please call [**Telephone/Fax (1) 3231**]. Department: NEUROLOGY When: MONDAY [**2119-10-30**] at 11:00 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 12567**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1844**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: NEUROSURGERY When: TUESDAY [**2119-10-31**] at 9:30 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 82584**], NP [**Telephone/Fax (1) 1669**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage ICD9 Codes: 5859, 3051, 2724
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Medical Text: Admission Date: [**2100-7-21**] Discharge Date: [**2100-7-22**] Date of Birth: [**2038-3-30**] Sex: M Service: MEDICINE Allergies: Latex / Verapamil Attending:[**First Name3 (LF) 7333**] Chief Complaint: elective ablation for A-fib Major Surgical or Invasive Procedure: s/p elective blation for A-fib s/p pericardiocentesis History of Present Illness: 62 year old man has a history of paroxysmal atrial fibrillation that dates back to his 20's. He has undergone about 7 cardioversions and has been trialed on several antiarrythmics including Sotalol and Flecainide. In late [**2097**] the patient began to experience increasing episodes of AF and underwent pulmonary vein isolation/flutter ablation on [**2099-4-1**]. Following the ablation he gradually weaned off of Flecainide. In [**Month (only) 1096**] of [**2098**] he had a prolonged episode of rapid palpitations that required cardioversion. Following this he has had almost monthly episodes of rapid palpitations that he has treated with am "Flecainide cocktail", described as 300mg every four hours until resolution of symptoms. His most recent episode in [**2100-6-6**] required admission to [**Hospital3 **] for repeat cardioversion. He has not had further palpitations since then and is referred for left atrial tachycardia ablation. . Prior to admission the patient reported feeling well except for an occasional sensation of skipped beat. He had intermittent LE edema which he treated with compression stockings and as needed lasix. When he is in the arrhythmia for a prolonged period, he is aware of palpitations and a feeling of being run down. . He presented on the morning of admission to the CCU for elective ablation for A-fib complicated by pericardial effusion. MAPs fell into the 40s. A drain was placed and 500cc were drained. His MAPs rose into the 80-90s and he was brought to the CCU for treatment and monitoring. . On arrival to the CCU, patient was intubated with normal pressures. Past Medical History: 1. CARDIAC RISK FACTORS: Diabetes (pre), + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: None -PACING/ICD: None 3. OTHER PAST MEDICAL HISTORY: PAF s/p multiple cardioversions, s/p ablation [**3-/2099**], s/p ablation [**7-/2100**] Sleep apnea (does not use machine) Elevated PSA, three prior biopsies negative [**2083**] Cholecystectomy ? Asthma, frequent bronchitis Microscopic Hematuria- cystoscopy negative per patient report Hx of Extended-spectrum beta-lactamase (ESBL) Social History: -Tobacco history: Never -ETOH: one beer 1-2 times per month -Illicit drugs: Denies Married with two children. Works as an electrical engineer. Family History: His grandfather also had atrial fibrillation. He has two daughters, one of whom is 29, has had paroxysmal atrial fibrillation for the past five years. Physical Exam: ADMISSION PHYSICAL EXAMINATION: VS: T=98.3 BP=124/73 HR=99 RR=17 O2 sat= 98% GENERAL: WDWN male, intubated HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. Pericardial drain in place. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. 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+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ Pertinent Results: Admission Labs: [**2100-7-21**] 07:00AM BLOOD WBC-8.1 RBC-4.90 Hgb-15.3 Hct-45.3 MCV-93 MCH-31.3 MCHC-33.8 RDW-13.0 Plt Ct-193 [**2100-7-21**] 07:00AM BLOOD PT-23.0* INR(PT)-2.2* [**2100-7-21**] 07:00AM BLOOD Glucose-167* UreaN-16 Creat-0.8 Na-142 K-3.8 Cl-106 HCO3-26 AnGap-14 [**2100-7-21**] 04:20PM BLOOD Calcium-8.2* Phos-3.4 Mg-1.8 . Discharged labs: [**2100-7-22**] 05:20AM BLOOD WBC-11.4* RBC-4.30* Hgb-13.2* Hct-40.4 MCV-94 MCH-30.8 MCHC-32.8 RDW-12.9 Plt Ct-201 [**2100-7-22**] 05:20AM BLOOD PT-21.1* PTT-32.2 INR(PT)-2.0* [**2100-7-22**] 05:20AM BLOOD Glucose-154* UreaN-13 Creat-0.8 Na-140 K-3.7 Cl-107 HCO3-25 AnGap-12 [**2100-7-22**] 05:20AM BLOOD Calcium-8.0* Phos-3.2 Mg-2.0 . [**2100-7-21**] TTE: There is a small-moderate pericardial effusion visualized along the LV apex and right ventricle. Tamponade physiology cannot be excluded based on the initial pre-pericardiocenthesis. Following aspiration of 400 cc of fluid, the amount of pericardial effusion appears small without echocardiographic signs of tamponade. After removal of an additional 100 cc of fluid, the pericardial effusion appears trivial. Based on limited views, global left ventricular systolic function is normal (LVEF > 55%). . [**2100-7-22**]: TTE There is a trivial/physiologic pericardial effusion. There is an anterior space which most likely represents a prominent fat pad. There are no echocardiographic signs of tamponade. . IMPRESSION: Focused study. Trivial pericardial effusion without echocardiographic evidence of tamponade. . Compared with the prior study (images reviewed) of [**2100-7-21**], the findings are similar (when compared to the post-pericardiocentesis images performed at the end of the study). Brief Hospital Course: 62 yo male with PAF, HTN, and HLD who presented for elective ablation for A-fib complicated by pericardial effusion. #Pericardial Effusion: Patient's ablation procedure was complicated with ablation through left atriam with resulting pericardial effusion. In the cath lab, patient's MAPs fell into the 40s during the procedure. He was placed on neo and pericardiocentsis was perfromed with drainage of 500cc of bloody fluid. Subsequently his MAPs rose into the 80-90s and neo was discontinued. He was transfered to CCU for further monitoring overnight. Per report patient ablation was not totally completed at the time of pericardial effusions. Overnight in the CCU patient's blood pressure reamined stable. He reported improvement in his pleuritic chest pain. Overnight patient had about 125ml of serosangrounes fluid in the drain with no blood or clot therefore the drain was removed and sterile dressing applied. He had repeat echo in the morning which did not show any further reaccumulation of pericardial fluid. Patient was discahrged on colchicine 0.6mg for one month to help with pain and prevent pericarditis. #Recurrent atrial fibrillation: He underwent a left atrial ablation for recurrent PAF. The procedure was complicated as above. His INR remained 2.0 and his Coumadin was continued as an outpatient with an INR check on [**2100-7-26**] at his [**Hospital 197**] clinic. He was continued on Metoprolol 25 mg twice daily as prescribed. he was also started on Aspirin 325 mg daily for 1 month post ablation. Prilosec 40 mg daily for 1 month. #HLD: continued home atrovastatin EMERGENCY CONTACT: [**Name (NI) 8513**] (wife) [**Telephone/Fax (1) 90267**] (cell) #Transitional issues: - Started patient one month of aspirin. Continued Coumadin daily, INR goal [**1-8**]. PT/INR at [**Hospital3 3765**] on [**2100-7-26**]. - Patient will follow up with Dr. [**Last Name (STitle) **] on thursday [**8-26**], [**2099**] at 2:40pm Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from webOMR. 1. Magnesium Oxide 500 mg PO DAILY 2. Metoprolol Tartrate 25 mg PO BID 3. Flecainide Acetate 300 mg PO Q4H:PRN while in AF 4. Warfarin 6-8 mg PO DAILY 5. Atorvastatin 10 mg PO DAILY 6. Furosemide 20 mg PO DAILY:PRN LE edema 7. Multivitamins 1 TAB PO DAILY 8. Calcium Carbonate 600 mg PO DAILY 9. Potassium Chloride 20 mEq PO DAILY:PRN while taking lasix Duration: 24 Hours Hold for K > 5.0 10. Tamsulosin 0.8 mg PO DAILY Discharge Medications: 1. Aspirin 325 mg PO DAILY Duration: 1 Months 2. Atorvastatin 10 mg PO DAILY 3. Metoprolol Tartrate 25 mg PO BID Hold HR<55, SBP<100 4. Omeprazole 40 mg PO DAILY Duration: 1 Months 5. Tamsulosin 0.8 mg PO DAILY 6. Warfarin 6 mg PO DAILY as directed 7. Potassium Chloride 20 mEq PO DAILY:PRN while taking lasix Duration: 24 Hours Hold for K > 5.0 8. Calcium Carbonate 600 mg PO DAILY 9. Furosemide 20 mg PO DAILY:PRN LE edema 10. Magnesium Oxide 500 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Colchicine 0.6 mg PO DAILY Duration: 30 Days Discharge Disposition: Home Discharge Diagnosis: Primary: pericardial effusion Secondary: atrial fibrilation Discharge Condition: Hospital course; Mr. [**Name14 (STitle) 90268**] was admitted to the hospital following an elective ablation for recurrent symptomatic atrial fibrillation. It was complicated by a collection of fluid around your heart. The fluid was drained and you did well. A follow up echo did not show any further accumulation of fluid. Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 90269**], It was a pleasure taking care of you at [**Hospital1 827**]. You were admittted to the hospital following an ablation to treat atrial fibrillation. The procedure was complicated by a collection of fluid around your heart. The fluid was drained and you did well. We made the following changes to your medications: - Please take Prilosec (omeprazole) daily for 1 month to decrease stomach acid. - Please take aspirin daily for 1 month to decrease inflammation. - Please take colchicine daily for 1 month to prevent inflammation around the heart. This medicine may cause nausea and diarrhea. Followup Instructions: Please have your INR checked at your clinic at [**Hospital1 **] on Monday. Department: CARDIOLOGY [**Location (un) **] When: THURSDAY [**2100-8-26**] at 2:40 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**Telephone/Fax (1) 1536**] Building: [**Apartment Address(1) 71186**] ([**Location (un) 1514**],MA) [**Location (un) 895**] Campus: OFF CAMPUS Best Parking: Parking on Site Completed by:[**2100-7-23**] ICD9 Codes: 9971, 2724, 4019
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Medical Text: Admission Date: [**2188-12-24**] Discharge Date: [**2188-12-30**] Date of Birth: [**2137-10-11**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 134**] Chief Complaint: Acute Coronary Syndrome with V-Fib Arrest Major Surgical or Invasive Procedure: Cardiac Catheterization with placement of Bare Metal Stents to the Right Coronary Artery - [**2188-12-24**] History of Present Illness: **History obtained from medical record/pt's wife 51-year-old man with a past medical history of hypertension and hyperlipidemia who was brought by EMS to the ED at [**Hospital1 **] on the evening prior to admission with VFib arrest. He complained of feeling "poorly" all day on the day prior to admission, with back pain, nausea, and profound weakness (though he did go towork). He took tylenol with codeine for back pain and Tums for symptoms of indigestion. He went to bed at midnight. As soon as his wife shut the lights off, she felt him shaking, turned on the lights and he was "having a seizure" and did not respond to her. 911 was called; EMS arrived within 5 minutes. Found the patient nonresponsive. Placed AED-->V-Fib arrest--> defibrillated him x 1. He developed sinus brady, transient Afib and then sinus tach. Lidocaine gtt started. SBP low at 80, dopamine gtt started. Unable to intubate, bagged him successfully. Given narcan due to pinpoint pupils with no response. He was transported to [**Hospital1 **]. . OSH COURSE: GCS on arrival to ED= 5. He was intubated, NGT and foley placed. Head CT negative for bleed, chest CT negative for PE. His cardiac enzymes were positive (trop 712, CPK 466, MBI 6.5, ALT 271, ALT 195, ABG: 7.37/36/231). Initial EKG with Afib at 98, Lateral ST depressions, inferior Q waves; then converted to sinus rhythm 117, lateral ST depression, inferior Q waves. BP increased to 210/140, dopamine and lidocaine discontinued. Given NS 1.5L, ASA 325, Plavix 300, heparin and integrillin gtts, metoprolol 5 mg IV, Ativan 2 mg. Admitted to OSH ICU overnight. Cardiac cath performed on the day of transfer; found to have 100% occluded RCA with collaterals, Left Main: 20% at ostium, LAD: clean, D1 50% ostial stenosis, LCx: 30% stenosis. V gram: EF 40%, inferior wall hypo/akinesis, normal mitral valve, normal aortic root. Started on integrillin, transferred to [**Hospital1 18**] for revascularization. Vitals at OSH: HR in 60's afebrile, SBP 9o's. . Past Medical History: Hypertension hyperlipidemia remote h/o tobacco use . Cardiac Risk Factors: - Diabetes, + Dyslipidemia, + Hypertension Social History: Social history is significant for the absence of current tobacco use; he is a former smoker (stopped in [**2161**], has 15 pk yr hx). There is no history of alcohol abuse, currently drinks less than 1 glass of wine/day. Exercises regularly. Family History: There is no family history of premature coronary artery disease or sudden death. Mother died of MI at 63, also had DM, depression. Father: died at 70 COPD, ETOH. He has 1 sister and 4 brothers, one had CABG in 50s. Works as architect, married x 25 years, has 2 sons. Physical Exam: VS: T 101 , BP 98/55, HR 82, RR 22, O2 100% VENT: AC 500x18, 40% O2, PEEP= 5. Gen: WDWN middle aged male, intubated/sedated. NGT in place, draining coffee grounds. NEURO: Sedated/nonresponsive. +gag, +corneal reflexes, withdraws RUE, RLE, LLE in response to pain, babinski upgoing b/l. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple CV: PMI located in 5th intercostal space, midclavicular line. heart sounds distant, RR, normal S1, S2. No S4, no S3. No murmur. Chest: No chest wall deformities, scoliosis or kyphosis. No crackles, wheeze, rhonchi on anterior exam. Abd: Obese, soft, ND, No HSM or tenderness. No abdominial bruits. NGT with guaic + drainage. Ext: No c/c/e. No femoral bruits. R fem arterial sheath in place Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ PT, dopperalble DP Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP, 1+ PT Pertinent Results: EKG demonstrated NSR at 79, nl axis, nl intervals, Q's in 2,3,avF, TWI 3, avF, 1 PVC. . TELEMETRY demonstrated: NSR at 85 . [**2188-12-24**] 02:28PM WBC-7.4 RBC-3.60* HGB-11.7* HCT-32.7* MCV-91 MCH-32.7* MCHC-36.0* RDW-12.6 [**2188-12-24**] 02:28PM NEUTS-86.5* BANDS-0 LYMPHS-8.6* MONOS-4.2 EOS-0.5 BASOS-0.2 [**2188-12-24**] 02:28PM CK-MB-97* cTropnT-5.19* [**2188-12-24**] 02:28PM GLUCOSE-159* UREA N-28* CREAT-1.1 SODIUM-140 POTASSIUM-4.4 CHLORIDE-111* TOTAL CO2-17* ANION GAP-16 [**2188-12-24**] 03:55PM CK-MB-88* MB INDX-5.2 cTropnT-5.91* . Cath: [**12-24**] 1. Limited coronary angiography demonstrated single (1) vessel coronary artery disease. The right coronary artery demonstrated a totally occluded proximal RCA with a large thrombus burden. The left system was not engaged - outside hospital angiography demonstrated no severe stenosis with the distal left supplying collaterals to the right. 2. Successful thrombectomy, PTCA and stenting of the proximal - mid RCA with a Vision (3x28mm) bare metal stent postdilated with a 4.0 mm balloon in the proximal portion of the stent. Final angiography demonstrated no angiographically apparent dissection, no residual stenosis and TIMI III flow (see PTCA comments). FINAL DIAGNOSIS: 1. One vessel coronary artery disease. 2. Acute inferior myocardial infarction, managed by thrombectomy, PTCA and stenting of the proximal-mid RCA with a bare metal stent. . TTE [**12-25**]: The left atrium is normal in size. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with inferior akinesis and basal inferolateral hypokinesis. The remaining segments contract normally (LVEF = 45%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Mild regional left ventricular systolic dysfunction, c/w CAD. Brief Hospital Course: ASSESSMENT AND PLAN Pt. is a 51y.o. M with a PMH of HTN and hyperlipidemia transferred from OSH after VFib arrest and diagnostic cath demonstrated TO of RCA. . # CAD/Ischemia: Pt presented with late sx of ischemia after suffering Vfib arrest at home. Per records EMS defibrillated w/in 5minutes of call. Diagnostic cath at OSH demonstrated no stenosis of LAD, 50% ostial D1, mild stenosis of mid LCx and prox occlusion of RCA. LVgram EF 40%. Pt underwent PCI upon transfer with BMS to RCA. Pt HD stable. Peak CK 1700. Patient was maintained on aspirin, plavix, metoprolol, high-dose statin, and lisinopril 10mg daily, and was discharged on these medications. . # Pump: LV gram as OSH demonstrated EF of 40%. ECHO showed EF of 45% with akinesis of inferior wall and no RV involvement. Patient to be continued on metoprolol and lisinopril as an outpatient, and should also have an echocardiogram done within 2 months time to assess his heart function. . # Rhythm: Pt currently NSR. History of Vfib arrest, most likely secondary to ischemic event. His QT-interval have been monitored on morning ECGs and are not concerning. He was monitored on telemetry while hospitalized and did not have any further arrhythmias. . # Altered Mental Status - Pt was bagged in the field by EMS and intubated on arrival at OSH. Per records, the Pt was resuscitated quickly following arrest. Unclear length of time the patient was anoxic. Per report CT head negative for evidence of CVA. Patient has been improving since extubation. Per behavioral neurology consult, this is likely anoxic brain injury, and will improve with time, no need for MRI at this time. Will need outpatient rehabilitation. Psychiatry was consulted to see patient for agitation, confusion, and paranoia, and suggested using Haldol and redirection rather than antipsychotics or sedatives. His mental status has since greatly improved, and his short term memory continues to improve as well. He is being discharged on Haldol 1mg at bedtime as needed, given this improvement. He will need further neuro-rehabilitation. . # PNA - Patient has been febrile since admission. PA and lateral CXR with RUL opacity, and sputum culture positive for heavy growth of MSSA. Blood cultures NGTD and patient will need to finish a 10-day course of Doxycycline. Etiology unclear but etiologies include aspiration during myocardial infarction, or introduction of organisms during intubation. He will complete his course of antibiotics on [**2189-1-6**]. . # GI bleed - On admission, pt with coffee ground emesis on NG tube suctioning - heme positive. No evidence of active bleeding with NG lavage. Bleed most likely related to trauma of NG tube placement with anticoagulation. Hematocrit has remained stable with no further evidence of bleed. Patient was maintained and discharged on a PPI. . # Elevated LFTs - At OSH AST 271, ALT 197. Elevation most likely related to MI, continued to improve during hospitalization. . Medications on Admission: MEDICATIONS AT HOME: (per OSH records) Lisinopril 40 daily Atenolol 25 daily . MEDICATIONS on Transfer: Lipitor 80 Heparin gtt Integrillin gtt Propofol gtt Aspirin 325 Plavix 300 mg then 75 daily Protonix 40 Discharge Medications: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 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. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 6. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: Three (3) Tablet Sustained Release 24 hr PO once a day. Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2* 7. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours) for 7 days. Disp:*15 Capsule(s)* Refills:*0* 8. Haloperidol 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for agitation. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: [**Hospital3 **] Discharge Diagnosis: Primary Diagnoses: 1. Myocardial infarction with Vfib arrest 2. MSSA pneumonia 3. Anoxic brain injury . Secondary Diagnoses: Hypertension hyperlipidemia remote h/o tobacco use Discharge Condition: Afebrile, stable vital signs, tolerating POs, ambulating without assistance, mental status improving. Discharge Instructions: You were admitted to the hospital as you had a heart attack and an abnormal heart rhythm called ventricular fibrillation. You were defibrillated, or shocked, by the EMTs in the ambulance, and were brought to [**Hospital1 18**]. You had a cardiac catheterization and with removal of a clot and subsequent placement of a bare metal stent in your right coronary artery. Given the amount of time that elapsed from the beginning of your symptoms you may have suffered some anoxic brain injury. You were agitated initially, and you were seen by Psychiatry and Behavioral Neurology, who recommended a medication at bedtime called Haldol, which you should continue to take at night as needed. You continued to improve greatly, but you will need further rehabilitation after discharge. . 1. Please take all medication as prescribed. 2. Please make all medical appointments. 3. Please return to the Emergency Room immediately if you have any concerning symptoms. Followup Instructions: You should follow-up with your Primary Care Provider, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 24298**], on Tuesday, [**1-6**], at 2:30pm. Phone: [**Telephone/Fax (1) 35985**] . You should follow-up with your cardiologist within 2 weeks following discharge. If you do not have one and would like to be followed at [**Hospital1 69**], please call the Dept of Cardiology at [**Telephone/Fax (1) 62**] to schedule an appointment. . You should also follow-up with Behavioral Neurology, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on Thursday, [**1-22**], at 9:30am, on [**Hospital Ward Name 77198**], at the [**Hospital Ward Name 860**] [**Doctor Last Name **] [**Apartment Address(1) 16806**]. Phone: [**Telephone/Fax (1) 1690**] . ICD9 Codes: 486, 4019, 2724
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Medical Text: Admission Date: [**2123-6-4**] Discharge Date: [**2123-6-7**] Date of Birth: [**2052-2-14**] Sex: F Service: MEDICINE Allergies: Penicillins / Tegretol / Insulin,Beef / Insulin,Pork / Zaroxolyn Attending:[**First Name3 (LF) 1620**] Chief Complaint: hypoxia, fever/cough Major Surgical or Invasive Procedure: none History of Present Illness: HPI: 71 y/o female with PMH significant for for severe diastolic dysfunction, atrial fib, severe PVD with chronic LE ulcers, and CAD admitted through the ED with hypoxia. Pt had a recent admission to the MICU [**Date range (1) 32718**]/5 for septic shock (presumed [**3-10**] LE ulcers). She was in her normal state of health until this morning when she appeared very lethargic when trying to get out of bed. Her oxygen saturation was found to be 60% on room air at [**Hospital1 100**] Senior Life. Pt was sent to the [**Hospital1 18**] ED where her sat was 85 to 100% on a NRB with a ABG of 7.30/63/161. She was started on CPAP of 10 which she tolerated well for approximately 20 minutes. However, she then became hypotensive to 78/40 so CPAP was discontinued and she was put back on a nonrebreather. After a 500 cc bolus, pt's SBP increased to around 90. Her Sats came up to 94-100% on 4L NC. Pt states she has had productive cough x 5 days. Otherwise ROS neg for f/c, HA, stiff neck, abd pain, d/c/n/v. . In ED, received vanco, levofloxacin, flagyl, solumedrol 50mg, tylenol . Past Medical History: 1. CHF diastolic dysfunction (EF 65% 1/05 MIBI normal) DRY WEIGHT 194 lbs 2. DM 2 on insulin 3. Atrial Fibrillation 4. Anemia 5. CAD s/p PTCA x 3 (RCA '[**09**], LCx '[**10**], RCA '[**13**]) 6. Pulmonary HTN 7. Hypercholesterolemia 8. COPD/[**Year (2 digits) 105496**] on home O2 (sometimes on home O2) 9. Thyroid CA s/p resection/now hypothryoid 10. Myoclonic tremors 11. H/O PE 12. OSA on CPAP (started last admission) 13. Depression/Anxiety 14. h/o MRSA/VRE. ICU admit x 2 for MRSA aortic valve endocarditis and pseudomonal sepsis (secondary to wound infection), status post intubation x 2. 15. S/p laproscopic cholecystectomy [**34**]. s/p right throcoscopy and decortication. Right lung bx. 17. s/p right hip ORIF 18. s/p right ankle ORIF Social History: SH: Pt lives at [**Hospital1 100**] Senior Life. She is divorced and has three children. She quit smoking in [**2104**] but has a history of 1 PPD for 15 years. No ETOH or drugs. Family History: FH: [**Name (NI) 1094**] father died at age 47 from a MI. Her mother died of colon CA. Pt has a brother with DM. Physical Exam: PE: 103.8 --->101.7 w/o meds 88 107/52 18 98% 2L NC Genl- well appearing, conversant, NAD HEENT- anicteric, sclera/op clear, dry mm Neck- jvd difficult to appreciate, supple Cardiac- irregular no m Lungs: crackles halfway up on R and [**2-8**] way up on L Abdomen- +bs, soft, nt Extremities- chronic LE ulcers b/l, chronic venous stasis changes Neuro- alert and oriented, moving all extremities Pertinent Results: [**2123-6-4**] 11:45AM LACTATE-1.6 [**2123-6-4**] 11:18AM K+-4.8 [**2123-6-4**] 11:15AM URINE HOURS-RANDOM [**2123-6-4**] 11:15AM URINE GR HOLD-HOLD [**2123-6-4**] 11:15AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG [**2123-6-4**] 11:15AM URINE RBC-0-2 WBC-[**4-10**] BACTERIA-FEW YEAST-NONE EPI-0-2 [**2123-6-4**] 09:16AM TYPE-ART RATES-/30 O2-100 PO2-161* PCO2-53* PH-7.30* TOTAL CO2-27 BASE XS-0 AADO2-506 REQ O2-84 INTUBATED-NOT INTUBA COMMENTS-NON-REBREA [**2123-6-4**] 09:16AM HGB-11.4* calcHCT-34 [**2123-6-4**] 09:05AM CK(CPK)-122 [**2123-6-4**] 09:05AM CALCIUM-8.7 PHOSPHATE-4.8* MAGNESIUM-1.9 [**2123-6-4**] 09:05AM CK-MB-2 [**2123-6-4**] 09:05AM WBC-22.0*# RBC-4.44 HGB-12.0 HCT-38.3 MCV-86 MCH-27.1 MCHC-31.4 RDW-30.5* [**2123-6-4**] 09:05AM NEUTS-86* BANDS-6* LYMPHS-3* MONOS-2 EOS-3 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2123-6-4**] 09:05AM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2123-6-4**] 09:05AM PLT COUNT-331# [**2123-6-4**] 09:05AM PT-13.4 PTT-31.9 INR(PT)-1.1 ECG- Narrow complex tachycardia at 134 beats per minute. No clear ST-T wave changes. . CXR (WET READ)- Cardiomegaly. Question of mild edema. Brief Hospital Course: 71f w/ extensive PMHx, including recent admit [**Date range (1) 32718**]/5 for septic shock (presumed [**3-10**] LE ulcers) who presents from Rehab with hypoxia, fever, leukocytosis and transient hypotension. 1. Hypoxia: This was most likley secondary to bronchitis/mucous plugging. Her hypoxia resolved with bringing up a mucous plug, and her oxygen saturation remained appropriate with minimal supplemental oxygen. She was weaned from 2L nc to room air. Her chest film on admission revealed stable chronic interstitial lung disease, with no evidence of acute PNA or CHF. h/o [**Month/Day (2) 105496**], ILD. transient hypoxia over hours. Pt's sat already up to 99% on 2L NC. . 2. Fever/leukocytosis: possible sources include LE ulcers, and pulmonary. UA neg. She recently completed 2week course of vanco/ceftaz/flagyl for her ulcers. Over course of hospital stay, trimmed abx down to just levo/vancomycin for presumed bronchitis since she has a hx of MRSA. She got a PICC line placed on [**6-7**] and will complete a 10 day course of Vanc/Levo for prsumed bronchitis vs bacterial pneumonia. She was seen by [**Month/Day (2) **] while in house, and continued her routine dressing changes and wound care. There was no evidence of wound infection at this time. . 3. Hypotension - Overall, this was transient, and likely secondary to decreased preload in the context of positive pressure ventilation. Thereafter, she remained normotensive, and required no further hemodynamic support. There was no evidence of sepsis, and her [**Last Name (un) 104**] stim test showed no evidence of adrenal insufficiency. . 5. DM - She was continued on glargine and RISS . 6. Pain - She was continued on fentanyl patch, prn oxcodone, and gabapentin. . 7. Asymmetric leg swelling: She has a hx of severe PVD and chronic venous stasis. LENI was negative for DVT. Asymmetric leg edema is likely from her chronic venous change. . 8. Access - She got a PICC line placed in the right arm on [**6-7**]. . 9. PPx - PPI, hep SC . 10. Code status - FULL CODE Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation every 4-6 hours as needed for shortness of breath or wheezing. 3. Atrovent 18 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation every four (4) hours. 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Fentanyl 50 mcg/hr Patch 72HR Sig: One (1) Patch 72HR Transdermal Q72H (every 72 hours). 6. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day). 7. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO HS (at bedtime). 8. Lansoprazole 15 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 9. Levothyroxine Sodium 200 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Methylphenidate HCl 10 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 11. Methylphenidate HCl 5 mg Tablet Sig: One (1) Tablet PO NOONTIME (). 12. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). 13. Simvastatin 40 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 14. Topiramate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 15. Olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed. 16. Oxycodone HCl 5 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed. 17. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 18. Insulin Glargine 100 unit/mL Solution Sig: Fifteen (15) units Subcutaneous at bedtime. 19. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 20. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 21. Vancomycin HCl 1000 mg IV Q12H 22. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours): day#1 was [**6-5**] for first full day of abx; continue for 10d course. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - [**Location (un) 550**] Discharge Diagnosis: 1. Hypoxia - resolved 2. fever, bronchitis/pneumonia 3. hypotension - resolved 4. atrial fibrillation 5. h/o CAD 6. DM 2 7. hypothyroidism 8. COPD/[**Location (un) 105496**], pulmonary htn 9. anxiety/depression 10. h/o MRSA and VRE 11. chronic lower extremity [**Location (un) 1106**] disease/ulcerations Discharge Condition: good Discharge Instructions: Weights at NH to monitor fluid status 2 gm sodium diet Continue antibiotics and regular medications. Follow up with [**Hospital1 100**] SeniorLife primary physician Completed by:[**2123-6-7**] ICD9 Codes: 4280, 2859
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Medical Text: Admission Date: [**2144-12-17**] Discharge Date: [**2144-12-22**] Date of Birth: [**2099-2-28**] Sex: F Service: NEUROLOGY Allergies: Penicillins / Dilantin Attending:[**First Name3 (LF) 19817**] Chief Complaint: transfer from CHB after status epilepticus Major Surgical or Invasive Procedure: extubation History of Present Illness: Per admitting resident: 54 year old woman with history of seizure disorder, smoker, who presents intubated after having been on and off seizures for 30 min. She is a patient of Dr. [**Last Name (STitle) 2442**], has partial complex seizures. She was having increased seizure frequency when she was last seen in clinic by Dr. [**Last Name (STitle) 2442**] in [**5-23**], one every other day. "Almost all are staring spells with oral automatisms and touching her lips. She is not aware of the start of them and may not be aware of the entire seizure or not for the reports of her children and coworkers"; her boyfriend says that she rarely has GTC seizures, last one was 2 months ago. She has been on lamictal 900mg; stopped keppra on [**12-22**] due to side effects. Of note, her first seizure occurred at age 16 and led to a fall and head injury. She works at the [**Hospital1 **] at the neurology department and was seen to have R sided twitching that evolved to GTC seizures, intermittently, for a period of 30 min. She received 15 diastat; was intubated in [**Hospital1 **] ER; sedated on versed and received a total of 8mg ativan. Her WBC was 20; had a temperature 38.9 C and she was given 2mg ceftriaxone. An LP was performed with 0 WBC 1 RBC (unknown protein and glucose values right now). She was loaded with 1g dilantin. A head CT was read as negative at [**Hospital1 **] and she was transferred here. On arrival here she had T 98.9 BP 103/60 P 93 RR 19 Sat 100, intubated. She received 1g of vancomycin. She was found to have a UTI. She had no jerks and eyes were midline. Past Medical History: -epilepsy (as above) -asthma -eating disorder -fibroids Social History: lives with 2 daughters, smokes 5 cigarettes per day as per previous notes, works at [**Hospital1 **] neurology department as a secretary; no history of alcohol abuse Family History: paternal uncle with seizures, sister with ESRD on HD, HTN, and "SA" (?substance abuse) Physical Exam: Exam on admission: T 98.9 BP 103/60 P 93 RR 19 Sat 100; intubated Gen: Lying in bed, intubated HEENT: NC/AT, moist oral mucosa Neck: supple CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema Neurologic examination: Mental status: intubated,on versed, grimaces to noxious stimuli Cranial Nerves: Pupils equally round and slugshly reactive, 3 mm bilaterally. Normal Doll's, corneal and gag reflexes. Motor: She moves all extremities symmetrically and spontaneously Sensation: She retracts all extremities symmetrically to noxious stimuli Reflexes: B T Br Pa Pl Right 2 1 1 1 1 Left 2 1 1 1 1 Toes were downgoing bilaterally. Coordination: not able to perform Gait: not able to perform Romberg: not able to perform Exam at time of discharge: Pertinent Results: Labs on admission: [**2144-12-17**] 10:52AM BLOOD WBC-30.5* RBC-3.93* Hgb-12.3 Hct-35.6* MCV-91 MCH-31.4 MCHC-34.6 RDW-12.6 Plt Ct-298 [**2144-12-18**] 02:12AM BLOOD WBC-18.5* RBC-3.45* Hgb-10.4* Hct-32.1* MCV-93 MCH-30.3 MCHC-32.6 RDW-13.3 Plt Ct-254 [**2144-12-18**] 02:12AM BLOOD Neuts-88.0* Lymphs-8.1* Monos-3.7 Eos-0.1 Baso-0.1 [**2144-12-17**] 10:52AM BLOOD PT-14.2* PTT-21.5* INR(PT)-1.2* [**2144-12-18**] 02:12AM BLOOD Glucose-92 UreaN-8 Creat-0.7 Na-144 K-3.3 Cl-114* HCO3-23 AnGap-10 [**2144-12-17**] 10:52AM BLOOD ALT-38 AST-26 LD(LDH)-257* CK(CPK)-122 AlkPhos-74 TotBili-0.4 [**2144-12-17**] 10:52AM BLOOD Albumin-4.5 Calcium-9.5 Phos-2.6* Mg-2.0 [**2144-12-17**] 10:52AM BLOOD cTropnT-<0.01 [**2144-12-17**] 10:52AM BLOOD Lipase-11 [**2144-12-17**] 03:35PM BLOOD TSH-0.99 [**2144-12-17**] 03:35PM BLOOD Phenyto-18.7 Toxicology: [**2144-12-17**] 10:52AM BLOOD ASA-4 Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG Urine studies: [**2144-12-17**] 10:52AM URINE RBC-0-2 WBC-[**6-24**]* Bacteri-MOD Yeast-NONE Epi-[**6-24**] [**2144-12-17**] 10:52AM URINE Blood-NEG Nitrite-NEG Protein-25 Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-TR [**2144-12-17**] 03:34PM URINE Blood-MOD Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG Imaging: CT head: Prelim - no acute intracranial process CXR - no pulmonary pathology CT abd/pelvis; 1. Abnormal perfusion of the left kidney with areas of decreased enhancement within the cortex. These findings are worrisome for an acute pyelonephritis. Please clinically correlate. 2. Low attenuating lesion within segment II of the liver, indeterminate in etiology, this may represent an atypical hemangioma. Further workup is recommended, and can commence with an ultrasound. 3. Enlarged uterus with multiple fibroids. There is also enlargement of the right ovary. Therefore, an ultrasound of the pelvis may be warranted for further evaluation and to ensure stability. Liver ultrasound; IMPRESSION: Nonspecific subcentimeter hypoechoic lesion within the left hepatic lobe, corresponding to CT abnormality. Findings not characterizable as hemangioma and MR may be performed to further assess as clinically indicated. Urine culture; yeast Brief Hospital Course: 45 year old woman with history of seizure disorder (complex partial seizures and occasional GTC) who was transferred from CHB after a seizure cluster (30 mins) in setting of 38.9C, WBC of 20K. On trasfer, she was intubated and her LP and CT head were reportedly negative. Patient was loaded with Dilantin at CHB with subsequent level of 18. She was admitted to Neuro ICU for further treatment and monitoring. NEURO: Suspected status epilepticus. Infectious evaluation was as below. Routine EEG did not show epileptiform activity. She was extubated and restarted on Lamictal 600mg [**Hospital1 **] (dosing reported by patient). Dilantin was discontinued, she was temporarily bridged with ativan 1mg IV Q8H while she was not able to take PO. After extubation, patient appeared encephalopathic, with impaired attention, intrusion saccades and lateral gaze nystagmus without focal features. It was felt that worsening of her seizure frequency was most likely due to either an infectious process, medication non-adherence or non-epileptic seizures (an event was witnessed while in ICU: report of a gaseous odor, staring for 10 seconds, bilateral arm shaking that was suppressible by examiner (total duration of 30 seconds) and no post-ictal confusion). The patient was transferred to the floor and refused further EEG monitoring during the hospitalization because she was very angry her hair was cut at time of presentation when leads were initially placed. She was maintained on the lamictal 600 [**Hospital1 **] but voiced concern over her dosing multiple times. The patient initially stated she was taking this dose at home, however there were several conflicting reports as to her actual dose she was taking. [**Location (un) 535**] was [**Location (un) 653**] and she had been receiving lamictal 100 mg tabs, directed to take 5 tabs [**Hospital1 **], and given 300 tabs per month. This was last filled [**2144-10-1**]. When this was discussed with the patient, she stated that she was taking 500 mg [**Hospital1 **], but still had pills left from her last refill (which appeared to be inconsistent with the number of pills dispensed at that time). The last note from the patient's epileptologist, Dr. [**Last Name (STitle) 2442**], reported a plan to take lamictal 900 mg daily. Given the conflicting reports, it was decided to discharge the patient on this dose. She had an episode [**12-21**] in which she vomited and then became unresponsive with tonic posturing, eyes open and midline with occasional frequent blinking, and was unresponsive to noxious stimuli. The episode lasted approximately five minutes and resolved after 1 mg ativan. She had no further episodes and neurological examination at time of discharge was nonfocal with fluent speech, EOMI with no nystagmus, and steady gait. ID: Temperature at CHB of 38.9C max, WBC of 30K. She had a history of chills and malaise 2 days prior to her event. No cough, no subjective fever, no diarhea, but had LLQ tenderness. BCx have showed no growth to date. UA was contaminated and repeat UA showed mild leukocyte count with elevated RBCs, which were treated as a UTI with ceftriaxone started. This was changed to PO bactrim on day 5. A urine culture only grew out yeast, which was presumed to be a contaminate. A CT abdomen/pelvis was concerning for acute pyleonephritis and she was continued on a 7-day antibiotic course for this. Her leukocytosis has trended down and has been afebrile for the past 4 days prior to discharge. A respiratory culture was negative. PULM: Patient was extubated on HD 1 w/o complications. CXR did not show evidence of PNA. GI: Patient was complaining LLQ pain x 1 week, which was attributed to pyleonepritis as above and had resolved with antibiotic treatment. Also, on CT abd/pelvis, a subcentimeter liver lesion was noted and ultrasound was performed for further evaluation which was also non-diagnostic. The patient's PCP was [**Name (NI) 653**] regarding this finding, which can be followed up as an outpatient. F/E/N: During the hospitalization there was also some concern by the primary team of weight loss since her last admission and anorexia, and it is advised that the patient continued to be evaluated for this by her PCP. Medications on Admission: -lamictal 600mg [**Hospital1 **] Discharge Medications: 1. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 3 days. Disp:*6 Tablet(s)* Refills:*0* 2. Lamotrigine 100 mg Tablet Sig: Four (4) Tablet PO QAM (once a day (in the morning)). 3. Lamotrigine 100 mg Tablet Sig: Five (5) Tablet PO QPM (once a day (in the evening)). Discharge Disposition: Home Discharge Diagnosis: Seizure disorder Pyelonephritis Discharge Condition: Fluent speech, attentive. EOMI, no nystagmus. No asterixis. Full strength throughout, steady gait. Discharge Instructions: You were admitted to [**Hospital1 18**] from [**Hospital3 1810**] after you were found to have a suspected seizure. At [**Hospital3 **] you underwent a lumbar puncture (negative) and a CAT scan of your head(negative), were intubated and were transferred to our hospital. You were found to have an infection in your kidney and treated with antibiotics. You were also found to have a small lesion in your liver on the CAT scan and ultrasound. Please follow this up with your PCP. [**Name10 (NameIs) 357**] continue your medications as prescribed, avoid driving or any other activities (such as unsupervised swimming) that may put you or others in danger should you have recurrent events. Followup Instructions: Please follow with the following appointments: NEUROLOGY:[**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 3506**] Date/Time:[**2145-2-9**] 9:30 PRIMARY CARE: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5447**], M.D. Date/Time:[**2145-1-12**] 5:20 ICD9 Codes: 3051
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Medical Text: Admission Date: [**2101-11-30**] Discharge Date: [**2101-12-6**] Date of Birth: [**2023-6-28**] Sex: M Service: HISTORY OF PRESENT ILLNESS: The patient is a 78 year old gentleman with a past medical history of syringomyelia with residual left hemi-diaphragmatic paralysis and chronic obstructive pulmonary disease on home oxygen. He presents from an outside hospital after two days of worsening shortness of breath. By report, the patient had stopped his Lasix two weeks prior to admission to the outside hospital and had begun home oxygen around the clock instead of at night only. On admission to the outside hospital, he was found to have a collapse of the left lung, initially thought secondary to mucus plugging, since he did improve with suctioning at that time. On [**2101-11-17**], the patient was diagnosed with a right lower lobe pneumonia at the outside hospital and started empirically on Vancomycin and Zosyn. The patient was transferred to the Intensive Care Unit there for respiratory failure on [**2101-11-21**] and intubated at that time. Bronchoscopy was performed on [**11-22**] which found a mass in the left medial basilar lobe, with intrinsic compression of other bronchi. Biopsy done on that lesion came back as collagen, with a question of possible chondroma or bronchial cartilage. The patient was transferred to our hospital for a possible endobronchial intervention by Dr. [**Last Name (STitle) **]. On receiving the patient from the outside hospital, he was alert and responsive to voice. He was in restraints but denied any pain or discomfort. He was resting comfortably on the vent. PAST MEDICAL HISTORY: Other past medical history of peptic ulcer disease, complicated by gastrointestinal bleeds. He has no known drug allergies. MEDICATIONS ON TRANSFER: Zosyn 3.375 grams q. 8 hours, day 15. Prevacid 30 mg p.o. q. day. Theophylline 50 mg p.o. four times a day. Albuterol. Reglan. Celexa 20 mg p.o. q. day. Timolol eye drops. Xalatan eye drops. Dulcolax. Milk of Magnesia prn. SOCIAL HISTORY: Lives at home with his wife. PHYSICAL EXAMINATION: On admission, the patient was afebrile; blood pressure 101/65; heart rate of 65; respirations of 20; saturating 93% on the vent. In general, he was alert and appeared comfortable. He had dry oral membranes. His neck was supple. Cardiovascular examination noted a normal S1 and S2, with no murmurs. His lungs were clear on the right. He had decreased breath sounds at the left base. Abdomen had positive bowel sounds, was soft and nontender. Extremities: Warm and without edema. Left upper extremity was somewhat atrophic with 1/5 strength. LABORATORY DATA: White count was 9.9; hematocrit was 29.8; platelets were 392. Sodium was 139; potassium was 4.1; chloride 100; bicarbonate was 35; BUN was 9; creatinine .6; glucose 115. Liver function tests were all within normal limits. Calcium, magnesium and phosphorus were all normal. Chest x-ray showed complete white-out of the left lung. Electrocardiogram showed sinus rhythm with frequent premature atrial contractions. Rate was 65. He had a left axis deviation and early R wave progression but no acute ST or T wave changes. HOSPITAL COURSE: 78 year old gentleman with left hemi-diaphragmatic paralysis secondary to syringomyelia and chronic obstructive pulmonary disease, transferred from an outside hospital for further work-up and management of possible endobronchial lesion and left lung collapse. On hospital day number three, a rigid bronchoscopy was performed in the operating room which showed a distal lesion with granulation; question of a possible foreign body. An attempt at biopsy was aborted secondary to heavy bleeding. A rigid bronchoscopy was repeated on hospital day number five and a successful biopsy of the lesion was obtained and sent to pathology for further review. In terms of the patient's questionable pneumonia status, the patient had received 15 days of Zosyn at the outside hospital and it was felt that the patient did not currently have a pneumonia; thus, the Zosyn was discontinued on admission to our hospital. In terms of his chronic obstructive pulmonary disease, the patient was on a vent and got nebs and inhalers as needed. In terms of his hematologic status, the patient received two units of packed red blood cells on hospital day number six, after he had dropped his hematocrit. This was after the second bronchoscopy and he dropped his hematocrit to 20. His hematocrit following the two units increased to 35. He remained stable. In terms of his cardiovascular status, he had no known heart dysfunction and that remained stable. DISCHARGE CONDITION: The patient had a tracheostomy performed on hospital day number six, along with a second rigid bronchoscopy. The patient was weaned off the ventilator for approximately two hours on hospital day number seven. He tolerated that well. The patient was placed back onto the ventilator, secondary to some desaturations into the high 80's, however, his respiratory rate remained at around 20. DISCHARGE STATUS: Back to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 805**] Hospital. DISCHARGE DIAGNOSES: Left endobronchial lesion, not otherwise specified. Left upper lobe collapse. Chronic obstructive pulmonary disease. Anemia. DISCHARGE MEDICATIONS: Acetaminophen 650 mg p.o. q. four to six hours as needed. Albuterol neb, one neb q. six hours as needed. Albuterol inhaler, two to four puffs every six hours as needed. Celexa 20 mg p.o. q. day. Docusate 100 mg p.o. twice a day. Ipratropium bromide four puffs inhaled four times a day as needed. Lantonoprost eye drops. Lansoprazole oral solution, 30 mg p.o. q. day. Lorazepam .5 to 2 mg p.o. every six hours prn. Oxycodone 5 mg p.o. q. six hours prn. Senna one tablet p.o. twice a day prn. Theophylline 100 mg p.o. q. 8 hours. Heparin 5000 units subcutaneous q. 8 hours. Timolol eye drops. Ipratropium bromide nebs, one neb q. six hours. FOLLOW-UP PLANS: The patient should follow-up with his primary care physician following his discharge from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 805**] Hospital. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 968**] Dictated By: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. MEDQUIST36 D: [**2101-12-6**] 04:07 T: [**2101-12-6**] 17:41 JOB#: [**Job Number 53448**] ICD9 Codes: 5180, 496, 2851
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Medical Text: Admission Date: [**2184-6-1**] Discharge Date: [**2184-6-12**] Date of Birth: [**2120-9-13**] Sex: M Service: MEDICINE Allergies: Zosyn Attending:[**First Name3 (LF) 2195**] Chief Complaint: Right shoulder infection Major Surgical or Invasive Procedure: Arthroscopy and drainage of right shoulder Intubation PICC placement History of Present Illness: Mr. [**Known lastname **] is a 63 year old man who was transfered from [**Hospital **] for surgical evaluation of his right shoulder. Per records, he had visited [**Hospital3 **] 2 times within the last 2 weeks for right shoulder pain after a fall which was without fracture. He was sent with pain medications and outpatient f/u. He had an MRI which was unrevealing (per [**Location (un) **] records). On [**5-28**] he was admitted to [**Hospital3 7569**] for increased weakness, fevers, and right shoulder pain. In [**Location (un) **] ED he was noted to have WBC of 16.7 with 54 neuts and 34 bands. He denied N/V, chest pain, SOB, abd pain, headache, or syncope. CXR showed no pneumonia. Right shoulder was reportedly swollen and erythematous. U/S showed a fluid collection under the deltoid and ortho was consulted. They deferred surgery given his persistent hyponatremia. He continued to spike fevers, developed ARF with BUN/Cr of 51/2.6 (baseline 1.0). He became hypotensive and required levaphed. LFTs remained stable and RUQ U/S was negative. Since it was felt that he needed surgical drainage of his shoulder, he was transfered to [**Hospital1 18**]. He had 2 peripheral IVs, and was recieving levaphed through them. He arrived on the floor, on max dose of levaphed through his peripheral IV, but was noted to have a pressure of 170s/100s. Levaphed was weaned off entirely and the patient remained stable. Review of sytems: (+) Per HPI (-) Denies 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, or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Past Medical History: HTN Right adrenalectomy MVA 20 yrs ago with multiple injuries. Significant ETOH abuse in past, but per wife, he now drinks only 2 days/wk Social History: Works as a computer analysist. Lives with wife. T - 20 pack year history A - Former drinker, but now only drinks socially on Fridays/Saturdays per wife D - Denies illicit drug use, no IVDU Family History: NC Physical Exam: Vitals: T: 96.5 BP: 118 P: 108/64 R: 24 O2: 97% on NC of 2L General: Alert, orientedx x 1, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachy, reg rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: surgical incision scar, soft, non-tender, moderately distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, 2+ edema. R shoulder. Very painful with movement Skin: diffuse erythematous rash over trunk/chest and arms. Pertinent Results: Labs on admission: [**2184-6-1**] 02:44AM BLOOD WBC-15.9* RBC-3.26* Hgb-9.2* Hct-28.9* MCV-89 MCH-28.3 MCHC-31.9 RDW-16.2* Plt Ct-293 [**2184-6-1**] 02:44AM BLOOD Neuts-76* Bands-7* Lymphs-5* Monos-4 Eos-4 Baso-1 Atyps-0 Metas-2* Myelos-1* [**2184-6-1**] 02:44AM BLOOD Hypochr-1+ Anisocy-NORMAL Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL [**2184-6-1**] 02:44AM BLOOD PT-14.5* PTT-24.5 INR(PT)-1.3* [**2184-6-1**] 02:44AM BLOOD Glucose-96 UreaN-52* Creat-2.3* Na-131* K-4.9 Cl-100 HCO3-19* AnGap-17 [**2184-6-1**] 02:44AM BLOOD Albumin-2.3* Calcium-8.0* Phos-4.0 Mg-2.5 [**2184-6-1**] 02:44AM BLOOD ALT-82* AST-93* LD(LDH)-320* AlkPhos-94 TotBili-1.0 [**2184-6-2**] 02:51AM BLOOD Lipase-31 [**2184-6-2**] 04:52PM BLOOD Lactate-1.1 [**2184-6-1**] 02:44AM BLOOD Cortsol-14.4 [**2184-6-1**] 05:53AM BLOOD Cortsol-28.5* [**2184-6-1**] ECG: Baseline artifact. Atrial fibrillation or probable atrial flutter with predominantly 2:1 block. The baseline is difficult in terms of making differentiation between atrial flutter and atrial fibrillation and possible ST-T wave abnormalities. There certainly is an RSR' pattern in lead V1. Clinical correlation is suggested. [**2184-6-2**] CT head: There is no hemorrhage, edema, mass effect, or CT evidence of acute large vascular territorial infarction. The [**Doctor Last Name 352**]-white matter differentiation is preserved. The ventricles and sulci are normal in size and configuration. There is no shift of midline structures. The basilar cisterns are preserved. There are no abnormal extra-axial fluid collections. Osseous structures demonstrate no fracture. There is minimal mucosal thickening with small mucus-retention cysts in the right maxillary sinus. The mastoid air cells are normally-pneumatized and clear. There are punctate calcifications in the vertex scalp soft tissues, of uncertain significance. [**2184-6-2**]: CT Abdomen: 1. No evidence of obstruction or volvulus. 2. Small bilateral pleural effusions and bibasilar atelectasis, new since outside hospital CT of [**2184-5-28**]. [**2184-6-4**]: MRI Shoulder: 1. Complex, enhancing joint effusion with associated loculated collections in the subacromial-subdeltoid bursa and the subscapularis recess. Findings are consistent with an inflammatory and/or infectious arthritis. 2. Full-thickness supraspinatus and infraspinatus tendon tears with tendon retraction. 3. No definite osteomyelitis. Echocardiogram [**2184-6-5**]: The left atrium is dilated. The right atrium is dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with probably mild inferior septal hypokinesis. Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. [**2184-6-5**]: MRI/MRA of the head: The head MRA demonstrates normal flow signal within the arteries of anterior and posterior circulation. Distal left vertebral artery ends in posterior- inferior cerebellar artery, a normal variation. [**2184-6-8**]: CXR - IMPRESSION: Satisfactory position of the left-sided PICC line with the tip in the lower SVC. Interval improvement in degree of atelectasis in the left lower lobe. Mild cardiomegaly with no overt evidence of pulmonary edema. Brief Hospital Course: Mr. [**Known lastname **] is a 63 year old male with a history of ETOH abuse and hypertension transferred from an OSH for septic shock with concern for septic right shoulder. # Septic shock/Septic Shoulder/HAP: The patient was transferred from OSH on levophed but hypertensive on arrival. Levophed weaned off without difficulty. R shoulder suspected source but cell count from initial joint tap by Ortho not clearly septic appearing with WBC only 18,000 in setting of traumatic tap with negative culture. Given agitation, patient required intubation for MRI shoulder. While awaiting that study, lung bases on CT showed pneumonia, presumed HAP. Levofloxacin was discontinued but patient continued on vanc/zosyn, which was later changed to vanc/meropenem given concern for drug rash. Pt subsequently had MRI shoulder which showed a complex joint effusion with loculated collections in the subacromial-subdeltoid bursa and the subscapularis recess. R shoulder was re-tapped, this time with 101,500 WBC although still culture negative. Pt underwent wash-out of septic right shoulder on [**2184-6-5**] requiring extensive debridement and notable for finding of rotator cuff tear; intraarticular and subacromial subdeltoid bursal drains left in place. He underwent joint washout which was uneventful. He completed a course of vancomycin/meropenem for hospital acquired pneumonia and will need to complete a 4 week course of antibiotics for septic shoulder (culture data negative but frank pus in the joint). His vancomycin trough was low at 11.8 on [**6-11**] and so his dose was increased to 1.5 grams Q12H. His last dose of antibiotics should be [**2184-7-9**] unless otherwise decided by his orthopedist. He should follow-up with orthopedics 2 weeks following discharge for suture removal and further discussion regarding his antibiotic course. Pain was managed via Dilaudid IV in house, patient transitioned to PO on discharge. # Altered Mental Status: Prior to admission, the patient was last mentally cleared approximately [**5-25**] while at OSH, prior to initiation of dilaudid and flexeril. Concern for head trauma given prior fall, but head CT without acute process. Lyme and erhlichia serologies negative. Did have history of heavy EtOH, but now only drinking 2 of 7 nights per week according to wife. [**Name (NI) **] history of illicit drug use prior. Likely secondary to polypharmacy given OSH dilaudid and short course of stress dose steroids for question of adrenal insufficiency. Agitation not responsive to escalating doses of haldol (received 100mg in one day) although some improvement with ativan (despite being out of time frame for EtOH withdrawal). Required intubation for studies on [**2184-6-2**] and controlled on propofol, which was later changed to fentanyl/versed secondary to hypertriglyeridemia. Extubated on [**2184-6-5**]. Patient was also given thiamine, folate, and a MVI. The patient's mental status gradually improved in the unit and the patient felt he was at his baseline the day prior to discharge. Oxazepam and neurontin were also held due to concern for AMS. These medications were not restarted as the patient appeared to be doing well without them. # Tachycardia: Atrial flutter vs. atrial fib alternating with sinus rhythm with PACs. TTE with biatrial enlargement with mild regional left ventricular systolic dysfunction (EF 45-50%) with probable mild inferior septal hypokinesis. On HCTZ/bisprolol at home. On [**2184-6-8**] required diltiazem drip and high dose metoprolol for rate control and subsequently spontaneously converted to sinus rhythm. He was placed back onto metoprolol for blood pressure and rate control. Also started on heparin drip as a bridge to coumadin. Patient was discharge on home Bisoprolol 20mg daily. # Transaminitis: No pain on palpation and RUQ U/S from OSH without evidence of cholecystitis. Lyme and ehrlichia serologies negative. [**Month (only) 116**] have been secondary to EtOH use. Improved on discharge. # Hypertension: On HCTZ/bisprolol 10/6.25 [**Hospital1 **], clonidine 0.6 mg QSun, and Avapro 300 mg daily as outpatient. Clonidine was initially held given mental status. He was restarted on a beta blocker in the unit initially for rate control, then uptitrated in setting of hypertension. Losartan was started as avapro is not on formulary. The patient was noted to be markedly hypertensive on transfer to the medical floor. HCTZ and clonidine patches were restarted on [**6-11**]. On discharge the patient was transitioned to home Bisoprolol 20mg daily and Avapro 300mg daily. # Rash: Concern for drug rash secondary to penicillins although no documented history of drug allergies. Zosyn changed to meropenem with improvement. # Anemia: Stable. Hematocrit was serially monitored. # S/p adrenalectomy: Initially presented with shock, hyponatremia, and hyperkalemia. [**Last Name (un) **] stim was normal so stress dose steroids were discontinued. # Acute renal failure: Cr down to 1.0 from peak of 3.1 at OSH on [**2184-5-30**] with improved UOP. FENa 0.8 suggested prerenal etiology. Cr trended back down to normal over hospital course. # Constipation: KUB concerning for cecal volvulus but not seen on CT abdomen. Started on aggressive bowel regimen with good subsequent stool output. # Hyponatremia: Na 131 on admission, thought secondary to dehydration. Corrected without intervention. Medications on Admission: Medications Home: ASA 325 daily HCTZ/Bisprolol 10/6.25 [**Hospital1 **] Clonidine 0.6 mg QSun Avapro 300 mg daily Prilosec 20 mg daily Oxazepam Q 6hr prn anxiety Ambien 5 mg HS Neurontin Paroxitine 20mg daily Discharge Medications: 1. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever or pain. 3. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed for rash. 4. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for pruritis. 5. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 6. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. 7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 10. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for itching. 11. Clonidine 0.3 mg/24 hr Patch Weekly Sig: Two (2) Patch Weekly Transdermal QFRI. 12. Sodium Chloride 0.9 % 0.9 % Syringe Sig: One (1) 3 mL flush Injection Q8H (every 8 hours) as needed for line flush. 13. 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. 14. Ondansetron 4 mg IV Q8H:PRN nausea 15. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 16. Heparin, Porcine (PF) 1,000 unit/mL Solution Sig: as directed Injection continuous IV infusion: based on weight-based heparin dosing plan. 17. Vancomycin 750 mg Recon Soln Sig: Two (2) Intravenous every twelve (12) hours for 4 weeks: Needs trough checked on morning of [**6-13**] with goal range of 15-20. . 18. Avapro 300 mg Tablet Sig: One (1) Tablet PO once a day. 19. Bisoprolol Fumarate 10 mg Tablet Sig: Two (2) Tablet PO once a day. 20. Dilaudid 2 mg Tablet Sig: [**12-30**] (two-three) Tablets PO q3h as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital6 **] Discharge Diagnosis: Primary Diagnoses: Septic arthritis (right shoulder) Atrial fibrillation Hospital Acquired Pneumonia Altered mental status Secondary Diagnoses: Hypertension Anemia Acute renal failure Discharge Condition: Vital signs stable. Symptoms improved. Discharge Instructions: You were transferred to [**Hospital1 18**] from an outside hospital. You were found to have pneumonia, and you completed a course of antibiotics for the pneumonia. You also had an infection in your right shoulder, which was drained and washed out by the orthopedic surgeons. You will need to continue taking intravenous antibiotics for 4 weeks. . You were also found to have atrial fibrillation, which is an abnormal rhythm of the heart. You were started on Coumadin, which is a blood thinner, since atrial fibrillation increases your risk of having clots. You should follow-up with a cardiologist as an outpatient to assess the need for life-long anticoagulation. . The following changes were made to your medications: 1. Restart your Avapro and Bisoprolol. You were continued on hydrochlorothiazide. 2. You were started on the blood thinning medication coumadin. You will need to have frequent INR checks until you are stable on this mediation. You will need to continue the heparin drip until your INR has become therapeutic. 3. Your oxazepam and neurontin were stopped. You seemed to do okay without these medications. Please talk with your PCP to determine if they are necessary. . Please call your physician or return to the hospital if you develop high fevers, worsening shoulder pain, chest pain, shortness of breath, or other concerning symptoms. Followup Instructions: Please follow-up at your primary care office on Friday [**6-18**] @ 9am. [**0-0-**] Please ask your primary care physician to refer you to a cardiologist to discuss how long you should be on anticoagulation. Also discuss with them the need to restart your oxazepam and neurontin Please call [**Telephone/Fax (1) 1228**] to schedule a follow-up appointment with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] to have the sutures in your shoulder removed and to follow-up after your shoulder surgery. ICD9 Codes: 0389, 5849, 486, 2761, 5180, 5119, 2767, 2859, 4019
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Medical Text: Admission Date: [**2125-4-4**] Discharge Date: [**2125-5-29**] Date of Birth: [**2070-4-5**] Sex: F Service: MEDICINE Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 2145**] Chief Complaint: Sepsis Major Surgical or Invasive Procedure: 1) Bedside incision and drainage, right hand [**2125-4-4**] 2) Operative incision and drainage, right hand [**2125-4-12**] 3) Arthroscopic wash out, bilateral shoulders [**2125-5-11**] 4) Percutaneous pigtail drainage of mid thoracic paravertebral abscess under radiographic guidance [**2125-4-18**] 5) Left PICC, placed [**2125-4-30**], repositioned [**2125-5-18**] History of Present Illness: 54 F with Crohn's disease on prednisode and Remicade, receiving TPN through a PICC, admitted to an outside hospital on [**4-3**] with two weeks of right hand swelling, fevers, and chills. At the OSH emergency department, she was ill-appearing, hypotensive, and afebrile, with a leukocytosis to 22 with 15% bandemia and 70% polys; her creatinine was 1.7. She was admitted to the MICU at the OSH where she was given stress dose steroids, empiric vancomycin and levofloxacin, 4L IVF, and blood cultures drawn. An ultrasound guided drainage of the right hand was performed, expressing a small amount of pus that was sent for gram stain and culture; Gram stain showed 2+ gram positive cocci. Four of four blood cultures grew gram positive cocci, as well. She subsequently developed respiratory distress overnight with an arterial blood gas of 7.2/14.5/95 and was intubated. Chest X-ray at the OSH was consistent with ARDS vs volume overload. An MRI of the right hand showed no definite fluid collection. . An attempt at a right subclavian central catheter prior to transport failed, and a right femoral line was placed instead. She received versed and vecuronium and was transported to [**Hospital1 18**] by [**Location (un) 7622**]. Past Medical History: Crohn's, longstanding on remicade, 5mg prednisone short bowel syndrome TPN through PICC Rheumatoid arthritis Social History: Lives at home with husband [**Name (NI) **] EtOH, IVDA. Family History: non-contributory Physical Exam: 100.9 130 104/53 31 100% on AC500X22 w/PEEP 8 and FIO2 1 Intubated, sedated MMD, PERRL RLL crackles, DTP Tachy, I/VI HSM @ apex; site of multiple R subclav attempts evident but clean soft, nt, nd, +BS WWP X 4; R hand swollen; R fem line c/d/i; multiple stick sites evident Not responding to commands, pain Pertinent Results: Admission laboratories: [**2125-4-4**] 02:13PM BLOOD WBC-26.7* RBC-3.78* Hgb-11.0* Hct-32.8* MCV-87 MCH-29.1 MCHC-33.5 RDW-15.2 Plt Ct-235 [**2125-4-4**] 02:13PM BLOOD Neuts-90.3* Bands-0 Lymphs-7.5* Monos-1.7* Eos-0.1 Baso-0.4 . [**2125-4-4**] 02:13PM BLOOD Glucose-151* UreaN-37* Creat-0.9 Na-143 K-3.6 Cl-116* HCO3-15* AnGap-16 [**2125-4-4**] 02:13PM BLOOD Albumin-2.2* Calcium-7.6* Phos-6.5* Mg-1.6 . [**2125-4-4**] 02:13PM BLOOD PT-14.0* PTT-42.1* INR(PT)-1.2* [**2125-4-4**] 02:13PM BLOOD Fibrino-576* D-Dimer-8768* . [**2125-4-4**] 02:13PM BLOOD ALT-25 AST-55* LD(LDH)-257* CK(CPK)-175* AlkPhos-276* TotBili-3.7* . [**2125-4-4**] 04:43PM BLOOD Type-ART Temp-38.3 pO2-75* pCO2-42 pH-7.06* calHCO3-13* Base XS--18 Intubat-INTUBATED . Discharge laboratories: [**2125-5-28**] 05:00AM BLOOD WBC-8.5 RBC-3.26* Hgb-9.0* Hct-27.8* MCV-85 MCH-27.8 MCHC-32.5 RDW-17.9* Plt Ct-521* . [**2125-5-29**] 05:17AM BLOOD Glucose-105 UreaN-26* Creat-0.7 Na-136 K-4.2 Cl-104 HCO3-23 AnGap-13 [**2125-5-29**] 05:17AM BLOOD Calcium-8.7 Phos-3.0 Mg-1.9 . Other relevant laboratories: [**2125-4-17**] 03:53AM BLOOD ESR-135* [**2125-4-16**] 03:02AM BLOOD CRP-149.6* . [**2125-5-4**] 05:44AM BLOOD Cortsol-20.4* . Relevant Studies: CHEST - PORTABLE AP ([**2125-4-16**]): Poorly defined nodular opacities in right upper and left mid lung zones, concerning for septic emboli or fungal infection. . CT CHEST W/CONTRAST ([**2125-4-16**]): The heart and great vessels are unremarkable. A single right axillary lymph node measures 1 cm. There are no other pathologically enlarged mediastinal lymph nodes. The airways are patent bilaterally. There is a small right pleural effusion with associated atelectatis. Lung windows revea severe emphysematous changes. There are multiple bilateral, scattered varying- sized rounded and irregular non-cavitating focal pulmonary opacities, predominantly with a peripheral location. In the left posterior paraspinal musculature just deep to the trapezius muscle extending inferiorly from the C1 level , there is a rim enhancing multiloculated fluid collection concerning for abscess. In the region of the lower thoracic spine there is an apparent encapsulated prevertebral fluid collection adjacent to the right pleural effusion, and with low but slightly higher [**Doctor Last Name **] density than the free pleual effusion. No gas is present within this effusion but The vertebral bodies at this level (probable T8.9 and 10) demonstrate a mixed sclerotic/ lytic pattern and findings are concerning for osteomyelitis. . MR [**Name13 (STitle) **] T-SPINE W &W/O CONTRAST ([**2125-4-17**]): There are signs of extensive osseous abnormality of the mid thoracic spine with a prevertebral collection associated with bone and interspace abnormality. This is most suspicious for infection and abscess formation. There is also an adjacent pleural effusion, and extension of an infectious process into this space should be considered. An area suspicious for large abscess collection is also identified in the subcutaneous musculature of the posterior back extending from roughly C7, 8 cm inferiorly into the thoracic region, to about T5. Abnormality at the C1-2 junction is also identified and though this could represent degenerative change, but infection cannot be excluded in this location. . TEE ([**2125-4-17**]): No spontaneous echo contrast is seen in the body of the left atrium or right atrium. No atrial septal defect is seen by 2D or color Doppler. Overall left ventricular systolic function appears preserved (LVEF>55%), however transgastic views were not obtained. Right ventricular systolic function also appears preserved. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. No masses or vegetations are seen on the aortic valve. No aortic valve abscess is seen. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. No mass or vegetation is seen on the mitral valve. No mitral valve abscess is seen. Trivial mitral regurgitation is seen. There is no abscess of the tricuspid valve. No vegetation/mass is seen on the pulmonic valve. . CT OF THE CHEST WITH IV CONTRAST ([**2125-5-22**]): Pulmonary arteries appear well opacified and there is no evidence of acute pulmonary embolism. Heart and great vessels appear unremarkable. Again seen are several mediastinal lymph nodes, however, none appear to meet CT criteria for pathological enlargement. There is no evidence of pathologically enlarged hilar or axillary lymphadenopathy. There has been interval improvement of previously seen small right-sided pleural effusion. Again seen are diffuse emphysematous bullous changes bilaterally. Three poorly-defined peripheral opacities are present in the right lung. The opacity seen on series 3, image 39, does not appear significantly changed from prior study. New linear/nodular opacities seen on series 2, image 34, possibly represents atelectasis. Also seen is a smaller irregular peripheral opacity, best seen on series 3, image 55. Peripheral opacity in the left lung (series 3, image 49) appears improved compared to prior study. Again seen is a paraspinal abscess collection anterior to the mid thoracic region. Small amount of fluid is again seen, decreased compared to [**4-16**]. Compared to [**4-28**], the fluid collection is likely not significantly changed to slightly larger in size. Soft tissue inflammation is also seen in this area. Again seen is destruction of the T7 through T9 vertebral bodies. . CT OF THE ABDOMEN WITH IV CONTRAST ([**2125-5-22**]): The liver, pancreas, spleen, adrenal glands, and kidneys appear unchanged. The bile duct measures 9 mm, not changed from prior study. There is no evidence of free fluid or free air within the abdomen. Scattered mesenteric lymph nodes again seen, however, none appear to meet CT criteria for pathologic enlargement. . CT OF THE PELVIS WITH IV CONTRAST ([**2125-5-22**]): The rectum and sigmoid appear unremarkable. Small amount of air is noted within the bladder, correlate with recent catheterization. Small area of enhancement again noted within the left psoas muscle, previously described as abscess, not significantly changed from prior study. . BONE WINDOWS ([**2125-5-22**]): Again seen is destruction of the T7 through T9 vertebral bodies. Degenerative changes also again noted within the spine, most notably at the L5 level. . Microbiology: STAPH AUREUS COAG + | ERYTHROMYCIN---------- 1 I GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- 0.25 S OXACILLIN------------- 0.5 S PENICILLIN------------ =>0.5 R Brief Hospital Course: 1) Sepsis/disseminated infection: Patient was transferred from OSH for sepsis thought secondary to a hand infection. An initial incision and drainage of the right hand abscess had been performed at the OSH. Here, she was started on vancomycin with gentamycin at synergistic dosing for gram positive cocci on outside hospital cultures. She was aggressively resuscitated with IV fluids, with Levophed for additional pressure support. She received a course of Xigris and stress dose steroids. When cultures showed MSSA on HD #2, vancomycin was changed to nafcillin. Gentamycin was stopped after 5 days of synergistic dosing. She was weaned off of pressor support by HD #4 and remained hemodynamically stable thereafter, although she remained intubated on mechanical ventilation to facilitate operative debridement of her right hand osteomyelitis. . Although she subsequently remained hemodynamically stable, she continued to be febrile. There was concern for line infection. Her chronic PICC for home TPN was removed at the outside hospital. Left and right internal jugular central catheters placed since admission were removed, as well as her arterial line. A new left subclavian catheter was placed. However, she continued to remain febrile. . A transesophageal echocardiogram was performed, which showed no evidence of endocarditis. A chest X-ray showed pulmonary nodules, prompting a follow up CT of the chest. This showed nodular opacities consistent with septic emboli. In addition, it showed two fluid collections, one involving the vertebral bodies of T8-T10, and another in the left paraspinal muscles extending inferiorly from C7. A CT of the abdomen and pelvis showed a left iliopsoas abscess. . The orthopaedic spine team was consulted, and an MRI of the spine was obtained for further delineation of these lesions. The MRI confirmed osteomyelitis of the T9 vertebra, and showed a fluid collection abutting the spine in addition to a fluid collection subcutaneously on the back. The orthopaedic spine service recommended a conservative approach with CT guided drainage of the paraspinal fluid collection. The infectious diseases team agreed with a strategy of attempting to treat each locus of infection discretely and attempt drainage. However at this point, the infection appeared fairly disseminated and there was some concern that the infection would be difficult to eradicate. The pulmonary nodules were felt to not be accessible by bronchoscopy, and not large enough for percutaneous drainage. The left iliopsoas abscess was likewise felt not to be amenable to drainage. These concerns were shared with the patient and the family. The patient underwent successful CT guided drainage of the superficial abscess on the back, in addition to the paraspinal fluid collection (with a pigtail catheter left in place for drainage). . She was called out to the floor where she continued to be febrile. Plans were made for CT guided drainage of the parascapular abscess. However, the scan showed no drainable fluid in the parascapular region. The T8-T10 paraspinal fluid collection was persistent, but slightly improved. Incidentally, however, it showed bilateral shoulder effusion. Orthopaedics performed a joint aspirate, which returned grossly cloudy fluid, with 41k WBCs and a negative gram stain. She was taken to the operating room for bilateral shoulder washouts, which she tolerated well. . She subsequently defervesced, and was afebrile x 1 week prior to discharge. She was discharged with plans for an indefinite course of nafcillin. . 2. Pain control: She was initially placed on a morphine PCA for pain control, but had difficulty operating the PCA. She was changed to a fentanyl patch with IV Dilaudid boluses for breakthrough. IV Dilaudid was transitioned to PO Dilaudid prior to discharge. On discharge, her pain was well controlled on 25 mcg/hr fentanyl patch with 8mg PO Dilaudid Q2h for breakthrough pain. . 3. Respiratory failure: The patient had developed respiratory failure at the OSH and arrived on mechanical ventilation. This was thought secondary to non-cardiogenic pulmonary edema in the setting of sepsis. Her ventilator settings were weaned, and she was clinically ready for extubation several days after admission. However, she remained intubated for an additional [**12-11**] days because of planned hand surgery by plastic surgery. She was extubated successfully on the following day, although her respiratory status remained tenuous. She was reintubated on [**4-17**] for a TEE and again successfully extubated on [**4-17**] after the TEE. Her respiratory status was stable through the remainder of her course on the floor. . 4. Crohns: She was given a short course of stress dose steroids on arrival, as described above, and subsequently put on 4mg IV Solu-Medrol QD. She was transitioned back to her home regimen of prednisone 5 mg PO QD prior to discharge. She was maintained on TPN throughout her hospitalization for short gut syndrome. It was initially run by continuous infusion, but was transitioned to a cycled regimen over 12 hours prior to discharge. Her Crohns was otherwise stable, without any complaints of abdominal pain. 5. Cardiac: She had a mild troponin T leak ~ 0.7, with a peak CK-MB of 95. This was felt to be demand related in the setting of sepsis. An initial TTE showed a depressed EF. However, this recovered on subsequent TEEs. . 6. Anemia: Patient had a stable anemia with iron studies consistent with chronic inflammation. . 7. Tachycardia: Patient was noted to be persistently tachycardic during hospitalization. This was confirmed to be sinus by ECG, and thought most likely multifactorial from anxiety, pain, and her hypermetabolic state from infection. In addition to treatment of her underlying infection and pain control described above, she was given anxiolytics as needed. CT was negative for PE. . 8. Acidosis/hyperkalemia: The patient was noted to have a metabolic acidosis on admission. This corrected spontaneously over the subsequent several days. However, as the acidosis resolved, she developed a significant hypokalemia, with potassium levels down to 2.4. There were no ECG changes. Potassium was repleted aggressively over the following several days, with subsequent resolution. . Prophylaxis: She received heparin in her TPN for DVT prophylaxis. . Code status was confirmed to be full. Medications on Admission: remicaide prednisone 5 mg Discharge Medications: 1. Nafcillin in D2.4W 2 g/100 mL Piggyback Sig: Two (2) gram Intravenous Q4H (every 4 hours). Disp:*2 week supply* Refills:*2* 2. Fentanyl 25 mcg/hr Patch 72HR Sig: One (1) Patch Transdermal Q72H (every 72 hours). Disp:*10 Patch(s)* Refills:*0* 3. Hydromorphone 8 mg Tablet Sig: One (1) Tablet PO Q2-4h as needed. Disp:*100 Tablet(s)* Refills:*0* 4. Prednisone 5 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 Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 6. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). Disp:*1 bottle* Refills:*2* Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: MSSA Sepsis Septic pulmonary emboli Left ileopsoas abscess T9 paraspinal abscess with T7-9 vertebral osteomyelitis - s/p percutaneous pigtail drain Parascapular abscess Right hand abscess - s/p open irrigation and debridement Crohns Disease Discharge Condition: Stable Afebrile Discharge Instructions: 1) Continue your medications as prescribed - You were started on an antibiotic called naficillin for multiple infections in your body. You need to continue this until you have back surgery, and likely for 6 weeks afterwards. 2) Follow up as directed below. 3) Call if any of your wounds looks worse, has worsened redness or pain, discharge, if you have chest pain, difficulty breathing, nausea, fevers, chills, or any other concerns. Followup Instructions: Follow up with Dr [**Last Name (STitle) **] (orthopaedics) for your shoulders on [**2125-6-7**] at 10:00am - Call [**Telephone/Fax (1) 1228**] if you have questions or need to reschedule. Follow up with Dr [**Last Name (STitle) **] (orthopaedic spine) [**2125-7-5**] at 11:00am - His coordinator will try to get you an earlier appointment. If possible, they will contact you at home. - Call [**Telephone/Fax (1) 1228**] if you have questions or need to reschedule. Follow up with Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (ID) on [**2125-6-15**] at 9:00am. - Call [**Telephone/Fax (1) 457**] if you have questions or need to reschedule. Follow up with Dr [**Last Name (STitle) 5385**] in Plastic Surgery Hand Clinic on [**2125-6-5**] at 9am. - Call [**Telephone/Fax (1) 5343**] if you have questions or need to reschedule. You asked to transfer your primary care here to the [**Hospital1 18**], and were scheduled for an appointment with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in the [**Hospital 191**] clinic Atrium Suite on [**2125-6-26**] at 1:30pm - You need to call your insurance company to change your listed PCP. [**Name Initial (NameIs) **] After you change your PCP, [**Name10 (NameIs) 138**] the clinic at [**Telephone/Fax (1) 250**] to request referrals for the specialists listed above. You will need these referrals before you see any of the specialists. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**] Completed by:[**2125-5-30**] ICD9 Codes: 5185, 5849
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7145 }
Medical Text: Admission Date: [**2138-3-3**] Discharge Date: [**2138-3-17**] Date of Birth: [**2085-6-26**] Sex: M Service: PODIATRY Allergies: Penicillins Attending:[**First Name3 (LF) 3529**] Chief Complaint: Right foot infection Major Surgical or Invasive Procedure: [**2138-3-4**] Right foot I&D [**2138-3-6**] Right foot I&D [**2138-3-11**] Right foot I&D, skin graft, wound vac placement History of Present Illness: Mr. [**Known lastname **] is a very pleasant 52 year old man with a PMH significant for DMII, HTN, HCol, who presents to his PCP today with [**Name Initial (PRE) **] swollen R foot, subsequently referred to the ED. He had not seen his PCP in two years, but came in to his PCP this AM because his right foot was hot, red, warm, and painful. He has had pain in this foot for the past three weeks; he attributes the onset to the self-removal of a callus on the ball of his foot. He had noted the development of some neuropathy in his bilateral lower extremities staring a year ago. There was purulent discharge from his wound. In the ED, initial VS were 99.6 120 158/83 18 96%. Labs were notable for U/A with 100 Protein, 1000 Glucose, 150 Ketones. Electrolytes are notable for Na 129, Cl 90, Bicarb 21, Glucose 326, and AG 18. Labs notable for WBC count 20.5, microcytic 36.5, without bandemia. The patient was given Vancomycin 1g, Metronidazole 500 mg IV, and Ciprofloxacin 400 mg IV. Foot films showed a tib/fib WNL, a R ankel that showed normal soft tissues, with retro- and plantar calcaneal spurs, and a R foot with no signs of osteomyelitis, fracture, or significant degenerative joint disease. Podiatric surgery evaluated him, and debrieded the wound x 2. Per podiatry notes, this lesion did not probe to bone. Per PCP records, last A1c% was 8.9 in [**2134**]. Baseline labs are notable for HDL 40, LDL 83, microalb 3.4 (elevated), Cr 0.77. On arrival to the MICU, he is AAOx3, but tachcyardic to the 110s. Past Medical History: DM Type II Hypertension Hypercholesterolemia . PSH: Appendectomy Social History: Works as an aide in a group home. He lives with his parents. He had a 26 pack year history, and has been sober from alochol for the past 28 years. States he has felt "depressed" and had stopped taking his medications for x1 year. Family History: Father Diabetes - Type II Mother [**Name (NI) 3730**] - [**Name (NI) **]; Hyperlipidemia Physical Exam: General: AAOx3 HEENT: Dry MM Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly Ext: warm, well perfused, 2+ pulses on the L, R foot is heaviliy bandaged, edema on the R foot to the mid-calf, warm . d/c fitals Gen: NAD, AAOx3 CV: RRR Pulm: [**Street Address(1) **] Abd: soft, NT UE: improved phlebitis to previous PIV sites, pulses palpable, no chords LE: b/l LE pulses palpable, RLE dressing CDI to thigh & foot Pertinent Results: LABORATORY RESULTS [**2138-3-3**] 08:26PM LACTATE-1.1 [**2138-3-3**] 08:00PM GLUCOSE-249* UREA N-16 CREAT-0.8 SODIUM-129* POTASSIUM-4.6 CHLORIDE-96 TOTAL CO2-23 ANION GAP-15 [**2138-3-3**] 08:00PM CK(CPK)-26* AMYLASE-42 [**2138-3-3**] 08:00PM LIPASE-38 [**2138-3-3**] 08:00PM CK-MB-1 cTropnT-<0.01 [**2138-3-3**] 08:00PM CALCIUM-8.4 PHOSPHATE-2.7 MAGNESIUM-2.0 IRON-14* [**2138-3-3**] 08:00PM %HbA1c-13.3* eAG-335* [**2138-3-3**] 08:00PM WBC-18.0* RBC-3.73* HGB-10.8* HCT-29.9* MCV-80* MCH-28.9 MCHC-36.0* RDW-12.2 [**2138-3-3**] 08:00PM PLT COUNT-339 RADIOLOGY [**2138-3-3**]: Foot/ankle/tib-fib Xrays: IMPRESSION: No signs of osteomyelitis, fracture, or significant degenerative joint disease. [**2138-3-3**]: CXR: Cardiac silhouette is within normal limits and there is no evidence of vascular congestion, pleural effusion, or acute focal pneumonia. [**2138-3-3**] Cardiovascular ECG: Sinus tachycardia. No previous tracing available for comparison. [**2138-3-4**] Radiology CHEST (PA & LAT): Slight increase in pulmonary and mediastinal vascular engorgement suggests borderline cardiac decompensation, although the heart is normal size and there is no pulmonary edema. There may be a tiny volume of pleural fluid in each side of the chest. Peribronchial opacification in the left lower lobe is probably atelectasis. [**2138-3-5**] Radiology MR FOOT W&W/O CONTRAST: 1. Plantar ulcer status post debridement one day prior with likely at least in part postoperative edema and enhancement in the subcutaneous tissues and plantar muscle compartments. Diabetic myositis and or infection can have similar appearance. 2. No evidence of osteomyelitis. 3. No abscess or drainable fluid. [**2138-3-6**] Cardiovascular ECHO: No vegetations or clinically-significant regurgitant valvular disease seen (adequate-quality study). Normal global and regional biventricular systolic function. In presence of high clinical suspicion, absence of vegetations on transthoracic echocardiogram does not exclude endocarditis. MICROBIOLOGY [**2138-3-3**] FOOT CULTURE: WOUND CULTURE (Final [**2138-3-6**]): STREPTOCOCCUS ANGINOSUS (MILLERI) GROUP. MODERATE GROWTH. [**2138-3-4**] SWAB: GRAM STAIN (Final [**2138-3-4**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND IN SHORT CHAINS. 3+ (5-10 per 1000X FIELD): GRAM NEGATIVE ROD(S). SMEAR REVIEWED; RESULTS CONFIRMED. WOUND CULTURE (Final [**2138-3-6**]): This culture contains mixed bacterial types (>=3) so an abbreviated workup is performed. Any growth of P.aeruginosa, S.aureus and beta hemolytic streptococci will be reported. IF THESE BACTERIA ARE NOT REPORTED BELOW, THEY ARE NOT PRESENT in this culture.. [**2138-3-6**] SWAB: GRAM STAIN (Final [**2138-3-6**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI IN PAIRS. WOUND CULTURE (Final [**2138-3-9**]): This culture contains mixed bacterial types (>=3) so an abbreviated workup is performed. Any growth of P.aeruginosa, S.aureus and beta hemolytic streptococci will be reported. IF THESE BACTERIA ARE NOT REPORTED BELOW, THEY ARE NOT PRESENT in this culture.. ANAEROBIC CULTURE (Preliminary): ANAEROBIC GRAM NEGATIVE ROD(S). RARE GROWTH. BLOOD CULTURES [**2138-3-3**] BLOOD CULTURE: Blood Culture, Routine (Final [**2138-3-9**]): STREPTOCOCCUS ANGINOSUS (MILLERI) GROUP. FINAL SENSITIVITIES. Sensitivity testing performed by Sensititre. SENSITIVE TO CLINDAMYCIN MIC <= 0.12 MCG/ML. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STREPTOCOCCUS ANGINOSUS (MILLERI) GROUP | CLINDAMYCIN----------- S ERYTHROMYCIN----------<=0.25 S PENICILLIN G----------<=0.06 S VANCOMYCIN------------ <=1 S Anaerobic Bottle Gram Stain (Final [**2138-3-4**]): Reported to and read back by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @ 3:10 PM ON [**2138-3-4**]. GRAM POSITIVE COCCI IN CHAINS. [**2138-3-3**] BLOOD CULTURE: Blood Culture, Routine (Final [**2138-3-7**]): STREPTOCOCCUS ANGINOSUS (MILLERI) GROUP. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # 342-0390S [**2138-3-3**]. FUSOBACTERIUM SPECIES. BETA LACTAMASE NEGATIVE. Anaerobic Bottle Gram Stain (Final [**2138-3-4**]): Reported to and read back by [**First Name4 (NamePattern1) 674**] [**Last Name (NamePattern1) **] PACU OVERRIDE LOCATION @ 12:42 PM ON [**2138-3-4**]. GRAM NEGATIVE ROD(S). Aerobic Bottle Gram Stain (Final [**2138-3-4**]): GRAM POSITIVE COCCI IN CHAINS. BLOOD CULTURES from [**Date range (1) 91825**] are still pending . [**2138-3-17**] 06:43AM BLOOD WBC-8.6 RBC-3.77* Hgb-10.3* Hct-32.4* MCV-86 MCH-27.2 MCHC-31.7 RDW-13.0 Plt Ct-599* [**2138-3-10**] 07:12AM BLOOD Neuts-77* Bands-0 Lymphs-16* Monos-5 Eos-1 Baso-0 Atyps-0 Metas-1* Myelos-0 [**2138-3-17**] 06:43AM BLOOD Glucose-92 UreaN-16 Creat-1.1 Na-137 K-4.5 Cl-101 HCO3-30 AnGap-11 [**2138-3-17**] 06:43AM BLOOD Calcium-8.9 Phos-4.4 Mg-1.8 [**2138-3-17**] 06:43AM BLOOD Vanco-9.9* . Brief Hospital Course: Mr. [**Known lastname **] is a very pleasant 52 year old man with a PMH significant for DMII, HTN, Hyperlipidemia, who presents to his PCP today with severe right leg cellulitis and a septic picture. On [**2138-3-4**], he was brought to the operating room; please see the operative report for full details. He tolerated the procedure well and was transferred to the PACU with vitals stable and vascular status intact. On admission he was admitted to the MICU but following the procedure and with stabilization of the pt overnight, the pt was transferred to the podiatry service. 2/2 blood cultures from [**2138-3-3**] grew back GNR and wcx showed preliminary GPB. An ID consult was placed and recommended an echo as well as daily blood cultures. The pt continued to have low grade fevers as well as an elevated wbc. There was no decrease in erythema to his foot with malodor, tenderness, and purulent bleeding. The pt was brought back to the operating room on [**2138-3-6**] for a further I&D; please see the operative report for full details. A rash to his PIV and perineal region was noted over the weekend which ID thought may be due to a drug reaction or to a fungal infection. Topical antifungals did not improve the affected sites and changing antibiotics did not aid the area as well. ID recommended a dermatology consult at this point. Dermatology recommended miconazole 2% cream [**Hospital1 **] to affected groing area, Triamcinolone 0.1% ointment to wrist & back [**Hospital1 **], sarna lotion and benadryl for symptomatic relief. On the floors, daily wet to dry dressings were changed during evaluation of the RLE. He remained afebrile at this time and was able to tolerate po nutrition. Physical therapy evaluated the pt and stated the pt would be best served at a rehabilitation facility. The pt was brought back to the operating [**2138-3-11**] for a right foot debridement, skin graft, and wound vac placement; please see the operative report for full details. The wound vac remained on while the pt was in-house with a wound vac change on the 5th day. The STSG was healing well to the plantar aspect of his foot, and all sutures remained intact with nice closure of wound edges. His thigh STSG donor site was notable to be heeling well, and was changed every second day with a non-adherent bandage. His wbc slowly began to trend downward. He remained hemodynamically stable. On discharge, his VSS and neurovascular status was intact to his RLE. He was discharged to rehab with strict NWB to RLE, non-adherent dry dressing changes to affected areas qdaily, and followup with Dr. [**First Name (STitle) 3209**], Dermatology and ID. # Sepsis: He met [**3-2**] SIRS criteria with fevers, tachycardia, elevated WBC count, and an infectious source on the form of a diabetic foot ulcer and resultant cellulitis. He was placed on broad spectrum antibiotics and cultures will need to be followed. . # Hyperglycemia/DM: Likely secondary to acute infection. Does not appear to have DKA/HONK given modestly elevated BS, normal lactate, and AG of around 18. Insulin drip was started in the ICU but quickly weaned off to insulin sliding scale. Upon transfer to the floor he remained on ISS which normalized his BS. . # ?Osteomyelitis: Per Podiatry wound does not probe to bone, but ESR and CRP are markedly elevated. Continue broad spectrum antibioitcs coverage with vanc/cipro/flagyl pending tissue culture. Consider MRI lower extremity to assess for any enhancement suggestive of osteomyelitis. . # Anemia: HCT was 36.5 with mild microcytosis. Iron studies consistent with anemia of chronic inflammation. . # Hyponatremia: Corrected sodium is 133 on admission. He was likely volume deplete in the setting of infection. . # Anion Gap Acidosis: Likely in the setting of elevated blood sugars and lactate. Resolved after IVF resuscitation and brief stint on an insulin drip in the ICU. . # Depression: Patient endorses having difficulty with his home medication regimen and may have some underlying depression making coping difficult. Therefore, a Social Work consult was placed. . # Communication: Patient, HCP/brother is [**Name (NI) **] [**Name (NI) **] . # Code Status: Full Code Medications on Admission: (per PCP [**Name Initial (PRE) 626**]; he has not filled nor taken any of these in the past year): Sildenafil 100 mg PRN Lisinopril 5 mg Daily Glyburide 10 mg Daily Simvastatin 40 mg QHS Omeprazole 20 mg Daily Discharge Medications: 1. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. oxycodone 5 mg Capsule Sig: [**12-30**] Capsules PO every 4-6 hours as needed for pain: Do not drive or drink alcohol while taking this medication. . Disp:*40 Capsule(s)* Refills:*0* 6. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours): Continue until [**4-1**] per ID. Disp:*30 Tablet(s)* Refills:*2* 7. metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours): Continue until [**4-1**] per ID. Disp:*90 Tablet(s)* Refills:*2* 8. vancomycin 1,000 mg Recon Soln Sig: One (1) Intravenous twice a day: Until [**4-1**] per ID - total of 1.5.g [**Hospital1 **]. Disp:*qs qs* Refills:*2* 9. vancomycin 500 mg Recon Soln Sig: One (1) Intravenous twice a day: until [**4-1**] per ID recs - total of 1.5g [**Hospital1 **]. Disp:*qs qs* Refills:*2* 10. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 11. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 13. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for anxiety. 14. heparin, porcine (PF) 10 unit/mL Syringe Sig: Three (3) ML Intravenous PRN (as needed) as needed for line flush. 15. diphenhydramine HCl 50 mg/mL Solution Sig: One (1) Injection Q6H (every 6 hours) as needed for itching. 16. triamcinolone acetonide 0.1 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day): Apply to hands and wrist for 5 more days (until [**3-22**]) & to back for 7 more days (until [**3-24**]). 17. miconazole nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day): Apply to all other areas of body where rash persists. 18. INSULIN please resume your previous Insulin regimen Discharge Disposition: Extended Care Facility: [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] - [**Location (un) 538**] Discharge Diagnosis: Right foot infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were discharged with new medications. Please take as directed. You may resume your normal home medications unless otherwise directed. You are to remain NONWEIGHT BEARING to your RIGHT FOOT at all times in a surgical shoe. Physical therapy will continue to work with you on your strength & balance. Nurses will perform all your dressing changes. Keep your dressings clean, dry, and intact. Avoid getting your dressings wet. You may resume your normal home diet. If you develop any of the symptoms listed below or anything else concerning, please see your PCP or go to your nearest emergency room. Please keep all follow up appointments. Followup Instructions: Provider: [**First Name11 (Name Pattern1) 3210**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **], DPM Phone:[**Telephone/Fax (1) 543**] Date/Time:[**2138-3-25**] 9:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8157**], M.D. Phone:[**Telephone/Fax (1) 1971**] Date/Time:[**2138-3-25**] 1:15 Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4091**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2138-4-1**] 9:00 [**First Name8 (NamePattern2) 3210**] [**Last Name (NamePattern1) **] DPM 48-137 Completed by:[**2138-3-18**] ICD9 Codes: 2761, 3572, 311, 4019, 2720
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7146 }
Medical Text: Admission Date: [**2106-10-27**] Discharge Date: [**2106-11-8**] Date of Birth: [**2033-5-27**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1267**] Chief Complaint: Chest/back pain Major Surgical or Invasive Procedure: CTA Torso/Neck/Head History of Present Illness: 73 y/o male who presented to ED after multiple episodes of dull pain which started between shoulder blades radiating to front of chest with abdominal nausea. Rated most severe pain [**1-8**] lasting 5-10 minutes. Admitted to re-check type b aorta dissection via CT. Past Medical History: Type B aortic dissection. Coronary Artery Disease s/p Coronary Artery Bypass Graft 10 yrs. ago Hypertension Hypercholesterolemia Rheumatoid arthritis Melanoma Social History: Lives with wife. Cigs: none ETOH: none Family History: DM Physical Exam: Elderly [**Male First Name (un) 4746**] in NAD HEENT: NC/AT, PERLA, EOMI, poor dentition Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids 2+ bilat. Lungs: Clear to A+P CV: RRR without R/G/M, nl s1, s2 Abd: +BS, soft, nontender without masses or hepatosplenomegaly Ext: without C/C/E Neuro: nonfocal, A&O x 3. MAE Discharge Gen NAD Neuro: a/ox3 nonfocal Pulm CTAB Card: RRR no murmur/rub/gallop Abd: soft, NT, ND +BS Ext warm well perfused pulses +2 Pertinent Results: [**2106-11-8**] 06:20AM BLOOD WBC-9.6 RBC-3.76* Hgb-11.4* Hct-31.9* MCV-85 MCH-30.3 MCHC-35.7* RDW-13.4 Plt Ct-311 [**2106-10-26**] 07:20AM BLOOD WBC-11.2* RBC-4.34* Hgb-13.3* Hct-37.5* MCV-86 MCH-30.5 MCHC-35.4* RDW-13.9 Plt Ct-160 [**2106-10-27**] 10:30AM BLOOD Neuts-81.9* Lymphs-10.4* Monos-5.8 Eos-1.8 Baso-0.1 [**2106-11-8**] 06:20AM BLOOD Plt Ct-311 [**2106-11-8**] 06:20AM BLOOD PT-13.5* PTT-30.4 INR(PT)-1.2* [**2106-10-27**] 10:30AM BLOOD PT-12.8 PTT-26.2 INR(PT)-1.1 [**2106-10-26**] 07:20AM BLOOD Plt Ct-160 [**2106-11-8**] 06:20AM BLOOD Glucose-106* UreaN-18 Creat-1.1 Na-139 K-4.8 Cl-101 HCO3-27 AnGap-16 [**2106-10-26**] 07:20AM BLOOD Glucose-124* UreaN-16 Creat-1.1 Na-139 K-4.5 Cl-100 HCO3-30 AnGap-14 [**2106-10-28**] 06:35AM BLOOD ALT-11 AST-12 CK(CPK)-26* AlkPhos-115 TotBili-0.6 [**2106-10-27**] 07:29PM BLOOD ALT-15 AST-20 LD(LDH)-310* CK(CPK)-59 AlkPhos-132* Amylase-35 TotBili-0.6 [**2106-10-28**] 06:35AM BLOOD cTropnT-<0.01 [**2106-10-27**] 07:29PM BLOOD Lipase-18 [**2106-11-4**] 06:15AM BLOOD Mg-2.4 [**2106-10-28**] 06:35AM BLOOD Triglyc-105 HDL-47 CHOL/HD-2.9 LDLcalc-66 CTA chest [**10-27**] IMPRESSION: 1. Aortic dissection involving the descending thoracic aorta ([**Location (un) 11916**] B, deBakey III). No extension to involve the ascending aorta is evident. 2. History of prior CABG corroborated. 3. There is severe emphysema with a persistent left pleural effusion. 4. There is cholelithiasis without evidence of cholecystitis. [**11-2**] Echo Left Atrium - Long Axis Dimension: *4.1 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: *5.8 cm (nl <= 5.2 cm) Right Atrium - Four Chamber Length: *6.3 cm (nl <= 5.0 cm) Left Ventricle - Septal Wall Thickness: *1.3 cm (nl 0.6 - 1.1 cm) Left Ventricle - Inferolateral Thickness: *1.3 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 4.7 cm (nl <= 5.6 cm) Left Ventricle - Systolic Dimension: 3.2 cm Left Ventricle - Fractional Shortening: 0.32 (nl >= 0.29) Left Ventricle - Ejection Fraction: >= 55% (nl >=55%) Aorta - Valve Level: 3.1 cm (nl <= 3.6 cm) Aorta - Ascending: *4.3 cm (nl <= 3.4 cm) Aortic Valve - Peak Velocity: 1.6 m/sec (nl <= 2.0 m/sec) Mitral Valve - E Wave: 0.9 m/sec Mitral Valve - A Wave: 0.8 m/sec Mitral Valve - E/A Ratio: 1.13 Mitral Valve - E Wave Deceleration Time: 133 msec TR Gradient (+ RA = PASP): *27 mm Hg (nl <= 25 mm Hg) INTERPRETATION: Findings: LEFT ATRIUM: Mild LA enlargement. RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA. LEFT VENTRICLE: Mild symmetric LVH with normal cavity size and systolic function (LVEF>55%). Normal regional LV systolic function. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic root diameter. Moderately dilated ascending aorta. Descending aorta intimal flap/aortic dissection. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. No AR. MITRAL VALVE: Normal mitral valve leaflets. No MVP. Mild mitral annular calcification. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. Mild PA systolic hypertension. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets with physiologic PR. PERICARDIUM: No pericardial effusion. Conclusions: The left atrium is mildly dilated. The right atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. Right ventricular chamber size and free wall motion are normal. The ascending aorta is moderately dilated. While no clear dissection flap is seen, color Doppler imaging suggests a proximal descending aortic dissection, originating just distal to the origin of the left subclavian artery. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Symmetric LVH with preserved global and regional biventricular systolic function. Moderately dilated ascending aorta. Descending aortic dissection. [**11-2**] Stress Thallium IMPRESSION: 1. Normal myocardial perfusion. 2. Normal LV cavity size and function. [**11-4**] CTA head/neck IMPRESSION: 1. Irregularity and narrowing along the V4 segment of the left vertebral artery. 2. Mild/moderate right internal carotid artery stenosis at the origin. 3. Atherosclerosis of bilateral carotids, most prominently at the bulbs and cavernous portions. 4. Emphysema. Brief Hospital Course: As mentioned in the HPI, Mr. [**Known lastname 8389**] was admitted for CT to evaluate aorta. His blood pressure was closely managed and cardiology was consulted. CT revealed no change in his Type B Dissection of his Aorta from prior study. Cardiac enzymes were followed with no increase suggestive of cardiac event. He was further evaluated for endovascular stent and underwent preoperative workup. He was transferred to the floor and pain resolved. At this time declined surgery and was discharged home a follow up CTA in 5 weeks and to call if pain returns. Medications on Admission: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 4. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 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:*0* 2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 4. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*0* 5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for back pain. Disp:*50 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Type B aortic dissection. Coronary Artery Disease s/p Coronary Artery Bypass Graft 10 yrs. ago Hypertension Hypercholesterolemia Rheumatoid arthritis Melanoma Discharge Condition: Good Discharge Instructions: Follow medications on discharge instructions. Call if pain reoccurs. Followup Instructions: Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in 6 weeks ([**Telephone/Fax (1) 170**]) please call for appointment CAT SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2106-12-14**] 9am - do not eat or drink anything 3 hours before. please go to [**Hospital Ward Name **] 4 at [**Hospital1 18**] Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**] in [**1-1**] weeks please call for appointment Completed by:[**2106-11-9**] ICD9 Codes: 2720, 4019
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Medical Text: Admission Date: [**2126-5-25**] Discharge Date: [**2126-6-2**] Date of Birth: [**2070-7-15**] Sex: M Service: CME CHIEF COMPLAINT: Abdominal pain. HISTORY OF PRESENT ILLNESS: This is a 55-year-old male with longstanding diabetes, CAD status post CABG on [**2126-3-6**], and peripheral vascular disease who presented after 2 days of nausea/vomiting with notable coffee-ground emesis on the morning of admission. He has had 2 days of epigastric pain and 2 days prior to admission was informed by PCP to start on PO vancomycin for positive C. difficile. The patient reported nausea immediately following initiation of vancomycin, which progressed to vomiting. He had 2 days of sharp, constant, abdominal pain and diarrhea, which was improving. No blood per rectum or black/tarry stools. The patient also complained of chest pain/left arm pain x 2-3 months, tender to palpation and worse with movement. He also has shortness of breath associated with the pain though different from prior angina. In ED, the patient was hypertensive with right arm 218/147, left 240/98, tachycardia to 103. EKG showed no T-wave inversions in V2 to V4 and lead I compared to that of [**2126-3-19**]. He was treated with sublingual nitroglycerin, IV Lopressor, and labetalol as well as morphine with response of decreasing chest pain and blood pressure. He was noted to vomit coffee-grounds and was NG lavaged clear with 600 cc. He was given IV Protonix at that time. PAST MEDICAL HISTORY: Hypertension. Left lower lobe collapse. Hypercholesterolemia. Insulin-dependent diabetes. CHF with EF of 30-35 percent on [**2126-2-27**]. Chronic renal insufficiency, baseline creatinine 1.5-1.9. CAD status post CABG x 4 in [**2-28**] with LIMA to LAD, SVG to RCA to PDA, SVG to OM1. PVD/claudication. Tracheomalacia. MEDICATIONS ON ADMISSION: 1. Aspirin 325 mg a day. 2. Lipitor 20 mg p.o. q.d. 3. Amitriptyline 25 mg q.h.s. 4. Lopressor 75 mg p.o. b.i.d. 5. Lasix 40 mg p.o. b.i.d. 6. Protonix 40 mg p.o. q.d. 7. Pletal 100 mg p.o. b.i.d. 8. Glargine 20 units q.a.m. 9. Atacand 16 mg p.o. q.d. ALLERGIES: CEFEPIME, WHICH GIVES FLUSHING AND TACHYCARDIA. SOCIAL HISTORY: A 20-pack-year tobacco history. No ETOH. No IVDU. Spanish-speaking from [**Country 7192**]. Lives with brother's family. Not married. No kids. FAMILY HISTORY: Father with CAD. PHYSICAL EXAMINATION ON ADMISSION: VITAL SIGNS: Afebrile, heart rate 90s, blood pressure 122/60, respirations 17, oxygen saturation 100 percent on 5 liters, decreasing to 97 percent on room air. GENERAL: Hispanic male, appearing older than stated age, resting, in no acute distress. HEENT: PERLA and EOMI. Moist mucous membranes. Clear oropharynx with poor dentition. NECK: Supple, bilateral carotid bruits. JVP about 8 cm at 45 degrees. CARDIOVASCULAR: Regular rate and rhythm. Normal S1, S2. Early systolic murmur over right upper sternal border and left upper sternal border radiating to carotids bilaterally. LUNGS: Clear to auscultation bilaterally. No egophony. Slight decreased breath sounds to left lower lung. ABDOMEN: Normoactive bowel sounds, soft, nondistended, tender in midepigastrium without rebound or guarding, audible bruit, midline abdomen with well-healed surgical scar. EXTREMITIES: Faint PT pulses bilaterally, but good flow with Doppler. Chronic venous stasis changes bilaterally. Sensation to touch and position intact bilaterally. No palpable cords or edema. RECTAL: Guaiac negative. NEURO: Cranial nerves II-XII grossly intact. LABORATORY DATA: Significant on admission for white count 12.4, hematocrit 35.1, and platelets 549. BUN 25, creatinine 1.5, CK 138, MB 6, troponin 0.04. Next set, CK 103 with MB of 4 and troponin of 0.02. RADIOGRAPHIC STUDIES: Chest x-ray, elevation of left hemidiaphragm, blunting of the right and left CPAs, no pulmonary vascular condition, no pneumothorax, persistent bibasilar atelectasis. MRA showing atherosclerotic changes of infrarenal abdominal aorta without evidence of aneurysmal dilatation. High-grade stenosis of right proximal common iliac and diffuse disease of left common iliac, severe disease of left superficial femoral artery. Bilateral disease of anterior tibial arteries. HOSPITAL COURSE: GI bleed: The patient had EGD on [**2126-5-26**], showing nonbleeding [**Doctor First Name **]-[**Doctor Last Name **] tear from vomiting in the gastric cardia. EGD also showed mild esophagitis and multiple erosions possibly consistent with NSAID-associated gastropathy and gastritis. The patient was started on Protonix b.i.d. with no further rebleeding from this tear. His hematocrit has remained stable, so he did require a few blood transfusions. He was guaiac negative later during admission. He also was treated with Carafate 4 times a day and was instructed to follow all pills with soft bread. Per GI fellow, he will need IV PPI b.i.d. x 8 weeks followed by PPI q.d. Clostridium difficile colitis: Because of abdominal upsets on oral vancomycin, he was switched to oral Flagyl to complete a 14-day course. Although, he experienced continued dyspepsia, he tolerated this medication well with no further nausea/vomiting. His diarrhea also had resolved by hospital discharge. CAD: The patient was status post CABG and ruled out for MI earlier on initial presentation. He experienced 1 further episode of chest pain for which he received 4 sublingual nitroglycerin with decrease in the pain. He had no EKG changes at that time, and repeat enzymes were sent, which were negative. He will be continued on aspirin, beta- blocker, and statin with re-adding of his ACE inhibitor as an outpatient once his creatinine is fully stable. His hematocrit was kept greater than 30 during admission. Hypertension: For extremely elevated blood pressure, the patient was started on nitroglycerin gtt and once this was weaned off, started on hydralazine and Isordil. His hydralazine was gradually weaned off during admission. The patient required increasing doses of his beta-blocker during admission with occasional persistent hypertension to systolic of 150s-160s. His ACE inhibitor was not restarted during admission secondary to chronic renal insufficiency issues, but should be restarted on discharge. CHF: The patient had an EF of 30-35 percent. Initially, gentle fluids were given with holding of Lasix secondary to renal failure, but Lasix was re-added at home dose later in admission. Because he developed crackles later in admission, he was also given 2 doses of IV Lasix with good response of urine output. Acute renal failure: After admission, creatinine noted to bump up to the mid-2 range. He was gently hydrated with holding of his Lasix, and creatinine decreased to baseline by discharge. His ACE inhibitor was held during admission. Right hand cellulitis: The patient was noted to have increase in white count with erythema, tenderness, and warmth on the dorsum of his right forearm, where his former IV site had been. Given that patient was diabetic, he was started on Augmentin for a 7-day course. Peripheral vascular disease: The patient has chronic claudication and was to be scheduled for outpatient bypass procedure by Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **]. Given that he was already an inpatient, the patient was taken to lab for bilateral iliac stent placement prior to discharge, which he tolerated well. He will need to return in the next 3 weeks for full bypass procedure once his renal issues are resolved. IDDM: The patient continued on Lantus and RISS. Urinary retention: The patient was noted to have urinary retention late during admission without administration of narcotics or other medications causing this. He was started on Flomax. DISCHARGE CONDITION: Stable. DISCHARGE STATUS: To home. DISCHARGE DIAGNOSES: Hypertensive emergency. Diabetes mellitus, insulin-dependent. Clostridium difficile colitis. Coronary artery disease. Status post coronary artery bypass surgery. Peripheral vascular disease status post bilateral iliac stent. Urinary retention. DISCHARGE MEDICATIONS: 1. Sucralfate 1 tablet p.o. q.i.d. 2. Pantoprazole 40 mg p.o. b.i.d. 3. Isosorbide dinitrate 40 mg p.o. t.i.d. 4. Simethicone p.r.n. 5. Atorvastatin 20 mg p.o. q.d. 6. Amlodipine 10 mg p.o. q.d. 7. Aspirin 81 mg by p.o. q.d. 8. Metoprolol 100 mg p.o. t.i.d. 9. Plavix 75 mg by p.o. q.d. 10. Furosemide 40 mg p.o. b.i.d. 11. Glargine 20 units subcutaneous q.h.s. 12. Tamsulosin 0.4 mg p.o. q.h.s. 13. Amoxicillin/clavulanate 500 mg/125 mg p.o. q.12 hours x 6 additional days. 14. Ibuprofen as needed. FOLLOW-UP PLANS: The patient will call PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], who was also in-patient attending, for follow-up appointment in the next 2-3 weeks and will also arrange to have full vascular surgery with Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] in the next 3 weeks. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] Dictated By:[**Last Name (NamePattern1) 7193**] MEDQUIST36 D: [**2126-6-3**] 11:21:45 T: [**2126-6-4**] 02:34:32 Job#: [**Job Number 7194**] ICD9 Codes: 4280, 5849
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Medical Text: Admission Date: [**2136-9-20**] Discharge Date: [**2136-9-26**] Date of Birth: [**2099-9-10**] Sex: F Service: SURGERY Allergies: Penicillins / Tetracyclines / Succinylcholine / Clozaril / Calcium Channel Blocking Agents-Benzothiazepines / Beta-Adrenergic Blocking Agents Attending:[**First Name3 (LF) 1384**] Chief Complaint: Infected transhepatic catheter Clotted right brachial-to-right atrial arteriovenous graft. Major Surgical or Invasive Procedure: [**2136-9-21**]: Angioplasty and stent of right brachial artery-to- right atrium arteriovenous graft. History of Present Illness: Patient was seen in clinic for evaluation of Right arm dialysis graft and was noted to be febrile and ill-appearing. The transhepatic catheter that was being used for hemodialysis was noted to have copious amounts of pus at the insertion site. Due to fever and septic appearance she was admitted through the ER to the SICU for catheter removal and medical management Past Medical History: PAST MEDICAL HISTORY: 1. ESRD due to IgA nephropathy 2. Schizoaffective disorder 3. Depression 4. Anemia 5. GERD 6. Cardiomyopathy 7. Hypothyroidism 8. GI bleed 9. Coagulase negative staph infection 10. RLE DVT 11. Seizures x 2 [**8-11**] PAST SURGICAL HISTORY: s/p L upper & lower AV fistula - failed s/p R AV fisula basilic v transposition - failed s/p R forearm AV graft - failed s/p PD catheter '[**27**] - failed central venous stenosis - R brachiocephalic v. occlusion of inominate v. s/p R arm brachial->axilla AV graft ([**2133-10-9**]) s/p thrombectomy & angioplasty of outflow stenosis ([**2133-10-11**]) s/p thrombectomy ([**2133-10-23**]) s/p thrombectomy and revision of R arm AV graft ([**2133-11-12**]) s/p thrombectomy of R arm AV graft ([**2133-11-16**], [**2133-12-15**]) s/p excision of infected R arm AV graft ([**2133-12-25**]) [**2136-8-2**] right brachial artery to right atrium graft [**2136-8-3**] rue graft thrombectomy 7/-/07 Trache [**2136-8-13**] RUE exploration -seroma [**2136-8-31**] UTI, pseudomonas [**2136-9-8**] replacement of transhepatic hemodialysis catheter Social History: Currently a patient at [**Hospital6 **], unemployed, no tobacco, alcohol, or recreational drug use. Estranged from mother [**Name (NI) **] ([**Telephone/Fax (1) 32972**]) Family History: Non-contributory. Physical Exam: VS: 102.2-104, 115, 80/48, 22, 100% 12L trach,mask Gen: Shaking, awake but appears sleepy Card: Sinus tach, regular Lungs: CTA, on trach mask Abd: Soft, ND, NT, pus at insertion site of catheter Pertinent Results: On Admission: [**2136-9-20**] WBC-10.3# RBC-2.66* Hgb-8.7* Hct-26.4* MCV-99* MCH-32.6* MCHC-32.8 RDW-17.2* Plt Ct-275 PT-17.5* PTT-31.5 INR(PT)-1.6* Glucose-116* UreaN-40* Creat-5.0* Na-143 K-4.8 Cl-104 HCO3-25 AnGap-19 ALT-14 AST-20 AlkPhos-137* Amylase-86 TotBili-0.3 TotProt-7.0 Calcium-8.5 Phos-4.2 Mg-1.9 On Discharge: [**2136-9-26**] WBC-4.7 RBC-2.41* Hgb-7.6* Hct-23.4* MCV-97 MCH-31.4 MCHC-32.3 RDW-16.8* Plt Ct-199 PT-25.6* INR(PT)-2.6* Glucose-82 UreaN-38* Creat-5.1*# Na-142 K-3.5 Cl-102 HCO3-29 AnGap-15 Calcium-8.4 Phos-3.7 Mg-1.7 Brief Hospital Course: Patient admitted to the SICU due to the severity of the fever and infected transhepatic catheter that had copious pus at the insertion site. The catheter was removed. Cultures of Blood, urine and sputum were ordered. Blood cultures grew Coag+ Staph, (MRSA) as well as the catheter tip. She was started on Vanco and Gentamycin on admission, the gentamycin was withdrawn once culture data received. She underwent thrombectomy and stent placement to the dialysis graft on [**2136-9-21**] with Drs [**Last Name (STitle) 816**] and [**Name5 (PTitle) 32976**]. Initial arteriographic images revealed occlusion and thrombus near the anastomosis with no blood flow to the heart. After a successful balloon dilation of the graft and advancing of the wire into the right atrium, there was evidence of blood flow and the area of the anastomosis of the right atrium was discovered. There was successful deployment of self-expandable stent in the graft followed by another deployment of a stent from the prior stent into the right atrium. The post-stenting images reveal excellent patency of the graft and flow immediately through the graft into the right atrium and into the right ventricle. She was placed on a heparin drip, and was then converted back to Coumadin which she will be discharged on. She was dialyzed using the Right graft with 350 blood flows. She was dialyzed again on [**9-24**] and [**9-26**]. On [**9-26**] she received 1 unit pRBCs for hct of 23.4% Of note the patient remains on the trach with O2 via trach mask. Laryngoscopy done on [**9-18**] just prior to this admission shows mild collapse medially of left arytenoid and omega shaped epiglottis. Patnet airway. Their recommendation is that respiratory therapy can try plugging the trach during the day and see how she tolerates. They recommend follow-up in 3 months with [**First Name4 (NamePattern1) 9317**] [**Last Name (NamePattern1) **] MD ([**Telephone/Fax (1) 32977**]) Please see attached report from ENT. Patient should continue to receive Vanco at hemodialysis and then PO Flagyl for 2 weeks following Vanco completion. Follow PT/INR per facility protocol, Coumadin is for thrombus management Of note, a cardiac echo was performed on [**9-25**]: there was no evidence of vegetations, EF > 55% Medications on Admission: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Levothyroxine 75 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Ropinirole 1 mg Tablet Sig: 1.5 Tablets PO QPM (once a day (in the evening)). 5. Fluphenazine HCl 10 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 6. Fluphenazine HCl 1 mg Tablet Sig: Five (5) Tablet PO LUNCH (Lunch). 7. Mirtazapine 15 mg Tablet Sig: 2.5 Tablets PO HS (at bedtime). 8. Clonazepam 0.5 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. 12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): hold for sbp <100 and HR <55. 13. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed. 14. Fluphenazine HCl 1 mg Tablet Sig: Five (5) Tablet PO BREAKFAST (Breakfast). 15. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 16. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed: Sarna for pruritus. 17. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 18. Warfarin 2 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain / fever. 2. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed. 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Midodrine 5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day). 5. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day): Through [**11-7**]. 6. Levothyroxine 100 mcg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 7. Ropinirole 1 mg Tablet Sig: 1.5 Tablets PO QPM (once a day (in the evening)). 8. Fluphenazine HCl 10 mg Tablet Sig: 0.5 Tablet PO Q AM WITH BREAKFAST (). 9. Fluphenazine HCl 10 mg Tablet Sig: 0.5 Tablet PO Q LUNCH (). 10. Fluphenazine HCl 10 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 11. Clonazepam 0.5 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. Mirtazapine 15 mg Tablet Sig: 2.5 Tablets PO HS (at bedtime). 16. Warfarin 3 mg Tablet Sig: One (1) Tablet PO at bedtime: Check PT/INR per facility protocol. 17. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) Intravenous HD PROTOCOL (HD Protochol): Give throughSept 19. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] Discharge Diagnosis: Infected transhepatic dialysis catheter/removed Thrombectomy Right arm dialysis graft Discharge Condition: Fair Discharge Instructions: Continue hemodialysis schedule T-Th-S Use Right AVG dialysis graft for hemodialysis. Check bruit and thrill daily. Please call [**Telephone/Fax (1) 673**] if unable to appreciate bruit/thrill No constrictive clothing, blood pressures, blood draws or IV's to Right arm Continue medications as directed Vanco for one additional month at hemodialysis Flagyl for 6 weeks Followup Instructions: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2136-10-4**] 9:50 [**First Name4 (NamePattern1) 9317**] [**Last Name (NamePattern1) **] MD: 3 month follow-up ([**Telephone/Fax (1) 32977**]) Completed by:[**2136-9-26**] ICD9 Codes: 0389, 4254, 5856, 2449, 2859, 311
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Medical Text: Admission Date: [**2130-8-13**] Discharge Date: [**2130-8-14**] Date of Birth: [**2083-4-1**] Sex: M Service: MEDICINE Allergies: Haldol / Navane / Morphine Attending:[**First Name3 (LF) 2817**] Chief Complaint: requesting detox Major Surgical or Invasive Procedure: EGD History of Present Illness: 47 yo male with PMH significant for borderline personality disorder, alcohol abuse, schizo-affective disorder, and IDDM who presented to the ED intoxicated after being brought in by EMS requesting detox. The pt reports that he is unable to recall the exact details of how EMS care was initiated. In the ED, initial vitals were 98.0, 105, 20, 138/88 and 94% RA. The pt was failry combative and required several doses of Ativan and Haldol for sedation. A serum EtOH level was found to be 291. The pt complained on nausea and was reported to have approximately 500 cc of bright red hematemasis; he was then given Zofran for nausea. A right subclavian line was placed as the pt has difficult access. Lab testing was remarkable for an elevated serum blood sugar and AG acidosis. The pt report that he had been in his usual state of health until the end of last week. Approximately four days PTA the pt stepped off a curb when he slipped and fell, injuring his left foot (denies hitting his head). The following day he stopped taking his insulin, which he reports he does intermittently. He denies significant NSAID use. At present, the pt reports he is comfortable but thirsty. He denies pain, fever, chills or persistent nausea. No CP, palpitations or diaphoresis. No cough, but the pt does report his breathing has felt "shallow" a few times in the last several days; he noted this while at rest. No abd pain. The pt reports he has noted some BRB streaking his stools over the last few days which is new for him; he denies melena or blood mixed within the stool. MSK complaints only as above. Denies weakness, change in sensation or balance. Past Medical History: *recent diagnosis of hepatitis B *History of alcohol and substance abuse *Borderline personality disorder *IDDM since [**2111**] with a history of diabetic ketoacidosis in the past *Prior suicidal behavior *Schizo-affective disorder *History of depression and paranoia *Questionable history of seizure disorder, no seizures in 25 years *History of microcytic anemia Social History: The patient is divorced with one child. He is currently homeless but lives in the [**Location (un) 86**] area. Positive history of alcoholism, reports drinking approximately one quart of whisky daily. History of IV drug use. Currently smoking 2 ppd; has smoked (at lower level) for 15 years. He is currently not working; former printer. Family History: Remarkable for DM. No bleeding diathesis or early CAD. Physical Exam: Gen: Chronically ill appearing adult male, no acute distress. HEENT: PERRL, EOMI. Dry MM. Conjunctiva well pigmented. Neck: Supple, without adenopathy or JVD. No tenderness with palpation. Chest: CTAB anterior and posterior. Cor: Normal S1, S2. Mildly tachycardic, regular rhythm. No murmurs appreciated. Abdomen: Soft, non-tender and non-distended. +BS, no HSM. Extremity: Warm, without edema. Tenderness and swelling noted at left foot. 2+ DP pulses bilat. Neuro: Alert; initially oriented to self only. CN 2-12 intact. Motor strength intact in all extremities. Sensation intact grossly. Cerebellar function intact. Gait not assessed. Pertinent Results: [**2130-8-12**] 09:40PM WBC-10.0 RBC-3.99* HGB-11.0* HCT-32.7* MCV-82 MCH-27.6 MCHC-33.8 RDW-14.7 [**2130-8-12**] 09:40PM NEUTS-85.1* LYMPHS-11.5* MONOS-2.4 EOS-0.7 BASOS-0.2 [**2130-8-12**] 09:40PM GLUCOSE-403* UREA N-9 CREAT-0.9 SODIUM-139 POTASSIUM-4.0 CHLORIDE-96 TOTAL CO2-19* ANION GAP-28* . Admission CXR: Bibasilar atelectasis. No free air under the diaphragms or evidence of pneumomediastinum. Mild gaseous distention of colonic loops of bowel in the left upper quadrant. Brief Hospital Course: 47 yo male with borderline personality disorder, alcohol abuse, schizo-affective disorder and IDDM admitted with DKA and and an episode of hematemesis. #DKA: Pt reports not taking his insulin; this, in conjunction with EtOH intake, appears to be the cause of his DKA. Currently no evidence of infection or myocardial ischemia. Found to have elevated serum glucose, glucose and ketones in urine and AG acidosis. Clinical picture is c/w DKA; HONK also in differential although less likely. -continue insulin gtt with hourly FBSB until controlled and AG closed -q4 hour lytes with aggressive repletion of Mg and K -continue aggressive fluid repletion #Hematemesis: Pt with episode of hematemasis in ED. HCT appears approximately five points below prior baseline; pt currently HD stable. No prior h/o GI bleeding or varicies. Pt is not coagulopathic. -PPI gtt -GI aware; probable EGD in AM -serial HCTs -type and cross -central access; attempt to also place PIV -hold home ASA for now #Elevated LFTs: Pt with elevated LFTs at admission, greater than in past. Denies abd sxs. Recent dx as above of hepatitis B. Ddx would include EtOH abuse, stone disease, NASH. -consider U/S -trend LFTs #Foot injury: Pt is s/p fall in which he injured foot. Will check x-ray. #EtOH abuse: Pt reports drinking one quart of alcohol daily. -continue home thiamine, folate and MVI -CIWA protocol #left foot injury: Pt is s/p fall. Will check x-ray to eval for fracture. #question history of seizures: Continue Depakote once able to clarify dose. #Psych: Pt currently reports treatment with Celexa and thorazine, however doses unclear. [**Name2 (NI) **] to clarify these in AM. Would consider psych consult once improved. SW consult now. #Anemia: Normocytic with normal RDW. Difficult to interpret in setting of possible acute GI bleeding. Will need additional workup once stable. #HTN: Hold antihypertensives in setting of possible GIB. #Hyperlipidemia: Would consider continuation of statin once dose can be clarified. #FEN: NS for volume repletion as above. Aggressive electrolyte repletion. NPO for now. #Code: Full #Prophy: Pneumoboots given possible bleeding. PPI infusion for hematemasis as above. On the morning after admission the patient was adamant to leave the hospital. He was able to clearly state the risks of this choice including death. Pysch had seen him the night prior and felt he did have capacity. He signed AMA paperwork and left the hospital with instructions for follow up Medications on Admission: ASA 81 mg daily Lantus 25 units QHS Humalog insulin SS with meals Depakote (dose unknown) Celexa (dose unknown) thorazine (dose unknown) antihypertensive (unknown) lipid lowering med ([**Last Name (un) 5487**]) multivitamin folate thiamine Discharge Medications: left ama Discharge Disposition: Home Discharge Diagnosis: UGIB DKA Discharge Condition: left ama Discharge Instructions: left ama - told to return to this or any hospital if he was willing to reconsider his decision or felt more ill Followup Instructions: left ama ICD9 Codes: 5789, 3051, 2859, 4019, 2724
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Medical Text: Admission Date: [**2194-2-26**] Discharge Date: [**2194-4-8**] Date of Birth: [**2115-9-30**] Sex: M Service: MEDICINE Allergies: Cytarabine Attending:[**First Name3 (LF) 7591**] Chief Complaint: dizziness Major Surgical or Invasive Procedure: none History of Present Illness: 78 yo Cantonese speaking male started noticing dizziness about 5 days ago. He felt a room spinning sensation with both standing up and change in head position. He did not have any tinnitus, hearing loss, ear pain or drainage, headache, visual changes, focal neurological changes. He denies fevers, chills, congestion, cough. He took a chinese herbal tea called "small box tea" day before yesterday and then went to see his PCP [**Name Initial (PRE) 1262**]. His PCP drew some labs and he was found to have neutropenia and anemia and pt was asked to see PCP again today. Over the last 2 days, his dizziness had been improving and currently he does not have any dizziness anymore. Other than the herbal tea, he denies ingesting any other over the counter or herbal medications. He does not get medications from anyone other that his PCP and has been on the same medications for years Other than recent dizziness he has not fallen ill in the last few months, he does not have any sick contacts and has not had any foreign travel. He denies easy bruising or bleeding He denies chest pain, shortness of breath, cough, nausea/vomiting/diarrhea, deneis urinary symptoms ROS: -Constitutional: [x]WNL []Weight loss []Fatigue/Malaise []Fever []Chills/Rigors []Nightweats []Anorexia -Eyes: [x]WNL []Blurry Vision []Diplopia []Loss of Vision []Photophobia -ENT: [x]WNL []Dry Mouth []Oral ulcers []Bleeding gums/nose []Tinnitus []Sinus pain []Sore throat -Cardiac: [x]WNL []Chest pain []Palpitations []LE edema []Orthopnea/PND []DOE -Respiratory: [x]WNL []SOB []Pleuritic pain []Hemoptysis []Cough -Gastrointestinal: [x]WNL []Nausea []Vomiting []Abdominal pain []Abdominal Swelling []Diarrhea []Constipation []Hematemesis []Hematochezia []Melena -Heme/Lymph: [x]WNL []Bleeding []Bruising []Lymphadenopathy -GU: [x]WNL []Incontinence/Retention []Dysuria []Hematuria []DIscharge []Menorrhagia -Skin: [x]WNL []Rash []Pruritus -Endocrine: [x]WNL []Change in skin/hair []Loss of energy []Heat/Cold intolerance -Musculoskeletal: [x]WNL []Myalgias []Arthralgias []Back pain -Neurological: [x] WNL []Numbness of extremities []Weakness of extremities []Parasthesias []Dizziness/Lightheaded []Vertigo []Confusion []Headache -Psychiatric: [x]WNL []Depression []Suicidal Ideation -Allergy/Immunological: [x] WNL []Seasonal Allergies . Past Medical History: 1. Diabetes Mellitus Social History: Lives with wife. Married for 30+ years. Denies smoking, alcohol or drug use history ever. Denies hx of blood transfusion. Does not have intercourse with anyone other than wife. Family History: No one in family has hx of cancer/blood disorders Physical Exam: Physical Exam: Appearance: NAD Vitals: T:98.4 BP:103/64 HR:93 RR: 16 O2:99 % RA Eyes: EOMI, PERRL, conjunctiva clear, anicteric, ENT: Moist Neck: No JVD, no LAD Cardiovascular: RRR, nl S1/S2, no m/r/g Respiratory: CTA bilaterally, comfortable, no wheezing, no ronchi, no rales Gastrointestinal: soft, non-tender, non-distended, normal bowel sounds Musculoskeletal/Extremities: no clubbing, no cyanosis, no joint swelling, no edema in the bilateral extremities Neurological: Alert and oriented x3, fluent speech, no pronator drift, no asterixis, sensation WNL, CNII-XII intact Integument: warm, no rash, no ulcer Psychiatric: appropriate, pleasant Hematological/Lymphatic: No cervical, supraclavicular, axillary, or inguinal lymphadenopathy GU: no CVAT Pertinent Results: [**2194-2-26**] 10:50AM WBC-0.9* RBC-2.78* HGB-9.6* HCT-27.1* MCV-97 MCH-34.7* MCHC-35.6* RDW-15.6* [**2194-2-26**] 10:50AM NEUTS-10* BANDS-0 LYMPHS-80* MONOS-10 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2194-2-26**] 10:50AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2194-2-25**] 09:33AM UREA N-16 CREAT-0.7 SODIUM-133 POTASSIUM-4.3 CHLORIDE-97 TOTAL CO2-27 ANION GAP-13 [**2194-2-25**] 09:33AM TSH-0.90 Brief Hospital Course: AP: 78 yo Chinese male w PMHx of T2DM presents with 4-5 day hx of dizziness which is now resolved and found to have neutropenia and anemia and AML. #. Leukemia: Patient presented with neutropenia and anemia. Found to have AML. Started on 7+3. Course complicated by stridor and ICU stay (see below). Patient recovered and continued his chemo course without complication. His counts dropped as expected and he developed severe abdominal pain and fevers (discussed below). Eventually his counts recovered and he did well. He was noted to have some atypical cells in his peripheral smear. He never had a day 14 BM biopsy because of his clinical deterioration during that time. He will follow up with Dr. [**Last Name (STitle) 410**] and they can discuss future treatments. . #. T2DM: Holding outpatient oral regemin and treating with lantus at night and sliding scale. Patient had increased inslulin requirements while on steroids. Then he had pretty well controlled diabetes until the week prior to discharge when he started having pretty severe hyperglycemia. [**Last Name (un) **] was consulted and his lantus and sldiding scale were changed. He was not on insulin prior to admission, and so he needed insulin teaching and was hooked into the [**Hospital **] clinic as an outpatient. He and his wife and children were doing well with insulin teaching. . # Febrile neutropenia / Fungemia - while patient was having fevers during his nadir, he had a positive blood cutlure growing [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 563**]. ID was consulted and the patient had an echo and eye exam, both of which were normal. He was started on micafungin and stopped having fevers. Eventually when he had elevated LFTs, we switched his micafungin to anidlofungin per ID recs. During this time, he was having severe abdominal pain, so with worries for hepatosleno candidemia, we did an MRI that did not show any involvement. His abdominal pain improved, but he contined to have elevated LFTs despite switching antifungals. He also was hyperglycemic and tachycardic which would lead more to continued infection. We thought he should have an extended course of the anidlofungin and was discharged home on it with ID follow up prior to the end of his course. . # Elevated LFTs - after having fungemia, he had elevated LFTs which were thought to likely be due to med effect v. hepatospleno candidemia. His MRI was negative, but he continued to have clinical signs of infection (although never spiked another fever once on antifungals). Liver was consulted, and his LFTs started trending down so it was decided that a biopsy was not needed. By time of discharge, they continued to be trending downward. Will follow up as outpatient. . # Abdominal pain - while patient was in his nadir of his counts, he developed severe abdominal pain, which caused him to stop eating. He was placed on TPN because of his poor PO intake. He had two CT scans that did not show any bowel infection or typhlitis. It did show severe constipation. He was treated for his constipation and his symptoms improved. When his counts recovered, he no longer had abdominal pain and was eating very very well by the time of discharge. . # Enterococcus UTI: Diagnosed from urine culture in the ED and treated with cefepime. Patient was spiking fevers after that which were attributed to Leukemia but as he was neutropenic he was continued on a course of Vancomycin and cefepime for neutropenic fevers until his count recovers. He had second fevers while on vanco/cefepime and found to have fungemia (as discussed above). . # Stridor/respiratory distress: The patient was started on chemotherapy on [**3-6**]. He was given cytarabine and idarubicin. After his first dose, he developed acute respiratory distress, with tachypnea and audible stridor. He was presumed to have an anaphylactic reaction to his chemotherapy, and was given solumedrol 125mg IV X1, Benadryl 25mg IV X1, inhaled racemic epinephrine, and epinephrine .3mg IM X1. His respiratory distress did not subside, and he was transferred to the [**Hospital Unit Name 153**] emergently for intubation. Anesthesia intubated the patient without complications, and did not observe swollen or edemetous trachea or vocal cords. His vitals at this time were Temp 103.0, BP 180/100, HR 160. He was transported to the ICU and intubated for airway protection. It could not be determined if he actually had a reaction to the chemo or a transfusion reaction. He was restarted on the chemo while getting IV steroids. He was premedicated for all blood products. His blood was sent for a transfusion reaction but none could be identified. He had no other respiratory symptoms except one day of wheezing which was likely due to fluid overload and disappeared after being diuresed. # Gluteal Hematoma: Patient had a traumatic bone marrow biopsy complicated by a gluteal hematoma. This eventually extended down his thigh and was likely the cause of a hematocrit drop. There was no evidence of compartment syndrome and he was transfused. He improved with supportive care. By time of discharge, the bruising and discoloration was gone and he had no pain. Medications on Admission: 1. Doxazosin 2mg QHS 2. Aspirin 325mg QD 3. Metformin 1000mg [**Hospital1 **] 4. Glipizide 10mg [**Hospital1 **] 5. Lisinopril 10mg QD Discharge Medications: 1. Doxazosin 4 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). Disp:*15 Tablet(s)* Refills:*2* 2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed: take for constipation. 3. 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* 4. Anidulafungin 100 mg Recon Soln Sig: One (1) Recon Soln Intravenous daily () for 11 days. Disp:*11 Recon Soln(s)* Refills:*0* 5. Saline Flush 0.9 % Syringe Sig: One (1) flush Injection twice a day for 30 days. Disp:*60 syringes* Refills:*0* 6. Lamivudine 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Lantus 100 unit/mL Solution Sig: 16 u in AM, 30 u in PM units Subcutaneous qAM and qPM. Disp:*10 ml* Refills:*2* 8. Insulin Syringes (Disposable) 1 mL Syringe Sig: One (1) syringe Miscellaneous twice a day. Disp:*120 syringes* Refills:*2* 9. Ultra Thin Lancets Misc Sig: One (1) lancet Miscellaneous four times a day. Disp:*120 lancets* Refills:*2* 10. Blood Glucose Test Strip Sig: One (1) strip In [**Last Name (un) 5153**] four times a day. Disp:*120 strips* Refills:*2* 11. Insulin Regular Human 100 unit/mL Solution Sig: as directed by sliding scale unit Injection four times a day. Disp:*10 ml* Refills:*2* Discharge Disposition: Home With Service Facility: Critical Care Systems Discharge Diagnosis: Final Diagnosis: 1. Neutropenia/Anemia 2. AML 3. Diabetes 4. Fungemia 5. Hepatospleno candidasis Discharge Condition: stable, walking around with walker, feeling well Discharge Instructions: You were admited because your primary care doctor found some of your blood levels to be low. You were worked up and found to have leukemia. You started chemotherapy. Right when you started you had a bad reaction to either some blood or the chemo. It required you to go to the intensive care unit and be intubated. You were extubated and restarted your chemotherapy without any issues. You were given medications to prevent another reaction with blood. . While your white count was low, you got an infection with [**Female First Name (un) **] (a type of yeast/fungus). You were very sick and had a lot of abdominal pain during this time, too. We treated you with antibiotics. You will need to continue receiving the anti-fungal at home through your PICC line, with the help of a home nurse. . We also did several CT and MRI scans to look at your abdomen. We think your pain was mostly from constipation. You should continue to make sure you are having bowel movements at home and call or take stool softeners if you have not had one in over 2 days. You also likely had the fungus infection in your liver. We followed your liver function tests in your blood and they have started going towards normal. You will need to continue getting IV antibiotics for the next two weeks. . Please return to the hospital for any fevers, chills, redness or pain around your PICC line, chest pain, shortness of breath, abdominal pain, worsening diarrhea, constipation or any other concerns. Please follow up as listed below. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 410**] on Thursday [**4-10**] at 11:00 am in [**Hospital Ward Name 23**] 7 to discuss the future AML treatment. Please follow up with Dr. [**Last Name (STitle) 724**] in infectious disease next Tues [**4-15**] at 2pm in [**Hospital Ward Name 23**] 7 (where you see Dr. [**Last Name (STitle) 410**] to determine whether or not you will need to continue your antibiotics. Please follow up at [**Last Name (un) **] in the Asian [**Hospital 982**] Clinic with [**First Name8 (NamePattern2) 8463**] [**Last Name (NamePattern1) 13260**] on [**5-13**] at 1:30 pm. [**Last Name (un) **] will be contacting you if there is a cancellation for you to see them earlier. Please make sure to call your opthamologist and make a follow up appointment at some point in the near future. They will help you set up this appointment when you see the diabetes doctor [**First Name8 (NamePattern2) **] [**Last Name (un) 4372**]. Please follow up with your primary care doctor Dr. [**First Name (STitle) **] [**Name (STitle) **] at phone number [**Telephone/Fax (1) 8236**]. Call to make an appointment for sometime in the next month. Completed by:[**2194-4-17**] ICD9 Codes: 5185, 5990, 4019, 2875
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Medical Text: Admission Date: [**2115-6-24**] Discharge Date: [**2115-6-29**] Date of Birth: [**2040-11-16**] Sex: M Service: MED Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1055**] Chief Complaint: Transfer from ICU, patient originally presented with acute shortness of breath. Major Surgical or Invasive Procedure: P-MIBI, gastric emptying study. History of Present Illness: Mr. [**Known lastname 11875**] is a 74 year old male with a history of HTN, DM2, ESRD on HD with atrophic L kidney, who presented to the ED on [**2115-6-24**] with a chief complaint of dyspnea on his way to hemodialysis. The patient is a poor historian, and it is difficult to get a history from him even with an interpreter, however the following was obtained: He had last received his regularly scheduled HD on [**2115-6-21**]. Patient denies any history of chest pain, palpitations, or change in diet (no high salt intake). He does describe some nausea, emesis, and lack of apetite for the last few months. About 1 week ago he noted increased peripheral edema, and on the night prior to admission he began having increased SOB. He denies any fevers. He describes a recent weight loss secondary to his nausea and decreased apetite, however he is uncertain of how much. He may have had some mild abdominal pain, but this is only over the last few days. On presentation to the ED, he was afebrile, with bp 220/148, HR 103, RR 30s, saturating 94-97% on 100%NRB. He was placed on BIPAP and NTG drip with good response: RR decreased to 20s, BP decreased to 173/115, and the patient was transfered to the MICU for further management of what was felt to be most likely a CHF exacerbation based on physical exam findings of volume overload. No recent echo reports, however patient had a stress test in [**2106**] with 9.5 minutes of [**Doctor First Name **] protocol, no ischemia or EKG changes. The patient was transferred to the MICU for further management of his CHF exacerbation. A CXR showed moderate CHF with small bilateral pleural effusions. EKG was without ST,T wave changes. He received HD with good response - normalization of BP, IV nitro drip was weaned. Received second HD [**6-25**] (day after admission to ICU), and was subsequently transferred to the floors. Past Medical History: HTN DM2 Nephrolithiasis, s/p bilateral ureteral stents in [**2110**] ESRD on HD (M,W,F) Atrophic L kidney Liver biopsy c/w granulomatous hepatitis h/o infected R IJ permacath s/p removal 3/04 L forearm AVG [**1-17**] Social History: Patient denies ever drinking alcohol, smoking, or doing drugs. Married, but no children. Lives at home where he says he has plenty of support, but won't elaborate regarding who the support is. Has difficulty with transportation to dialysis, and is very interested in acquiring this transportation. Family History: Difficult to elicit, even with translator. Physical Exam: VS: 96.2, P 76, BP 126/81, R 16. Gen: African American male, resting comfortably in bed, NAD. HEENT: Anicteric sclera, [**Name (NI) 3899**], PEARL, pterygium in R eye. Neck: No JVD, supple, no lymphadenopathy. CVS: RR, normal rate, no M/R/G. Lungs: Rales b/l at the bases. Abd: Normoactive BS. Mild RUQ tenderness, worse with inspiration. No organomegaly. Extr: 1+ bipedal edema extending up to knees. Palpable radial, DP pulses b/l. Pertinent Results: [**2115-6-24**] WBC-13.4*# RBC-4.15*# Hgb-14.2# Hct-44.5# MCV-107*# MCH-34.3*# MCHC-31.9 RDW-13.3 Plt Ct-226 [**2115-6-24**] Neuts-66 Bands-0 Lymphs-29 Monos-5 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2115-6-28**] 03:30PM BLOOD WBC-8.1 RBC-4.27* Hgb-14.5 Hct-42.0 MCV-98 MCH-33.9* MCHC-34.5 RDW-13.8 Plt Ct-240 [**2115-6-27**] 07:10AM BLOOD Neuts-55.7 Lymphs-27.5 Monos-11.6* Eos-4.6* Baso-0.7 [**2115-6-24**] PT-12.2 PTT-24.0 INR(PT)-1.0 [**2115-6-24**] Glucose-190* UreaN-42* Creat-7.5* Na-135 K-4.5 Cl-95* HCO3-24 AnGap-21* Calcium-9.7 Phos-5.8* Mg-2.2 [**2115-6-29**] 07:35AM BLOOD Glucose-143* UreaN-40* Creat-6.7*# Na-138 K-3.9 Cl-95* HCO3-29 AnGap-18 [**2115-6-26**] 07:05AM BLOOD ALT-74* AST-28 AlkPhos-204* TotBili-0.5 [**2115-6-27**] 07:10AM BLOOD ALT-54* AST-22 AlkPhos-196* TotBili-0.5 [**2115-6-29**] 07:35AM BLOOD ALT-32 AST-19 AlkPhos-192* Amylase-228* TotBili-0.5 [**2115-6-24**] CK(CPK)-213*, cTropnT-0.33* [**2115-6-25**] CK(CPK)-160, CK-MB-5, cTropnT-0.42* [**2115-6-25**] CK-MB-4 cTropnT-0.41* [**2115-6-27**] 07:10AM BLOOD Lipase-84* [**2115-6-27**] 07:10AM BLOOD calTIBC-231* VitB12-1102* Folate-16.9 Ferritn-1297* TRF-178* [**2115-6-27**] 07:10AM BLOOD Triglyc-139 HDL-82 CHOL/HD-2.7 LDLcalc-115 [**2115-6-27**] 07:10AM BLOOD TSH-1.3 [**2115-6-27**] 07:10AM BLOOD Free T4-1.7 Echocardiogram [**2115-6-26**]: Left to right shunt across the interatrial septum consistent with a stretched patient foramen ovale or small atrial septal defect. Left ventircular wall thickness was normal. The left ventricular cavity size is normal. Resting regional wall motion abnormalities include distal anterior and septal apical hypokinesis, inferior hypokinesis/akinesis and basal inferoseptal hypokinesis with mild hypokinesis elsewhere. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets are mildly thickened. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild mitral regurgitation. Mild pulmonary artery systolic hypertension. Trivial/physiologic pericardial effusion. Brief Hospital Course: The patient was transferred to the MICU for further management of his CHF exacerbation. A CXR showed moderate CHF with small bilateral pleural effusions. EKG was without ST,T wave changes. He received HD with good response - normalization of BP, IV nitro drip was weaned. Received second HD [**6-25**] (day after admission to ICU), and was subsequently transferred to the floors. 1) CHF - The patient was still mildly volume overloaded on PE upon arrival to the floors, with mild bipedal edema and rales at the right base, [**Last Name (un) 11876**] he received hemodialysis M,T,W with more than 11 kg fluid removed, and is without signs of failure on physical exam currently. As to the cause of the CHF exacerbation, renal feels that patient may not have been having enough fluid removed at HD since patient has recently lost weight, and therefore dry weight may have been overestimated, and therefore they weren't removing as much fluid as they should have been. They do not feel that the patient needs to be on Lasix, as they will remove fluid via HD, which he will continue as an outpatient M,W,F. Cardiac enzymes were ordered to rule out a myocardial infarction as a cause of his CHF, with Troponin T elevated, however in this patient with renal failure, a TnI would be more useful. CK-MB has been wnl. We also ordered an echocardiogram in order to evaluate his pump function, which showed diffuse hypokinesis of the left ventricle, as described in the pertinent results section. As the patient has never had a stress test before, we ordered a p-MIBI in order to further evaluate his cardiac risk, which was a poor study secondary to failure of the patient to achieve greater than 60% of his maximum heart rate, and was stopped after 4 minutes. In light of this, the interpretation of perfusion defects is somewhat unreliable. No perfusion defects were seen on this limited study. What was able to be determined, however, was that his EF was only 26%, indicating a cardiomyopathy. Cardiology recommends a dobutamine echo as an outpatient to further evaluate his coronary vasculature. We started him on Aspirin 325 mg PO qday. 2) ESRD - Patient currently receiving HD and being followed by renal. Most likely secondary to his DM, and HTN. We felt that addition of an ACE-I would be beneficial in this patient with Diabetes, CHF, and HTN, and started Lisinopril 2.5 mg qday, discontinuing his calcium channel blocker in order to allow for this addition. We also started him on nephrocaps 1 tab PO qday, Phoslo 2 tabs TID for phosphate binding, and Renagel. We continued his epogen, and held a couple of doses secondary to normal hematocrit. He continued to put out some of his own urine. 3) HTN - Patient's b.p. was elevated in the MICU, however has been well controlled on the floors, and was responsive to fluid removal. As discussed above, we discontinued his calcium channel blocker (Nifedipine CR 30 mg PO qday), and started Lisinopril 2.5 mg PO qday. We also decreased his atenolol to once a day in order to add the Lisinopril. 4) Lipids - This patient was continued on Lipitor 10 mg PO qd. We obtained a lipid profile to help evaluate his cardiovascular risk, which showed: Chol 225, LDL 115, TG 139, HDL 82, ratio 2.7. This is a surprisingly good lipid profile, with quite high HDL, and therefore his lipitor dose was maintained and not increased, especially in light of his mild transaminitis. 4) Nausea/abdominal pain - The patient seems to have been having some nausea, with decreased apetite and weight loss prior to this hospitalization. He says these have resolved since admission, however, and may have been related to uremia. A gastric emptying study was performed which was normal, making gastroparesis less likely in this diabetic patient. Of note, the patient was noted to have changes consistent with chronic pancreatitis on a MRI of the abdomen in [**2114-1-29**], and this may be the cause of his recurrent nausea and vomitting. The patient is being scheduled for an appointment with Dr. [**Last Name (STitle) 7307**] in gastroenterology to further evaluate his nausea and vomiting. He may want to consider a trial of pancrelipase. 5) Granulomatous Disease: The patient has a history of granulomatous hepatitis on liver biopsy, and in light of his nausea, we did a hepatic/biliary ultrasound which showed some heterogeneity of the liver, with no distinct masses, no choledocholithiasis or cholecystitis. His AST and ALT were found to be 28, and 74, respectively, on [**6-26**], and 22, 54 on [**6-27**], with an ALP > 200. He has had a transaminitis in the past, which was what brought him to the attention of gastroenterology. His prior course: A hepatic ultrasound on [**2114-1-23**] showed a heterogeneous liver with multiple small nodules and cirrhosis versus metastatic disease as the primary cause, as well as bilateral renal calculi. A follow up MRI on [**2114-1-29**] showed a heterogeneous liver, and a liver biopsy revealed a granulomatous hepatitis. Additionally, this patient has been found to have a polyclonal hypergammaglobulinemia, and a CT of the abdomen/pelvis on [**2111-5-15**] showed multiple buttock granulomas. The patient has also been found to have bilateral hilar and mediastinal lymphadenopathy on CT [**2115-4-30**] consistent with a diagnosis of sarcoidosis. In summary, it seems most likely that this is a patient with sarcoidosis, when taking all evidence into account: Bilateral hilar and mediastinal lymphadenopathy, restrictive PFTs, granulomatous hepatitis, buttock granulomas, perhaps the chronic nephrolithiasis, and now with a cardiomyopathy on echo and stress test. We discussed the risks versus benefits of steroid therapy in this patient in light of the possible myocardial involvement (though we do not know that this is due to sarcoidosis), however even if the myocardial involvement were due to sarcoidosis we do not believe steroids would be indicated. Not only have steroids not been conclusively shown to be effective in sarcoidosis, but they also would not improve any fibrosis that has already developed causing the organ dysfunction that he has. Most importantly, this is a 74 year old male with diabetes, hypertension, and renal failure - steroids could exacerbate his diabetes, his hypertension, and worsen his volume overload. It is therefore recommended to simply continue observation. A dobutamine echo has been recommended by cardiology to further evaluate whether or not this cardiomyopathy is due to ischemia or another process (such as sarcoidosis). If it is due to ischemia, he may be a candidate for a cath. Dr. [**Last Name (STitle) 8499**] should make these arrangements should he deem them appropriate. 5) DM - His diabetes was managed with an insulin sliding scale while in the hospital, and finger stick readings were generally less than 200. He seemed to have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1131**] in the 200s every night at 10 pm, and the patient says that he does take medication for his diabetes at home, however he was unable to tell us what it was. We continued his insulin sliding scale, and he will be restarted on his outpatient diabetes medications by Dr. [**Last Name (STitle) 8499**] when he sees him next week. 5) GU - We continued this patient's Detrol while in the hospital. He had a couple of episodes of incontinence after we removed the foley catheter that he had while in the MICU. A UA revealed both yeast, and bacteria, and we know he has had persistent yeast in the urine in the past. We started a course of Levaquin, renally dosed, to treat the UTI. He received a loading dose of 500 mg while in the hospital, and will continue 250 mg PO q 48 hours after leaving the hospital, his second dose being tomorrow ([**2115-6-30**]). He has been asymptomatic. 6) Prophylaxis: He was given subcutaneous heparin TID. 7) PT: The patient was able to walk up and down 2 flights of stairs, and down the hallway without assistance. He took them slowly and carefully, somewhat weakened from the last few days of bedrest, though not unsteady. He feels ready to go, and has a wife at home for support. IN SUMMARY: More than 11 kg of fluid removed via HD this admission. CHF exacerbation resolved. This patient should most likely have a dobutamine echocardiogram set up as an outpatient. He should also have an appointment with Dr. [**Last Name (STitle) 7307**] set up (I am unable to do this now as it is the weekend) - I am not sure if he will be able to do this on his own - maybe Dr. [**Last Name (STitle) 8499**] can help to facilitate this. He will continue dialysis M,W,F. He is on a 14 day course of Levaquin (7 doses) for a UTI. He was started on Lisinopril. His CCB was stopped, atenolol was decreased to qday. He was started on Aspirin. An echo and stress test showed diffuse left ventricular hypokinesis, most likely a cardiomyopathy. A diagnosis of Sarcoidosis is strongly suspected after reviewing all of the information, however would not start steroids. Medications on Admission: Atenolol 50 mg [**Hospital1 **] Detrol 4 mg qhs Humalin Lasix 80 mg QOD on non-HD days Nifedipine 30 mg PO qd Protonix 40 mg PO qd Lipitor 10 mg PO qd Discharge Medications: 1. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 2. Pantoprazole Sodium 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* 3. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO QD (once a day). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 4. Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*90 Tablet(s)* Refills:*2* 5. Tolterodine Tartrate 4 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO at bedtime. Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*2* 6. Atenolol 50 mg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO QD (once a day). Disp:*15 Tablet(s)* Refills:*2* 8. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO every other day for 14 days: 7 doses. Disp:*7 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 **] Family & [**Hospital1 1926**] Services Discharge Diagnosis: CHF exacerbation. ESRD. DM2. Likely sarcoidosis. Discharge Condition: Stable Discharge Instructions: Take all of your medicines as directed. Do not take your nifedipine (Procardia) anymore. Take atenolol only once a day. New medications: Lisinopril, Aspirin. Take levofloxacin (Levaquin) every other day for a total of 7 doses. Return to the hospital if you become short of breath again. See Dr. [**Last Name (STitle) 8499**] next Wednesday ([**2115-7-3**]) at 3:15. Followup Instructions: Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 7976**] Next Wednesday ([**2115-7-3**]) at 3:15. Call to change. Gastroenterology: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7307**] [**Telephone/Fax (1) 1954**]. Call to make an appointment. ICD9 Codes: 4280, 5990
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Medical Text: Admission Date: [**2158-8-8**] Discharge Date: [**2158-9-5**] Date of Birth: [**2128-3-22**] Sex: F Service: MEDICINE Allergies: Penicillins / Haldol / Compazine / Desipramine / Chlorpromazine / Imipramine / Zoloft / Shellfish Derived Attending:[**First Name3 (LF) 5893**] Chief Complaint: transfered to [**Hospital1 18**] for Chest pain. Transfered to [**Hospital Unit Name 153**] for: unresponsiveness/respiratory failure Major Surgical or Invasive Procedure: endotracheal intubation central line arterial line History of Present Illness: 30 yo female morbid obesity past history of DVTs and PEs s/p IVC filter placement 2 years ago who was transferred to [**Hospital1 18**] ED for PE. Initially went to [**Hospital 26380**] hospital on Thursday and had bilateral DVTs + PEs (lower ext swelling) and was placed on heparin + coumadin. After discharge, she returned to OSH with horrible CP 2 days ago and also had leg pain. She was found to have a worsening PE w/ increased clot burden despite being supratherapeutic, with INR of 4.8, and filter placement. Repeat CT at [**Hospital1 18**] ED -> small subsegmental right lower lobe with no evidence of infarct; LENIs were not repeated. Patient reports that she has had 2 days of sharp throbbing chest pain that is worse upon respiration and radiates to lower L chest, similar to pain she had with previous PEs. Also has had 3-4 days of BL leg pain and numbness along with 'sores' on lower legs. Has difficulty moving legs, but unsure if due to pain or weakness. Has been at [**Hospital **] Rehab since discharge from [**Hospital 27217**] Hospital and reports being certain that she has been taking coumadin daily. . Also has had 4 days indwelling catheter -> dark + bloody urine; as per pt was being treated for UTI with ceftin Past Medical History: 1. Borderline personality disorder 2. Mood Disorder, NOS 3. History of self-mutilation 4. History of DVT/PE 5. Obesity hypoventilation vs. sleep apnea 6. Asthma 7. Urinary Incontinence 8. History of hypercarbic respiratory failure 9. Obesity 10. History of suicidal ideation with multiple past attempts 11. History of MRSA cellulitis 12. History of Pneumonia 13. History of Bacteremia Social History: After recent admission for PE at [**Hospital 27217**] hospital, has been at [**Hospital **] Rehab center in [**Location (un) **]. Pt reports having no family or contacts. Denies cigarette or recreational drug use. Previous social alcohol use but has not had drink for several months. Has history of psychogenic hyporesonsiveness episodes requiring intubation. Family History: Parents deceased; otherwise noncontributory. Physical Exam: 98.9 100/65 108 18 98%on 3L Gen: alert, cooperative, morbidly obese, in NAD. Pulm: anterior exam, ctab w/o coarse breath sounds. Cor: tachycardic, RR, nl S1S2 Abd: obese, protuberant, nontender. Extrem: multiple pink tender blisters on anterior lower legs 1cm. 1+ DP and 2+ radial pulses. Acyanotic extremities. Neuro: LE perception to light touch intact. Strength appears to be limited by pain. Pertinent Results: [**2158-8-12**] 3:39 pm SPUTUM Site: ENDOTRACHEAL Source: Endotracheal. **FINAL REPORT [**2158-8-14**]** GRAM STAIN (Final [**2158-8-12**]): >25 PMNs and <10 epithelial cells/100X field. 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 1+ (<1 per 1000X FIELD): BUDDING YEAST. RESPIRATORY CULTURE (Final [**2158-8-14**]): MODERATE GROWTH Commensal Respiratory Flora. STAPH AUREUS COAG +. MODERATE GROWTH. SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 53485**] FROM [**2158-8-10**]. [**2158-8-11**] 12:10 am BLOOD CULTURE Source: Line-central line. **FINAL REPORT [**2158-8-17**]** Blood Culture, Routine (Final [**2158-8-17**]): STAPHYLOCOCCUS, COAGULASE NEGATIVE. OF TWO COLONIAL MORPHOLOGIES. ISOLATED FROM ONE SET ONLY SENSITIVITIES PERFORMED ON REQUEST.. Brief Hospital Course: FLOOR COURSE: Ms. [**Known lastname **] was admitted with complaint of chest pain found to have right subsegmental PE and supratherapeutic INR. Patient has been maintained on room air while INR corrected in setting of warfarin being held. Two days after admission, patient was found incontinant of stool face down in her bed, unresponsive. Vitals at that time were afebrile, SBP 120-130's, HR 110's, RR 12-18, SpO2 100% RA, she had a pulse and did not appear to have respiratory difficulty. She was not responsive to verbal or tactile stimuli. Fingerstick was slightly elevated blood glucose. Patient recieved small amount of narcotic, Narcan given and she remained non-responsive. Also noted, patient had flickering of eyelids, concerning for seizure. She recieved 5mg ativan with no significant improvement. Due to concern for possible ICH and inability to protect airway, patient was transferred to [**Hospital Ward Name 332**] ICU for emergent intubation with plan for CT Head. Of note, patient was vomitting [**3-14**] to ambu bag. ICU course: #Unresponsiveness: Upon further investigation of Ms. [**Known lastname **] chart, it appears that she has a history of psychogenic hyporesponsivenss requiring multiple intubations in the past. Head CT returned negative and neuro team did not feel that this episode was a seizure. Psych was consulted and said there was nothing to do while patient was intubated. #Respiratory Failure: During the code, patient was found to have vomited resulting in an aspiration pneumonia. She was intubated and vented and treated with empiric antibiotics. Sputum and blood cultures grew staph aureus and she was continued on Vancomycin and Meropenem, [**Last Name (un) **] changed to Linezolid on Day 8 due to known MRSA in her sputum. On ICU Day 9, her left lower lobe asp PNA seems to have cleared, but patient developed a new right middle lobe infiltrate. She continued to have persistent infiltrate on CXR L > R and ID was consulted. They recommended continuing vancomycin therapy for MRSA and also obtaining input from interventional pulmonology to evaluate for possible empyema. IP did not feel there was an obvious complicated effusion present. The patient was continued on the ventilator and antibiotics. She had persistent hypoxic respiratory failure requiring increasing levels of PEEP and 100% FiO2. She was transitioned to APRV when unable to oxygenate on volume cycle ventilation. Eventually she was placed back on ACV, but required 100% FIO2 and high PEEP levels (20's). She desaturated with any re-positioning adn we were unable to wean from the ventilator.. #Septic shock: Found to have staph aureus in the blood. She was hypotensive requiring pressors. By ICU Day 10, patient is still dependent on pressors. She continues to spike fevers despite broad spectrum antibiotic coverage. Blood culture from [**8-19**] grew coag (-) staph in 1 of 2 sets; patient maintained on vancomycin. An IJ tip grew yeast and the patient was started on fluconazole per ID. A urine culture grew [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 563**] and the patient was treated with micafungin. The patient remained on pressor support. The patient remained persistently febrile during her hospital course. Infectious disease followed the patient each day. She had documented infections including [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 563**] in urine, pseudomonas/klebsiella in sinuses, pseudomonas in sputum as well as urine, and MRSA in lungs. Unfortunately, due to the patient's body habitus, we were unable to evaluate her for abscess with CT and had to rely on U/S, which did not show an obvious abscess or loculated fluid. #Bipolar: patient was continued on all psych meds as well as her antidepressants until she began having high OG residuals and she was not able to tolerate PO meds. #Diabetes: given ISS, glargine, and closely monitored glucose levels. She had an increasing insulin requirement during her ICU course. #Guardianship: [**Name2 (NI) **] not found to have a guardian or proxy. Group home, Vinfen Corp, was contact[**Name (NI) **] and they reported that there was no oone appropriate to provide guardianship. Legal services at [**Hospital1 18**] is currently pursuing legal guardianship. Eventually, a guardian was assigned who determined that the patient's prognosis was extremely poor. Her code status was changed to comfort measures only. Medications on Admission: OxycoDONE (Immediate Release) 5 mg PO/NG Q3H:PRN pain Gabapentin 300 mg PO/NG Q8H Acetaminophen 325-650 mg PO/NG Q6H:PRN fever>101 Ciprofloxacin HCl 500 mg PO/NG Q12H Warfarin 5 mg PO/NG DAILY16 Insulin SC (per Insulin Flowsheet) Vitamin D [**2148**] UNIT PO/NG DAILY Omeprazole 40 mg PO DAILY Fluoxetine 40 mg PO/NG DAILY bipolar depression Divalproex (EXTended Release) [**2148**] mg PO Divalproex (DELayed Release) 500 mg PO DAILY Aripiprazole 30 mg PO/NG HS Amantadine 100 mg PO/NG [**Hospital1 **] Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheeze Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheeze Fluticasone-Salmeterol Diskus (500/50) 1 INH IH [**Hospital1 **] Discharge Medications: n/a Discharge Disposition: Expired Discharge Diagnosis: Pulmonary embolus Psychogenic hyporesponsiveness Aspiration pneumonia Septic Shock Respiratory Failure Discharge Condition: patient died in ICU after code status changed to comfort measures only ICD9 Codes: 5070, 2761, 5990
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Medical Text: Admission Date: [**2195-2-19**] Discharge Date: [**2195-3-1**] Date of Birth: [**2130-7-6**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 338**] Chief Complaint: Respiratory distress Major Surgical or Invasive Procedure: None History of Present Illness: 64yo M with peripheral vascular disease (s/p left AKA), hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and right deep venous thrombosis transferred from [**Hospital **]. He was at home and fell out of his wheelchair yesterday, and couldn't get off the floor. Denies head trauma. Was taken to [**Hospital3 **] and evaluated, then pt asked to be transferred here because he has gotten most of his care here. . Prior to arrival, the patient got solumedrol and levofloxacin at [**Hospital3 **] hospital. He got vanc and flagyl here. In our ED, he was noted to have cough, wheezes, and bruises. He was found to be hypoxic to 86% on RA on arrival, which improved to 99% on 4L after nebs. VBG was 7/26/63/22. CXR showed possible left sided pneumonia, but CT abdomen showed a left base pneumonia. The abdominal CT also showed a large hematoma consistent with his exam and history of falls. Though his creatinine was elevated, the ED considered a CTA to rule out PE in the setting of a positive D-dimer at [**Hospital3 **]; then considered a VQ scan but the decision was made to defer these studies to the floor team. He also had an elevated troponin of 0.05 and CK of 2935 (MB 24, index 0.8) and was given aspirin. Cards was notified, but the decision for official consult was deferred to floor team. The patient was admitted to the MICU due to "tenuous respiratory status". He is DNR/DNI. Past Medical History: 1. History of seizure disorder, type unknown. 2. History of hypertension. 3. Chronic obstructive pulmonary disease. 4. History of left deep vein thrombosis. 5. History of peptic ulcer disease with gastrointestinal bleed. 6. Remote history of osteoarthritis. 7. History of fracture of the left elbow. 8. Methicillin resistant Staphylococcus aureus infections in [**2190-6-7**]. 9. Vancomycin resistant enterococcus in [**2190-9-7**]. 10. History of Clostridium difficile in [**2190-5-8**]. 11. History of peripheral vascular disease, status post left external iliac stenting in [**2189-12-8**]. Social History: Lives at home alone in [**Location (un) 5110**]. No ETOH, tabacco x 40 years currently 2 packs per day. Family History: Mother died of cancer, unknown which type or age at death. Father died of MI in his 80s. Pt. has two brothers amd two sisters. Physical Exam: V: T96.7 P62 BP 100/65 sat 92-95% 3LNC Gen: sleepy but arousable. Gutteral voice difficult to understand at times. No respiratory distress. HEENT: right pupil reactive, left surgical. eyes disconjucate at rest with right eye lateral deviated, but conjugate to movement Neck: no JDV Resp: wheezes diffusely with inspiration and expiration CV: RRR nl s1s2 no MGR Chest: left ecchymosis over chest above nipple, 10 cm in diameter, well demarcated Abd: ecchymotic, purple, with firm area left side. +BS nontender Ext: left leg s/p AKA. small scab over [**Last Name (LF) **], [**First Name3 (LF) **] erythema. right leg with erythema lower area, not warm, with some anterior tibial ulcer 2 cm, and scab over medial malleolus (3 cm) without drainage Neuro: oriented to place, person, date Pertinent Results: [**2195-2-27**] 06:05AM BLOOD WBC-12.7* RBC-3.01* Hgb-9.7* Hct-29.0* MCV-96 MCH-32.4* MCHC-33.6 RDW-15.9* Plt Ct-433 [**2195-2-26**] 05:38AM BLOOD Neuts-78.1* Lymphs-10.0* Monos-6.2 Eos-5.3* Baso-0.4 [**2195-2-26**] 05:38AM BLOOD Hypochr-3+ Anisocy-1+ Macrocy-3+ [**2195-2-27**] 06:05AM BLOOD PT-15.4* INR(PT)-1.4* [**2195-2-21**] 06:20AM BLOOD ESR-40* [**2195-2-27**] 06:05AM BLOOD Glucose-96 UreaN-31* Creat-1.0 Na-140 K-3.5 Cl-97 HCO3-35* AnGap-12 [**2195-2-20**] 03:20AM BLOOD CK(CPK)-2717* [**2195-2-19**] 06:37PM BLOOD CK(CPK)-2208* [**2195-2-19**] 01:32PM BLOOD CK(CPK)-2489* [**2195-2-19**] 05:35AM BLOOD ALT-38 AST-85* CK(CPK)-2935* AlkPhos-128* Amylase-29 TotBili-0.7 [**2195-2-19**] 05:35AM BLOOD Lipase-19 [**2195-2-24**] 06:15AM BLOOD proBNP-802* [**2195-2-20**] 03:20AM BLOOD CK-MB-18* MB Indx-0.7 cTropnT-<0.01 [**2195-2-19**] 06:37PM BLOOD CK-MB-15* MB Indx-0.7 cTropnT-<0.01 [**2195-2-19**] 01:32PM BLOOD CK-MB-18* MB Indx-0.7 cTropnT-0.03* [**2195-2-23**] 06:00AM BLOOD Calcium-8.7 Phos-2.7 Mg-2.2 [**2195-2-24**] 06:15AM BLOOD Triglyc-148 HDL-56 CHOL/HD-2.8 LDLcalc-71 [**2195-2-21**] 06:20AM BLOOD CRP-102.9* [**2195-2-27**] 06:05AM BLOOD Vanco-25.6* [**2195-2-24**] 06:15AM BLOOD Phenyto-4.0* Brief Hospital Course: A/P: 64M with history of PVD and COPD presents s/p fall with COPD exacerbation, PNA, and RLE cellulitis/vascular insuficiency who expired in the MICU. #) COPD exacerbation +/- PNA - Admitted to ICU for O2sat in the 80's on room air but mid 90's on 3L NC. Pt neg for influenza. Started on Levofloxacin for COPD exacerbation and a question of retrocardiac opacity on CXR. Also started on Nebulizers and Prednisone IV then tapered to 60mg PO. Following stabilization in the MICU, his floor course was marked by waxing and [**Doctor Last Name 688**] respiratory status with O2sats ranging from 88-96% on a significant O2 requirement (3-4L, patient is not on oxygen at home). He recieved a 7 day course of Levofloxacin and 6 days of Prednisone 60mg. He benefited from Chest PT and clearance of secretions with improved clinical exam and O2sats. His O2sats were thought to be lowered in his digits by the presence of significant PVD and forehead O2sats were obtained showing better saturation. Given waxing and [**Doctor Last Name 688**] respiratory status and O2sats, a repeat CXR was performed which was essentially unchanged and did not reveal any acute cardiopulmonary process. A Chest CT was also performed to r/o any evidence of mucus plug and showed tracheobronchomalacia, collapse of the LLL concerning for PE, and R pericardic triangular opacity. The patient was started on Heparin IV drip and given NaHCO3 in D5W and a CTA was obtain that showed no PE. Subsequently, patient's sats dropped to 83 % on 4 L. He was given nebs and the 96% on 4L but sats dropped to 85% on 4L again and Bp dropped to 90s systolic. Patient was disoriented and denied any complaints VBG 7.36/86/47. He was transferred to the ICU for further management where his respiratory status continued to worsen. Diuresis was attempted with lasix but the pt did not have much UOP. O2 sats were lowered to the low 90's given pt's somnolence and concern for CO2 retention, but he continued to remain somnolent. He became diaphoretic and tachycardic and was started on BiPAP. Multiple ABG's were attempted but only venous blood was obtained. His family was notified that his clinical status was declining and they felt that he would only want intubation if it would be a quick turn around. However, given his poor lung function it was felt that the pt's course on the ventilator would likely be long. His family felt he would not want this, and thus the pt was made CMO. He expired a few hours later. . #) RLE pain/erythema: There was a 1.5x1.5 inch circular scabbed ulcer involving the medial malleolus with surrounding erythema. The patient stated that he had had the ulcer for approximately 2-4 weeks. The foot was thought to be cold on exam in the MICU and he did not have a DPP pulse by doppler u/s. He remained afebrile throughout his course and was start4d on Vancomycin due to concern for cellulitis and his history of MRSA cellulitis. Given his severe PVD, vascular insufficiency was also a potential cause of the pain, erythema, and ulcer formation. Vascular surgery was consulted and they performed a RLE arteriogram revealing severe vascular insufficiency. Vein mappping of the upper extremities was performed and a candidate graft from the left upper extremity was identified. Per vascular surgery, the wound care included dry dressing changes with accuzyme QD. . #) Elevated troponin/CK - CK elevation most likely from fall. Trop more likely from renal insufficiency. EKG without acute changes. Assymptomatic. . #) Renal failure - He presented with a creatinine of 1.6 which trended down to his baseline of 0.8 during his course. . #) Frequent falls with hematoma - Could be from seizures or baseline immobility. Denies loss of consciousness but somnolent on admission. Dilantin level low, however patient says that he has not had seizures in years and did not appear post-icatl during intial evaluation. His home dose of AEDs was continued. . #) PVD with edema: Continued ASA. Consulted vascular surgery as above. . #) HTN - Continued metoprolol with adeuqate control. Was held for pharmacologic stress echo testing. . #) GI - Patient did not have any stools during his floor course while on narcotics and was started on an aggressive bowel regimen. Medications on Admission: Magnesium Oxide 400 mg PO BID Atorvastatin 10 mg PO DAILY Amlodipine 5 mg PO DAILY Ipratropium Bromide 0.02 % Solution Sig: 1-2 puffs Inhalation Q6H (every 6 hours) as needed for COPD. Pantoprazole 40 mg PO Q24H Docusate Sodium 100 mg PO BID Ibuprofen 400 mg PO Q8H prn Phenytoin Sodium Extended 300 mg PO BID Metoprolol 75mg PO Furosemide 80 mg PO DAILY Folic Acid 1 mg Tablet PO DAILY Aspirin 325 mg po qd Discharge Disposition: Extended Care Discharge Diagnosis: COPD Exacerbation Pneumonia Right Leg cellulitis/vascular insufficiency Discharge Condition: expired. Discharge Instructions: pt expired. Followup Instructions: pt expired. ICD9 Codes: 486, 5849, 4280, 2724, 4019
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Medical Text: Admission Date: [**2110-6-27**] Discharge Date: [**2110-7-11**] Date of Birth: [**2110-6-27**] Sex: M Service: NB HISTORY OF PRESENT ILLNESS: Baby boy twin 2 is a preterm male infant, born at 34-1/7 weeks gestation by cesarean section. Mother is a 33-year-old, gravida 5, para 3 to 5 woman with prenatal screens, A-, antibody negative, hepatitis B surface antigen negative, GBS unknown, rubella immune and RPR nonreactive. Pregnancy was dichorionic-diamniotic twin gestation with no complications reported during pregnancy. The mother was admitted on the day of delivery with history of contractions intermittently for the past 2 days and cervical dilation to 4 to 5 cm. As per parents' wishes, delivery was performed by cesarean section. Apgars were 8 and 8. The baby required only some blow-by O2 in the delivery room. However, on admission to the NICU, he was noted to have grunting and retracting, and was placed on CPAP with some improvement. Poor perfusion was noted initially and the patient was treated with a normal saline bolus. PHYSICAL EXAMINATION ON ADMISSION: Weight 2135 grams (50th percentile), length 46 cm (60th to 70th percentile), head circumference 32 cm (50th percentile). Temperature 98.2, heart rate 122, respiratory rate 40 to 70, blood pressure 69/39 (49), O2 saturation 90% on room air. General: Pink, alert, active, AGA, preterm infant. HEENT: Anterior fontanelle soft and flat. Normocephalic. Eyes with normal red reflexes bilaterally. Palate intact. Respiratory: Retractions and mild grunting, improved on CPAP. Cardiovascular: S1 and S2 normal intensity, no murmur. Abdomen: Soft with no organomegaly. GU: Normal male. Testes down bilaterally. Neuro: Tone within normal limits. Skin clear. Musculoskeletal: Hip laxity which increased slightly with time. Physical measurements at discharge: Weight 2135g, head circumference 31.5cm, length 46cm. SUMMARY OF HOSPITAL COURSE BY SYSTEM: 1. Respiratory: The baby was placed on nasal CPAP after birth and was intubated on day of life #0 and given surfactant x2. He was extubated to CPAP on day of life #2 and remained on CPAP until day of life #5, when he was weaned to room air. He has been on room air since that time without apnea of prematurity. 2. Cardiovascular: The baby had normal blood pressure and heart rate at birth but had poor perfusion, so was given a normal saline bolus at birth. He has been stable cardiovascular wise since that time. 3. Fluid, electrolytes and nutrition: The baby was started NPO on IV fluids. He was started on feeds on day of life #5 and they were advanced as tolerated. He is currently on breast milk 24 with Enfacare, taking p.o. p.g. feeds. He is also on a multivitamin. 4. GI: The baby was found to have hyperbilirubinemia with a peak on day of life #4 of 11.3/0.3. He received phototherapy for 3 days with a rebound bilirubin of 7.9/0.2. He continues to be slightly jaundiced with no further issues. 5. Hematology: On admission, a CBC was done with a hematocrit of 48.5 and platelets of 323,000. He was started on iron sulfate on day of life #12. 6. Infectious disease: Rule out sepsis workup was done on admission with a white count of 9.7 with 47 polys and 0 bands. He received ampicillin and gentamicin for 48 hours which were stopped with negative blood cultures. 7. Neurology: The baby always had a normal neurologic exam and there has been no need for head imaging. He continues in an off isolette for low temperatures. 8. Sensory: (A) Audiology - a hearing screen was not performed prior to transfer. (B) Ophthalmology - secondary to the baby's gestational age of greater than 32 weeks, no ophthalmology exam was done. CONDITION AT DISCHARGE: Fair. DISCHARGE DISPOSITION: To [**Hospital6 302**] level 2 NICU. PRIMARY CARE PEDIATRICIAN: Dr. [**Last Name (STitle) 74231**] at South Core Pediatrics. CARE RECOMMENDATIONS: 1. Feeds at discharge: Please continue breast milk 24 with Enfacare or Neosure powder and encourage p.o. feeds. 2. Medications: Multivitamin 1 mL p.o. daily, iron sulfate 2 mg per kilogram per day. 3. Iron and vitamin D supplementation: (A) Iron supplementation is recommended for preterm and low birth weight infants until 12 months corrected age. (B) All infants that are predominantly breast milk fed should receive vitamin D supplementation at 200 international units (may be provided as a multivitamin preparation) daily until 12 months corrected age. 4. Car seat position screening was not done prior to transfer. 5. State newborn screening status: The baby had 2 [**Name2 (NI) **] newborn screens. The first one was within normal limits and the second one has results pending. 6. Immunizations received: None. 7. Immunizations recommended: (A) Synagis RSV prophylaxis should be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following 4 criteria: First, born at less than 32 weeks; second, born between 32 and 35 weeks with 2 of the following: Day care during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities or school age siblings; third, chronic lung disease; or fourth, hemodynamically significant congenital heart disease. (B) 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. (C) 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. 8. Followup appointment schedule recommended: No followup appointments are scheduled at this time. DISCHARGE DIAGNOSES: 1. Prematurity at 34-1/7 weeks gestation. 2. Twin gestation. 3. Respiratory distress syndrome. Reviewed By: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 53043**], [**MD Number(1) 53044**] Dictated By:[**Last Name (NamePattern1) 69933**] MEDQUIST36 D: [**2110-7-11**] 13:13:43 T: [**2110-7-11**] 14:03:12 Job#: [**Job Number 74234**] ICD9 Codes: 769, 7742, V290
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Medical Text: Admission Date: [**2139-10-26**] Discharge Date: [**2139-11-3**] Date of Birth: [**2085-2-5**] Sex: F Service: MEDICINE Allergies: Adhesive Tape / Ativan Attending:[**First Name3 (LF) 1936**] Chief Complaint: Respiratory Distress. Major Surgical or Invasive Procedure: [**2139-10-28**]: Flexible bronchoscopy and Therapeutic aspiration of secretions. History of Present Illness: 54 yo woman with a history of myasthenia [**Last Name (un) 2902**], TBM, obesity, anxiety, admitted to the medical ICU for weakness, respiratory distress, possible myasthenia [**Last Name (un) 2902**] exacerbation. MICU course ==[**2139-10-26**] - [**2139-10-28**]: She complained of neck extensor weakness, urinary incontinence, and dyspnea. Initially treated with biPAP. Had excellent NIFs (>-80) with suboptimal VCs (consistently < 1 L, though ?limited by effort and able to count [**1-21**] on single breath). Had bronchoscopy with IP; tracheal stent unremarkable. IVIG started [**2139-10-28**] to [**10-30**]. Psychiatry also consulted for anxiety management. She was transferred to neuro service where she felt well though c/o intermittent diplopia. ==[**2139-10-29**] - [**2139-10-31**]: readmitted to the MICU for dyspnea, shallow breathing, diplopia, ptosis, concerning for myasthenic crisis. ABG with significant respiratory acidosis 7.10/143/59. NIFs -80s. improved after placed on BiPap and flumenazil trial to counteract clonazepam 0.25mg given in the AM. given solumedrol 125mg stress dose steroids. Azathioprine started [**2139-10-29**] to supplement immunosuppression (cellcept, prednisone). Urine culture with klebsiella, ciprofloxacin started on [**2139-10-30**]--> changed to ceftriaxone on [**2139-10-31**]. Transfer to the floor with improved respiratory parameters: [**2139-10-31**]. Currently, she says her breathing has improved though she still feels tightness in her chest. She has no ptosis, diplopia, dysarthria, and she can masticate without difficulty. However, she notes that she increasingly forgets words. She continues to have a cough productive of thick green to yellow sputum. She continues to have non bloody loose stools about 4x/day. She has baseline urinary incontinence, no hematuria, dysuria. No chest pain, arthralgias, myalgias, leg swelling, abdominal pain. Past Medical History: --myasthenia [**Last Name (un) 2902**] (+MUSK Ab): dx [**4-30**], treated with pyridostigmine, prednisone, cellcept, IVIG, plasmapheresis; difficult fibroscopic intubation, unable to tolerate BiPAP. --tracheomalacia s/p flexible and rigid bronchoscopy with stent placement on [**2139-5-7**], Y stent replacement [**2139-10-15**] --sinus tachycardia when awake or anxious, thought [**1-24**] to autonomic instability from myasthenia [**Last Name (un) 2902**] --DMII, diet controlled, on ISS while on steroids --anxiety --GERD --obesity --anxiety --s/p cholecystectomy, appendectomy, tonsillectomy --nephrolithiasis Social History: No smoking, etoh, illicit drug use. Lives alone. Does not use home O2 since she has a gas stove, feels uncomfortable with BiPAP. used to work as a case manager. Family History: father with CAD and DM, brother with bronchitis, no family hx of myasthenia [**Last Name (un) 2902**], autoimmune disease. Physical Exam: VS: 96.8 140/80 134 20 90%3L Gen: NAD, speaking in [**2-25**] word sentences, not using accessory muscles to breathe HEENT: PERRL, sclera anicteric, MMM, O/P clear Neck: obese Cor: tachycardic, no mrg Pulm: rhonchorous bronchial sounds diffusely Abd: obese, soft, NT ND Ext: +1 non pitting edema, +DP and PT pulses b/l Neuro: alert, oriented x 3. able to count [**1-18**] in 1 breath. EOMI. Upgaze held for >20 seconds with no ptosis, however, during conversation eyelids would droop. CNII-XII intact. [**4-27**] strength upper and lower extremities. [**4-27**] neck extension and flexion. Pertinent Results: [**2139-10-26**] WBC-7.5 Hct-43.2 Plt Ct-419 [**2139-10-29**] WBC-16.9* Hct-36.5 Plt Ct-322 [**2139-11-3**] WBC-7.4 Hct-39.4 Plt Ct-360 [**2139-10-26**] Glucose-119* UreaN-10 Creat-0.7 Na-143 K-4.5 Cl-103 HCO3-37* [**2139-11-3**] Glucose-204* UreaN-14 Creat-0.8 Na-138 K-3.7 Cl-93* HCO3-40* [**2139-10-26**] cTropnT-<0.01 [**2139-11-1**] Calcium-8.8 Phos-2.6* Mg-2.1 [**2139-10-26**] FiO2-20 pO2-66* pCO2-75* pH-7.28* [**2139-10-30**] pO2-54* pCO2-77* pH-7.36 ... [**2139-10-27**] URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG URINE CULTURE (Final [**2139-10-29**]): KLEBSIELLA PNEUMONIAE. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ KLEBSIELLA PNEUMONIAE | AMPICILLIN/SULBACTAM-- 8 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CEFUROXIME------------ <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- 32 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- =>16 R ... FECAL CULTURE (Final [**2139-10-30**]): NO SALMONELLA OR SHIGELLA FOUND. CAMPYLOBACTER CULTURE (Final [**2139-10-30**]): NO CAMPYLOBACTER FOUND. OVA + PARASITES (Final [**2139-10-29**]): NO OVA AND PARASITES SEEN. CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2139-10-28**]): Feces negative for C.difficile toxin A & B by EIA. MICROSPORIDIA STAIN (Pending): CYCLOSPORA STAIN (Pending): OVA + PARASITES (Pending): Cryptosporidium/Giardia (DFA) (Pending): RESPIRATORY CULTURE (Final [**2139-10-29**]): MODERATE GROWTH OROPHARYNGEAL FLORA. ... CT-PE: 1. Tracheal stent is seen in situ and is patent throughout its course. 2. Atelectasis at the lung bases along with retained secretions in the right as well as the left lower lobe bronchi. 3. No pulmonary embolism or aortic dissection. Coronary arteries arise from the normal expected anatomical location. ... CXR [**2139-10-26**]: Low lung volumes which limits examination sensitivity. Persistent bibasilar atelectasis. Early pneumonia cannot be excluded. CXR [**2139-10-31**]: Since yesterday, bilateral blunting of costophrenic angles is unchanged. Lung volumes are still low. Left basilar ill-defined opacity increased, could be early pneumonia, aspiration, or atelectasis. Minimal left pleural effusion increased. There is overall no other change. Brief Hospital Course: In brief, the patient is a 54 year old woman with MUSK Ab+ myasthenia [**Last Name (un) 2902**], tracheobroncomalacia, anxiety, and sinus tachycardia who presented with gradual worsening in weakness found to have a UTI whose course was complicated by hypercarbic respiratory failure and intermittent hypoxia. 1. Dyspnea - admitting differential diagnosis included muscle weakness (from myasthenia or other cause, incited perhaps by UTI), structural abnormalities/TBM, anxiety, PE (which was ruled out), CAD/ischemia (no ecg changes, not c/w history). Patient had no fever, leukocytosis, or clear infiltrate to suggest pneumonia as cause. Patient noted to have mild hypoxemia with respiratory acidosis on admit and is a CO2 retainer at baseline. A bronchoscopy was performed [**2139-10-28**] to rule out stent obstruction, which revealed a patent stent with minimal mucous impaction. Patient was followed in the MICU for the first two days of her stay, with neuro consult, with adequate oxygenation and NIF at -80 and vital capacity measurements of >500cc, with assistance of breathing treatments (i.e. nebulizers). Myasthenia [**Last Name (un) 2902**] exacerbation was not believed to be the sole etiology of her [**Last Name (un) 7186**] of breath. Klonopin was initiated to control an element of anxiety, with good relief. Patient receieved her routine administration of IVIG over a three-day course of 50g, 55g, and 55g, initated on [**10-28**]. She was transferred to the neurology floor on [**10-28**]. On [**10-29**], she developed respiratory distress in setting of not using her BIPAP overnight, receiving benzos for anxiety, and SOB. CXR stable. She was transferred back to the MICU where her PCO2 was found to be 150. NIFs -80s. improved after placed on BiPap and flumenazil trial to counteract clonazepam 0.25mg given in the AM. given solumedrol 125mg stress dose steroids. She was then transferred to the floor, where she continued to have twice daily NIF and VC measurements (NIF -80s, VC 500-900). She was weaned off O2, but triggered on [**2139-11-2**] for O2 sat 77% RA and HR 150s while ambulating, likely related to exertion, minimal ventilation, and reflex tachycardia on top of baseline tachycardia. She was discharged on [**2139-11-3**] with instructions to use 2L NC (while at rest, 93% on room air and 95% on 2L NC. while walking, 87% on room air and 92-94% on 2L NC). 2. Myasthenia [**Last Name (un) 2902**] - contributation as above, noted to also have neck weakness. Was continued on her prednisone, mestinon, cellcept, and Bactrim ppx. As above, she received a 3-day course of IVIG at 50g, 55g, and 55g, started on [**10-28**]. Azathioprine was started on [**2139-10-29**] to supplement immunosuppression (cellcept, prednisone). She received bactrim for prophylaxis. We avoided beta blockers, calcium channel blockers, and quinolones due to potential exacerbation of myasthenia [**Last Name (un) 2902**]. 3. Anxiety - patient has history of anxiety and has been on SSRI and benzos in past. A psychiatry consult was placed, recommending outpatient follow-up. Patient was started on klonopin tid for anxiety control with good effect. However, after returning to the MICU for respiratory distress with possible inciting cause of receiving clonazepam 0.25mg that morning, all further benzodiazepines were avoided. 4. Tachycardia - had intermittent sinus tachycardia (150s when walking, 80s when sleeping) with an unchanged ECG, reportedly at her baseline. Avoided beta blockade and calcium channel blockade due to myasthenia [**Last Name (un) 2902**] history. 5. Urinary incontinence - chronic problem with recent worsening. Urine culture [**2139-10-27**] with klebsiella, ciprofloxacin started on [**2139-10-30**]--> changed to ceftriaxone on [**2139-10-31**]. WBC trended down. She was discharged on Keflex, with total antibiotic course of 7 days. She was recommended to discuss with her PCP [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 13511**] to urogynecology. 6. Diarrhea - noted to have [**12-24**] month history of diarrhea with subacute/chronic fecal incontinence, previously attributed to mestinon in past. Cdiff cultures were negative and extensive stool studies were unrevealing, some studies pending at discharge. Neuro recommended outpatient MRI C-spine to r/o trauma given her multiple procedures. She was continued on loperamide. 7. Tracheobronchomalacia: followed by IP service, mucolytic increased to TID. 8. DM2: placed on insulin sliding scale for better glycemic control in the setting of steroid use. Medications on Admission: Prednisone 20 mg DAILY Trimethoprim-Sulfamethoxazole 80-400 mg Tablet MWF. Calcium Carbonate 500 mg TID Pyridostigmine Bromide 60 mg Q6H Dextromethorphan-Guaifenesin Ten (10) ML PO Q6H prn Alendronate 70 mg Tablet QSUN Fluticasone 50 mcg/Actuation Spray, (2) Spray Nasal [**Hospital1 **]. Alprazolam 0.25 mg Tablet Sig: 0.5 to 1 Tablet PO three times a day as needed for anxiety. Paroxetine HCl 10 mg Tablet 1.5 Tablets PO DAILY (Daily). Guaifenesin 600 mg Tablet Sustained Release (2) Tablet [**Hospital1 **] (). Loperamide 2 mg Capsule One (1) Capsule PO QID as needed Insulin ?dosing Omeprazole 40 mg twice a day. Sodium Chloride 0.9 % Solution (1) neb Injection q6h Mycophenolate Mofetil 1000 mg [**Hospital1 **] Xopenex 0.63 mg/3 mL One (1) neb every 6-8 hours as needed. Discharge Medications: 1. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO 3X/WEEK (MO,WE,FR). 2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 3. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: Five (5) ML PO Q6H (every 6 hours) as needed. 4. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2) Spray Nasal [**Hospital1 **] (2 times a day). 5. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 6. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO four times a day for 2 days. Disp:*8 Tablet(s)* Refills:*0* 7. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 8. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO TID (3 times a day). 9. Levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization Sig: One (1) ML Inhalation q2 prn (). 10. Loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times a day) as needed. 11. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 12. Paroxetine HCl 10 mg Tablet Sig: 1.5 Tablets PO once a day. 13. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week: please take on empty stomach first thing in morning. and remain upright for 30 minutes after. 14. Azathioprine 50 mg Tablet Sig: One (1) Tablet PO twice a day for 8 days. Disp:*16 Tablet(s)* Refills:*0* 15. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q8H (every 8 hours) as needed. Disp:*30 inhaler* Refills:*0* 17. Home Oxygen Home Oxygen via nasal cannula (2L) for O2sat <88% 18. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale unit Injection QACHS: please see insulin sliding scale instructions included with discharge paperwork. 19. Azathioprine 100 mg Tablet Sig: One (1) Tablet PO twice a day: please start 100mg dose on [**2139-11-12**]. Disp:*60 Tablet(s)* Refills:*0* 20. Pyridostigmine Bromide 60 mg Tablet Sig: One (1) Tablet PO four times a day. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary diagnosis: myasthenia [**Last Name (un) 2902**] crisis tracheobronchomalacia urinary tract infection sinus tachycardia Secondary diagnosis: diabetes anxiety diarrhea Discharge Condition: stable. breathing comfortably with good oxygen saturation on room air. 93%RA at rest. 87-88%RA with exertion. 94% with 2LNC with exertion. Discharge Instructions: You were admitted for [**Last Name (un) 7186**] of breath and neck weakness. You were given BiPAP and then weaned to nasal cannula oxygen. You underwent flexible bronchoscopy to clean out secretions and the stent looked in good shape. You received IVIG therapy and new immunosuppression for your myasthenia [**Last Name (un) 2902**]. You were also found to have a urinary tract infection and were treated with antibiotics. Please use 2L oxygen while exerting yourself. Please continue your medications. Please continue your new immunosuppressant azathioprine 50mg twice a day until [**2139-11-11**]. Please take azathioprine 100mg twice a day starting [**2139-11-12**]. Please continue your antibiotic Keflex for 2 days. Please attend your recommended follow-up appointments. Please call your doctors [**First Name (Titles) **] [**Last Name (Titles) 7186**] of breath, chest pain, neck weakness, vision changes, or any other symptoms concerning to you. Followup Instructions: Please follow up with: --[**Last Name (Titles) 1220**]. [**Name5 (PTitle) **] & [**Doctor Last Name **] Phone:[**Telephone/Fax (1) 2846**] Date/Time:[**2139-12-8**] 10:30, please call ([**Telephone/Fax (1) 44**] with additional questions. --Dr. [**First Name (STitle) 9466**] [**Name (STitle) **] on Friday [**2139-11-6**] at 9am. Please call [**Telephone/Fax (1) 250**] with questions. --Interventional Pulmonology: The clinic will call you with an appointment to be seen in ~2 weeks. Please call ([**Telephone/Fax (1) 3020**] with questions. --We recommend that you discuss with your PCP how to set up an appointment with urogynecology to address your urinary incontinence. ICD9 Codes: 5990, 2762
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Medical Text: Admission Date: [**2149-3-18**] Discharge Date: [**2149-3-27**] Date of Birth: [**2068-1-30**] Sex: M Service: MEDICINE Allergies: Sulfa(Sulfonamide Antibiotics) Attending:[**First Name3 (LF) 2880**] Chief Complaint: Bowel obstruction, COPD, PNA, NSTEMI Major Surgical or Invasive Procedure: s/p diverting colonostomy and Lysis of adhesions on [**3-13**] at [**Hospital3 **] History of Present Illness: 81yoM with COPD, Parkinsons disease, asbestosis who presented to [**Hospital3 **] on [**3-11**] with abdominal pain, distension, and cough, whose course was complicated by PNA and NSTEMI, now being transferred to [**Hospital1 18**] with hemodynamic instability. . The patient had reported difficulty moving his bowels, abdominal pain, and distension for 2 days prior to presentation to [**Hospital1 **] on [**3-11**]. He had a leukocytosis of 12 with left shift of 80% PMN, 5% bands. He also reported upper respiratory symptoms with recent CXR showing only evidence of abestosis and had completed a course of Zithromax. He was determined to have a bilateral lower lobe PNA and was started on Levofloxacin and then broadened to Vanc/Zosyn, and was given duonebs and Methylprednisolone 40mg IV. He was also diagnosed with bowel obstruction and after three days of conservative management with NGT, enemas, IVF, he underwent an exploratory laparotomy with lysis of adhesions on [**3-13**] and ?colectomy with diverting transverse loop colostomy. He had an NGT placed and was started on TPN for nutrition. Post-op, he had a lateral wall NSTEMI believed to be due to demand ischemia, and a TTE on [**3-17**] showed a new diagnosis of severe aortic stenosis with normal EF. He was started on a Heparin gtt. He was also found to be in an acute CHF exacerbation with pulmonary edema on CXR, and was placed on a non-rebreather. He was subsequently diuresed with Lasix 20-40 mg IV and had multiple episodes of hypotension. During his stay at [**Hospital3 **], the patient's blood pressure and volume status was difficult to manage and he was intermittently on Phenylephrine and Neosynephrine. He has intermittently been on bipap and was weaned to a venti-mask the day of transfer. . Additionally, the patient was also found to be anemic with a hct ranging from 30-40, and was given 1 unit PRBC. He was also found to have an elevated d-dimer and underwent LENI's which were negative for DVT. . On arrival to the MICU, the patient was in moderate respiratory distress on a venti-mask and was also very anxious. He complained of abdominal pain at his colostomy and recent surgical site, but otherwise denied other pain. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . Past Medical History: - COPD - Asbestosis - Severe aortic stenosis (valve area 0.7cm2) - Dyslipidemia - Diverticulosis - Parkinson's Disease - Bipolar disorder - History of exploratory laparotomy - s/p bilateral knee replacement - s/p s/p diverting colonostomy and Lysis of adhesions at [**Hospital1 **] on [**2149-3-13**] Social History: - Tobacco: Denies current use. Prior smoker. - Alcohol: Denies current use. - Illicits: Denies. Married and lives with wife. Retired shipyard worker and merchant seaman. Family History: NC. Physical Exam: Vitals: Not listed General: Alert, oriented, moderate respiratory distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI Neck: Supple, JVP ~13-14 cm CV: Regular rate, tachycardic, normal S1 + S2, no murmurs or extra heart sounds appreciate in the setting of diffuse rhoncherous upper airway noises throughout Lungs: Use of accessory muscles with labored breathing. Tachypneic. Diffuse rhonchorous upper airway noises throughout. Crackles at bases bilaterally. Minimal wheezes bilaterally. Abdomen: Soft, tender at midline surgical site, ostomy pink and intact, mild to moderately distended, hypoactive bowel sounds GU: Foley in place Ext: Warm, well perfused, equal thready DP pulses b/l, no clubbing, cyanosis, trace pitting edema Neuro: non-focal Discharge: T98.1 BP 123/50 103-123/50-61, P 70s-80s, 96% RA, 24 H I/O [**0-0-**]. General: Alert, oriented, appears quite comfortable with breathing HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI Neck: Supple, JVP 10 cm CV: Regular rate and rhythm, normal S1, inaudible S2, parvus et tardus, [**4-15**] late peaking systolic murmur with radiation to carotids L>R vs carotid bruit, murmur heard across precordium Lungs: Mildly Tachypneic. Diffuse rhonchorous airway noises throughout. Crackles at bases bilaterally. Minimal wheezes bilaterally. Abdomen: Soft, tender at midline surgical site, ostomy pink and intact, mild to moderately distended, positive bowel sounds GU: No foley Ext: Warm, well perfused, equal thready DP pulses b/l, no clubbing, cyanosis, edema resolved Neuro: non-focal Pertinent Results: OSH labs [**3-18**]: 131 96 30 -------------- 87 3.6 29 0.5 . Ca 7.3, Mg 2.0, Phos 3.1 . AST 31, ALT 5, Tbili 0.5, Albumin 1.9, TP 4.3 . 10.3 11.0 ------ 261 29.8 . PT 12.1, INR 0.96, PTT 24.6 . Troponin I 0.52 . Micro: BCx at [**Hospital3 **] [**3-13**]: ntd Peritoneal Tissue: negative . Images: CXR OSH [**3-18**]: CHF has improved, decreased vascular congestion and pulmonary edema. Smaller pleural effusions. Atelectasis at the lung bases. NGT remains in position. . LENIs [**3-17**]: No DVT. . KUB [**3-17**]: Large amount of feces in the right colon. Several top normal air-filled dilated small bowel loops. Small amount of air in the left colon. No definite free air. Dense pleural calcifications noted. . CT Abdomen/Pelvis [**3-11**]: Modest hiatal hernia. Patchy bibasilar airspace process - bibasilar atelectasis or subsegmental consolidations. Extensive calcified pleural plaques. Colonic dilation (transverse colon 8cm) to the dital colon with marked stool burden and associated physiologic small bowel obstruction. Marked dilation of small bowel loops suggestive of obstructive pattern. No discrete transition zone. Distal sigmoid diverticulosis without diverticulitis. Small left inguinal hernia. . TTE [**3-16**]: EF 50-55%. Preserved systolic function. Borderline inferior wall hypokinesis. LA enlargement. Severe aortic stenosis (valve area 0.72 cm2, mean gradient 33mmHg). Mild aortic regurgitation. Mildly thick mitral valve with mitral annular calcification and mild MR. Moderate TR. . ADMISSION LABS AT [**Hospital1 18**]: [**2149-3-18**] 10:00PM BLOOD WBC-15.5* RBC-4.85 Hgb-13.4* Hct-40.8 MCV-84 MCH-27.7 MCHC-32.9 RDW-15.2 Plt Ct-423 [**2149-3-18**] 10:00PM BLOOD Neuts-86.0* Lymphs-7.8* Monos-4.5 Eos-1.2 Baso-0.5 [**2149-3-19**] 04:10AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-1+ Macrocy-NORMAL Microcy-1+ Polychr-NORMAL Ovalocy-1+ Ellipto-OCCASIONAL [**2149-3-18**] 10:00PM BLOOD PT-11.3 PTT-28.5 INR(PT)-1.0 [**2149-3-18**] 10:00PM BLOOD Glucose-107* UreaN-38* Creat-0.7 Na-138 K-4.6 Cl-101 HCO3-29 AnGap-13 [**2149-3-18**] 10:00PM BLOOD ALT-9 AST-43* LD(LDH)-278* AlkPhos-59 TotBili-0.4 [**2149-3-18**] 10:00PM BLOOD Albumin-3.5 Calcium-8.9 Phos-4.3 Mg-1.9 [**2149-3-18**] 10:00PM BLOOD Triglyc-66 [**2149-3-20**] 07:40AM BLOOD Vanco-12.9 [**2149-3-20**] 04:06AM BLOOD Digoxin-0.5* [**2149-3-18**] 09:50PM BLOOD Type-ART Temp-36.4 O2 Flow-12 pO2-71* pCO2-50* pH-7.37 calTCO2-30 Base XS-1 Intubat-NOT INTUBA [**2149-3-19**] 09:44AM BLOOD Type-ART Temp-36.6 Rates-/13 FiO2-40 pO2-88 pCO2-47* pH-7.44 calTCO2-33* Base XS-6 Intubat-NOT INTUBA Vent-SPONTANEOU [**2149-3-18**] 09:50PM BLOOD Lactate-0.7 [**2149-3-20**] 04:22AM BLOOD freeCa-1.06* At discharge: [**2149-3-27**] 08:04AM BLOOD WBC-8.7 RBC-3.67* Hgb-10.4* Hct-30.7* MCV-84 MCH-28.4 MCHC-34.0 RDW-16.3* Plt Ct-493* [**2149-3-27**] 08:04AM BLOOD Glucose-161* UreaN-9 Creat-0.8 Na-139 K-4.0 Cl-102 HCO3-31 AnGap-10 MICRO: [**2149-3-18**] 10:00 pm MRSA SCREEN Source: Nasal swab. **FINAL REPORT [**2149-3-21**]** MRSA SCREEN (Final [**2149-3-21**]): No MRSA isolated. [**2149-3-18**] 9:40 pm URINE Source: Catheter. **FINAL REPORT [**2149-3-20**]** URINE CULTURE (Final [**2149-3-20**]): NO GROWTH. URINE LEGIONELLA: NEG BLOOD CULTURES: NGTD =============== STUDIES/IMAGES: =============== ECG Study Date of [**2149-3-18**] 10:51:48 PM Supraventricular tachycardia. Consider atrial flutter with 2:1 block. There are also two wide complex beats which may be ventricular. ST-T wave abnormalities. No previous tracing available for comparison. Clinical correlation is suggested. Intervals Axes Rate PR QRS QT/QTc P QRS T 147 0 124 318/470 0 -13 152 # CT ABD AND PELVIS WITH ORAL CONTRAST ON [**3-19**]: FINDINGS: Coronary and aortic annulus calcifications are seen. Calcifications of the pericardium are seen. Pleural plaques are seen. Bilateral basilar atelectases are identified. ABDOMEN: The liver is with no gross pathology. The gallbladder is within normal limits. There is no intra- or extra-hepatic biliary duct dilatation. Calcifications of the spleen are seen. The pancreas is with no gross pathology. Both kidneys are unremarkable. No stones or hydronephrosis are seen within the kidneys. The patient is status post colectomy with diverting double-barrel colostomy. Diverticulosis is seen in the sigmoid colon without signs of diverticulitis. The small bowel is unremarkable. No signs of bowel obstruction are seen. No peritoneal lymphadenopathy is seen. There are no signs of retroperitoneal hematoma. Note is made to a small fluid collection with small gas bubble within it along the incision line. The collection is anterior to the peritoneum and measures 25 x 58 mm (2, 47). Atherosclerotic changes are seen along the course of the aorta. PELVIS: Foley catheter is seen within the urinary bladder, which is not fully distended. The prostate is within normal limits. Small amount of fluid is seen in the presacral region. OSSEOUS STRUCTURES: Degenerative changes are seen in the spine with no concerning lytic or osteoblastic lesion. IMPRESSION: 1. No evidence of hematoma. 2. Post operation fluid collection along the incision line, as described. ECHO [**2149-3-26**]: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. There are three aortic valve leaflets. The aortic valve leaflets are moderately thickened. There is critical aortic valve stenosis (valve area <0.8cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Physiologic mitral regurgitation is seen (within normal limits). The tricuspid valve leaflets are mildly thickened. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the prior study (images reviewed) of [**2149-3-19**], the function of the distal segments appears normal on the current study. Estimated aortic valve area is slightly less. The other findings are similar. Brief Hospital Course: 81yoM with COPD, Parkinsons disease, asbestosis who presented to [**Hospital3 **] on [**3-11**] found to have LBO s/p loop colostomy, course complicated by PNA and vasopasm vs aborted STEMI from thrombus or embolus w/ newly found severe AS transferred to [**Hospital1 18**] with hemodynamic instability now stable. Echo results show mostly apical hypokinesis c/w possible stress induced cardiomyopathy now resolved. . #. Respiratory Distress: Patient presented profoundly volume overloaded with labored breathing, elevated JVP ~13-14cm and crackles bilaterally, hypertension in the 180's systolic at admission which is consistent with fluid overload. Also with evidence of multifocal pneumonia on CT chest from OSH initially treated with Levofloxacin then broadened to Vanc/Zosyn for which he completed an 8 day course. Respiratory status significantly improved with diuresis, initially on Lasix gtt then transitioned to boluses. He then had persistent hypotension for which lasix drip was held. He was maintained euvolemic off lasix with breathing back to baseline. Pt with very mild swelling of extremities but given pt's preload dependence for blood pressure, further diuresis was held. . #. Aborted MI vs Vasospasm: Patient had vasospasm or transient thrombotic/emobolic event post-op, causing I and aVL ST elevation with reciprocal lead depression seen on OSH EKG. This resolved on further EKGs and the echo does not show focal deficits in this distribution. Pt was given heparin at that time. Most likely patient has stable CAD with an acute event that spontaenously resolved given the very mild troponin elevation at OSH and echo findings. Pt had no chest pain, trops trended down, EKG unremarkable for ischemia while here. [**Hospital 75195**] medical management was continued for stable CAD, including Aspirin 81 mg daily, Atorvastatin 80 mg daily, and Toprol 12.5 mg. Pt should be considered for LHC/RHC with vasodilator trial for aortic valve eval, vessel evaluation, ?primary pulmonary hypertension given severe lung disease. . # Acute on chronic systolic and diastolic CHF from stress induced cardiomyopathy: Pt initially grossly volume overloaded thought to be from diastolic failure secondary to aortic stenosis. Echo on [**3-19**] showed mild regional left ventricular systolic dysfunction with mostly apical hypokinesis, at least moderate pulmonary hypertension, and moderate diastolic dysfunction. Pt responded well to lasix but became hypotensive with continued diuresis and this was held with restoration of blood pressure with gentle fluid boluses. On repeat echo before discharge regional wall motion abnormalities resolved. Notably, pt did have I and aVL ST elevation which does not correspond with apical hypokinesis. Most likely pt had a stress induced cardiomyopathy which may have exacerbated hypotension and volume overload on top of his diastolic dysfunction. The patient was tolerating metoprolol well at time of discharge. Captopril was tried during hospitalization, but pt became hypotensive; most likely from too much afterload reduction for patient's aortic stenosis. . #. Aortic Stenosis: Patient with severe aortic stenosis with valve area 0.8cm2. Developed pulmonary edema and diastolic failure from this. Management discussed above. Cardiology follow-up as outpatient with possible cath and surgical AVR evaluation if indicated. Given severe lung disease and high pulmonary artery pressures on echo, would consider vasodilator trial as well if PVR high. . # Hypotension: Thought to be from severe AS leading to significant pre-load dependence, stress-induced cardiomyopathy, multifocal pna, possible medication effects (seroquel and lorazepam). Overdiuresis led pt to became hypotensive and episodes of hypotension also seemed to correlate with administration of seroquel for the patient's bipolar disorder. Thus, patient was placed on haldol. Pt's blood pressures were in the 110s-120s at discharge with maintanence of euvolemia as well as improvement in heart function on repeat echo. . #. Atrial Flutter: Patient with evidence of 2:1 aflutter at 150 bpm for less than 48 hours, which resolved. Most likely this was stress related. Rates at that time controlled with metoprolol and digoxin. There was no need for anticoagulation given the event was <48 hours and pt had no recurrence. Pt was continued on metoprolol for CHF and CAD and digoxin was stopped. . #. RUE Swelling: Patient with RUE swelling concerning for thrombus. RUE US neg for DVT . #. Parkinson's Disease: - Continue Carvidopa-Levodopa per home regimen . #. Bipolar Disorder: D/C??????ed seroquel given oversedation and hypotension. Psych was consulted and recommended starting patient on Haldol 1mg [**Hospital1 **], however given hypotension this was decreased to 0.5mg [**Hospital1 **]. Pt did well on this regimen. We retried seroquel before discharge, but this again resulted in hypotension, thus the patient was maintained on haldol. Will need outpatient psych followup. . # s/p large bowel obstruction: Patient presented to OHS with abd distention and was found to have ? large bowel obstruction. He had diverting colonostomy and Lysis of adhesions on [**3-13**] at [**Hospital3 **]. He now has a colostomy that has been draining liquid brown stool. He had a repeat abd CT with oral contrast on [**3-19**]. Our surgery team was consulted and he has possible lower L colon obstruction, past the stoma, concerning for malignancy. He will need to have a colonoscopy either from his rectum or from the stoma (if it is done from the stoma) he will need be at least 3 weeks post op. He is tolerating his diet well. Staples were removed here, but retention sutures to be removed in 30 days from surgery by surgeons at [**Hospital3 **]. . # Anemia: Labs c/w mix of anemia of chronic disease and [**Doctor First Name **], but predominant ACD likely given lower serum iron, low TIBC and transferrin, and normal ferritin. Would tend to expect high ferritin but possibly normal from [**Doctor First Name **] and [**Doctor First Name **] possible given left colonic obstruction/mass. . # Code: Full (confirmed with pt) . TRANSITIONAL: 1) The surgeons at [**Hospital1 **] who did your colostomy. They should remove the sutures a month from the surgery and decide how they would like to proceed with the colostomy 2) GI doctors [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] who will need to perform a colonoscopy for concern of lower left colon obstruction 3) Your PCP [**Last Name (NamePattern4) **]. [**First Name (STitle) **] who is aware of these health issues 4) Cardiology who will [**First Name (STitle) 4656**] you for aortic valve repair as well as coronary disease 5) Lung doctors [**First Name (Titles) **] [**Last Name (Titles) 4656**] your COPD and Absestosis 6) Neurology for your parkinsons 7) Psychiatry for Bipolar Medications on Admission: Home Medications: ([**First Name8 (NamePattern2) **] [**Hospital1 **] records) - Guaifenesen/codeine 5mL qid prn cough - Oxybutynin 10 mg daily - Neurontin 600 mg tid - Combivent 2 inhalations qid - Ventolin 2 inhalations qid prn - Senokot 2 tabs qhs - Docusate 200 mg qhs - Seroquel XR 600 mg qhs - Carbidopa/Levodopa 25/100 mg 2 tabs tid - Clonazepam 0.5 mg po daily . Transfer Medications: - Metoprolol 25 mg po tid - Atorvastatin 80 mg po qhs - Aspirin 325 mg daily - Vancomycin - Zosyn 3.375 IV q6h - Seroquel 400 mg qhs - Digoxin 0.125 mg po daily - Lactobacillus 1 tab [**Hospital1 **] - Pantoprazole 40 mg IV daily - Insulin regular SC sliding scale - Tylenol 650 mg po prn - Albuterol/Ipratropium nebs q4h - Docusaete 200 mg qhs - Senna 10 ml qhs - Carbidopa/Levodopa 2 tabs tid po - Clonazepam 0.5 mg po daily - Oxybutynin 10 mg po daily - Albuterol inhaler prn - Gabapentin 600 mg po with meals - Guaifenesin/Codeine 5 mg qid prn - Zofran 4 mg IV q6h prn - Fentanyl IV - Phenyleprhine gtt - Norepinephrine gtt - Heparin IV gtt - TPN Discharge Medications: 1. oxybutynin chloride 10 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO once a day. 2. Neurontin 600 mg Tablet Sig: One (1) Tablet PO three times a day. 3. Combivent 18-103 mcg/actuation Aerosol Sig: Two (2) inh Inhalation four times a day. 4. Xopenex HFA 45 mcg/actuation HFA Aerosol Inhaler Sig: Two (2) puffs Inhalation every 4-6 hours as needed for shortness of breath or wheezing. Disp:*1 unit* Refills:*2* 5. senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime. 6. docusate sodium 100 mg Capsule Sig: Two (2) Capsule PO at bedtime. 7. carbidopa-levodopa 25-100 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 8. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 9. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 10. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 11. multivitamin,tx-minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 12. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*0* 13. Toprol XL 25 mg Tablet Extended Release 24 hr Sig: 0.5 Tablet Extended Release 24 hr PO once a day. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0* 14. haloperidol 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary: Aortic stenosis, Pneumonia, Hypotension, Coronary vasospasm vs aborted STEMI, Acute systolic and diastolic heart failure Secondary: Parkinson's, Bipolar Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname **], You were admitted to [**Hospital1 18**] for low blood pressure in the setting of a pneumonia and severe aortic stenosis. You had a recent surgery at [**Hospital3 4107**] for a large bowel obstruction after which you developed many complications including pneumonia, heart failure, low blood pressure, and a small heart attack. You were treated with antibiotics, diuretics, and medications to help improve your heart function. It will be very important for you to follow up with your outpatient providers as you have many medical conditions that need follow up. This includes: 1) The surgeons at [**Hospital1 **] who did your colostomy. They should remove the sutures a month from the surgery and decide how they would like to proceed with the colostomy 2) GI doctors [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] who will need to perform a colonoscopy for concern of lower left colon obstruction 3) Your PCP [**Last Name (NamePattern4) **]. [**First Name (STitle) **] who is aware of these health issues 4) Cardiology who will [**First Name (STitle) 4656**] you for aortic valve repair as well as coronary disease 5) Lung doctors [**First Name (Titles) **] [**Last Name (Titles) 4656**] your COPD and Absestosis 6) Neurology for your parkinsons 7) Psychiatry for Bipolar The following changes were made to your medication: STOP Seroquel as this medication seemed to be tied to low blood pressure. This can be tried again when you are healthier at the discretion of your psychiatrist and primary care physician START Haldol for bipolar disorder START Atorvastatin for coronary artery disease START Xoponex inhaler for COPD STOP Albuterol inhaler (If Xoponex is not covered by your insurance, then it is okay to continue using albuterol instead) START Toprol for coronary artery disease START Aspirin for coronary artery disease START Multivitamin Followup Instructions: **It is recommended you schedule a follow up with your Primary Care Physician [**Name Initial (PRE) 176**] 1 week of discharge.** The following appointments were made for you: Department: CARDIAC SERVICES When: FRIDAY [**2149-4-4**] at 11:00 AM With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: PULMONARY FUNCTION LAB When: THURSDAY [**2149-4-10**] at 2:40 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: PFT When: THURSDAY [**2149-4-10**] at 3:00 PM Department: MEDICAL SPECIALTIES When: THURSDAY [**2149-4-10**] at 3:00 PM With: [**Name6 (MD) 610**] [**Name8 (MD) **] RN/DR. [**Last Name (STitle) 611**] [**Telephone/Fax (1) 612**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**First Name11 (Name Pattern1) 900**] [**Last Name (NamePattern1) 2882**] MD, [**MD Number(3) 2883**] Completed by:[**2149-4-1**] ICD9 Codes: 486, 4241, 4280, 4589, 2724, 496, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7157 }
Medical Text: Admission Date: [**2189-1-5**] Discharge Date: [**2189-1-8**] Date of Birth: [**2113-11-5**] Sex: F Service: [**Company 191**] HISTORY OF PRESENT ILLNESS: The patient is a 75-year-old female who is well-known to the [**Hospital **] Community Health Center, is mentally retarded, has diabetes mellitus type 2, hypertension, a history of ETOH abuse who presented to her PCP on the day of admission complaining of 2 weeks of cough and lethargy. She was found to have a BP of 60/palp and difficulty ambulating. She was brought by ambulance to the [**Hospital1 18**]-ED where her BP was noted to be 73/56, and she was noted to be in possible atrial flutter on EKG. She was treated with adenosine which produced a 3:1 conduction, and then with diltiazem at 10 mg IV which put her in normal sinus rhythm. She also received a total of 6 liters of normal saline IV fluid with a BP up to 111/60, and ceftriaxone 1 gm IV, and the sepsis protocol was initiated. Her temperature in the ED was 99.8. A left subclavian triple-lumen catheter was placed for access, and she was admitted to the [**Hospital Unit Name 153**]. REVIEW OF SYMPTOMS: She denied chest pain, dizziness. She complained of a mild cough but no sputum. She denied dysuria, urinary frequency, diarrhea and abdominal pain. A question was raised whether the patient's history was reliable, as she denied ETOH, because she is known to ingest alcohol. PAST MEDICAL HISTORY: 1. Mental retardation diagnosed in [**2167**] with no formal evaluation by psych or neuro. 2. Chronic active hepatitis B. 3. Diabetes mellitus type 2. 4. Hypertension. 5. ETOH abuse. 6. Cirrhosis. MEDICATIONS AT HOME: 1. Hydrochlorothiazide 50 qd. 2. Lisinopril 5 qd. ALLERGIES: No known drug allergies. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient lives in a home on her own. ADL are performed by patient. IQ 53. Ethics is involved but there is no healthcare proxy. The patient smokes. The patient drinks. The guardianship process is underway. PHYSICAL EXAMINATION ON ADMISSION: Temperature 98.1, pulse 72, BP 123/90, respiratory rate 20, oxygen saturation 97% on 2 liters. GENERAL: A frail, elderly female, lying in bed, no acute distress. HEENT: Mucous membranes moist. Oropharynx clear with whitish discharge on tongue. Pupils equal, round and reactive to light. NECK: Supple. No JVD. No LAD. Left subclavian triple-lumen catheter in place. CARDIOVASCULAR: Normal S1, S2, regular rate and rhythm without murmur. PULMONARY: Clear to auscultation bilaterally, no wheezes. ABDOMEN: Positive bowel sounds, soft, nontender, nondistended without hepatosplenomegaly. Mild discomfort in the right upper quadrant. EXTREMITIES: No edema bilateral lower extremities, warm, 2+ DP pulse left, 1+ DP pulse right. NEURO: [**4-15**] motor strength in bilateral lower extremities, [**4-15**] left upper extremity, [**3-16**] right upper extremity. Reflexes 1+ throughout. Very slow finger-to-nose. Oriented to season, not to year or to place. LABORATORIES ON ADMISSION: White count 17.9, hematocrit 42.7, platelets 255, sodium 133, potassium 3.7, chloride 94, bicarb 24, BUN 49, creatinine 2.1, glucose 138, calcium 10.2, mag 2.2, phos 4.3, albumin 2.9, ALT 192, AST 291, alk phos 197, T-bili 1.7, lactate 5.2. Blood cultures and urine cultures have been no growth to date. UA was negative. An EKG showed AFIB versus AFLUTTER versus MAT at 150 beats per minute which converted to normal sinus at 75 after diltiazem, with a normal axis, no Q waves, and no acute ST-T wave changes. A chest x-ray initially showed mild CHF with left lung base patchy atelectasis, no pneumothorax, no effusions, no consolidations. Right upper quadrant ultrasound showed coarse liver echo texture, no masses, no intrahepatic ductal dilatation, no free fluid in the abdomen. The portal vein was patent. The common bile duct was 7.5 mm. There was gallbladder wall thickening but this was not consistent with acute cholecystitis. It was consistent with cirrhosis. BRIEF SUMMARY OF HOSPITAL COURSE: The patient was initially admitted to the [**Hospital Unit Name 153**] under the sepsis protocol. She did quite well with fluids, and ceftriaxone IV. The next day she was called out to the floor and transferred that night to the [**Company 191**] Medicine service. 1) SEPSIS/HYPOTENSION/ID: The patient presented severely dehydrated with a creatinine 4x her baseline. She also had an elevated white count, elevated lactate, and was hypotensive. She responded quite well to aggressive fluid repletion, and also to ceftriaxone empiric treatment. She was essentially afebrile throughout, never really showing any signs of infection. Ceftriaxone was continued for 3 days. A follow-up chest x-ray was read as left lower lobe consolidation, could be consistent with pneumonia, though the patient did not have other signs or symptoms of pneumonia. At this point, she was transitioned to Levofloxacin 500 po qd. She should complete a 5-day course of the Levofloxacin. The patient presented with what sounded like a viral syndrome, initially a chest x-ray without signs of pneumonia. It is possible that burgeoning pneumonia brought her in and it developed over several days radiographically. It is also possible that this left lower lobe consolidation is atelectasis and that she never had a bacterial pneumonia. She is also to follow-up with her PCP on [**Name9 (PRE) 766**], [**1-12**]. 2) ACUTE RENAL FAILURE: The patient's baseline creatinine noted to be 1.0. She presented at 2.1. This was felt to be purely prerenal. As she responded well to fluids, her creatinine is actually 0.5 today. Her urine output was adequate. This was felt simply due to hypotension and volume depletion. 3) TACHYCARDIA: On presentation, the patient was in a SVT felt to be atrial flutter versus atrial fib versus multifocal atrial tachycardia. After fluids and diltiazem, she converted to normal sinus rhythm and essentially remained in normal sinus rhythm. This was felt probably the result rather than the cause of her hypotension. A TSH was checked which was normal. We do not believe the patient requires further evaluation at this time. 4) ELEVATED LFTS: The patient has a history of ETOH abuse, hepatitis B and known cirrhosis. When she presented, her LFTs were elevated and they consistently trended down over the course of her stay. Her LFT elevations were likely multifactorial due to hypotension, her Hep B, and possible alcohol ingestion. The right upper quadrant ultrasound showed no signs of cholecystitis, and there were no clinical signs of cholangitis. Also of note, the patient's INR appears at baseline to be slightly elevated likely due to decreased hepatic function combined with perhaps poor nutritional intake. 5) ETOH ABUSE: The patient denied alcohol intake; however, she is known to consume alcohol. She was placed on a CIWA scale for diazepam. However, few doses were needed. She did not appear to be in withdrawal. 6) DIABETES MELLITUS TYPE 2: The patient is diet controlled at home. She was placed on qid fingersticks and regular insulin sliding scale, but had good control on her own. 7) HYPERTENSION: The patient is on hydrochlorothiazide and lisinopril at home. These medications were held in the setting of hypotension. We will hold them on discharge, and they can be restarted as needed by her PCP next week. 8) HEME: The patient was admitted with a hematocrit of 43 which decreased to 33 with aggressive hydration, and then came up to 35. This was likely due to fluid shifts rather than to any acute blood loss. Her hematocrit settled out around 33-36. There were no signs of bleeding at any time. DISPOSITION: The patient was evaluated by physical therapy. Upon conversations with the patient's primary nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) **], it was felt that she was pretty close to her baseline. At this time, the final decision had not been made whether the patient would be discharged to an extended care facility or home with services. DISCHARGE DISPOSITION: To either extended care facility or homeless services. DISCHARGE INSTRUCTIONS: 1. You are to see Dr. [**Last Name (STitle) 3649**] on [**2189-1-12**] at 10:00 am, or perhaps this will be the nurse, Ms. [**Last Name (Titles) 931**]. 2. You should contact your primary doctor, or come to the ED with any fever, chills, shortness of breath, nausea or vomiting. DISCHARGE MEDICATIONS: 1. Colace 100 mg [**Hospital1 **]. 2. Thiamine 100 mg qd. 3. Folic acid 1 mg qd. 4. Multivitamin qd. 5. Levofloxacin 500 mg 1 tablet q 24 h x 5 days. DISCHARGE DIAGNOSES: 1. Sepsis or hypovolemia. 2. Atrial flutter. 3. Acute renal failure, now resolved. 4. Possible pneumonia versus atelectasis. MAJOR PROCEDURES: Central venous catheter placement. DISCHARGE CONDITION: The patient is taking good PO, able to ambulate, appears euvolemic. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 4704**], M.D. [**MD Number(1) 4705**] Dictated By:[**Last Name (NamePattern1) 6006**] MEDQUIST36 D: [**2189-1-8**] 10:40 T: [**2189-1-8**] 10:48 JOB#: [**Job Number 108669**] ICD9 Codes: 0389, 5849, 2765, 486, 5715
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Medical Text: Admission Date: [**2164-11-28**] Discharge Date: [**2164-12-6**] Date of Birth: [**2164-11-28**] Sex: F Service: NEONATOLOGY HISTORY OF PRESENT ILLNESS: The patient is an 1880 g female infant born at an estimated gestational age of 30 and 5/7 weeks. She is currently 8 days old with a corrected gestation [**Doctor Last Name **] age of 31 and 6/7 weeks. The mother is a 40- year- old, gravid a 2, para [**11-30**], woman with prenatal screens: B+, antibody negativ e, hepatitis B surface antigen negative, RPR nonreactive, rubella immune, GBS unknown. The mother's past medical history is notable for spina bifida occulta and infertility. The pregnancy is notable for a donor egg IVF gestation. Fetal survey was within normal limits. There wa s a premature rupture of membranes on [**2164-11-5**], and the mother was admitted to [**Hospital3 **] and treated with Magnesium Sulfate and antibiotics. A course of Betamethasone w as complete on [**2164-11-6**]. The mother was transferred to Be th [**Hospital1 **] [**First Name (Titles) **] [**Last Name (Titles) **] on [**2164-11-23**], due to a biophysical profile of 6 out of 8 and proceeded to develop spontaneous preterm labor. Her delivery was by spontaneous vaginal delivery. There was a maternal fever to 100.6??????and feta l tachycardia during labor. Antibiotics were started two hours prior to delivery. The infant was vigorous at delivery and received blow-by oxygen. Apgar scores were 7 at one minute and 8 at five minutes. She was transferred to the NICU for prematurity. PHYSICAL EXAMINATION: Vital signs: On admission temperature was 99.7??????, heart rate 190, respirations 68, blood pressure 54/34 with a mean of 44, oxygen saturation 95% in room air. General: The infant was a well-appearing preterm baby. [**Name (NI) 4459**]: Anterior fontanele open and flat, nondysmorphic, palate intact, mild nasal flaring, normal red reflex bilaterally. Cardiovascular: Regular, rate and rhythm. Normal S1 and S2. No murmur. Normal pulses. Chest: Minimal subcostal retractions. Good aeration bilaterally. No crackles. Abdomen: Soft, nondistended. No hepatosplenomegaly or masses. Patent anus. GU: Normal female external genitalia. Neurological: Active and responsive to stimulation. Normal tone. Moving all extremities symmetrically. Normal reflexes. Musculoskeletal: Normal spine, hips, and clavicles. No deformities noted. HOSPITAL COURSE: 1. Respiratory: The infant had mild retractions and nasal flaring for the first 2-3 days of life; however, she has remained stable in room air without any need for respiratory support. She has had occasional episodes of desaturation was started on Caffeine for apnea of prematurity, after which the desaturatio ns resolved. 2. Cardiovascular: The infant has been hemodynamically stable. A soft intermittent murmur was noted on day of life #4. Chest x-ray showed normal cardiac silhouette, and four extremity blood pressures were normal. The murmur has since resolved. 3. Fluids, electrolytes and nutrition: The infant was initially started on intravenous fluids. She had an initial D - stick shortly after birth of 22, but since then has not had an y significant hypoglycemia. She had some spitting with advancem ent of feeds, but is currently tolerating full enteral feedings vi a gavage tube of PE22. Weight on the day of discharge is 1.77 kg, length 43 cm, head circumference 28.75 cm. 4. Gastrointestinal: The infant was treated wtih phototherap y for hyperbilirubinemia. Peak bilirubin on day of life #3 was 12.5. Single phototherapy, which was discontinued on day of l ife #6. Rebound bilirubin on day of life #7 was 5.4. 5. Hematologic: The infant had an initial CBC with a white count of 7, hematocrit 39.6, platelet count 248. She has not received any transfusions. 6. Infectious disease: The infant was treated with Ampicillin and Gentamicin for 48 hours due risk factors for sepsis. Her blood culture was negative, and she has had no clinical signs of sepsis. 7. Neurologic: A screening head ultrasound on day of life #7 was notable only for subtle increased echogenicity of the ependymal lining of the ventricles. Although this may simply represent a technical artefact, the radiologist also noted that this oculd be suggestive of chemical ventriculitis secondary to a small intraventricular hemorrhage . There was no germinal matrix hemorrage or intraventricular blo od noted, and the ventricles were normal in size. A repeat head ultrasound should be performed in [**1-1**] days. 8. Sensory: The infant will require both a hearing screen an d an ophthalmologic exam prior to discharge home. 9. Psychosocial: A [**Hospital6 256**] Social Work has been involved with the family. We have held a family meeting, as well as frequent bedside updates. CONDITION ON DISCHARGE: Fair. DISPOSITION: Discharged to Level II Nursery. PRIMARY CARE PHYSICIAN: [**Name Initial (NameIs) 23198**]. CARE RECOMMENDATIONS: Feeds at discharge: Premature Enfamil with HMF 22 kcal per ounce at 140 cc/kg/day all PG. MEDICATIONS: Caffeine citrate 12 mg PG every day. CAR SEAT POSITIONING: Screening should be performed prior to discharge. STATE NEWBORN SCREENING: Has been sent. Hearing SCreens have not been done and are suggested prior to ultimate dischargeischarge homeI ZATIONS RECEIVED: The infant has not ultimate discharge home. immunizations and will require hepatitis B vaccine prior to discharge home. Synagis RSV prophylaxis should be considered from [**Month (only) 359**] [**Last Name (un) **] ugh [**Month (only) 547**] for infants who meet any of the following three criteria : 1) born at less than 32 weeks, 2) born between 32 and 35 weeks with plans for daycare during RSV season, with a smoker in the household, neuromuscular disease, airway abnormalities, or wit h preschool siblings, or 3) with chronic lung disease. Influenza immunization should be considered annually in the fall for preterm infants with chronic lung disease once they reach six months of age. Before this age, the family and other caregivers should be considered for immunization against influenzae to protect the infant. DISCHARGE DIAGNOSIS: 1. Prematurity. 2. Rule out sepsis. 3. Feeding immaturity. 4. Hyperbilirubinemia. 5. Apnea of prematurity. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 36142**], M.D. [**MD Number(1) 36143**] Dictated By:[**Last Name (NamePattern1) 50798**] MEDQUIST36 D: [**2164-12-5**] 08:05 T: [**2164-12-5**] 08:13 JOB#: [**Job Number 52502**] ICD9 Codes: 7742, V290
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Medical Text: Admission Date: [**2154-5-4**] Discharge Date: [**2154-5-15**] Service: HISTORY OF PRESENT ILLNESS: This is a [**Age over 90 **]-year-old man, with a history of dementia and atrial fibrillation, who presents from home. He originally went to an outside hospital where a chest x-ray revealed left pleural effusion and a large cardiac silhouette. The patient was found to have increasing shortness of breath and pleuritic chest pain radiating to his back, and was transferred to the [**Hospital1 **] Hospital for further evaluation and work-up. The patient denies nausea, vomiting, diaphoresis, but does admit to shortness of breath and chest pain, as above. PAST MEDICAL HISTORY: 1) Atrial fibrillation, 2) Status post spinal fusion, 3) History of prostate cancer, status post XRT in [**2142**], 4) Mitral valve prolapse, 5) Status post knee surgery, 6) Status post appendectomy, 7) History of pneumonia eight months ago. ALLERGIES: None. MEDICATIONS: 1) coumadin 5 mg po qd, 2) lasix 20 mg po qd, 3) digoxin 0.25 mg po qd, 3) Aricept 5 mg po qd, 4) KCL 20 mg po qd. PHYSICAL EXAM ON ADMISSION: Generally, agitated, demented. JVP was at 8 cmH2O. Distant heart sounds. Pulsus 15 mmH2O. Bilateral rales at the bases. Decreased breath sounds, left greater than right, at the bases. II/VI systolic murmur. White count 8.5, crit 32.2, platelets 422. Sodium 138, potassium 4.6, chloride 101, bicarb 25, BUN 31, creatinine 0.9, glucose 162. CT chest and abdomen revealed no aortic dissection, but did reveal a 4x4 abdominal aortic aneurysm, infrarenal, cardiomegaly, and a large pericardial effusion with bilateral pleural effusions. EKG was atrial fibrillation at a rate of 110, biphasic T waves in 4 through 6, but no alternans, no decreased voltage. HOSPITAL COURSE - 1) PERICARDIAL EFFUSION: The patient was monitored closely with daily measurements of his pulsus paradoxus and close blood pressure monitoring, as it was thought that he had possible impending tamponade. Serial echocardiograms revealed some echocardiographic evidence for tamponade, but the patient was able to maintain a normal to high blood pressure. Nevertheless, on hospital day #5, the patient was taken to the Catheterization Lab and a pericardiocentesis was performed where blood was removed from the pericardial space, and there was found to be a loculated pericardial effusion with significant amounts of blood clot. The patient's INR was 6.5 at admission which may have explained the patient's bloody pericardial effusion. There was cytology done on this sample that was negative; however, malignancy was still a concern in this patient with a history of prostate cancer. The patient's pleuritic chest pain, shortness of breath improved after pericardiocentesis. The patient was monitored in the CCU for 48 hours, and the patient had symptomatic improvement, was able to be weaned off the minimal amount of oxygen, had decreased shortness of breath. 2) PLEURAL EFFUSION: The patient's pleural effusion was also tapped and almost 2 liters of fluid were removed. This was consistent with an exudative effusion; however, there was no obvious cause for exudative effusion, no Gram stain findings. The fluid culture was negative. The patient was afebrile throughout his hospitalization and showed no sign of infection. Again, malignancy was at the top of the list for the possible etiology of the effusions. The pleural disease service was consulted and considered pleuroscopy with biopsy. However, the patient's pleural effusion did not reaccumulate; therefore, pleuroscopy was not pursued. However, at a future date pleuroscopy could be pursued for both biopsy and pleurodesis if this patient has recurrent problems with pleural effusions and shortness of breath. 3) ATRIAL FIBRILLATION: The patient's atrial fibrillation was uncontrolled for several days with a high rate of 131-40. Minimal rate control was pursued because of the patient's possible tamponade physiology. When the patient's pericardial effusion was further characterized and tapped, more aggressive rate control was pursued with Lopressor which was titrated up to 75 mg po tid. The patient was also started on Norvasc for rate control and blood pressure control. The patient's heart rate was better controlled at the time of discharge, between 80 and 90. The patient had a run of CHF when his rate was quite high in the context of this pericardial effusion. The patient was diuresed in the CCU, and the patient was no longer short of breath, and was off oxygen at the time of discharge. 4) DEMENTIA: The patient had definite sundowning. He was started on Zyprexa at 5:00 pm each day with prn Risperdal. The patient responded well to this regimen and was minimally disruptive. At time of discharge, the patient did require 1:1 sitter for much of his hospitalization, but this was discontinued several days prior to discharge. 5) ACTIVITY LEVEL: The patient became physically decompensated after being in bed for several days with his shortness of breath and pericardial effusion. The patient was seen by physical therapy and evaluated, and thought to be a good candidate for acute rehab, as he had been pretty independent and functional prior to discharge. DISCHARGE CONDITION: Good. The patient was discharged to acute rehab. DISCHARGE MEDICATIONS: 1) Norvasc 7.5 mg po qd, 2) Olanzapine 7.5 mg po q 5:00 pm every night, 3) Lopressor 75 mg po tid, 4) Risperdal 1 mg po bid prn, 5) digoxin 0.25 mg po qd, 6) subcu heparin 5,000 U q 12 h, 7) lasix 20 mg po qd, 8) docusate 100 mg po bid, 9) Donepezil 5 mg po q hs. DISCHARGE DIAGNOSES: 1) Congestive heart failure. 2) Pericardial effusion. 3) Pleural effusion. 4) Atrial fibrillation with rapid ventricular response. 5) Dementia. 6) Status post prostate cancer. [**Doctor First Name 475**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 474**], M.D. [**MD Number(1) 9632**] Dictated By:[**Last Name (NamePattern1) 7942**] MEDQUIST36 D: [**2154-5-15**] 08:39 T: [**2154-5-15**] 07:57 JOB#: [**Job Number 99862**] ICD9 Codes: 4280, 5119, 4240
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Medical Text: Admission Date: [**2127-6-22**] Discharge Date: [**2127-6-26**] Date of Birth: [**2068-10-17**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 689**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: Cardiac Catheterization History of Present Illness: 58 M with h/o DM, hyperlipidemia, hypertension, neuropathy, tenosynovitis, and chronic headaches presents with sharp left-sided chest pain radiating to his left shoulder and scapula which started yesterday morning. The pain was slightly worsened by movement. He felt slightly lightheaded and short of breath. He has a history of capsulitis to which he initially attributed the pain to, however pain did not improve with Tylenol, so he presented to the ED. In the ED, pain slightly improved with SL NTG x3 and aspirin. EKG was without acute changes and cardiac enzymes have been negative. He was admitted to the observation unit where he had continued chest pain that again slightly improved with SL NTG and admitted to medicine. Patient describes the pain as a constant, sharp pain. Has never experienced this before. . On the medicine service, he continued to have chest pain. Cardiology was consulted and recommended cardiac catheterization given atypical chest pain that has persisted for over 24 hours. Pain was again slightly improved with SL NTG x3, IV morphine 2mg x3, and IV metoprolol 5 mg x1. EKG over the course of the day showed that he has progressively peaking T waves. Patient was started on a heparin drip for concern for ACS. He continued to have pain. Nitro drip was unable to be started on the floor to help in controlling pain and so patient was transferred to the CCU for further management. . Cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, or syncope Past Medical History: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: none 3. OTHER PAST MEDICAL HISTORY: - DM - Hyperlipidemia - Hypertension - Hypothyroidism - Tenosynovitis - Tension Headaches - Peripheral Neuropathy - Palmar Contracture - Peptic Ulcer and GI bleed - last bleed in [**2097**] - h/o TIA x5 Social History: -Tobacco history: former smoker - quit [**2115**] -ETOH: denies -Illicit drugs: denies Former ENT physician in [**Country 532**]. Married. Family History: Father with CAD (60s). No premature heart failure or sudden cardiac death. Physical Exam: VS: 98, L 140/79, R 140/80, 98, 18, 96% 2L Gen: WDWN male in NAD, AAOx3 Eyes: No conjunctival pallor. No icterus. ENT: MMM. OP clear. CV: JVP low. Normal carotid upstroke without bruits. PMI in 5th intercostal space, mid clavicular line. RRR. nl S1, S2. No murmurs, rubs, clicks, or gallops. Full distal pulses bilaterally. No femoral bruits. LUNGS: CTAB. No wheezes, rales, or rhonchi. ABD: NABS. Soft, NT, ND. No HSM. Abdominal aorta was not enlarged by palpation. No abdominal bruits. Heme/Lymph/Immune: No CCE, no cervical lymphadenopathy. SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**2-1**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred. PSYCH: Mood and affect were appropriate. Pertinent Results: ADMISSION: [**2127-6-22**] 01:37PM BLOOD WBC-4.3 RBC-5.03 Hgb-14.6 Hct-43.4 MCV-86 MCH-29.0 MCHC-33.6 RDW-13.5 Plt Ct-208 [**2127-6-22**] 01:37PM BLOOD Neuts-62.4 Lymphs-30.5 Monos-4.7 Eos-1.1 Baso-1.4 [**2127-6-23**] 08:00AM BLOOD PT-11.4 PTT-29.6 INR(PT)-0.9 [**2127-6-22**] 01:37PM BLOOD Glucose-156* UreaN-23* Creat-1.4* Na-141 K-4.6 Cl-102 HCO3-33* AnGap-11 [**2127-6-24**] 03:10AM BLOOD ALT-17 AST-16 CK(CPK)-65 AlkPhos-72 Amylase-21 TotBili-0.9 [**2127-6-24**] 03:10AM BLOOD Lipase-32 [**2127-6-22**] 01:37PM BLOOD cTropnT-<0.01 [**2127-6-22**] 07:30PM BLOOD cTropnT-<0.01 [**2127-6-23**] 12:50AM BLOOD CK-MB-3 cTropnT-<0.01 [**2127-6-23**] 08:00AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2127-6-23**] 09:08PM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2127-6-24**] 03:10AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2127-6-23**] 08:00AM BLOOD Calcium-8.6 Phos-3.1 Mg-2.2 [**2127-6-26**] 06:40AM BLOOD Triglyc-134 HDL-56 CHOL/HD-2.8 LDLcalc-76 LDLmeas-78 [**2127-6-22**] 01:37PM BLOOD D-Dimer-152 [**2127-6-26**] 06:40AM BLOOD HBsAg-NEGATIVE HBsAb-BORDERLINE HBcAb-NEGATIVE [**2127-6-26**] 06:40AM BLOOD HCV Ab-NEGATIVE DISCHARGE: [**2127-6-26**] 06:40AM BLOOD WBC-4.4 RBC-5.06 Hgb-14.3 Hct-43.6 MCV-86 MCH-28.3 MCHC-32.9 RDW-13.6 Plt Ct-212 [**2127-6-26**] 06:40AM BLOOD Glucose-108* UreaN-15 Creat-1.0 Na-142 K-3.8 Cl-102 HCO3-31 AnGap-13 [**2127-6-26**] 06:40AM BLOOD Albumin-4.6 Calcium-9.0 Phos-3.6 Mg-1.8 Cholest-159 REPORTS: [**2127-6-22**] Cardiology ECG Normal sinus rhythm. Possible left atrial enlargement. Minor non-specific ST-T wave abnormalities. Compared to the previous tracing of [**2122-5-8**] heart rate has decreased. Non-specific ST-T wave abnormalities are slightly less marked. Otherwise, no diagnostic change. [**2127-6-22**] Radiology CHEST (PA & LAT) FINDINGS: The heart and mediastinal contours are normal. The hila are normal appearing bilaterally. The lungs are clear of masses or consolidations. There is no pleural effusion or pneumothorax. Bony structures are grossly intact. IMPRESSION: No acute cardiopulmonary process. [**2127-6-23**] Cardiology ECHO The left atrium is elongated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF 55%). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The ascending aorta and aortic arch are mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Mild mitral regurgitation with normal valve morphology. CLINICAL IMPLICATIONS: Based on [**2124**] AHA endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is NOT recommended. Clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. [**2127-6-24**] Cardiology C.CATH 1. Selective coronary angiography of this right dominant system revealed no significant CAD. The LMCA and LCX were without angiographically apparent disease. The LAD had a 30% stenosis in the proximal LAD. The RCA had a proximal 30% stenosis. 2. The celiac artery, superior mesenteric artery, and renal arteries (bilaterally) were selectively engaged and found to have no significant disease. 3. Central aortic pressure and left sided filling pressures were both normal. FINAL DIAGNOSIS: 1. Coronary arteries are normal. 2. Normal diastolic function. 3. Normal celiac, superior mesenteric, and renal arteries. 3. Dilated bowel loops seen under fluoroscopy. [**2127-6-24**] Radiology CTA CHEST W&W/O C&RECON 1) No pulmonary embolism or acute aortic pathology. 2)Mild linear atelectasis and dependent atelectasis in the lower lobes bilaterally. 3)Sub-2-mm nodules in the right upper lobe and right lower lobe do not require followup in the absence of smoking history. If there is a smoking history, followup CT thorax should be performed in one year to evaluate interval change. 4)Moderately severe coronary artery calcification and small hiatal hernia. [**2127-6-24**] Radiology ABDOMEN (SUPINE & ERECT ABDOMEN PORTABLE, TWO VIEWS: The ascending colon is dilated to 7.7 cm. there is a large amount of air in the small and large bowel. However, air is seen all the way to the sigmoid colon and rectum. Small bowel loops are not significantly dilated, measuring up to 2.6 cm. There is no evidence of free air. IMPRESSION: Findings consistent with ileus. Brief Hospital Course: 58M with [**Location (un) 47**] risk factors of diabetes, hypertension, and hyperlipidemia who presented with new acute onset chest pain. . # CHEST PAIN: The patient continued to have chest pain on the floor with an EKG showing new prominent T waves although cardiac biomarkers were negative. There was concern for cardiac ischemia given his multiple cardiac risk factors. He was started on a heparin drip, aspirin, beta blocker and high dose statin. He was taken for cardiac catheterization which was negative for coronary artery disease. He then underwent CTA which was negative for PE or for any other cause of his chest pain. Finally, he underwent EGD which revealed possible varices which was followed up by GI. It also showed mild esophagitis for which he was started on a PPI. He also had a small hiatal hernia. The cause of his chest pain was unclear although it may have been due to esophagitis. He was chest pain free upon discharge. . # DIABETES: He was continued on his insulin pump as well as a sliding scale with close monitoring for sugars. . # ACUTE RENAL FAILURE: His renal function was found to be slightly worse than baseline. This was thought to be pre-renal in setting of dehydration. He was given fluids and his creatinine returned to [**Location 213**]. He was continued on lisinopril for his proteinuria. His renal function was at baseline by discharge. . # CONSTIPATION: Patient had not had a bowel movement in several days and KUB was concerning for ileus. His abdominal exam however remained benign and he denied any pain. He moved his bowels prior to discharge with the help of a bowel regimen. . # INCIDENTAL LUNG NODULE: Found on CTA, because of his smoking history he will need a repeat CT scan in 1 year ([**6-10**]), and this will be communicated to his PCP. . # HYPERLIPIDEMIA: He was continued on a statin. . # HYPERTENSION: continued lisinopril and started low dose metoprolol . # Hypothyroidism: continued levothyroxine . # h/o tension headaches: continued nortriptyline . # Tenosynovitis - takes methotrexate at home qFriday: held methotrexate in acute setting and this was restarted upon discharge. . # h/o TIA x5 - no neurological deficits noted. Patient has not been on anticoagulation in the past. Patient was continued on a statin. Medications on Admission: Insulin pump Levothyroxine 125 mcg daily Lisinopril 5 mg daily Nortriptyline 25 mg daily Methotrexate (unknown dose) weekly (last taken on Friday) Folic Acid 1 mg daily Discharge Medications: 1. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Nortriptyline 25 mg Capsule Sig: Three (3) Capsule PO HS (at bedtime). 5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 7. Insulin Pump Reservoir 3 mL Misc Sig: One (1) Miscellaneous once a day: As directed. 8. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO DAILY (Daily). Disp:*30 Tablet Sustained Release(s)* Refills:*2* 9. 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* Discharge Disposition: Home Discharge Diagnosis: 1) Atypical chest pain 2) Esophageal varices 3) Constipation 4) Possible esophageal spasm 5) Possible gastroesophageal reflux disease 6) Gastritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: It was a pleasure to take care of you here at [**Hospital1 18**]. You were admitted for chest pain. Fortunately, all our testing was negative for the most life-threatening causes of chest pain, including a heart attack, pulmonary embolism, pneumothorax, or aortic dissection. You also underwent a scope of your upper GI tract which showed mild inflammation and varices of your esophagus. You should undergo an ultrasound of your liver and follow up with the GI department for these findings. Although we don't have a definitive diagnosis on the cause of your chest pain, the two most likely possibilities include esophageal spasm, for which you are being treated with nifedipine (calcium channel blocker) as well as gastroesophageal reflux for which you are being treated with pantoprazole (a proton pump inhibitor). We have set you up with cardiology and the GI team to follow up your chest pain as an outpatient. Fortunately, most of your symptoms improved the last 2-3 days prior to admission, possibly due to starting these medications. If you develop severe chest pain again, you should call your doctor or come to the emergency department. And although your cardiac catheterization was negative for obstructive disease, you should still be on a life-long baby aspirin and a cholesterol lowering [**Doctor Last Name 360**] such as atorvastatin to keep your LDL cholesterol below 70. We have made the following changes to your medications. - START taking aspirin 81mg by mouth daily - START taking pantoprazole 40mg by mouth daily - START taking nifedipine 60mg by mouth daily - START taking atorvastatin 40mg by mouth daily - DISCUSS with your doctor about the esophageal varices and whether the methotrexate may be contributing before continuing to take this medicine Followup Instructions: Department: HMFP When: TUESDAY [**2127-7-1**] at 9:00 AM With: N [**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 **] SQ When: TUESDAY [**2127-7-8**] at 12:15 PM 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 Department: [**Last Name (un) 12214**] [**Doctor Last Name **] MED GRP When: TUESDAY [**2127-7-15**] at 1 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], MD [**Telephone/Fax (1) 5068**] Building: [**Location (un) **] ([**Location (un) 86**], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: On Street Parking Completed by:[**2127-9-22**] ICD9 Codes: 5849, 3572, 2724, 2449
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7161 }
Medical Text: Admission Date: [**2165-8-13**] Discharge Date: [**2165-8-22**] Service: MEDICINE Allergies: Tramadol / Advil / Nsaids / Hydrocodone Attending:[**First Name3 (LF) 9240**] Chief Complaint: GI Bleed Major Surgical or Invasive Procedure: Bedside Debridement R Heel Ulcer History of Present Illness: Mr. [**Known lastname **] is an 86M with PMH significant for h/o duodenal ulcer s/p partial duodenectomy, who presents from [**Hospital 100**] Rehab after melena noted on [**8-11**]. Denied CP, SOB, abd pain, N/V, though his son had noted some increased confusion during the previous few days. He was found to have a hct drop from baseline 29 to 19, and was sent to the ED. EMS VS BP 110/60, HR 92, RR 18. In the ED, initial VS were T: 99.4F, HR: 119, BP 108/39, RR 19, SaO2 100%. ECG demonstrated NSR at 96bpm, LAD, incomplete RBBB, poor r-wave progression. A decision was made not to place NGT since patient uncooperative, and due to concerns about aspiration. A 16ga and an 18ga PIVs were placed, and he was given 2U PRBC and 2L NS, and was given protonix 40mg IV. GI was consulted, and is aware. Mr. [**Known lastname **] was also found to have a UTI, and was given Levofloxacin 500mg IV. He was transferred to the [**Hospital Unit Name 153**] for monitoring. . Originally had GIB in [**8-17**] with black, tarry stools, dx'ed as PUD. He had a hip replacement in [**11-17**], and was d/c'ed on coumadin. Later that month, he re-presented to [**Hospital1 **] with bloody stools, hypotensive, and anemic to hct 14.7. EGD demonstrated bleeding duodenal ulcer, but epi was not attempted [**2-14**] inability to visualize clot. He was taken for angio and embolization, with subsequent rebleeding requiring ex lap, duodenotomy, oversewn ulcer, j-tube placement and biopsy of liver mass. He was continued on a proton pump inhibitor. He failed various swallow evaluations and was fed through his J-tube. Course was complicated by difficulty weaning from vent and MRSA PNA and pseudomonas UTI and bacteremia. Also found to have superficial femoral vein clots, and IVC filter was placed. Had subsequent LGIB in [**2-18**], with colonoscopy revealing grade 1 internal hemorrhoids, and a cecal popyp, which was cauterized. Course c/b c. diff colitis, s/p flagyl and PO vanc treatment x total 28 days. Also with 06/06 admission for J-tube replacement, with Klebsiella UTI sensitive only to Bactrim, Unasyn, Zosyn, and carbapenems. . in the [**Hospital Unit Name 153**], initial BPs found to be SBP 80s-90s, HR 80s. Given 1L NS over 1 hour, which raised SBP to 100s-110s. UOP 80mL in first hour. Repeat hct 19.1 -> 21.8 after 2U PRBC, started two additional units PRBCs over two hours each. NGT placement was attempted, but aborted after multiple unsuccessful attempts, significant patient distress, and transient desats to 90%. Spoke with GI, who plans to scope on [**8-14**] unless becomes unstable. Past Medical History: 1. Hypertension 2. Chronic obstructive pulmonary disease 3. Osteoarthritis 4. Osteopenia 5. Dementia 6. Depression 7. Status post bilateral inguinal hernia repair 8. Status post bilateral cataract surgery 9. Status post right total hip replacement . Cardiac: Stress [**2164-9-6**]: no ecg changes. Moderate fixed inferior wall perfusion defect. LV EF of 60%. Echo [**2165-1-9**]: LV EF>55% no LVH, nl RV size/fxn. 1+AR, PAP wnl Social History: Currently a patient at [**Hospital **] rehab. Patient is on the waiting list at [**Hospital1 5595**]. The patient previosly reported that his parents as well as his siblings were all killed during the holocaust. He is a retired meat manager at a local supermarket. He immigrated from [**Country 532**] in the late [**2099**]. The patient had denied any tobacco or alcohol use Family History: noncontributory Physical Exam: VS: T: 99.1F BP: 99/38 HR: 85 RR: 20 SaO2: 96% 1L NC Gen: Cachectic Caucasian male, mildly distressed, disoriented HEENT: Sclerae anicteric, OP dry CV: RRR, nl S1 and S2, III/VI SEM loudest at apex Pulm: Poor inspiratory effort, decreased breath sounds throughout, no clear w/r/r Abd: Soft, no clear tenderness, though pt uncooperative with exam, no erythema with mild white discharge around J-tube site, no HSM, +BS Extr: +stage III coccyx ulcer, dressing c/d/i, +R heel ulcer, necrotic, dressing c/d/i. 1+ DPs bilaterally, extremities warm. +clubbing Neuro: A&Ox1, MAEW, uncooperative with formal exam Pertinent Results: [**2165-8-13**] 09:55PM COMMENTS-GREEN TOP [**2165-8-13**] 09:55PM LACTATE-2.8* [**2165-8-13**] 08:20PM URINE COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.013 [**2165-8-13**] 08:20PM URINE BLOOD-SM NITRITE-POS PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-MOD [**2165-8-13**] 08:20PM URINE RBC-0-2 WBC->50 BACTERIA-MANY YEAST-NONE EPI-0 [**2165-8-13**] 07:30PM GLUCOSE-96 UREA N-27* CREAT-0.6 SODIUM-141 POTASSIUM-4.6 CHLORIDE-105 TOTAL CO2-25 ANION GAP-16 [**2165-8-13**] 07:30PM CK(CPK)-49 [**2165-8-13**] 07:30PM CK-MB-NotDone cTropnT-0.03* [**2165-8-13**] 07:30PM WBC-10.2 RBC-2.67*# HGB-5.8*# HCT-19.1*# MCV-72* MCH-21.8*# MCHC-30.5* RDW-17.9* [**2165-8-13**] 07:30PM NEUTS-76.8* LYMPHS-13.1* MONOS-6.6 EOS-2.8 BASOS-0.6 [**2165-8-13**] 07:30PM HYPOCHROM-3+ ANISOCYT-1+ POIKILOCY-2+ MICROCYT-3+ [**2165-8-13**] 07:30PM PLT COUNT-609* [**2165-8-13**] 07:30PM PT-12.9 PTT-21.7* INR(PT)-1.1 .. MR R foot: 1. Posterior calcaneal edema. Given the close proximity to the soft tissue ulcer, findings are highly suspicious for osteomyelitis. (it is not clear whether the cortical loss seen on the xray is secondary to infection or post- surgical. The marrow edema seen in the calcaneus likely reflects a combination of osteomyelitis (closer to the ulcer) and surorunding reactive edema, but the precise demarcation between these two areas cannot be assessed by imaging. 2. Edema of the quadratus plantae muscle -- the ddx includes both infeciton and reactive edema. 3. No bone or soft tissue abcess identified. .. R foot XR: 1. Soft tissue deformity with subcutaneous emphysema and corresponding bony destruction of the posterior right calcaneus consistent with diagnosis of osteomyelitis. 2. Extensive [**Month/Day/Year 1106**] calcifications and diffuse osteopenia. Brief Hospital Course: 1) Melena: EGD ([**8-14**]) showed 2 duodenal ulcers without visible vessel, adherent clot or active bleeding. HCT has been stable since 4 units total on admission. Treated initially with protonix 40mg IV bid, transitioned to lansoprazole 30 mg per J tube [**Hospital1 **], H.Pylori treatment with amox/clairithromycin/PPI, amoxicillin was d/c'd due to zosyn administration for UTI/osteo. . 2) Hypotension: Was likely due to combination of GIB and sepsis from UTI. Responded to IVF and antibiotics/blood. Remained normotensive during rest of admission. . 3) UTI: Urine Cx with Klebsiella (ESBL) sensitive only to Bactrim, carbapenems, Zosyn, and Unasyn. - Will treat with Zosyn 4.5mg IV q6h for 2 weeks . 4) Right Heel ulcer: pressure ulcer of right heel necrotic with evidence of underlying osteo on XR, on Vanco 1 gm IV q12 for gram + coverage as well as zosyn. Consulted [**Hospital1 1106**] and seen by Dr. [**Last Name (STitle) **] is [**Last Name (STitle) 1106**] surgeon as well. Was discussed and felt that only definitive treatment would be AKA, but given age and comorbidities and risk of surgery sons opted for conservative course of antibiotics and follow up with Dr. [**Last Name (STitle) **]. Patient also will be seen by Dr. [**Last Name (STitle) **] at [**Hospital 100**] Rehab to minitor his wounds. . 5) Dementia: Has agitation, likely with overlying delerium from UTI Resolved agitation/delirium after treatment of infections. . 6) FEN: Resume tube feeds, monitor lytes and replete prn . 7) Ppx: Pneumoboots for DVT ppx, PPI twice daily, BR . 8) Access: PICC line . 9) Full Code. . 10) Contact/HCP/POA: [**Name (NI) **] [**Name (NI) **] (son): [**Numeric Identifier 52080**] (h), [**Telephone/Fax (1) 52081**] (c). Local son: [**Name (NI) **] [**Name (NI) **]: [**Telephone/Fax (1) 48070**] Medications on Admission: 1. Acetaminophen 325mg 1-2 tabs PO bid. 2. Erythromycin 5 mg/g Ointment 0.5 OU QID 3. Papain-Urea 830,000-10 unit/g-% Spray, 1 Spray prn for R heel . 4. CALCIUM 500+D 1 tab PO bid 5. Folic Acid 1mg PO qD. 6. Thiamine HCl 100mg PO qD. 7. Toprol XL 25mg PO qD 8. Zinc Sulfate 220mg PO qD. 9. Ascorbic Acid 500mg PO bid 10. Mirtazapine 15mg PO qHS 11. Albuterol 1 neb q4-6h prn 12. Tamsulosin 0.4mg PO qHS. 13. Famotidine 20mg PO qD 14. Ferrous Sulfate 325mg PO qD 15. Seroquel 25mg PO bid 16. Ativan 0.5mg PO q6hr prn agitation Discharge Medications: 1. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed for wheezing. 2. Erythromycin 5 mg/g Ointment Sig: 0.5 in Ophthalmic QID (4 times a day). 3. Papain-Urea 830,000-10 unit/g-% Spray, Non-Aerosol Sig: One (1) Appl Topical [**Hospital1 **] PRN (). 4. Clarithromycin 250 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day) for 2 weeks. 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed. 8. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO HS (at bedtime). 9. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 10. Therapeutic Multivitamin Liquid Sig: Five (5) ML PO DAILY (Daily). 11. Acetaminophen 160 mg/5 mL Solution Sig: Six [**Age over 90 1230**]y (650) mg PO Q6H (every 6 hours) as needed. 12. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty (30) mg PO BID (2 times a day): The Patient MUST recieve a PPI [**Hospital1 **] for his ulcer. 13. Iodosorb 0.9 % Gel Sig: One (1) appl Topical qd (): Please apply to R heel with dressing change daily. This will need to be ordered from [**Hospital 100**] Rehab. 14. Zosyn 4.5 g Recon Soln Sig: 4.5 g Intravenous every eight (8) hours for 2 weeks. Disp:*qs 2 weeks* Refills:*0* 15. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) g Intravenous Q 24H (Every 24 Hours) for 2 weeks. Disp:*14 g* Refills:*0* 16. Heparin Flush 100 unit/mL Kit Sig: Two (2) cc Intravenous once a day: for PICC care. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - LTC Discharge Diagnosis: Upper GI Bleed Urosepsis R Heel Osteomyelitis Discharge Condition: stable Discharge Instructions: Please continue your regular medications and in addition you will continue vancomycin and zosyn IV for your foot infection for 2 weeks. Please follow up with Dr. [**Last Name (STitle) **], and follow up with your PCP. [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] will follow up with you in 2 weeks at [**Hospital 100**] Rehab. Please order Iodosorb gel to be used to dress patient's R heel ulcer. Please make sure patient is recieving a PPI twice daily for his duodenal ulcer, an H2 blocker is not an acceptable substitution. Please place patient in a Kinair bed or an equivalent to halp prevent progression of his wounds. Followup Instructions: 1. Please arrange to have patient sent by ambulance to his appointment: Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY (NHB) Date/Time:[**2165-9-10**] 1:45pm, you can call [**Telephone/Fax (1) 1241**] if you have questions. They are located on the [**Location (un) 442**] of the [**Hospital Unit Name 3269**]. 2. Please also make sure pt. is seen by Dr. [**Last Name (STitle) **] when he visits [**Hospital 100**] Rehab in 2 weeks to evaluate his wounds. 3. Please follow up with your PCP in the next 1-2 weeks as well. ICD9 Codes: 2851, 5990, 496, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7162 }
Medical Text: Admission Date: [**2109-12-18**] Discharge Date: [**2110-1-2**] Date of Birth: [**2056-4-21**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 30**] Chief Complaint: Hypoxia Major Surgical or Invasive Procedure: Burr hole placement Central lines LP PICC line History of Present Illness: 53 yo F w/ Hx of HTN and obesity s/p remote gastric bypass p/w fever, altered mental status and hypoxia. Started having headaches about one week ago and then yesterday had nausea and vomiting and was noted by her husband to be less responsive. About one week ago the pt. went to her PCP and was prescribed tetracycline for a bump on her foot which was persistently painful. Today her husband called home to check on her because she did not go to work and she did not answer. Her daughter found her unresponsive and unable to breath so called 911. She was intubated at NWH and CT head showed diffuse edema w/ near herniation. she was given acyclovir, CTX and vancomycin. She was noted to be febrile there to 104F. At [**Hospital1 18**] she was difficult to oxygenate, CXR showed ARDS and her PEEP was increased to 20 w/ 100% FIO2 to maintain her oxygenation. No specific sick contacts but pt. had been complaining about being exposed to sick people at Shaws grocery store. In the ED, initial VS: 137, 87/54 on neo 5, 100% on FIO2 100% and PEEP of 20. on Versed 10mg/hr, fentanyl 25mcg/hr. CMV 100%, 400x22, PEEP 20. Overbreathing. Has L fem line, R IO, peripherals. Past Medical History: HTN FMG obesity s/p gastric bypass Rosacea asthma Social History: Patient lives with husband [**Name (NI) 11805**], who also works as a cashier at Shaws. She quit smoking 25 years ago, denies alcohol or illicit drug use. Family History: NC Physical Exam: On admission Vitals - T: 100.6 BP: 100/72 HR: 128 RR: 22 02 sat: 99% on FIO2 100% PEEP 20 GENERAL: Sedated on vent HEENT: Pupils 5->3mm w/ light, Multiple dental caries and erythematous gums. CARDIAC: regular, tachycardic, distant heart sounds LUNG: diffuse inspiratory and expiratory rhonchi. ABDOMEN: Obese, well healed midline gastric bypass scar, LTCS scar, soft, ND EXT: Cold, mottled skin DERM: No rashes. Pertinent Results: ============= Labs ============= Admission labs [**2109-12-18**] 09:50PM BLOOD WBC-32.1* RBC-3.73* Hgb-11.9* Hct-37.6 MCV-101* MCH-31.9 MCHC-31.6 RDW-15.2 Plt Ct-374 [**2109-12-18**] 09:50PM BLOOD Neuts-97.2* Lymphs-1.9* Monos-0.8* Eos-0.1 Baso-0.1 [**2109-12-18**] 09:50PM BLOOD PT-15.9* PTT-32.7 INR(PT)-1.4* [**2109-12-18**] 09:50PM BLOOD Glucose-210* UreaN-13 Creat-0.9 Na-143 K-3.6 Cl-110* HCO3-19* AnGap-18 [**2109-12-18**] 09:50PM BLOOD Lipase-10 [**2109-12-18**] 09:50PM BLOOD CK-MB-44* MB Indx-10.2* [**2109-12-18**] 09:50PM BLOOD Albumin-3.4 Calcium-7.8* Phos-5.6* Mg-1.9 [**2109-12-18**] 07:25PM BLOOD Glucose-172* Lactate-3.2* Na-135 K-3.5 Cl-105 =============== Micro =============== FINAL REPORT [**2109-12-19**]** DIRECT INFLUENZA A ANTIGEN TEST (Final [**2109-12-19**]): Negative for Influenza A. DIRECT INFLUENZA B ANTIGEN TEST (Final [**2109-12-19**]): Negative for Influenza B. ============= Radiology ============= CT Head [**12-18**] Largely stable appearance of diffuse sulcal effacement and loss of ambient cisterns, consistent with diffuse brain edema. No new intracranial hemorrhage or herniation. RUQ u/s [**12-20**] Extremely limited study due to body habitus. Cholelithiasis with distended gallbladder. HIDA scan can be done for further evaluation if clinically warranted. CT Spine [**12-27**] Technically very limited study. Pneumonic infiltrates in both lungs, more evident on the right side. Right renal cystic mass. Suboptimal position of left central venous line. CT Head [**12-27**] No definite sign of a brain abscess. Please note that this study is very insensitive in the detection of meningeal inflammatory disease. ADDENDUM: There is also mild atherosclerotic calcification of the distal left vertebral artery at the level of the foramen magnum ============ Cardiology ============ TTE [**12-20**] The left atrium and right atrium are normal in cavity size. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is 10-20mmHg. Left ventricular wall thicknesses are normal. The left ventricular cavity size is top normal/borderline dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. There is severe global left ventricular hypokinesis (LVEF = 20-30 %). There is no ventricular septal defect. Right ventricular chamber size is normal. with depressed free wall contractility. The ascending aorta is moderately dilated. The number of aortic valve leaflets cannot be determined. The aortic valve is not well seen. There is no aortic valve stenosis. No 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. ============== Neurology ============== EEG [**12-23**] This is an abnormal portable EEG due to slowing and disorganization of the background rhythm with periods of semi-rhythmic generalized moderate to high voltage theta/delta activity at times concerning for sharp and slow wave activity. These findings suggest a moderate to severe encephalopathy with underlying cortical irritability. Medications, toxic/metabolic disturbances, and infection are common causes. Although no electrographic seizures were seen during this recording, the rhythmic theta/delta activity is concerning for possible development of seizure activity and would recommend continuous video EEG monitoring for further characterization and evaluation. Note is made of an irregular rhythm with frequent PVCs. EEG [**12-26**] This telemetry captured no pushbutton activations. Routine sampling showed primarily an encephalopathic background but with many generalized frontally predominent sharp wave epileptiform discharges. These were seen in isolation rather than reptitively or in an electrographic seizure. A single suspicious event occured at 13:00 on the afternoon of [**12-25**]. This showed a sudden appearance of alpha frequency activity primarily in the right central parietal area but with spread to the left frontal region and with an increase in frequency over 30 seconds. By video, this was associated with apparent hyperventilation. This raises the possibility of a single seizure. Otherwise, there were frequent epileptiform sharp wave discharges but no clear seizures. Brief Hospital Course: # Encephalitis/meningitis: Severe cerebral edema on CT head. LP was performed by IR that showed with 7000 WBCs, 1000RBCS protein 645, glucose 34. Opening pressure was 37 and bolt was placed with initial ICP 25. Patient required mannitol and hypertonic salien with improvement to 13. The following day ICPs were stable around 10 and the ICU team stopped hypertonic saline and manatol. Etiology felt to be likely bacterial meninigitis but CSF did not grow bacteria because patient was started on antibiotics prior to fluid collection. Patient received 2 week course of vanco/cefepime/ampicillin. Bolt was placed by neurosurgery to decompress on admission, which was removed on [**12-23**]. On [**12-24**] patient was found to be seizing on EEG and dilantin was started with a bolus followed by standing Q8 hour dosing. Plan for patient to continue dilantin until she can follow up with neurology as an outpatient. The patient had persistent fevers which were felt to be due to VAP and dvt (see below). CT spine and head were performed to rule out absess which were negative, and patient as afebrile prior to transfer to the medicine floor. # Respiratory failure: Patient intubated for hypoxia intially and weaning was somewhat limited by depressed mental status and high peep requirements due to the patients body habitus. Also complicated by VAP which was treated with an 8 day course (see below). Patient was eventually extubated on [**12-31**] with 2 hour transition to CPAP prior to tolerating 2 L of oxygen later that day. Towards the end of her ICU admission she was diuresed well with intermittent doses of Lasix 20mg IV. She continued to autodiurese after this likely back down to her baseline volume status. Once on the medicine floor, she easily transitioned to room air. She no longer has an oxygen requirement is has an oxygen saturation of 96-98% on room air. # RUQ pain/pancreatitis: Patient had intermittent abdominal pain on the ventilator with mildly elevated lipase. Ultrasound was a poor study, and patient had mildly elevated lipase. Pain improved when patient was extubated and she told the MICU team that pain was only related to coughing fits and likely MSK in nature. Pain has completely resolved and the patient is tolerating a regular diet. # VAP: On [**12-24**], new bilateral consolidations were noted on CXR and GNRs in the sputum. Patient was initially managed on ceftriaxone which was increased to cefepime for a total of 8 days of vanco/cefepime for VAP treatment ending on [**2110-1-2**]. # DVT: During fever workup, LENI was positive for LLE dvt. Patient was initially started on heparin drip followed by coumadin. Because this was presumed to be a provoked dvt, a hypercoagulable workup was not pursued. Her INR was found to be supratherapeutic, and her coumadin has been held for 3 days. As antibiotics are being discontinued on [**2110-1-2**], a rapid drop in PT/INR may be noted. Patient will need to have coumadin restarted at extended care facility with a goal INR of [**2-5**]. She will likely require anticoagulation for 3-6 months. #Elevated cardiac enzymes: On admission, cardiac enzymes were mildly elevated. There were no st elevations on EKG. Most likely demand in the setting of sepsis. An echocardiogram was completed that showed marked systolic heart failure with an estimated LV EF of 20-30%. While in hospital, she was started on aspirin 81 mg, Lisinopril 5 mg PO daily, and her home atenolol was transitioned to metoprolol 25 mg PO BID. #Anemia: Patient was found to have hematocrit on presentation of 37.6 that drifted down to a nadir of 25.3 and currently is 29.4. Iron studies were completed and she appears to have iron deficiency anemia. She was restarted on her home dose of iron and added ascorbic acid to increase absorption. #Weakness: After extubation, patient complained of generalized weakness. This is likely due to her long hospitalization and deconditioning. She worked with physical therapy in hospital, and will require aggressive physical therapy at her rehab facility. Medications on Admission: FeSO4 325mg QD Naproxen 500mg TID Diltiazem 180mg QD Tetracycline 500mg QD Atenolol 25mg QD Tylenol Albuterol simvastatin 20mg QHS Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for fever. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 4. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipatin. 5. Phenytoin Sodium Extended 100 mg Capsule Sig: Four (4) Capsule PO Q8H (every 8 hours). 6. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for sob, wheeze. 7. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for sob, wheeze. 8. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). 9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 14. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime. 15. Coumadin to be dosed to maintain INR of [**2-5**]. Discharge Disposition: Extended Care Facility: [**Hospital6 979**] - [**Location (un) 246**] Discharge Diagnosis: Primary: - Meningoencephalitis - Nonconvulsive seizure - Acute systolic heart failure - Ventilator associated pneumonia - Left lower extremity DVT - Pancreatitis - Right thyroid nodule measures 3.8 x 3.2 cm - 0.9 x 1.2 x 1.3 cm hepatic cyst Secondary: - Morbid obesity s/p gastric bypass [**2100**] - Hypertension - Hyperlipidemia - Asthma - Arthritis - Fibromyalgia - Iron deficiency anemia Discharge Condition: Mental Status: Clear and Oriented Level of Consciousness: Alert and interactive Activity Status: Out of bed with assist Discharge Instructions: You were emergently transferred to this hospital from [**Hospital3 1196**] because you were unresponsive. A tube was placed in your airway to help you breathe, and CTs were performed that showed severe swelling in your head. You were initially treated in the emergency department and received antibiotics and further tests. You were in the medical intensive care unit for almost two weeks for a presumed bacterial meningitis. While on the ventilator, you were found to have a pneumonia and were continued on your antibiotics. While in the hospital, you also developed a blood clot in your left leg. You were initially started on blood thinning medicine and the began taking a medicine called coumadin to continue to keep your blood thin. You will need to remain on this medicine for approximately 3-6 months. After antibiotics and further treatment, the tube was able to be taken out of your airway. You transitioned to the floor and were able to have several tubes removed. During your stay, you worked with the physical therapists in order to regain strength. New Medications: (1) Coumadin, dosed as needed by extended care facility to maintain INR [**2-5**]. (2) Lisinopril 5mg by mouth once daily (3) Metoprolol 25 mg by mouth twice daily (4) Aspirin 325mg by mouth daily The following medications were changed: (1) Diltiazem 120mg by mouth daily (lower dose) The following medications were discontinued: (1) Atenolol 25 mg by mouth daily Followup Instructions: Provider: [**First Name11 (Name Pattern1) 1037**] [**Last Name (NamePattern4) 2335**], MD (Infectious Disease) Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2110-1-15**] 9:50 Provider: [**Name10 (NameIs) 640**] [**Name11 (NameIs) 747**] [**Name12 (NameIs) **], M.D. (Neurology) Phone:[**Telephone/Fax (1) 1844**] Date/Time:[**2110-1-30**] 2:00 Completed by:[**2110-1-2**] ICD9 Codes: 2760, 4280, 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7163 }
Medical Text: Admission Date: [**2190-7-6**] Discharge Date: [**2190-7-7**] Date of Birth: [**2153-3-6**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3561**] Chief Complaint: ethanol abuse Major Surgical or Invasive Procedure: none History of Present Illness: MICU GREEN RESIDENT ADMIT NOTE . CC:[**CC Contact Info 64928**]. HPI: This is a 37 year old male with a history of alcohol abuse with multiple attempts at detox who presented to the ED for ETOH detox. He feels that he is currently feeling as though he is "at the end of [his] rope." He last drank about 12-24 hours ago and has recently been feeling as though alcohol does not make him feel better. He self-referred himself to the ED to "get the alcohol out of my system." In the ED he felt shaky, diaphoretic, and nauseous, consistent with his usual sypmtoms of withdrawl. Per ED report, he was combative and required an intermittent 1:1 security sitter. . He was in the ED for approximately 14 hours prior to being admitted to the MICU. Initial EDVS HR 109 177/97 and afebrile. He received a total of 10 mg of ativan during his stay in the ED. HE also received a banana bag and 2 L IVF. In the MICU he reports that he still feels shaky, and nauseous, though somewhat improved. He denies any other ingestiosn. . He reports that he drinks about 1 pint of vodka per day for over 20 years. He considers himself a binge drinker, drinking heavily for several days at a time, but not necessarily on a daily basis. He reports having had multiple episodes of "DTs." When asked to describe these DTs, he describes them as periods of "sweating, shaking, and sometimes hallucinations" that self-resolve over the course of a few days. He has had one seizure event many years ago, that he believes was related to his ETOH. . PMH: Alcohol abuse and dependence: At [**Hospital1 **] for detox about [**3-2**] months prior. He completed detox and then began drinking again soon afterwards. Suicide attempt in [**12-3**], requiring inpt psych admisison Depression: He has a counselor/therapist that he used to see at the [**Hospital3 33953**] Community Center. He had been on prozac and seroquel until he stopped going to his therapy sessions a few months ago. . Medications: None . Allergies: NKDA . Social Hx: Born in [**Location (un) 3678**], MA. Lives alone, 1PPD x 20 years, denies illict drugs. . Family Hx: Mother- alcohol dependence . PE: VS: 158/110 HR 103 Afebrile 97% RA RR 12 GEN: Awake, alert, oriented x 3 HEENT: AT, NC, PERRLA, EOMI. Neck supple, no LAD. CV: RRR, nl s1, s2, no m/r/g PULM: CTAB, no w/r/r with good air movement throughout ABD: soft, NT, ND, + BS, no HSM EXT: warm, dry, +2 distal pulses BL, right lower extremity large ecchymoses, multiple scars and superficial lacerations NEURO: alert & oriented, CN II-XII grossly intact, 5/5 strength throughout. No sensory deficits to light touch appreciated. No asterixis PSYCH: Slow speech, at times tangential, flat affect . LABS: See below . Imaging: None . Brief Hospital Course: 37 year old male with a history of alcohol abuse and dependence who presents for alcohol detoxification. Pt. left AMA . Alcohol abuse, dependence: With BAL 411, significant history of ETOH withdrawl. Given nausea and difficulty tolerating POs, will give IV ativan (less corrosive to veins than IV valium). He was transitioned to PO valium. He left AMA. . Elevated Anion gap: Anion gap of 18. Suspect ketoacidosis secondary to alcohol binge, supported by ketones in urine. Denies other toxin ingestion. There was no osmolality gap. . Depression: Difficult to assess for primary psychiatric illness at this time in the setting of active withdrawal. . History of suicide attempt: pt. explicitly denied any wish or plan of self harm. . #CODE: FULL . #COMMUNICATION: patient . #DISPO: pt left ama Medications on Admission: none Discharge Medications: none Discharge Disposition: Home Discharge Diagnosis: ethanol abuse Discharge Condition: ama Discharge Instructions: pt. left ama Followup Instructions: ama Completed by:[**2190-7-7**] ICD9 Codes: 2762, 311
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Medical Text: Admission Date: [**2201-5-12**] Discharge Date: [**2201-6-5**] Date of Birth: [**2201-5-12**] Sex: M Service: Neonatology IDENTIFICATION: Baby [**Name (NI) **] [**Known lastname 1794**] is a 24 day old former 35 [**4-28**] wk premature infant with a history of respiratory distress syndrome and apnea of prematurity who is being discharged from the [**Hospital1 18**] NICU. HISTORY OF PRESENT ILLNESS: Baby boy [**Known lastname 1794**] is a 3.8 kg product of a 35 [**4-28**] week gestation born to a 28-year-old G2, P1, woman with history of type 1 diabetes. Prenatal screens were unremarkable, and included blood type A positive, antibody negative, hepatitis surface antigen negative, RPR nonreactive, rubella immune, GBS unknown. Pregnancy was reportedly unremarkable. Mother presented on day delivery with lower abdominal pain, and ultrasound suggested a thin-walled uterus. With her history of diabetes and prior c-section, mother was considered to be at high risk of uterine dehiscence, and she was taken for elective c-section. At delivery, attended by L&D staff and anesthesia, patient required brief positive pressure ventilation, with Apgars of 6 and 8. The NICU NNP was called to the delivery room at approximately 10 to 15 minutes of age for respiratory distress. The patient was pink in room air with mild grunting, flaring, retracting. He was brought to the newborn intensive care unit after visiting with parents. PHYSICAL EXAMINATION AT ADMISSION: WT 3810 gm (>90%) HC 35 cm (>90%) L 57 cm (>90%). GEN: well perfused, well-saturated on blow-by oxygen. SKIN: without lesions. HEENT: Within normal limits. CARDIOVASCULAR: Normal S1 and S2 without murmurs. LUNGS: Coarse equal breath sounds bilaterally. Mild to moderate grunting, flaring, retracting on cannula. ABDOMEN: Benign GENITALIA: Normal male. Anus patent. HIPS: Normal. NEUROLOGIC: Nonfocal and age appropriate. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: RESPIRATORY: The infant was admitted to the newborn intensive care unit. He was on nasal cannula briefly with increased oxygen requirements, and was transitioned quickly to CPAP. He continued to have increased oxygen requirements. Chest x-ray was consistent with moderate hyaline membrane disease. The infant was intubated and received 1 dose of surfactant. He was extubated within the first 24 hours of age to nasal cannula oxygen which he remained on for a total of 4 days. He has subsequently been on room air without evidence of respiratory distress. The infant has had mild apnea/bradycardia events, with the most recent episode of apnea/bradycardia on [**2201-6-1**]. These events have been mild, occasionally requiring stimulation but mostly self-resolving and characterized by brief dips in heart rate and oxygen saturation. They are presumed to be secondary to apnea of prematurity or immaturity of respiratory control. She has not received methylxanthine treatment. CARDIOVASCULAR: The infant remained hemodynamically stable throughout hospital course. A murmur was noted to develop, thought to be most with consistent with persistent pulmonary stenosis. CXR, EKG, 4-extremity BP, and hyperoxia test were all within normal limits. FLUIDS, ELECTROLYTES AND NUTRITION: Birth weight was 3.91 kg. The infant was started on 60 cc per kg per day of D10W. Enteral feedings were initiated on day of life 3. The infant was gradually advanced to PO ad lib feedings, taking in adequate amounts of BM 20 with appropriate weight gain. His discharge weight is 4110 gm. Infant was started on tri-vi-[**Male First Name (un) **]. GASTROINTESTINAL: Peak bilirubin was on day of life 5 of 15.4/0.4. He received phototherapy for a total of 24 hours at which time it was discontinued and he has had no further issues. Last bilirubin was 8.5/0.3 on day of life 7. HEMATOLOGY: Hematocrit on admission was 47.8. He has not required any blood transfusions. INFECTIOUS DISEASE: CBC and blood culture were obtained on admission. CBC was benign and blood cultures remained negative after 48 hours at which time ampicillin and gentamycin were discontinued. The infant has had no further issues with sepsis. NEUROLOGIC: He has been appropriate for gestational age. SENSORY: Hearing screen has been performed with automated auditory brain stem responses and the infant passed in both ears. PSYCHOSOCIAL: A social worker has been involved with this family. The contact social worker is [**Name (NI) **] [**Name (NI) **] and can be reached at [**Telephone/Fax (1) 8717**]. CONDITION ON DISCHARGE: Stable. DISCHARGE DISPOSITION: To home. NAME OF PRIMARY PEDIATRICIAN: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], [**Location (un) 64028**]. Telephone No. [**Telephone/Fax (1) 64029**]. CARE RECOMMENDATIONS: Continue ad lib feeding breast milk. MEDICATIONS: Continue Tri-vi-[**Male First Name (un) **]. CAR SEAT POSITION SCREEN: Car seat position screening was performed and the infant passed with 90-minute screen. THE STATE NEWBORN SCREEN: The last State Newborn Screen was sent on [**2201-5-26**] and was within normal limits. IMMUNIZATIONS RECEIVED: Hepatitis B vaccine on [**2201-5-20**]. DISCHARGE DIAGNOSES: 35 and 6/7 weeks infant. Respiratory distress syndrome treated with surfactant. Rule out sepsis with antibiotics. Mild hyperbilirubinemia. Apnea/bradycardia of prematurity. Murmur, likely peripheral pulmonic stenosis. [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**MD Number(2) 56682**] Dictated By:[**Name8 (MD) 64030**] MEDQUIST36 D: [**2201-6-4**] 23:33:36 T: [**2201-6-5**] 01:46:04 Job#: [**Job Number 64031**] ICD9 Codes: 769, 7742, V053, V290
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Medical Text: Admission Date: [**2117-11-28**] Discharge Date: [**2117-12-10**] Date of Birth: [**2117-11-28**] Sex: M Service: NEONATOLOGY HISTORY OF THE PRESENT ILLNESS: This is an interim dictation summary covering the time course from [**2117-11-29**] to [**2117-12-10**]. The patient is a term newborn with features consistent with trisomy 21 who was transferred to the NICU for evaluation of possible cardiac disease. The mother is a 37-year-old G3, P2-3, apparently uncomplicated gestation. No notations of features consistent with Down's syndrome on the antenatal ultrasound. No karyotype noted. Birth weight 3,725 grams. PHYSICAL EXAMINATION ON ADMISSION: Dysmorphic consistent with trisomy 21 including a flattened occiput, low-set ears, upslanting palpebral fissures, palmar creases, hypoplastic nipples, axial hypotonia, Brushfield's spots not examined. Room air saturations in the high 90s. Lungs: Clear. Heart: Normal S1, loud S2, grade I/VI systolic ejection murmur at the middle left sternal border. No diastolic murmur noted. Pulses normal. Abdomen: Benign. Genitalia: Normal male. Neurologic: Notable for generalized hypotonia. Spine intact. Hips normal. HOSPITAL COURSE: 1. RESPIRATORY: The patient was initially on nasal cannula 02 as high as 3 liters, gradually weaned on 02 requirement and the patient was weaned to room air on [**2117-12-6**]. The patient was noted to have upper airway congestion felt to be inhibiting ability to p.o. feed. The patient was started on Neo-Synephrine nasal drops on [**2117-12-6**] and was continued for three days. Also started on [**2117-12-7**] on dexamethasone ophthalmic drops to the nose for three days. Currently receiving no intranasal treatment. The upper airway congestion improved remarkably with this treatment. Currently, one day off of all nasal treatment with no rebound-effecting congestion seen. 2. CARDIAC: The patient is with low oxygen saturations noted in the Newborn Nursery including desaturations with crying and with feeding. Echocardiogram performed on the date of admission to the NICU which revealed a common AV canal and pulmonary hypertension. Cardiology was consulted and involved throughout. Symptoms of pulmonary hypertension gradually resolved and the patient with evidence of fluid overload beginning on [**2117-12-8**]. The patient was started on q.o.d. Lasix with a good response. Planned for surgical repair at six months of age. 3. FLUIDS, ELECTROLYTES, AND NUTRITION: Initially n.p.o. on IV fluids at 60 cc per kilogram per day; p.o. feeds initiated on day of life number four and tolerated well. The patient advanced rapidly to full feeds and calories advanced for growth. Currently on 150 cc per kilogram per day of breast milk 26. Initially with poor p.o. intake; however, p.o. intake improving in the past several days, currently taking about two-thirds of feeds p.o. Glucose was monitored and remained stable throughout, maintaining good urine output throughout. Electrolytes on [**2117-12-1**] revealed a sodium of 140, K 4.4, chloride 104. 4. HYPERBILIRUBINEMIA: The bilirubin levels were monitored. The bilirubin peaked at 16.1/0.4 on day of life number four and the patient was started on phototherapy. The phototherapy was discontinued on [**2117-12-6**] with a bilirubin of 8.0/0.3. 5. HEMATOLOGY: Crit 66.2% on admission. The patient has not required any blood products. 6. INFECTIOUS DISEASE: CBC and blood cultures sent on admission. White count 16.8 with 72 polys and 6 bands, platelets 263,000. The patient was not treated with antibiotics. Blood cultures revealed no growth. 7. GENETICS: The Genetics Team was consulted given features consistent with trisomy 21. The initial FISH suggestive of trisomy 21 and final chromosomes with 47 XY, consistent with trisomy 21. Genetics met with the family as well as the [**Hospital 10814**] Clinic Program from [**Hospital3 1810**]. The dad has been doing extensive [**Location (un) 1131**] on the topic. 8. PSYCHOSOCIAL: [**Hospital1 18**] Social Work was involved with the family. The contact social workers name is [**Name (NI) **] and she can be reached at [**Telephone/Fax (1) 8717**]. DR.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] 50-477 Dictated By:[**Last Name (NamePattern1) 50027**] MEDQUIST36 D: [**2117-12-10**] 06:13 T: [**2117-12-10**] 19:02 JOB#: [**Job Number 50733**] ICD9 Codes: V053
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Medical Text: Admission Date: [**2153-1-16**] Discharge Date: [**2153-1-19**] Date of Birth: [**2079-7-20**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 458**] Chief Complaint: Respiratory depression. Major Surgical or Invasive Procedure: [**Hospital1 **]-ventricular ICD upgrade History of Present Illness: 73yoM retired surgeon with history of Parkinson's disease (? diffuse [**Last Name (un) 309**] body disease), HTN, DM, systolic HF (EF 20% in [**11-4**]), history of CVA (residual left visual field cut), AF s/p AVN ablation and pacer, admitted initially to CMI for BiV ICD placement [**1-15**], with post-procedure admission planned for heparin-coumadin (indication for anticoagulation AF - CVA). Intra-procedure, received haldol 5 mg IV, fentanyl 200 mg IV, and versed 1.5 mg IV and noted to be poorly responsive to commands and low RR in recovery area; [**Hospital Unit Name 196**] called to evaluate. VBG at that time 52/46/7.37. At 1 hr post-procedure, patient began to become more responsive to commands and increased level of consciousness. Patient being transfer to CCU for observation of his clinical status. Past Medical History: 1. Parkinsons Disease. ? LBD 2. DM II 3. HTN 4. Autonomic dysfunction-hx of orthostatic hypotension. Treated with Florinef in the past, was d/c'd due to fluid retention. Restarted [**5-4**]. 5. CAD- s/p MI in [**2120**], s/p CABG 6. CHF- Echo [**11-4**]-: Regional LV wall motion abnormalities include: basal anteroseptal - akinetic; mid anteroseptal - akinetic; basal inferoseptal -akinetic; mid inferoseptal - akinetic; basal inferior - akinetic; mid inferior- akinetic; basal inferolateral - akinetic; mid inferolateral - akinetic; septal apex- akinetic; inferior apex -akinetic; [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 5660**] dilated. RA is moderately dilated. The left ventricular cavity is moderately dilated. There is severe global left ventricular hypokinesis. Overall left ventricular systolic function is severely depressed (EF <20) 7. Stroke [**11-2**]- right PCA, residual left field cut 8. Sick Sinus syndrome, s/p PCM 9. A.fib/SVT, s/p ablation [**56**]. Hypercholesterolemia 11. Cervical stenosis 12. H/o back pain and L1 compression fxr 13. Anemia 14. h/o prostate CA, s/p [**Year (2 digits) 16859**] ([**2146**]) and hormonal tx 15. h/o renal stones and s/p lithotripsy 16. s/p appy Social History: Lives with his wife. There is becoming an increasingly difficult situation due to the need for live-in/24 hr care at home. There is an ongoing dialogue about this, but no plans have been made definitively. He is a retired physician. [**Name10 (NameIs) **] [**Name11 (NameIs) **], occasional EtOH. Family History: HTN, colon ca, Parkinson's Physical Exam: VS: T BP 133/76 HR 80 RR 19 Sats 97 RA Gen: patient somnolent, slowly responds to questions. HEENT: no JVD, no LAD Chest: Left side pacemaker poket with compression dressing, small hematoma, Lungs: clear to auscultation b/l, no crackles or wheezes Cardiovascular: RRR, s1-s2 normal, holosytolic murmur in the apex Abdomen: Bowel sounds +, non tender, non distended. GU: condom catheter in place Extremities: no LE edema, right groin site clean, no ozzing. peripheral pulses upper and lower extremities normal. Neuro: a&ox3, cn ii-[**Doctor First Name **] intact; resting tremor. Pertinent Results: [**2153-1-16**] 07:30AM BLOOD WBC-6.1 RBC-4.43* Hgb-12.3* Hct-37.1* MCV-84 MCH-27.8 MCHC-33.2 RDW-14.8 Plt Ct-147* Neuts-76.4* Lymphs-17.9* Monos-4.7 Eos-0.8 Baso-0.2 [**2153-1-16**] 07:25AM BLOOD INR(PT)-1.6 [**2153-1-16**] 07:30AM BLOOD Glucose-92 UreaN-19 Creat-1.2 Na-145 K-4.0 Cl-107 HCO3-27 AnGap-15 [**2153-1-16**] 09:28PM BLOOD ALT-15 AST-21 LD(LDH)-236 AlkPhos-56 TotBili-1.0 [**2153-1-16**] 07:30AM BLOOD Digoxin-0.6* [**2153-1-16**] 09:28PM BLOOD Phos-4.6* Mg-1.8 [**2153-1-16**] 05:39PM BLOOD Lactate-1.3 . [**2153-1-16**] 09:28PM Hct-30.3* [**2153-1-17**] 06:07AM Hct-27.5* [**2153-1-17**] 05:00PM Hct-24.8* [**2153-1-18**] 10:45AM Hct-29.4* [**2153-1-18**] 04:38PM Hct-28.0* . [**2153-1-17**]: CHEST PA AND LATERAL. Compared to the prior radiograph obtained yesterday, there is decreased CHF. There is mild cardiomegaly. There are small bilateral effusions, more on the left. The new biventricular pacer device is seen in the left hemithorax. The pacer leads are seen in the right atrium and two in the floor of the right ventricle. The previous abandoned right pacer leads are also seen in the right atrium and right ventricle. No pneumothorax. Persistent left lower lobe atelectasis/consolidation. IMPRESSION: 1. Improving CHF. 2. Small bilateral layering pleural effusions, more on the left. 3. Persistent left lower lobe atelectasis/consolidation. 4. Good position of the new biventricular pacer device. . [**2153-1-17**]: TECHNIQUE: Non-contrast head CT. FINDINGS: There is no intra- or extra-axial hemorrhage. The appearance of the ventricles, cisterns, and sulci is unchanged. There is no mass effect, hydrocephalus, or shift of the normally midline structures. The [**Doctor Last Name 352**]-white matter differentiation is preserved. The visualized mastoid air cells are clear. Again noted is sinus mucosal thickening bilaterally in the maxillary sinuses, not fully characterized here. IMPRESSION: 1. Similar sinus mucosal thickening. 2. No evidence of significant interval change. 3. Similar appearance of the brain including prominent encephalomalacic changes in the right occipital lobe, and possibly in the left occipital lobe as well. . [**2153-1-17**]: CT OF THE ABDOMEN WITHOUT IV CONTRAST: There is a biventricular pacemaker in place, not fully characterized here, and evidence of prior sternotomy. There are large bilateral pleural effusions with adjacent areas of compressive atelectasis. Otherwise, the lung bases are clear. Within the limitations of the non-contrast study, the liver, gallbladder, pancreas, spleen, and adrenal glands are within normal limits. A 7-mm nonobstructing stone is again visualized in the left kidney, as well as a 12 mm stone in the left renal pelvis. These are unchanged. A small new 2- mm nonobstructing stone is now seen in the right kidney. Left-sided hydronephrosis has resolved. Within the limitations of the non-contrast study, the appearance of the kidneys is otherwise unremarkable. There is calcification of the abdominal aorta, and of the splenic artery. The stomach, small and large bowel are unremarkable. There is no retroperitoneal or mesenteric lymphadenopathy, or free air or fluid. Along the anterior left lateral ribs at the base of the chest, there is a soft tissue density, not fully characterized here, which may represent a small hematoma or inflammatory stranding from recent pacer placement. Its extent is not delineated here. There is no evidence of a retroperitoneal hematoma. CT OF THE PELVIS WITHOUT IV CONTRAST: There is considerable amount of stool in the rectum. The prostate, seminal vesicles, and bladder are within normal limits. There is a 5-mm calcific density in the distal left ureter, which could represent a nonobstructing stone. It was not seen previously. BONE WINDOWS: There are no suspicious lytic or blastic lesions. Degenerative changes of the lumbar spine are seen. IMPRESSION: 1. Large bilateral pleural effusions. 2. Possible hematoma along the left basal chest wall, in the subcutaneous tissues, not fully evaluated here. 3. No evidence of retroperitoneal hematoma. 4. Multiple nonobstructing stones in the kidneys bilaterally, as well as a 6- mm calcific density in the left pelvis, which may represent a nonobstructing renal stone in the left ureter. . [**2153-1-18**]: TECHNIQUE: Left upper extremity venous ultrasound and Doppler examination, and limited evaluation of the subcutaneous tissues of the left upper hemithorax. FINDINGS: Grayscale and Doppler son[**Name (NI) 1417**] of the left internal jugular, axillary, basilic, and paired brachial veins show no evidence of deep vein thrombosis. Because of the presence of the overlying pacer, the left subclavian vein could not be evaluated. No intraluminal thrombus is identified. In the tissues overlying the pacemaker, there is heterogeneous appearance, which may represent postoperative change, but the presence of hematoma cannot be excluded. No large discrete fluid collection is identified. Laterally, near the insertion of the pectoralis major muscle, the appearance suggests either edematous muscle or complex fluid, but the static images presented are indeterminant. IMPRESSION: 1. Heterogeneous tissue in the region of the pacer, which is indeterminant in etiology. 2. Suggestion of edematous left pectoral muscle and/or complex fluid, suggested by resident review in real time scanning. However on the static images, it is difficult to discern the relationship between the muscle, the adjacent heterogeneous soft tissue, and the pacer. A followup ultrasound for evaluation and comparison, or alternatively a CT, which may show an area of hyperdensity to correspond to an acute hematoma if present, is suggested. . Day of discharge labs: [**2153-1-19**] 07:30AM BLOOD WBC-9.9 RBC-3.26* Hgb-10.0* Hct-27.6* MCV-85 MCH-30.5 MCHC-36.0* RDW-15.6* Plt Ct-116* [**2153-1-19**] 07:30AM BLOOD PT-14.4* PTT-31.8 INR(PT)-1.4 Brief Hospital Course: A 73yoM with parkinson disease, HTN, DM, systolic HF (EF 20% in [**11-4**]), history of CVA (residual left visual field cut), AF s/p AVN ablation and pacer, inmediate s/p BiV pacer upgrade with slowly recover after sedation transfer to CCU for monitoring. After the haldol wore off, mental status was felt to return to baseline. Of note, hematocrit was noted to drop on the day of procedure. CT abd/Pelvis was done and was negative for retroperitoneal bleed. Left upper extremity also noted to be more swollen on [**1-18**] and ultrasound was performed which was negative for DVT. # mental status change: Patient likely sensitive to sedation, requiring , more alert, able to follow simple commands. He is able to movilize all extremities, still somnolent. more likely given his baseline disease, he is more sensitive to sedation. Patient seemed to recover in the 10-12 hours post-sedation. Head CT was performed and was negative for intracranial bleed. Neurology was consulted and agreed that mental status changes likely to haldol being given. . 1. Parkinson's disease: will continue home medications sinemet, mirapex and pramipexol. 2. CV: Rhythm: h/o Afib - heparin bridge to coumadin. Heparin was stopped in setting of hematocrit drop and restarted on [**2153-1-19**]. S/P BiV pacer- he was given Vancomycin Iv x 3 doses. AV paced Carvedilol continued for rate control Pace maker checked on [**2153-1-19**]. Pump: EF 17% on MIBI, currently euvolemic. Will continue Carvediolol and Furosemide home dose and digoxin. We will recommend to discusse with your primary cardiologist regarding Ace inhibitor medications CAD: continue aspirin, statin, Carvedilol 3. Heme: On admission Hct noted to be 37. This was likely hemoconcentrated as Hcts from 3 weeks prior were 31-32. However, given Hct decrease to 25, CT scan of Abd/Pelvis and including upper thighs done and negative for hematoma or bleed. He was tranfused 2 units of pRBCs and Hct increased. Hematocrit should be monitored on an outpatient basis. 4. left upper extremity swelling: noted on [**1-18**]. Concern for DVT or bleed. Ultrasound of upper extrmity done and negative for DVT. 5. GERD: Continue Pantoprazole 6. FENA: Cardiac healthy -diabetic diet. 7. Dispo: to rehab. Patient should have Hematocrit checked on [**1-22**] (Hct 27.6 on [**1-19**]). Left upper extremity swelling seems to be resolving. His left arm may be elevated to decrease swelling, but is not to be elevated above shoulder level given new biVentricular pacemaker placement. Full code Medications on Admission: Carbidopa-Levodopa 25-100 mg qAM Carbidopa-Levodopa 25-100 mg qHS Acetaminophen 325 mg q4-6h Carbidopa-Levodopa 50-200 mg Q6H Mirapex 0.25 mg TID Fluoxetine 20 mg QD Fludrocortisone 0.2 mg QD Donepezil 5 mg qHS Pantoprazole 40 mg/ QD Carvedilol 12.5 mg [**Hospital1 **] Clonazepam 0.5 mg Qhs bedtime Digoxin 125 mcg Tablet daily Provigil 100 mg Tablet/ qd Atorvastatin 10 mg Tablet QD Furosemide 20 mg Tablet QD Aspirin 81 mg Tablet, QD Warfarin 5 mg Tablet qhs Modafinil 200 mg ebery morning. Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 5. Simvastatin 40 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 7. Carbidopa-Levodopa 50-200 mg Tablet Sustained Release Sig: One (1) Tablet PO QID (4 times a day). 8. Carbidopa-Levodopa 25-100 mg Tablet Sustained Release Sig: One (1) Tablet PO 2200 (). 9. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for 4 days. 12. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. Tablet(s) 13. Warfarin 5 mg Tablet Sig: One (1) Tablet PO at bedtime. 14. Bupropion 100 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. 15. Modafinil 100 mg Tablet Sig: One (1) Tablet PO once a day. 16. Potassium Chloride 20 mEq Packet Sig: Two (2) PO once a day. 17. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. 18. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital6 979**] - [**Location (un) 246**] Discharge Diagnosis: s/p pacemaker placement Parkinson's disease Discharge Condition: stable Discharge Instructions: You need to have your PT/INR level checked in 3 days for coumadin titration and a serum creatinine checked in one week (because of numerous renal stones that could obstruct your urine output and harm your kidneys). Please have your hematocrit checked on [**1-22**] (3 days after discharge), please have these results sent to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office, ([**Telephone/Fax (1) 9530**]. Followup Instructions: Please call Dr[**Name (NI) 8996**] office to make an appointment in [**2-2**] weeks. ([**Telephone/Fax (1) 103173**]) [**Hospital Ward Name **] 4 . Please call Dr.[**Name (NI) 10444**] office on ([**Telephone/Fax (1) 63315**] to scheduled an appointment in the next 1-2 months or earlier if indicated. Completed by:[**2153-1-19**] ICD9 Codes: 4280, 2859, 412, 2720, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7167 }
Medical Text: Admission Date: [**2176-5-31**] Discharge Date: [**2176-6-7**] Date of Birth: [**2095-12-13**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2176-5-31**] - Coronary artery bypass grafting x3: Left internal mammary artery graft to left anterior descending, reverse saphenous vein graft, diagonal branch of the posterior descending artery. [**2176-6-1**] - Re-exploration for bleeding History of Present Illness: 80 year old very active man was recently referred for stress testing after complaining of occasional exertional chest heaviness. He exercises on the treadmill for one hour a day. Occasionally he will notice mild chest heaviness after 30-40 minutes. This easily resolves when slowing down. He has also noticed that his exercise routine is a little bit more difficult to do than it had been in the past. Nuclear stress testing has revealed inferolateral ischemia with a normal LVEF. He was then referred for a cardiac catheterization which revealed two vessel coronary artery disease. He presents today for surgical evaluation. Past Medical History: Past Medical History -Hypertension -Hyperlipidemia -Moderate mitral regurgitation -Trace guaiac positive stool s/p treatment for H Pylori and Colon polypectomy [**2175**] -Histoplasmosis (remote) Past Surgical History -s/p Resection of basal cell carcinoma (nose) -s/p Remote L5 back surgery -s/p Resection of pilonidal cyst -s/p Trigger finger release bilaterally x 2 -Tenosynovitis of hand s/p surgery -s/p Cataract surgery bilaterally [**2173**] -s/p Ptosis eyelid surgery -s/p Tonsillectomy Social History: Lives with: Wife Occupation: Retired. Previously employed in finance. Tobacco: Quit pipe in [**2147**], quit cigarettes in [**2133**]. ETOH: [**1-21**] glasses of wine per night Family History: Non-contributory Physical Exam: Pulse: 54 Resp: 16 O2 sat: 98% B/P Right: 123/80 Left: 132/83 Height: 6'1" Weight: 147 lb General: Well-developed male in no acute distress Skin: Dry [X] intact [X] HEENT: PERRLA [X] EOMI [X] Neck: Supple [X] Full ROM [X] Chest: Lungs clear bilaterally [X] Heart: RRR [X] Irregular [] Murmur Abdomen: Soft [X] non-distended [X] non-tender [X] +BS [X] Extremities: Warm [X], well-perfused [X] Edema: none Varicosities: superficial 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: - Left: - Pertinent Results: [**2176-5-31**] ECHO PRE-CPB: The left atrium is mildly dilated. No thrombus is seen in the left atrial appendage. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). The RV systolic function is normal. The ascending aorta is mildly dilated. There are simple atheroma in the descending thoracic aorta. No thoracic aortic dissection is seen. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened and appear mildly tethered. Mild to moderate ([**1-21**]+) central mitral regurgitation is seen. POST-CPB: The LV systolic function remains normal. The MR remains mild to moderate. The TR is mild to moderate. There is no evidence of dissection. Dr. [**Last Name (STitle) **] was notified in person of the results at time of study. Admission [**2176-5-31**] 07:46AM HGB-13.7* calcHCT-41 [**2176-5-31**] 07:46AM GLUCOSE-98 LACTATE-2.0 NA+-137 K+-3.6 CL--100 [**2176-5-31**] 12:11PM FIBRINOGE-209 [**2176-5-31**] 12:11PM PT-14.4* PTT-35.6* INR(PT)-1.2* [**2176-5-31**] 12:11PM PLT COUNT-135* [**2176-5-31**] 12:11PM WBC-11.4*# RBC-2.92*# HGB-9.3*# HCT-26.7*# MCV-92 MCH-31.8 MCHC-34.8 RDW-12.6 [**2176-5-31**] 01:36PM UREA N-16 CREAT-0.8 SODIUM-141 POTASSIUM-3.7 CHLORIDE-107 TOTAL CO2-26 ANION GAP-12 Discharge [**2176-6-4**] 04:36AM BLOOD WBC-10.4 RBC-3.49* Hgb-10.4* Hct-30.5* MCV-88 MCH-29.9 MCHC-34.2 RDW-16.9* Plt Ct-222# [**2176-6-4**] 04:36AM BLOOD Plt Ct-222# [**2176-6-4**] 04:36AM BLOOD PT-13.0 INR(PT)-1.1 [**2176-6-4**] 04:36AM BLOOD Glucose-117* UreaN-24* Creat-1.1 Na-139 K-4.0 Cl-100 HCO3-35* AnGap-8 [**2176-6-3**] 01:18AM BLOOD ALT-16 AST-40 LD(LDH)-203 AlkPhos-44 TotBili-2.6* [**2176-6-3**] 01:18AM BLOOD Albumin-3.4* Calcium-8.2* Phos-2.4* Mg-2.3 Radiology Report CHEST (PA & LAT) Study Date of [**2176-6-4**] 9:05 AM FINDINGS: As compared to the previous radiograph, the lung volumes have slightly decreased. Bilateral small areas of pleural effusions with subsequent areas of atelectasis. Moderate cardiomegaly without pulmonary edema. No evidence of pneumonia. No pneumothorax. Unchanged position and course of the right internal jugular vein catheter. Brief Hospital Course: Mr. [**Known lastname 39477**] was admitted to the [**Hospital1 18**] on [**2176-5-31**] for surgical management of his coronary artery disease. He was taken directly to the operating room where he underwent coronary artery bypass grafting to three vessels. Please see the operative report for details. In summary he had: Coronary artery bypass grafting x3: Left internal mammary artery graft to left anterior descending, reverse saphenous vein graft, diagonal branch of the posterior descending artery. Postoperatively he was taken to the intensive care unit for monitoring. He extubated and was hemodynamically stable. On POD1 and the nurse noted acute bleeding into the chest tube system, he was taken emergently to the operating room where he underwent a re-exploration for bleeding. During this episode he had: mediastinal re-exploration with closure of perforation in the right vein graft. Hemostasis was acheived and he was returned to the intensive care unit for monitoring. He awoke neurologically intact and was extubated. Beta blockade, aspirin and a statin were resumed. During the post-op course he developed atrial fibrillation and was treated with amiodarone after which he converted to normal sinus rhythm. On postoperative day three, 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. Abx started for phlebitis. He continued to make steady progress and was discharged home on postoperative day 6. All follow-up appointments were advised. Medications on Admission: Norvasc 2.5mg daily, Hydrochlorothiazide 25mg daily, Isosorbide mononitrate 30mg daily, Crestor 40mg daily, Toprol XL 25mg, aspirin 162mg daily, Multivitamin daily, Omega-3 fatty acids daily, SL Nitro prn Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) for 1 months. Disp:*60 Capsule(s)* Refills:*0* 2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 2 weeks. Disp:*14 Tablet(s)* Refills:*0* 3. 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:*2* 4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain/fever. 5. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day: 400mg daily x1 wk then 200mg daily. Disp:*35 Tablet(s)* Refills:*1* 6. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 8. rosuvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 9. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 10. omega-3 fatty acids Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*30 Capsule(s)* Refills:*2* 11. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO once a day for 2 weeks. Disp:*28 Tablet Extended Release(s)* Refills:*0* 12. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 2 weeks. Disp:*14 Tablet(s)* Refills:*0* 13. amoxicillin-pot clavulanate 500-125 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) for 7 days. Disp:*21 Tablet(s)* Refills:*0* 14. polyvinyl alcohol-povidone 1.4-0.6 % Dropperette Sig: [**1-21**] Drops Ophthalmic PRN (as needed) as needed for dry eyes. Disp:*2 bottles* Refills:*0* 15. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical TID (3 times a day) as needed for pruitis. Disp:*2 bottles* Refills:*0* Discharge Disposition: Home With Service Facility: All Care VNA Discharge Diagnosis: -Coronary artery disease - phlebitis -Hypertension -Hyperlipidemia -Moderate mitral regurgitation -Trace guaiac positive stool s/p treatment for H Pylori and Colon polypectomy [**2175**] -Histoplasmosis (remote) Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Tylenol and Ultram Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema-trace bilat 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. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time: [**2176-6-27**] 1:15 Cardiologist: Dr. [**Last Name (STitle) **] Phone:[**Telephone/Fax (1) 62**] Date/Time: [**2176-7-5**] 9:00 Please call to schedule appointments with your Primary Care Dr. [**Last Name (STitle) 2912**] [**Telephone/Fax (1) 8543**] in [**4-23**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2176-6-6**] ICD9 Codes: 4019, 2724, 4240
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7168 }
Medical Text: Admission Date: [**2128-3-5**] Discharge Date: [**2128-3-15**] Date of Birth: [**2054-12-30**] Sex: F Service: MEDICINE Allergies: Captopril / Sulfa (Sulfonamide Antibiotics) / Simvastatin / Neurontin / IV Dye, Iodine Containing Attending:[**First Name3 (LF) 69390**] Chief Complaint: acute on chronic renal failure Major Surgical or Invasive Procedure: Right swan catheter placement s/p removal Right temporary dialysis line placement s/p removal Right internal jugular tunneled dialysis line placement History of Present Illness: 73 yr old patient with chronic CHF r/t non ischemic dilated cardiomyopathy, EF 20%, CRF from h/o renal cell carcinoma, mono-clonal gamopathy, htn, no acute indication for HD.has an AICD for primary prevention. She is transferred from [**Hospital1 882**] for management of acute on chronic renal faillure. . In [**Month (only) **] was admitted to [**Hospital1 **] for back pain and incidentally found to have gallbladder stones. On that admission she was treated with vand and unasyn followed by Augmentin for a total of a 10 day course end [**2128-3-2**] for GB PPX and UTI. She was discharged to rehab. . She then was re-presented to [**Hospital1 **] with nausea, vomiting x6 episodes NBNB and diarhea, and renal failure thought to be secondary to dehydration. ERCP was planned at [**Hospital1 112**]; however, this was cancelled secondary to renal failure. She was transferred to [**Hospital1 18**] for further management. Of note her Creatinine on admission was 3.5 and is now up to 4.5 (baseline 2.5-3.0). Given her history the initial though was that she was dry and they gave her 750cc NS, however her creatinine went up. Thinking she was suffering from poor forward flow in the setting of her volume overload she was restarted on her torsemide with worsening of her renal function. The patient has never been dialyzed and has no acute indication. . She was transferred to the [**Hospital1 **] for further management, though why cardiology is unclear. . On review of systems, s/he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. S/he denies recent fevers, chills or rigors. S/he denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. Past Medical History: DM (last A1c 7.6) Renal cell carcinoma s/p nephrectomy [**2119**] MGUS vs Myeloma CRI (baseline 2.5 --> 4.49) Pacemaker Gout Right nephrectomy Pyleonephritis Hyperlipidemia Ischemic Cardiomyopathy (EF 20 %) Hypertension Osteoporosis Chronic back pain (on fentanyl) h/o pyelo c/b urosepsis Social History: No tobacco, alcohol, or drugs. She is married and lives with family. Family History: No cardiovascular history Physical Exam: VS: T=97.5 BP=103/62 HR=59 RR=18 O2 sat=91%RA GENERAL: WDWN W 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 beyond jawline cm. CARDIAC: AICD, Pacer in place PMI laterally displaced 5th intercostal space, midclavicular line. RR, normal S1 early crescendo decrescendo murmure no S2. No No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. Diffuse crackles noted ABDOMEN: Obese Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. EXTREMITIES: Edematous to thighs, but non-pitting SKIN: several echymoses noted. 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: I. Labs A. Admission [**2128-3-6**] 01:19AM BLOOD WBC-5.3 RBC-3.36* Hgb-11.1* Hct-32.8* MCV-98 MCH-32.9* MCHC-33.7 RDW-14.3 Plt Ct-309 [**2128-3-6**] 01:19AM BLOOD Glucose-118* UreaN-123* Creat-5.1*# Na-130* K-4.2 Cl-96 HCO3-17* AnGap-21* [**2128-3-6**] 01:19AM BLOOD ALT-222* AST-146* LD(LDH)-276* CK(CPK)-45 AlkPhos-191* TotBili-0.7 [**2128-3-6**] 01:19AM BLOOD Albumin-3.8 Calcium-8.7 Phos-6.9* Mg-2.5 [**2128-3-6**] 03:08PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.014 [**2128-3-6**] 03:08PM URINE Blood-NEG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2128-3-6**] 03:08PM URINE RBC-0 WBC-0 Bacteri-MOD Yeast-NONE Epi-1 RenalEp-<1 [**2128-3-6**] 03:08PM URINE CastHy-9* [**2128-3-6**] 03:08PM URINE AmorphX-OCC [**2128-3-6**] 03:08PM URINE Mucous-RARE [**2128-3-6**] 03:08PM URINE Eos-NEGATIVE [**2128-3-6**] 03:08PM URINE Hours-RANDOM UreaN-397 Creat-119 Na-LESS THAN K-38 Cl-LESS THAN TotProt-29 Prot/Cr-0.2 B. Discharge/Misc [**2128-3-12**] 06:10AM BLOOD WBC-6.0 RBC-3.17* Hgb-10.0* Hct-31.5* MCV-99* MCH-31.7 MCHC-31.9 RDW-15.5 Plt Ct-196 [**2128-3-12**] 06:10AM BLOOD Glucose-96 UreaN-57* Creat-4.4*# Na-130* K-4.4 Cl-97 HCO3-23 AnGap-14 [**2128-3-12**] 06:10AM BLOOD ALT-105* AST-61* LD(LDH)-247 AlkPhos-199* TotBili-0.8 [**2128-3-12**] 06:10AM BLOOD Calcium-7.9* Phos-4.8* Mg-2.2 [**2128-3-8**] 06:40AM BLOOD calTIBC-332 VitB12->[**2117**] Ferritn-131 TRF-255 [**2128-3-8**] 06:40AM BLOOD TSH-0.86 [**2128-3-8**] 06:40AM BLOOD Cortsol-48.2* [**2128-3-7**] 02:50PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-NEGATIVE [**2128-3-7**] 05:04PM BLOOD ANCA-NEGATIVE B [**2128-3-7**] 05:04PM BLOOD [**Doctor First Name **]-NEGATIVE C. MM work-up [**2128-3-10**] 06:58AM BLOOD b2micro-15.7* [**2128-3-9**] 04:33PM BLOOD IgG-1705* IgA-73 IgM-11* [**2128-3-7**] 02:50PM BLOOD C3-113 C4-14 [**2128-3-7**] 02:50PM BLOOD HCV Ab-NEGATIVE [**2128-3-9**] 04:33PM BLOOD FREE KAPPA AND LAMBDA, WITH K/L RATIO Test Result Reference Range/Units FREE KAPPA, SERUM 94.0 H 3.3-19.4 mg/L FREE LAMBDA, SERUM 14.3 5.7-26.3 mg/L FREE KAPPA/LAMBDA RATIO 6.57 H 0.26-1.65 Interpretation: In serum, the kappa/lambda ratio of whole immunoglobulin molecules is 2:1, whereas the kappa/lambda ratio of free light chains is 1:1.5. The latter is attributed to the occurrence of lambda light chains as dimers whose serum [**1-18**]- life is approximately 3 times longer than that of monomeric kappa light chains. Excess production of kappa or lambda light chains alters the kappa/ lambda ratio. Alterations that fall outside the normal range are attributed to the presence of monoclonal light chains. Monoclonal light chains are found in serum of patients with multiple myeloma, the light chain variant of MM, Waldenstrom's macroglobulinemia, mu-heavy chain disease, primary amyloidosis, light chain deposition disease, monoclonal gammopathy of undetermined significance, and lymphoproliferative diseases such as B-CLL. Measurement of free light chain concentration in serum is useful for diagnosis, prognosis, monitoring disease activity and following response to therapy of these disorders. Chronic infection and chronic inflammatory diseases, as well as renal insufficiency, may be accompanied by a diffuse increase in both kappa and lambda free chains, but the kappa/lambda ratio remains within the normal limits. The serum concentration of free light chains increases with age over 60 years; light chains may reach 50 mg/L in those 70-80 yrs of age; in these cases the kappa/lambda ratio still remains within normal limits. Physicians, who are accustomed to the identification of clonal protein by electro- phoretic means, may order immunofixation in addition to free light chain immunoassay. In rare instances, immunofixation may identify monoclonal light chain protein in the absence of abnormalities in the quantitative light chain immunoassays. [**Doctor Last Name 2809**] [**Female First Name (un) **] et [**Doctor Last Name **]., Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: Relative sensitivity for detection of monoclonal light chains. Clin Chem [**2119**],48:1437-1444. THIS TEST WAS PERFORMED AT: [**Company **]/CHANTILLY [**Numeric Identifier 14272**] CHANTILLY, [**Numeric Identifier 14273**] [**First Name11 (Name Pattern1) 1730**] [**Last Name (NamePattern4) 14274**], MD PROTEIN AND IMMUNOELECTROPHORESIS Protein Electrophoresis ABNORMAL BAND IN GAMMA REGION BASED ON IFE (SEE SEPARATE REPORT), MONOCLONAL IGG KAPPA DETECTED NOW REPRESENTS, BY DENSITOMETRY, ROUGHLY 24% (1500 MG/DL) OF TOTAL PROTEIN INTERPRETED BY [**Name6 (MD) 761**] [**Name8 (MD) 762**], MD, PHD Prot. Electrophoresis, Urine NEGATIVE FOR BENCE-[**Doctor Last Name **] PROTEIN ALBUMIN IS THE ONLY PROTEIN DETECTED FOR ACCURATE QUANTITATION, ORDER RANDOM URINE ALBUMIN/CREATININE RATIO INTERPRETED BY [**Name6 (MD) 761**] [**Name8 (MD) 762**], MD, PHD II. Microbiology [**2128-3-7**] STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B TEST-FINAL INPATIENT [**2128-3-6**] URINE URINE CULTURE-FINAL INPATIENT III. Radiology A. Renal US INDICATION: Acute renal failure. COMPARISON: None available. FINDINGS: The right kidney is surgically absent and the right renal fossa is unremarkable. The left kidney is 12 cm in length and normal in echotexture. There is no hydronephrosis or evidence of nephrolithiasis. The urinary bladder is unremarkable. Color Doppler analysis of the left kidney reveals abnormal arterial waveforms throughout the kidney well as involving the left main renal artery, specifically with evidence of to and fro flow, raising the possibility of reversal of flow in diastole. The left main renal vein appears patent. Note that color Doppler analysis was limited overall as the patient had severe difficulty with breath holding. IMPRESSION: Technically limited study with evidence of to and fro flow in the renal arteries on the left, raising the possibility of reversal of flow in diastole. Overall, this finding is nonspecific, though raises concern for elevated renal parenchymal pressure. If clinically relevant, these findings could be further evaluated via an MRI. Results were provided as a wet read on ED dashboard at the time of dictation. . B. [**2128-3-8**] CHEST PORT. LINE PLACEMENT Reason: Check HD line placement. FINDINGS: Right IJ dialysis catheter tip lies in the region of the lower SVC. Cardiac pacing leads are stable. Severe enlargement of the cardiac silhouette persists with relatively mild vascular congestion, raising the possibility of cardiomyopathy or pericardial effusion. The study and the report were reviewed by the staff radiologist. C. CXR([**2128-3-11**]) A AND LATERAL VIEWS OF THE CHEST REASON FOR EXAM: Decreased breath sound and CHF. There is mild cardiomegaly. Left transvenous pacemaker leads terminate in standard position in the right atrium, right ventricle and through the coronary sinus. Bilateral pleural effusions larger on the right side are associated with atelectasis. There is increased kyphosis. Mild vascular congestion has improved. D. Skeletal survey ([**2128-3-10**]) INDICATION: 73-year-old female with MGUS and question lytic lesions of multiple myeloma. COMPARISON: Chest CT dated [**2124-10-12**] and chest radiograph dated [**2128-3-10**]. SKELETAL SURVEY CALVARIUM: There are multiple punctate lucent lesions within the calvarium concerning for myelomatous deposits. THORACIC AND LUMBAR SPINE: On a background of diffuse demineralization, there is focal kyphosis within the upper/mid thoracic spine secondary to a compression fracture of a upper/mid thoracic vertebral body with approximately 70% loss of vertebral body height. This is new compared to [**2124-10-12**]. The hemithoraces demonstrate bilateral pleural effusions and atelectasis. PELVIS: There are severe degenerative changes of the left sacroiliac joint. RIGHT AND LEFT FEMURS: There are subtle lucencies within both femurs without cortical destruction which may represent myelomatous deposits versus osteopenia. HUMERI: There are no lytic lesions concerning for myelomatous deposits. Clips are seen within the abdomen. IMPRESSION: 1. Multiple punctate lucencies in the calvarium concerning for myelomatous deposits. 2. Wedge compression fracture of an upper/mid thoracic vertebral body, age indeterminate. E. VEIN MAPPING - pending III. Cardiology A. EKG Cardiology Report ECG Study Date of [**2128-3-7**] 4:45:56 PM A-V sequentially paced rhythm with capture. Wandering baseline. Compared to the previous tracing of [**2124-10-13**] the rhythm is now A-V sequentially paced and the rate has slowed. Otherwise, no diagnostic interim change. Read by: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**] Intervals Axes Rate PR QRS QT/QTc P QRS T 60 0 160 496/496 0 -180 -9 B. ECHO ([**2128-3-11**]) The left atrium is dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is moderately dilated. Overall left ventricular systolic function is severely depressed (LVEF= 20-25 %). [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). The right ventricular cavity is moderately dilated with depressed free wall contractility. [Intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation.] There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Severe [4+] tricuspid regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. [In the setting of at least moderate to severe tricuspid regurgitation, the estimated pulmonary artery systolic pressure may be underestimated due to a very high right atrial pressure.] There is no pericardial effusion. IMPRESSION: Mild symmetric LVH. Moderately dilated LV with severe global hypokinesis. Diastolic dysfunction. Dilated and hypokinetic right ventricle with severe tricuspid regurgitation and likely pulmonary artery hypertension. Evidence of pressure/volume overload. Mild aortic and moderate aortic regurgitation. Brief Hospital Course: HOSPITAL COURSE: 73-year-old female with dilated cardiomyopathy (EF 20%), s/p nephrectomy for renal cell carcinoma in [**2119**] with left solitary kidney, hypertension, diabetes, MGUS that presented with 1-month history of nausea and vomiting thought to be related to cholelithiasis with plan for initial plan for ERCP. She subsequently went into acute on chronic renal failure with etiology unknown after extensive work-up. One consideration is multiple myeloma given findings on skeletal survey. . HOSPITAL COURSE: # Acute on chronic renal failure: Patient has underlying renal disease and is s/p right nephrectomy in setting of renal cell carcionoma in [**2119**] with left solitary kidney. Her baseline creatinine is 3 with subsequent elevation to 6.3 with BUN 141 on admission. The etiology of her renal failure was initially thought to be hypovolemia at the [**Hospital1 882**], but she was unresponsive to fluids. No recent contrast exposure. She was subsequently underwent diuresis with thought that poor forward output in setting of cardiomyopathy could be the etiology; however, this as well did not improve her renal function. On admission, she displayed signs and symptoms consistent with uremia. Her volume status was difficult to assess. The differential was broad given her comorbidities. Renal US showed elevated renal parenchymal pressure. MRI was going to be performed to rule out renal vein thrombosis, but the patient had a pacemaker. Renal consultants suggested transfer to the CCU with placement of a SG catheter to assess volume status and possibly initiation HD or UF. Given PA numbers as below, patient was thought to be euvolemic to mildly hypervolemic. Labs were significant for negative ANCA, [**Doctor First Name **], urine eosinophils and normal complement levels. Work-up for myeloma was performed as described below. She had two sessions of HD in the CCU, which she tolerated, without any fluid removed. She subsequently continued HD on the cardiology floor with fluid removal limited by hypotension at times. She had associated pleural effusions with goal to be net negative with dialysis, which was possible with downtitration of carvedilol. She should continue to receive dialysis with goal net negative given pleural effusions. In addition, her hepatitis panel was negative, and PPD was 0 mm of induration for outpatient dialysis screening purposes. She received vein mapping during hospitalization for potential future placement of fistula access on non-dominant left arm, which should be spared from blood draws, blood pressure measurements, or other procedures. She was started on sevelamer, nephrocaps. # MGUS - The patient has a diagnosis of MGUS. Her SPEP at [**Hospital1 882**] on [**2128-2-23**] showed IgG [**2019**], free Kappa 160.74 (H), Free K/L ratio 8.82 (H), M-spike concentration of 1.42 g/dL. Urine showing Bence-[**Doctor Last Name **] protein and faint monoclonal free kappa. Labs showed similar values here. Her last bone marrow biopsy was in [**2115**]. Oncology consult at [**Hospital1 882**] felt that condition was stable. Heme/Onc followed patient in house and recommended above tests in addition to a skeletal survey, which suggested multiple punctate lucencies in the calvarium concerning for myelomatous deposits. A bone marrow biopsy was discussed with the patient who refused as she wanted to discuss this procedure with her primary care doctor. The issue of whether she has MGUS or perhaps myeloma remains moot. Her labs showed stable anemia, no hypercalcemia. In the setting of unexplained oliguric renal failure, cast nephropathy is a consideration, and ruling out myeloma should be considered on an outpatient basis. Another consideration is if her cardiomyopathy is perhaps related to this process. . # Non-ischemic chronic systolic and diastolic cardiomyopathy (Last EF 20 %): She did not appear to have an acute on chronic heart failure exacerbation on admission. Her mild hypervolemia may be secondary to renal failure. She was continued on carvedilol as above. No ACEi/[**Last Name (un) **] was given in setting of renal failure and relative hypotension. As above, she had a PA catheter placed in the CCU, with values of mean RA 26, v-waves to 50mmHg, RVSP/RVEDP ~50/14 and PA pressures 50/22 on entry; Mean wedge 19mmHg; PA pressures increased to 60/28 after the procedure. She was determined to be euvolemic to mildly volume up. TTE showed mild symmetric LVH, moderately dilated LV with severe global hypokinesis, diastolic dysfunction, dilated and hypokinetic right ventricle with severe tricuspid regurgitation and likely pulmonary artery hypertension with evidence of pressure/volume overload and mild aortic and moderate aortic regurgitation. . # Hyponatremia: Most likely hypervolemic hyponatremia given CHF and volume overload. Her admission Na was 134. Her volume status by SG catheter was as above. TSH was normal, and cortisol was appropriately elevated in setting of acute illness. Etiology is likely multifactorial with no mental status changes. Na level should continued to be monitored. . # Metabolic encephalopathy Patient was AAOx2-3 at times at [**Hospital1 882**] and [**Hospital1 18**]. Etiology likely multifactorial given uremia, narcotics, electrolyte abnormalities, acute illness with prolonged hospitalization. Patient was encouraged to use assistive devices such as glasses. Husband visited daily to assist with re-orientation. . # Macrocytic anemia Admission Hgb 11.1 and stable. The differential is broad including primary marrow process vs. nutritional deficiency vs. anemia of chronic renal disease. Iron and B12 studies were suggestive of iron deficiency for which oral iron with anti-constipation regimen was started. . # Cholelithiasis Patient was going to undergo ERCP at [**Hospital1 112**] for stone extraction at some point; however, ERCP deferred in setting of actue on chronic renal failure. Abdominal US on [**3-5**] at [**Hospital1 882**] showing cholelithiasis with two gallstones within gallbladder neck. KUB not suggesting bowel obstruction. Patient continues to have some abdominal tenderness but has remained afebrile with no leukocytosis suggesting against systemic infection. Repeat RUQ US showed cholelithiasis without cholecystitis. Given concurrent transaminitis discussed below, there was a concern for a stone in the CBD, but the etiology of this issue is likely multifactorial. The patient should at some time on an outpatient basis have this issue discussed with her primary care doctor for further evaluation. She was able to take adequate PO intake without significant vomiting or nausea. . # Transaminitis OSH LFTs on [**2128-2-25**] showing ALT 58, AST 22, ALKP 188 with uptrend to ALT 143 AST 111 ALPKP 255 TBili 0.8 on [**2128-3-3**]. Discharge LFTs ALT 105, AST 61, LD 2476, ALP 199, Tot bili 0.8 with overall downtrend. Etiology likely multifactorial including passive congestion from chronic heart failure, possible medication side effect from amiodarone, resolving biliary process. Non-hepatic causes such as thyroid disorder or rhabdomyolysis unlikely given TSH and CK. Intrinsic hepatic causes are not suggested by laboratory (hepatitis panel) or imaging (no lesions noted). She should have repeat LFTs in [**1-18**] weeks to ensure downtrend with continued monitoring. . # Hypertension She was continued on carvedilol, which was reduced from 6.25 mg to 3.125 mg given relative hypotension with dialysis. . # S/p ICD/[**Hospital1 **]-V pacer Patient in paced rhythm. She was continued on amiodarone, which should not be discontinued unless discussing with her primary cardiologist. . # DM2 She was continued on insulin. . # Chronic pain - Primary pain generator is her back for which XR showed wedge compression fracture of an upper/mid thoracic vertebral body (age indeterminate). Patient was continued on fentanyl patch and PO dilaudid. . # Code: Full. Consider outpatient discussion of code status and goals of care. Patient is NOT likely to survive cardiopulmonary arrest especially with such severe heart failure. Medications on Admission: Tylenol 650mg q6h Amiodarone 200mg [**Hospital1 **] Aspirin 81 daily Coreg 6.25 [**Hospital1 **] Colace Fenatanyl 25 ucg q72H Apresoline 25mg TID Dilaudid .5mg q4h prn pain Lantus 10 units qHS HSS Lidoderm patch Maalox liquid 30ml q4h prn omeprazole 20mg daily Senna 2 tabs [**Hospital1 **] Demadex 80mg [**Hospital1 **] Discharge Medications: 1. heparin (porcine) 1,000 unit/mL Solution Sig: 4000-[**Numeric Identifier 2249**] unit Injection PRN (as needed) as needed for line flush: Dialysis Catheter (Temporary 3-Lumen): DIALYSIS Lumens/ DIALYSIS NURSE ONLY: Withdraw 4 mL prior to flushing with 10 mL NS followed by Heparin as above according to volume per lumen. . 2. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain. 3. amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 5. Coreg 3.125 mg Tablet Sig: One (1) Tablet PO twice a day. 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. fentanyl 25 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr Transdermal Q72H (every 72 hours). 8. hydromorphone 2 mg Tablet Sig: 0.25 Tablet PO Q6H (every 6 hours) as needed for pain. 9. Other Humalog insulin sliding scale 10. omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 11. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as needed for constipation. 12. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for pain. 14. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 15. Miralax 17 gram Powder in Packet Sig: One (1) packet PO once a day as needed for constipation. 16. sevelamer HCl 400 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Primary: acute on chronic renal failure, chronic non-ischemic systolic heart failure (EF 20 %), hyponatremia, acute metabolic encephalopathy, macrocytic anemia, cholelithiasis, transaminitis, atrial fibrillation, monoclonal gammopathy of uncertain significance Secondary: Diabetes mellitus, low back pain secondary to compression fracture Discharge Condition: Mental Status: Confused - sometimes. Alert and oriented to person, place, sometimes time. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: You were transferred from The [**Hospital1 882**] to [**Hospital1 18**] for acute on chronic renal failure of unknown etiology. You were started on dialysis. It was also discussed that you may have possibly developed multiple myleoma but did not want to pursue bone marrow biopsy. You should talk to your outpatient hematologist about this matter. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Medication changes: START ferrous sulfate for anemia (low blood count) START nephrocaps for kidney health START sevelamer for kidney health CHANGE coreg from 6.25 mg by mouth twice daily to 3.125 mg by mouth twice daily STOP apresoline 25 mg by mouth three times daily STOP demadex 80 mg by mouth twice daily Followup Instructions: [**2128-3-15**] with Dr. [**Last Name (STitle) 84995**] (oncology) ([**Location (un) **] [**Location (un) 2274**]) [**2128-3-23**] with Dr. [**Last Name (STitle) 94422**] ([**Location (un) **] [**Location (un) 2274**]) [**2128-3-31**] with Dr. [**Last Name (STitle) **] ([**Location 1268**] [**Location 2274**]) [**First Name8 (NamePattern2) 20**] [**Last Name (NamePattern1) **] MD [**MD Number(1) 69391**] ICD9 Codes: 5845, 2761, 4254, 4280, 4241, 2724, 2749
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Medical Text: Admission Date: [**2101-8-6**] Discharge Date: [**2101-8-12**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 443**] Chief Complaint: Transferred from [**Hospital3 628**] for management of tachy-brady syndrome/cardiac pauses. Major Surgical or Invasive Procedure: 1)Temporary pacing wire placement 2)Permanent dual pacemakder placement History of Present Illness: [**Age over 90 **] year old male with a history of DVT/PE on coumadin, intermittent AF, CHF with EF 45% who presents from [**Hospital 620**] Hosp for multiple pauses in the setting of CHF exacerbation. The patient initially presented to his PCP in [**Name9 (PRE) **] for a routine visit and was found to be tachycardic with an "abnormal ECG", per patient's niece. He was subsequently admitted to [**Hospital 882**] hospital ([**Date range (1) 57274**]/07). In the ED, he was tachypneic, tachycardic, and hypoxemic. CXR at the time showed bibasilar consolidations and TTE revealed a slightly depressed EF (45%) and elevated PA pressures. He was treated for both CHF and community-acquired pneumonia. . The patient did well until [**8-2**], when he went for follow-up to the pulmonologist, where he had a CXR revealing pulmonary edema with similar symptoms of shortness of breath and hypoxia and was admitted to [**Hospital3 **] for CHF exacerbation (BNP 6141, Trop 0.055). However, on [**8-4**], he was transferred to the ICU for persistent tachycardia to the 110s thought to be AF/flutter. He was started on digoxin load and maintenance, IV lopressor, and IV lasix while there. On [**8-6**] he had 2 episodes of cardiac pauses (10s at 10:30am, 24s at 4:30pm). BP remained stable during these episodes. He was transferred to [**Hospital1 18**] for further management. On transfer from [**Location (un) 620**]-- SBP 110s, HR 80s, afib with PVCs and no pauses, 100% on 2L. . On review of symptoms, he admits to DVT/PE, but he denies any prior history of stroke, TIA, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Past Medical History: 1)DVT/PE on coumadin-In [**11-5**], the patient had several episodes of shortness of breath in the setting of left leg swelling for 4-6 weeks. US showed clot from the left common femoral vein to the left popliteal vein. PE CT showed non-oclusive pulmonary emboli bilaterally in the upper lobe arteries. On ECHO, there was no evidence for right sided heart strain. He was discharged on Coumadin 5mg Daily with INR goal of [**3-5**]. 2)Intermittent AF-Present during the [**7-7**] [**Hospital 882**] Hospital admission. At this time, he was started on Diltiazem. 3)CHF-ECHO in [**11-5**] at an OSH showed an EF of 60% with LVH, nml LV size. Dilated LA, RA. Nomral size RV and nml RV function. Mild AS, Trace TR. In [**7-7**], an ECHO at an [**Last Name (LF) 57275**], [**First Name3 (LF) **] was 45% with LVH, nml LV size, Dilated LA. RV enlargement with hypokinesis, mild AS, 1+ MR, 1+TR, PAP of 34mmHg. 4)Hearing loss with hearing aids 5)Right bundle branch block, ? trifascicular block-In 4/89, EKG showed 1st degree AV block and RBBB. 6)History of asbestos exposure 7)Hernia repair in 4/95 Social History: Patient previously lived alone in [**Location (un) 620**]. His brother lives near by and checks on him frequently. The patient was a former shipyard worker, carpenter. He stopped smoking 20 years ago and he uses alcohol rarley. His brother [**Name (NI) 122**] is his health care proxy and his [**Last Name (LF) 21457**], [**Name (NI) **] [**Name (NI) 57276**] is his alternate health care proxy. Family History: There is no family history of premature coronary artery disease or sudden death. Physical Exam: PHYSICAL EXAMINATION: VS: T: 98.0 , BP: 108/58 , HR: 77 , RR: 24 , O2 %: 91 on 2L Gen: Patient awake, interactive, and oriented to person and place. Mood and affect is appropriate. HEENT: Normal cephalic atraumatic. Sclera anicteric. Extra-ocular movements intact. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with JVP of 8-9cm. CV: Regular heart rate. Normal S1 and S2. II/VI systolic murmur heard loudest at the apex. No S4, no S3. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. Soft bibasilar crackles improved from yesterday. Abd: Soft, non-tender, non-distended, no masses. Ext: No lower extermity edema. 2+ dorsal pedal pulses. Skin: Bilateral lower extremity venous stasis changes. Pulses: Right: Carotid 2+, DP 2+ Left: Carotid 2+, DP 2+ Pertinent Results: EKG:Atach vs afib, RBBB w LAFB, Q in II, III, aVF, 1mm STD/TWI in V2-4 . CXR [**2101-8-6**]: Calcified pleural plaques consistent with previous asbestos exposure. There is blunting of the bilateral costophrenic angels that may be pleural thickening or pleural effusions. . CXR [**2101-8-9**]: Confirms placement of a pacemaker with leads in the right atrium and right ventricle. There is improvement of the bilateral infiltrates. A 10mm in diameter denisty was noted in the upper lobe of the right lung. Pleural plaques are unchanced from previous studies. . ECHO [**2101-8-8**]: Sym LVH, nml LV cavity size, global LV hypokinesis with LVEF of 35%. RA dilation. RV dilation with depressed RV function. Moderate AS with peak velocity of 3.0, peak gradient of 36mmHg. 1+ AR, 1+ MR, trivial TR. . . Head CT [**2101-8-9**]. Demonstrated no acute intracranial process ushc as mass effect, infarcts, intracranial hemorrhage. IThere is calcification of the flax cerebri. . Video Swallowing Study [**2101-8-11**]-Showed mild dysphagia and aspiration on thin liquids corrected by compensatory maneurves such as chin tuck. . Admission Labs: [**2101-8-6**] 11:23PM TYPE-ART TEMP-36.1 PO2-66* PCO2-46* PH-7.44 TOTAL CO2-32* BASE XS-5 INTUBATED-NOT INTUBA [**2101-8-6**] 11:23PM LACTATE-1.2 [**2101-8-6**] 11:23PM O2 SAT-93 [**2101-8-6**] 11:23PM freeCa-1.18 [**2101-8-6**] 11:05PM GLUCOSE-126* UREA N-29* CREAT-1.2 SODIUM-139 POTASSIUM-5.1 CHLORIDE-101 TOTAL CO2-31 ANION GAP-12 [**2101-8-6**] 11:05PM estGFR-Using this [**2101-8-6**] 11:05PM CALCIUM-8.9 PHOSPHATE-3.3 MAGNESIUM-2.5 [**2101-8-6**] 11:05PM WBC-9.6 RBC-4.20* HGB-13.3* HCT-40.5 MCV-96 MCH-31.8 MCHC-33.0 RDW-15.3 [**2101-8-6**] 11:05PM PT-24.0* PTT-30.0 INR(PT)-2.4* [**2101-8-6**] 11:05PM PLT COUNT-176 . Discharge Labs: [**2101-8-12**] 05:00AM BLOOD WBC-9.2 RBC-4.02* Hgb-12.7* Hct-38.5* MCV-96 MCH-31.6 MCHC-33.0 RDW-15.3 Plt Ct-163 [**2101-8-12**] 05:00AM BLOOD Glucose-99 UreaN-29* Creat-1.0 Na-141 K-4.1 Cl-101 HCO3-30 AnGap-14 [**2101-8-8**] 03:24AM BLOOD ALT-25 AST-24 LD(LDH)-221 AlkPhos-84 TotBili-0.6 [**2101-8-12**] 05:00AM BLOOD Calcium-8.8 Phos-3.1 Mg-2.3 [**2101-8-7**] 06:00AM BLOOD TSH-1.4 [**2101-8-12**] 05:00AM BLOOD PT-17.4* PTT-38.2* INR(PT)-1.6* . MICRO: [**2101-8-10**] 6:37 am STOOL CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2101-8-11**]): FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA. Brief Hospital Course: Mr. [**Name14 (STitle) 57277**] is [**Age over 90 **] year old man with a history of DVT/PE on coumadin, A-Fib/aflutter, CHF with an EF of 45% who presents with a CHF exacerbation and extensive cardiac pauses during sleep. The patient was transferred to the [**Hospital1 **] CCU for further work up . Asystolic Pauses/Rhythm-On admission, the patient was found to be in A-fib with episodes of bradycardia and sinus pauses (lasting up to 20-30 seconds.) This was thought to that was thought to be possibly due to tach-brady syndrome and significant conduction system disease. The patient was placed on telemetry and followed with serial EKG. On [**2101-8-7**], a temporary pacing line was placed. Metoprolol was used to control episodes of tachycardia to the 120's. On [**2101-8-8**], a dual pacemaker device with leads in the right atrium and ventricle was placed. The pacemaker was interrogated on [**2101-8-9**] and PA and lateral chest x-rays confirmed the pacemaker placement. He should follow up with his cardiologist and the device clinic to assess proper pacemaker functioning . A-fib: On admission, Digoxin was discontinued because this medication was thought to be contributing to asystolic pauses. The patient was rate controlled with metoprolol 25mg PO TID. On [**2101-8-9**], with resolution of the cardiac pauses with pacemaker placement, Digoxin 0.125mg every other day was restarted. It is hoped that the patient will be able to be converted into sinus rhythm. This will be attempted after a full month of anticoagulation on coumadin at therapeutic levels. Then, chemical cardioversion should be attempted as an outpatient. . CHF: Pt admitted with dyspnea and likely CHF exacerbation in the setting of a-fib and cardiac asystole. OSH medical records indicated normal LVEF of greater than 55% in [**11-5**]. However, on this hospitalization, the Left ventricular ejection fraction was found to be 35%, with global left ventricular hypokinesis, left ventricular hypertrophy, and Aortic stenosis. This change in cardiac function is believed to be due to cardiomyopathy from abnormal rhythm/prolonged atrial tachycardia. The patient was treated with IV lasix and over the lengths of hospital stay, he diuresed more than 9L. The patient's heart rate was controlled with metoprolol in the hopes that a slower heart rate would allow more effective filling of the ventricles. And ACE inhibitor was not started for afterload reduction because of the patient's low blood pressures, but can be considered in the future. As an outpatient, Mr. [**Known lastname 57278**] should get an ECHO in a month or so to reassess cardiac function. It is very likely that the LVEF will improve with the normalization of his rhythm. . DVT/PE/Anticoagulation: The patient was on home coumadin for treatment of his PE and a-fib. His INR was 2.4 on admission. The coumadin was held and sliding scale heparin was started in preparation for the pacemaker placement. The patient was given 2 units of fresh frozen plasma to correct his INR to below 1.8. After the pacemaker was placed, the patient was put on Lovenox as a bridge until his coumadin became therapeutic. On discharge, the patient was on coumadin 5mg a day with Lovenox 80mg SC with an INR of 1.6. When the patient reaches a therapeutic INR of [**3-5**] for 48 hours, the patient should discontinue Lovenox and continue on coumadin mg PO daily. . Change in mental status-On [**2101-8-9**], the patient became somnolent and PO medications were not administered. A head CT was obtained that showed no acute intracranial process. An ABG was also obtained that showed adequate oxygenation and electrolytes were normal. The patient became more alert and was able to eat breakfast on [**2101-8-10**]. The patient's metal status continued to improve for the rest of the hospitalization. . Pulmonary Nodule-With resolution of the pulmonary edema, a pulmonary nodule in the Right upper lobe of the lung was found on chest x-ray on [**2101-8-9**]. The family decided to follow this result with an outpatient CT. . Difficulty Swallowing: On [**2101-8-10**], the patient underwent a swallowing evaluation that showed aspiration. The patient was scheduled for a video swallow study that was performed on [**2101-8-11**] and showed mild dysphagia for thin fluids that could be corrected with compensatory maneuvers. It was felt that the patient could continue on a regular diet as long as compensatory maneuvers such as a chin tuck were performed during feeding. The patient should follow up with speech therapy for a re-evaluation. . C.diff-Patient was found to be C.diff positive by stool cultures on [**2101-8-10**]. The patient was started on Flagyl 500mg PO TID for a 14 day course. . The patient was placed on a bowel regimen, cardiac diet, and is full code. . Medications on Admission: Home Medications: diltiazem 45mg po q8 lasix 40mg po daily coumadin 3mg po qhs ipratropium 0.5mg q6 guafenesin 10ml po q6 senna 2 tabs [**Hospital1 **] multivitamin colace 100mg po prn acetaminophen 650mg prn levalbuterol 0.63mg q4 prn benzonate 100mg po tid prn mom prn dulcolax prn lactulose prn mechanical soft diet, nectar thick liquids Transfer Medication from Outside hospital: lasix captopril 6.25 po tid Coumadin 5mg daily Digoxin 0.125mg daily Nystatin Lasix 40mg daily Discharge Medications: 1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). Disp:*30 Tablet(s)* Refills:*2* 2. Lasix 20 mg Tablet Sig: Three (3) Tablet PO once a day. Disp:*90 Tablet(s)* Refills:*2* 3. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day: Please adjust accordingly for a goal INR [**3-5**]. Disp:*30 Tablet(s)* Refills:*2* 4. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: Three (3) Tablet Sustained Release 24 hr PO once a day. Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2* 5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 6. Ipratropium Bromide 0.02 % Solution Sig: One (1) inhalation Inhalation Q6H (every 6 hours) as needed for wheezing, SOB. 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for pain. 8. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) injection Subcutaneous Q12H (every 12 hours): to take until therapeutic on coumadin for 48hours. 9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 14 days. Discharge Disposition: Extended Care Facility: [**Location (un) 582**] Of [**Location (un) 620**] Discharge Diagnosis: asystolic pauses atrial fibrillation congestive heart failure right upper lobe pulmonary nodule C. difficile infection Discharge Condition: stable Discharge Instructions: You were admitted for a bad heart rhythm and congestive heart failure. A pacemaker was placed during this admission. You also have C. diff infection for which we are treating you with an antibiotic. Please take all medications as prescribed and keep all follow up appointments. . You were also found to have an incidental pulmonary nodule on a chest x ray. Please follow up with your primary care physician to consider further imaging. . Please call your physician or call 911 if you experience chest pain, shortness of breath, fevers, abdominal pain, nausea, vomiting, or other concerning symptoms. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) **] in his [**Location (un) 620**] office([**Telephone/Fax (1) 4105**]) on [**2101-8-25**] at 3PM. If you are unable to keep this appointment, please contact him. . You have an appointment in the DEVICE CLINIC for your pacemaker Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2101-8-15**] 3:00 . You will need a follow up appointment with your PCP as soon as possible. Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 57279**] ICD9 Codes: 4280, 4241
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7170 }
Medical Text: Admission Date: [**2105-2-28**] Discharge Date: [**2105-3-1**] Date of Birth: [**2067-9-21**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: dyspnea, chest pain Major Surgical or Invasive Procedure: none History of Present Illness: This is a 37 year-old female with a history of metastatic cholangiocarcinoma who presents with dyspnea and abdominal pain. . In the ED, initial VS were 100.8 rectal, 119, SBP 80 (per old records lives in 90s), 20, 98% RA. She was given 2L NS with improvement of her BP to 115/75. She was noted to have significant ascites on exam, but otherwise unchanged. On her lab work, she was noted to have significnant leukocytosis, no bands, and thrombocytosis. Sodium was 113 with AG of 14. She had a CTA torso which showed no PE, but marked ascites and worsening of her metastatic disease. Otherwise no definite pathology. Her LFTs were unremarkable. Transplant surgery evaluated the patient for purulent discharge from her biliary drain, but this was felt to be unchanged. Paracentesis was not performed. The patient was given vanco/zosyn for empiric coverage. She had 2 PIVs placed, and transferred to the ICU for the above. Her vitals at the time of transfer were VS: 118, 115/74. 100%RA. . ROS: The patient denies any fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia, chest pain, shortness of breath, orthopnea, PND, lower extremity oedema, cough, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. . Past Medical History: 1) Chloangioncarcinoma with neuroendocrine features (as below) 2) Cholelithiasis with large CBD stone . ONCOLOGIC HISTORY: *per Heme/Onc note Mrs. [**Known lastname **] is a 37-year-old, who has a long history of cholelithiasis since more than 20 years ago. Post-partum day 3 ([**2104-11-11**]) she underwent IR drainage and pigtail catheter placement into her gallbladder with fluid consistent with carcinoma with neuroendocrine features. She was discharged on [**11-15**] with an indwelling cholecystostomy tube; however, she was readmitted a week later due to abdominal pain. [**2104-11-21**] Abd CT noted multiseptate lesion and progression in dilation of gallbladder. [**2104-11-24**] chest and pelvic CT negative for distant mets. On [**2104-11-27**] CT guided bx of the lesion showed positive malignant cells, consistent with carcinoma. [**2104-11-25**] octreotide scan showed exophytic component of the multiseptated segment III lesion displays very avid octreotide uptake, compatible with neuroendocrine tumor. Discussed her case on GI tumor conference and it was determined that she has unresectable gallbladder small cell cancer. - [**2104-12-8**] C1D1 Cisplat/VP16 - [**2104-12-9**] C1D2 VP16 - [**2104-12-10**] C1D3 VP16 - [**2104-12-29**] C2D1 Cisplat/VP16 - [**2104-12-30**] C1D2 VP16 - [**2104-12-31**] C1D3 VP16 Social History: Lives at home with husband and 2 daughters. One daughter 8 years old and one daughter born [**2104-11-8**]. Was employed in food service prior to illness. Tobacco: None EtOH: None . Family History: No history of cancer or diabetes. Father died in his 80s from heart disease Physical Exam: GEN: Well-appearing, well-nourished, no acute distress HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear 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, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Strength 5/5 in upper and lower extremities. Patellar DTR +1. Plantar reflex downgoing. No gait disturbance. No cerebellar dysfunction. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. . Pertinent Results: Admission labs: [**2105-2-28**] 07:15PM BLOOD WBC-16.7*# RBC-3.10* Hgb-7.7* Hct-24.3* MCV-78* MCH-24.8* MCHC-31.8 RDW-18.6* Plt Ct-1053* [**2105-2-28**] 07:15PM BLOOD Neuts-98* Bands-0 Lymphs-1* Monos-1* Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2105-2-28**] 07:15PM BLOOD Hypochr-1+ Anisocy-2+ Poiklo-1+ Macrocy-2+ Microcy-2+ Polychr-NORMAL [**2105-2-28**] 07:15PM BLOOD PT-13.3 PTT-33.8 INR(PT)-1.1 [**2105-2-28**] 07:15PM BLOOD Glucose-89 UreaN-43* Creat-0.9 Na-113* K-6.6* Cl-81* HCO3-18* AnGap-21* [**2105-2-28**] 07:15PM BLOOD ALT-20 AST-51* CK(CPK)-184* AlkPhos-91 TotBili-0.3 [**2105-2-28**] 07:15PM BLOOD CK-MB-5 [**2105-2-28**] 07:15PM BLOOD cTropnT-<0.01 [**2105-2-28**] 07:15PM BLOOD Albumin-2.7* Calcium-7.8* Mg-2.6 Iron-14* [**2105-2-28**] 07:15PM BLOOD calTIBC-265 Ferritn-312* TRF-204 [**2105-2-28**] 07:15PM BLOOD Osmolal-259* [**2105-2-28**] 07:17PM BLOOD Lactate-2.2* [**2105-2-28**] 09:06PM BLOOD K-4.8 [**2105-2-28**] CTA chest, CT abd and pelvis: 1. No evidence of pulmonary embolism. 2. Mild progression of innumerable diffuse hepatic, mesenteric, peritoneal and pelvic metastases. 3. Mild right renal hydroureteronephrosisis new. 4. Diffuse esophageal wall thickening may represent esophagitis. Correlate with symptoms. Brief Hospital Course: This is a 37 year-old female with a history of end stage metastatic cholangiocarcinoma who presents with chest pain and dyspnea noted to be hypotensive and hyponatremic with low grade fevers Sepsis: The patient was initially thought to be septic given her low grade fevers, tachycardia, and leukocytosis, with a possible source being peritonitis. She was covered broadly with vancomycin and zosyn and blood and urine cultures were sent. An abdominal paracentesis was planned but not performed because of the patient's inability to remain motionless and comfortable during the procedure. The procedure was planned to be performed under IR-guidance but she expired prior to its exeution. # Hyponatremia: The patient's hyponatremia was thought to be hypovolemic hyponatremia. She received IVF with some improvement in her sodium levels. # Anemia: The patient was found to have a microcytic anemia, likely secondary to anemia of chronic inflammation. Her stools were planned for guaiac. She did not receive any transfusions while she remained in the [**Hospital Unit Name 153**]. # Cholangiocarcinoma: The patient has metastatic cancer and is followed by Dr. [**Last Name (STitle) **]. Clinically, she has significant ascites and undergoes frequent paracentesis. The palliative care service was also consulted. Her cause of death is unclear but likely related to her metastatic cancer. # Code: DNR/DNI- confirmed with patient & husband via interpreter Medications on Admission: per OMR Dexamethasone 4 mg [**Hospital1 **] Lorazepam 0.5 mg q4-6 PRN Ondansetron 8 mg q8 PRN Prochlorperazine 10 mg Q6H PRN Spironolactone 25 mg daily MVI daily patient states she takes only oxycodone for pain. Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: cholangiocarcinoma sepsis Discharge Condition: expired Discharge Instructions: N/a Followup Instructions: n/a Completed by:[**2105-3-3**] ICD9 Codes: 0389, 2761, 2859
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Medical Text: Admission Date: [**2190-2-8**] Discharge Date: [**2190-2-11**] Service: NEUROLOGY Allergies: Keflex / Lipitor Attending:[**Last Name (NamePattern1) 1838**] Chief Complaint: Transient right hand weakness and speech arrest Major Surgical or Invasive Procedure: None History of Present Illness: The pt is an 88 year-old right-handed man with a PMH of recent SDH in addition to seizures, CAD and afib now off Coumadin. He was admitted on [**1-24**] after a fall from a tread mill while on ASA and coumadin. He was found to have a 7mm L parietal/occipital SDH. He was admitted to the neurosurgery service for evaluation. His hospital course at the time was complicated by a worsening mental status on admission and he was found to have an expanding bleed. His INR was 2.8 on arrival and he was reversed with Factor 9, FFP, Plts, and VitK. He was intubated and admitted to the ICU and his course was also remarkable for significant HTN which required a Nipride drip at times. After extubation his exam was felt to be non-focal and he was eventually discharged to rehab. He presented again today after transfer from an OSH with a 20 minute episode of R hand weakness and difficulty getting words out. He states that he was in his USOH this morning when he sat down to eat breakfast. He was speaking on the phone with his wife when he abruptly felt that his R hand was "weak" and he dropped the spoon. He did not see any additional movements or jerking. He then felt that his mouth "was full of cotton" and when he tried to speak his words were both slurred and difficult to produce. He recalls that he knew what he wanted to say but had difficulty producing the words. He did not make paraphasic errors but after a minute or so from the onset he stopped speaking. He was able to understand others however. The entire episode lasted about 20 minutes after which he was back to baseline. He denied HA or vision changes as well as numbness or tingling. He was not aware of any involvement of the leg but recalls that [**Name8 (MD) **] RN at the rehab thought he had a facial droop. He was taken to an OSH where he was hypertensive to the 200's and a head CT was done. This allegedly showed new hyperintensity in his persistent L parietal subdural hematoma. He was then transferred here where he was seen in the ED by neurosurgery who felt that his CT was stable without of evidence mass effect or shift and recommended that he start Keppra as he was "not been on seizure prophylaxis". Additionally, he remained severely hypertensive and was given atenolol and lisinopril PO, hydralazine 10mg IV, labetalol 10mg IV. ROS: The pt denied headache, loss of vision, blurred vision, diplopia, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Pt unsure if he has had any bowel or bladder incontinence or retention. Denied difficulty with gait. The pt denied recent fever or chills but has felt cold in the ED. Past Medical History: - A-fib now off coumadin - HTN - HLD - CAD - Parkinson's ? - ? CAROTID STENOSIS - PUD - pacemaker implantation in [**2179**] - BPH - Seizure disorder (last seizure 15-20 yrs ago) with GTC - Appy - Eye surgery for congenital cataracts/lens implants - Hernia surgery - Glomerulonephritis 2 yrs ago - recent SDH as above - ? IVC filter Social History: -currently resides at rehab -EtOh: denies -tobacco: denies -drugs: denies Family History: NC Physical Exam: Vitals: T: 97.7 P: 61 R: 12 BP: 193/82 SaO2: 98% RA General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: decreased breath sounds bilaterally Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive, language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Speech was not dysarthric. Able to follow commands. There was no evidence of apraxia or neglect. Recent and remote memory intact. Cranial Nerves: No evidence of anosmia. PERRL 3 to 2mm and brisk. VFF to confrontation. There is no ptosis bilaterally. Fundoscopic exam revealed no papilledema, exudates, or hemorrhages. EOMI without nystagmus. Facial sensation intact to pinprick. No facial droop, facial musculature symmetric. Hearing intact to finger-rub bilaterally. Palate elevates symmetrically. [**5-25**] strength in trapezii and SCM bilaterally. Tongue protrudes in midline. Motor System: Normal tone throughout. Muscle bulk normal. No pronator drift bilaterally. No asterixis noted. Full motor strength in all groups tested. Reflexes: [**Hospital1 **] Tri [**Last Name (un) 1035**] Pat Ach L 2 2 2 2 1 R 2 2 2 2 1 Plantar response was flexor bilaterally. Sensory System: Sensory: No deficits to light touch, pinprick, cold sensation, vibratory sense, proprioception. Coordination: R sided postural tremor and intention tremor. Gait: deferred given concern for severe HTN Pertinent Results: [**2190-2-10**] 06:06AM BLOOD WBC-5.8 RBC-3.60* Hgb-11.4* Hct-32.7* MCV-91 MCH-31.7 MCHC-35.0 RDW-14.8 Plt Ct-206 [**2190-2-10**] 06:06AM BLOOD Glucose-104 UreaN-15 Creat-0.9 Na-135 K-3.6 Cl-101 HCO3-29 AnGap-9 [**2190-2-8**] 01:30PM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2190-2-8**] 10:30PM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2190-2-9**] 06:38AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2190-2-10**] 06:06AM BLOOD Calcium-8.4 Phos-2.9 Mg-1.7 [**2190-2-9**] 06:38AM BLOOD %HbA1c-5.8 [**2190-2-9**] 06:38AM BLOOD Triglyc-94 HDL-49 CHOL/HD-2.9 LDLcalc-72 [**2190-2-8**] 10:30PM BLOOD TSH-4.1 [**2190-2-9**] 06:38AM BLOOD Carbamz-3.5* Echocardiogram: Mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w CAD (LVEF 50~55%). Mild mitral regurgitation. CT Head: Evolving Left frontoparietal subdural hematoma is unchanged in size and distribuation. CTV: No evidence of intracranial venous thrombus. Carotid US: Bilateral 60~69% stenosis. EEG: Drowsy but normal EEG otherwise. Brief Hospital Course: The pt is an 88 year-old RH man with a complex PMH including seizures, CAD and afib off coumadin and a recent SDH. He presented with transient difficulty producing speech and R hand weakness. His exam is remarkable for parkinsonian features but is otherwise non-focal. Given his presentation, his symptoms could be due to a TIA vs. seizure hence he was admitted for possible stroke work-up and seizures. Because of his pacemaker, it was not possible to obtain a MRI but CT was obtained which showed stable, old SDH without signs of increase in size or new hemorrage. He has R IJ thrombus hence CT venogram was obtained but he has no evidence of intracranial venous thrombus. Also echo and carotid US plus labs including fasting lipid panel and HbA1C were obtained - all within normal range and/or stable. His Tegretol level was subtherapeutic hence his dose was increased to 300mg daily from 200 and EEG was also obtained which was essentially normal. His Na+ dropped to 132 from 136 and likely due to Tegretol hence he will ne discharged with labs of chem 7 every Friday to monitor for his sodium. He remained symptom-free during this admission and he was evalutated per PT and OT for return to [**Hospital3 7665**]. As for his atrial fibrillation, he was restarted on aspirin 81mg during this admission but given his risk factor and the fact that his SDH was "traumatic," will consider restarting Coumadin in ~ 2 weeks when he follows up with Dr. [**Last Name (STitle) **]. He will also get a head CT prior to seeing Dr. [**Last Name (STitle) **]. Medications on Admission: 1. Carbamazepine 200 mg Tablet Sustained Release 12 hr Sig: One (1) Tablet Sustained Release 12 hr PO DAILY (Daily). 2. Atenolol 50 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 10. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 11. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 12. Aliskiren 150 mg Tablet Sig: One (1) Tablet PO QD (). 13. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). 16. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 17. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 18. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 19. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-22**] Drops Ophthalmic PRN (as needed). 20. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed. Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed. 2. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 4. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 7. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 8. Aliskiren 150 mg Tablet Sig: One (1) Tablet PO Qday (). 9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 11. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: [**1-22**] Inhalation Q6H (every 6 hours) as needed. 12. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). 14. Carbamazepine 100 mg Tablet Sustained Release 12 hr Sig: Three (3) Tablet Sustained Release 12 hr PO DAILY (Daily). 15. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 16. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Atenolol 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 18. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN (as needed). 19. Outpatient Lab Work Chem 7 (Na+, K+, Cl-, HCO3-, BUN, Cr and Glucose) every Friday. 20. Non-contrast head CT on the morning before seeing Dr. [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Discharge Disposition: Extended Care Facility: northeast acute rehab Discharge Diagnosis: TIA Seizure disorder hx of L SDH Atrial fibrillation - off Coumadin since SDH ([**2190-1-24**]) Discharge Condition: Stable - Bilateral (L>R) intention and postural tremor plus Parkinsonian features but otherwise non-focal exam. Intermittent stuttering of speech as well. Discharge Instructions: You were admitted after an episode of R arm weakness and speech trouble concerning for small stroke/transient ischemic attack or seizure activity. Due to your pacemaker, you were not able to get a MRI but repeat CTs were not indicative of new infarct or worsening of your prior SDH. Given that your Tegretol (carbamazepine) level was low, it was increased to 300mg daily with improved level on repeat check. You did not have further episodes of weakness during this admission but your speech was stuttering at times hence CT of head was again repeated on [**2-11**] which was stable. Also, you were restarted on Aspirin 81mg daily. You will be returning to [**Hospital 5130**] Rehab for continued physical and occupational therapy. You will be following up with Dr. [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] during which you will have a repeat head CT prior to the appointment and if no new bleed, you will likely be restarted on Coumadin for your atrial fibrillation. Please take your meds as prescribed. You will also need weekly labs including Na+ because Tegretol can cause hyponatremia. On the day of your discharge, your Na+ was 132. Please call your PCP or go to the nearest ED if you have worsening weakness, speech trouble, numbness and/or visual problems. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 640**] [**Last Name (NamePattern4) 3445**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2190-3-15**] 2:30 - you may be called to reschedule this appointment; also you will have a head CT on the morning before your appointment. Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2190-3-10**] 8:40 Provider: [**Name10 (NameIs) 27270**] [**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2190-7-8**] 9:00 Completed by:[**2190-2-11**] ICD9 Codes: 2761, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7172 }
Medical Text: Admission Date: [**2105-2-9**] Discharge Date: [**2105-2-13**] Date of Birth: [**2038-12-14**] Sex: F Service: CARDIOTHORACIC Allergies: Accupril / Zestril / Avandia / Tetanus Attending:[**First Name3 (LF) 1505**] Chief Complaint: dizziness Major Surgical or Invasive Procedure: ASD closure/resection left atrial myxoma [**2105-2-9**] History of Present Illness: 66 yo female with dizziness and bradycardia noted on Holter monitor. Dyazide was reduced and workup revealed left atrial mass. Referred for surgery. Past Medical History: left atrial mass hypertension insulin-dependent diabetes mellitus bradycardia remote fractured ankle bilat. carotid disease Social History: works part time no tobacco use no ETOH used lives with husband Family History: aunt with CABG in her 70's father with CAD and CABG in his 80's Physical Exam: HR 54 147/62 5" 132# WDWN in NAD skin/HEENT unremarkable neck supple, full ROM CTAB RRR 2/6 murmur soft, NT, ND, + BS extrems warm, well-perfused, no edema or varicosities noted neuro grossly intact no carotid bruits appreciated Pertinent Results: Conclusions PREBYPASS A mass consistent with a myxoma or tumor is seen in the body of the left atrium along the lower anteroseptal area of the interatrialo septum. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. Physiologic mitral regurgitation is seen (within normal limits). POSTBYPASS There is preserved biventricular systolic function. The LA mass is no longer visualized. The interatrial septum is intact by 2d, Color Doppler and by agitated saline at rest and with Valsalva manuever. The study is otherwise unchanged compared to prebypass. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2105-2-9**] 10:05 [**2105-2-12**] 06:55AM BLOOD WBC-9.5 RBC-3.14* Hgb-9.5* Hct-27.1* MCV-86 MCH-30.3 MCHC-35.1* RDW-14.4 Plt Ct-154 [**2105-2-12**] 06:55AM BLOOD Glucose-113* UreaN-22* Creat-0.8 Na-139 K-4.2 Cl-103 HCO3-30 AnGap-10 Brief Hospital Course: Admitted [**2-9**] and underwent surgery with Dr. [**Last Name (STitle) **]. Transferred to the CVICU in stable condition on phenylephrine and propofol drips. Extubated that evening. Given first dose of lopressor 12.5mg and developed bradycardia w/ HR 30's. Paced until recovered -in junctional rhythm 60's-70's. Chest tubes d/c'd w/ stable CXR. transferred from the ICU to the floor. Rhythm converted to sinus. The patient made excellent progress on the floor, showing good strength and balance with physical therapy. Pacing wires were discontinued without incident. She was discharged in good condition to home on POD 4 with appropriate follow up instructions. Medications on Admission: ASA 81 mg daily calcium 1000 mg [**Hospital1 **] diovan 160 mg daily dyazide 37.5/ 25 mg daily folic acid 400 mcg daily actos 45 mg daily glucophage 1000 mg daily byetta 10 mg SQ [**Hospital1 **] glipizide 5 mg [**Hospital1 **] MVI daily fish oil 1200 mg [**Hospital1 **] cinnamon 500 mg [**Hospital1 **] red yeast rice 600 mg [**Hospital1 **] Discharge Medications: 1. Pioglitazone 15 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). Disp:*90 Tablet(s)* Refills:*2* 2. Glipizide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Glucophage 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 5. Exenatide 10 mcg/0.04 mL Pen Injector Sig: One (1) Subcutaneous once a day. Disp:*qs * Refills:*2* 6. 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:*2* 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. 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* 9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for 2 weeks. Disp:*14 Tablet(s)* Refills:*0* 10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 2 weeks. Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: left atrial mass s/p resection hypertension insulin-dependent diabetes mellitus bradycardia remote fractured ankle bilat. carotid disease Discharge Condition: good Discharge Instructions: no lotions , creams or powders on any incision shower daily and pat incisions dry call for fever greater than 100.5, redness, drainage or weight gain greater than 2 pounds in 2 days no driving for one month no lifting greater than 10 pounds for 10 weeks Followup Instructions: see Dr. [**Last Name (STitle) **] in [**1-2**] weeks see Dr. [**Last Name (STitle) **] in [**2-3**] weeks see Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] call for all appts. Completed by:[**2105-2-13**] ICD9 Codes: 4019
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Medical Text: Admission Date: [**2149-5-16**] Discharge Date: [**2149-5-20**] Date of Birth: [**2100-1-17**] Sex: F Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 3984**] Chief Complaint: Altered mental status/TCA overdose Major Surgical or Invasive Procedure: CVL, attempted a lines History of Present Illness: 49F sent in by ambulance to ED after found with altered mental status s/p likely suicide attempt by medication overdose. Patient was found at home after friends found suicide note, transported by ambulance to [**Hospital1 18**] ED altered, agitated. Per EMS report, there were two empty desipramine bottles in her apartment (total likely 50 pills) leading to high suspicion of TCA overdose. . In the ED, vitals on arrival were T 99.3, HR 91, BP 89/72 RR23 O2 sat 99% on 100% NRB. On exam in the ED she was found to be delirious and agitated and to have intermittent nystagmus and myoclonic jerking. Her pupils were reactive 4->2. Her tox screen came back positive for TCA, negative for all other substances on serum screen. Lactate:1.8. Patient intubated for airway protection, then weaned down to 100% on FiO2 of 50, PEEP 5, TV 450, propofol used for sedation. Also started on neosynephrine 1.5mcg/kg, after her hypotension not responsive s/p 7L fluid in total (NS). Also given bicarb - 2 to 3amps push, then 150/hr 3amp bicarb gtt, 200cc/hr with multiple ABGs. Patient with multiple EKGs with wide complex tachycardia, QRS 128-148. . Full history and ROS unable to obtain as patient intubated/sedated on arrival to MICU. Past Medical History: clonazepam 1mg TID - full bottles lamictal 300mg daily- full bottles desipramine 250mg PO - per records, was filled on [**5-14**] and there were two empty bottles in apartment (30 pills/bottle) Social History: Unknown Family History: Unknown Physical Exam: On admission GENERAL: intubated, sedated HEENT: sluggish but reactive, 6->4mm, evidence of small laceration in anterior tongue, +Horiz/vertical nystagmus Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, rubs or gallops. JVP=7 LUNGS: soft, decreased BS EXTREMITIES: Hyperreflexic bilaterally, with intermittent myoclonic symmetric jerks in all extremities. Equivocal toes, without clonus Pertinent Results: [**2149-5-16**] 08:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-POS . CT head [**2149-5-17**] IMPRESSION: No evidence of acute intracranial hemorrhage or major territorial infarct detected. MRI is more sensitive for the detection of acute ischemia. . CXR [**2149-5-19**] The endotracheal tube is seen with the tip 5.3 cm above the carina. The NG tube is seen traversing the esophagus with tip and side port in the expected location of the stomach. The cardiac silhouette, mediastinal and hilar contours are unchanged. There is no pneumothorax. An interval decrease of bilateral pleural effusions is noted, along with an artificial appearance of increased interstitial markings, representing otherwise unchanged moderate fluid overload. Retrocardiac atelectasis is unchangeed. No new focal parenchymal opacity is identified to suggest pneumonia. IMPRESSION: Interval decrease of bilateral pleural effusions. Unchanged moderate fluid overload. No new focal parenchymal opacity to suggest pneumonia. Brief Hospital Course: 49F with prescribed desipramine at home found with altered mental status at home with likely TCA overdose. . #. TCA overdose: TCAs were the likely cause of her altered mental status on presentation given positive TCA serum tox screen and the empty bottles in her apartment. On admission the patient had evidence of both cardiotoxicity with widened QRS, and neurotoxicity with myoclonus and hyper-reflexia. Toxicology followed the patient closely. She was started on a HCO3 gtt in the ED and her EKGs were followed closely and had a prolonged QRS. Her electrolytes were aggressively repleated. A head CT was negative for bleed. An EEG was done but the results were pending at the time of her death. She was on benzos as part of her sedation and also to help with seizure prophylaxis. She was hypotensive likely secondary to her overdose and required pressors. A central line was placed and multiple A lines were attempted but difficult given how edematous the patient had become. Given no further progression of her EKGs (although QRS was still wide) approximately 60 hrs into her hospital course her HCO3 gtt was discontinued (TCA toxicity typically resolves in 24hrs). On [**5-19**] the patient began to exhibit difficulty with oxygenation. Her CXR had air bronchograms and concern for ARDS. She was put on PEEP and low TV per ARDS protocal. She was started on vancomycin and ceftriaxone for PNA coverage given that she was spiking fevers and with difficult to read CXR. Her EKG deteriorated overnight from [**Date range (1) 26511**]/09 and she was restarted on her bicarb gtt. She was given hypertonic saline as well as fat emulsion. Her EKG continued to progress to a ventricular rhythm with widened QRS and slurring of the S wave in AVR. She was continued on levophed and phenylephrine with plans to switch to an epinephrine gtt and isoproterenol. At this time, she went into a pulseless ventricular rhythm and CPR was initiated with-in seconds. She was given a lidocaine push and started on lidocaine gtt given that lidocaine is preferable in TCA overdose. She was coded for approx 20-25 minutes with an initially shockable rhythm, but then remained refractory to resussitation efforts. She expired on [**2149-5-20**] at 9:13 am. Dr. [**Last Name (STitle) **], her attending, was present for the entire length of the code. Her psychiatrist Koldzic was on vacation but the covering psychiatrist was contact[**Name (NI) **]. Our only contacts at the time of death were Rabbi [**First Name8 (NamePattern2) **] [**Last Name (Titles) 37791**] and her friend [**Name (NI) 1022**] [**Name (NI) 80762**] were both contact[**Name (NI) **]. [**Name2 (NI) **] case was sent to the medical examiner. Medications on Admission: clonazepam 1mg TID - full bottles lamictal 300mg daily- full bottles desipramine 250mg PO - per records, was filled on [**5-14**] and there were two empty bottles in apartment (30 pills/bottle) Discharge Medications: Expired Discharge Disposition: Expired Discharge Diagnosis: Expired Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**] Completed by:[**2149-5-20**] ICD9 Codes: 5070, 2768, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7174 }
Medical Text: Admission Date: [**2108-2-21**] Discharge Date: [**2108-4-14**] Date of Birth: [**2045-4-2**] Sex: F Service: MEDICINE Allergies: Lisinopril / Kefzol / Sulfa (Sulfonamide Antibiotics) / Shellfish Derived Attending:[**Last Name (NamePattern1) 1167**] Chief Complaint: Weakness and Shortness of breath Major Surgical or Invasive Procedure: [**2108-2-27**] Right sided cardiac catheterization History of Present Illness: 62 year old woman with pmh significant for dilated right sided systolic heart failure and diastolic left sided heart failure, presenting with hypoxia and hypotension in the setting of diarrhea. The patient states for 3 days prior to her ICU admission she had diarrhea and extreme fatigue and DOE. She was only able to walk a few steps prior to stopping. Normally she can walk a [**12-23**] flight of stairs prior to stopping due to fatigue and DOE but in total able to walk up 2 flights of stairs. She was admitted to the [**Hospital Unit Name 153**] and rehydrated, it was thought that her cardiac index was low due to her dehydration and than she now had a significant shunt through a large PFO (based on + bubble then TEE) which was worsening her oxygenation. Her blood pressure was improved with IVF and dopamine and renal was consulted for her renal failure who thought it was secondary to her low cardiac output state. She has been feeling slightly better over the past few days however still very fatigued and has not walked so is unable to give a history in regards to DOE. She has stable [**1-24**] pillow orthopnea now and prior to admission, no PND. She has noticed an increase in her lower extremity edema since admission. Her diarrhea has stopped. No chest pain. No LH or syncope, no F/C/NS or any other complaints. . She was transferred from the [**Hospital Unit Name 153**] to the [**Hospital1 1516**] service for a R heart cath to [**Hospital1 4656**] the effect of NO on reducing PVR to see if PFO closure would be helpful. Past Medical History: - Diastolic LV failure, pulmonary hypertension, RV systolic dysfunction - Tricuspid regurgitation, evaluated by cardiac [**Doctor First Name **]. not operative candidate at this time. - Atrial fibrillation on aspirin. Decision not to persue anticoagulation - Ulcerative Colitis - Liver disease, (congestion vs. EtOH vs. primary biliary pathophys.) - Alcohol abuse, remote - Ventral hernia repair - Back surgery - History of GI bleed, [**10-28**] with 5cm duodenal ulcer - Hypokalemia - Hyponatremia - hypertension - hypercholesterolemia (TG 53, Chol 145 HDL 71 LDL 63 on [**10/2107**]) Social History: The patient is married. She does have an abusive partner but states that she feels safe at home. She has very supportive children and 17 grandchildren. She drinks ETOH socially and denies smoking Family History: Father with MI at age 68. Mother with breast cancer at 52 Physical Exam: VS: afebrile. HR 100 BP 123/56 96% on 2L GEN: NAD, AOX3 HEENT: JVP 14cm, MM slightly dry, OP clear CARD: [**1-27**] HSM at LLSB, RRR, normal S1, S2 PULM: CTAB ABD: obese, soft, NT, ND, no masses, BS+ EXT: 3+ edema bilaterally, L > R. Midcalf measurements circumference: L 56cm, R 49cm. unilateral LUE swelling NEURO: CN2-12, AOx3, 5/5 strength in all 4 extremities Pertinent Results: [**2108-2-21**] CXR: Since [**2108-1-13**], right pleural effusion decreased, now small with improved adjacent atelectasis. Left pleural effusion also decreased, now tiny. Left-sided central venous line was removed. There is no interstitial edema and no focal area of consolidation. Cardiomegaly persists. . [**2108-2-22**] ECHO: The left atrium is moderately dilated. No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). A right-to-left shunt across the interatrial septum is seen at rest. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). The right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. [Intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation.] The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. The tricuspid valve leaflets fail to fully coapt. Moderate to severe [3+] tricuspid regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is no pericardial effusion. Compared with the prior study (images reviewed) of [**2108-1-23**], a right-to-left shung is now identified (no saline used on the prior study). Right ventricular free wall motion is minimally more depressed. The severity of mitral regurgitation is reduced (may be related to lower systemic blood pressure). This constellation of findings is suggestive of primary RV cardiomyopathy (ARVC, myocarditis, ischemia) or prior large intracardiac shunt/ASD and LESS suggestive of a primary pulmonary process (e.g., pulmonary embolism, COPD, PPH, etc.). . [**2108-2-22**] Renal ultrasound: Unremarkable examination without evidence of hydronephrosis. . [**2108-2-23**] RUQ US: No biliary ductal dilation. Probable gallbladder sludge. Right pleural effusion. . [**2108-2-27**] Cardiac Cath: 1. Resting hemodynamics demonstrated marked elevation in biventricular filling pressures, with a baseline RVEDP of 33 mmHg and a mean PCWP of 37 mmHg; moderate pulmonary hypertension with a mean PA pressure of 48 mmHg; and preserved cardiac output. There was no evidence of right-to-left shunting at the current loading conditions. 2. Treatment with 100% FiO2 demonstrated mild improvedment in pulmonary vascular resistance with slight worsening of the PCWP. 3. Treatment with inhaled NO at 40ppm did not change the pulmonary pressures significantly. . [**2108-3-1**] Cardiac MR: 1. Limited and incomplete study secondary to early termination of protocol due to MR system failure. Recommend repeat study at later stage. 2. The left upper, left lower, right upper, and right lower pulmonary veins were visualized in their correct anatomical positions and entered the left atrium. Other anomalous pulmonary venous drainage or ASD cannot be definitively excluded. 3. Normal left ventricular cavity size with normal global systolic function. 4. Moderate right ventricular enlargement with mild systolic dysfunction. No CMR evidence of right ventricular fatty infiltration/dysplasia. 5. The indexed diameters of the ascending and descending thoracic aorta were normal. The main pulmonary artery diameter index was mildly increased. 6. Moderate [**Hospital1 **]-atrial enlargement. 7. A note is made of moderate right pleural effusion and right lower lobe basal atelectasis. . [**2108-3-2**] Cardiac CT: 1. No evidence of anomalous pulmonary vein return. There are two right and two left pulmonary veins draining into the left atrium. 2. Interval decrease in moderate amount of right pleural effusion associated with compressive right lower lobe atelectasis. 3. Unchanged mild cardiomegaly. 4. 3.6-mm lung nodule. If patient has history of smoking or other known risk factors, a followup in one year is recommended. 5. Asymmetric breast parenchyma (left > right). Please correlate with physical examination. Brief Hospital Course: 62 yo female with history of A-fib, CHF, PUD, and Ulcerative Colitis, presented with hypoxia and hypotension. Both hypoxia (secondary to shunting) and hypotension resolved with fluid resucitation in the ICU. She was transferred to the cardiology floor where she has been closely monitored and her heart failure treated with aggressive diuresis. She began having rectal bleeding and was transferred to the [**Hospital Ward Name **] for endoscopy w/ general anesthesia. Cscope report read: 2 small superficial ulcerated areas with very active oozing and adherent clot were noted in the sigmoid and distal transverse colon. The rest of the colonic mucosa looked normal - no evidence of active ulcerative colitis. A single clip was successfully applied to the transverse lesion and 2 clips were successfully applied to the sigmoid lesion. Otherwise normal colonoscopy to cecum. Her bleeding continued slowly but her Hct remained stable and after a short stay in the ICU she was transferred back to the cardiology service for diuresis. ON the cardiology floor she had very poor urine output with lasix gtt so was transferred to the CCU for ultrafiltration. The following is a problem based brief hospital course after her transfer to the CCU. # CHF: Patient has a known complicated CHF history requiring multiple hospitalizations. Patient's right sided heart failure was presumed to be secondary to left diastolic heart failure (EF 55%). During this admission she was found to have a PFO which demonstrated R to L flow and caused her hypoxia. Increasing left sided pressures with IV hydration in the ICU resolved the shunt and hypoxia. Patient was then transferred to the floor. Right heart cath was performed. Pulmonary hypertension did not respond to nitric oxide. Decision was made to treat CHF with aggressive diuresis. Diuresis was titrated up to lasix gtt at 30 cc/hr and metalozone 5 mg po bid with minimal output. At this point patient became hypoxic and hypotensive with acute renal failure again and diuresis was discontinued. Her hypoxia/hypotension improved and her UOP continued to be poor so she was restarted on lasix drip with metolazone and transferred back to cardiology. The patient continued to have poor uop despite lasix gtt at 30. She was transferred to the CCU for UF to remove the excess fluid. Over the next few days she was net negative > 20L. A repeat RH cath showed minimal elevation of PA pressures and PVR. After UF patient had TTE that showed improvement in pressures and UF was discontinued. Her CVP was less than 10, compared to 35+ initially. Subsequetly she was able to maintain a urine output of 30-60 ml/hr without lasix drip. Eventually her vasopressin and phenylephrine were discontinued. She was transitioned to oral midodrine. She occasionally required neosynephrine to keep her MAPs >50 however she continued to have good uop regardless of her pressor requirement. On her repeat TTE, there was evidence of persistent tricuspid regurgitation despite improvement in her volume status. The idea of performing a tricuspid valve repair/replacement was discussed with CT surgery and she had a cardiac MR [**First Name (Titles) **] [**Last Name (Titles) 4656**] her right heart function. As she improved significantly and she was able to maintain her blood pressures and UOP on midodrine alone for many days, the decision was made to postpone discussion of TVR until a later date. She was able to be started on low dose metoprolol 12.5mg [**Hospital1 **] without a significant drop in her blood pressure. She was also restarted on a lower dose of spironolactone 25mg. She was discharged with this medication regimen and strict instructions to monitor her weights daily, and restrict her sodium intake to 2gm per day. The patient will follow up with Dr. [**First Name (STitle) 437**] in 2 weeks. VNA will be provided to ensure medication and nutrition compliance and daily weights are documented. # ARF: Baseline Cr 1.2. Creatinine peaked during this admission at 3.4 shortly after presentation likely secondary to ATN from hypotensive insult. Renal was consulted and patient's mesalamine was held, and discontinued. Diuresis was held initially and her creatinine returned to baseline. With reinitiation of diuresis patient's creatinine again started to rise up to 3.6. She was transferred to the CCU and started on UF as above. After aggressive diuresis, her creatinine continued to trend down suggesting poor forward flow from poor CO from RHF as the cause for her ARF. Her renal function was at her baseline on discharge. # Bacteremia: Patient had hypotension and peripheral vasodilation with elevated WBC about 1 month into her hospitalization. Cultures were drawn and she was found to have serratia from the PA catheter line and coagulase negative staph from the A-line. She was started on Vanc, aztreonam (allergy to cefalosporins and ARF so gentamicin contraindicated), and cipro. The lines were discontinued. Sensitivities of GNRs showed Serratia sensitive to Cipro. She was continued on cipro and aztreonam was discontinued. GPCs were coag negative staph. Repeat TTE showed no vegetations. Follow up blood cultures remained negative. The patient was afebrile many days after discontinuing antibiotic therapy. # UTI: Patient had positive UA with GNRs (>100,000) on her urine culture. She was started on Cipro as above. Sensitivities showed seratia and enterobacter both sensitive to cipro. The patient completed a course of cipro prior to discharge and did not require additional antibiotics. # Atrial fibrillation: Patient has history of chronic atrial fibrillation. She was remained rate controlled thoughout admission. She was not on anticoagulation at presentation. She was treated with daily aspirin and metoprolol until the onset of significant GI bleed. At this time both were held. She underwent PFO closure on [**2108-3-14**] and was not restarted on anticoagulation because of her GIB. She was able to be restarted on metoprolol 12.5mg [**Hospital1 **] for rate control. No other anticoagulation other than aspirin was initiated prior to discharge given her GI bleed. # Hyponatremia: Na 131 on presentation. Patient was clearly hypervolemic. Hypervolemic hyponatremia was related to heart failure and volume overload. The sodium continued to slowly decrease without neurologic compromise. In part this was attribute to vasopressin use in addition to CHF. On discharge her sodium had returned to 130. # LFT abnormalities: Elevated AST and Alk phos with normal ALT on presentation. Liver US showed no pathology. Per outpatient GI workup LFT abnormalities are likely attributed to congestive hepatopathy. Will have the patient follow up with Dr. [**Last Name (STitle) 497**] as an outpatient. # CODE: FULL CODE . # CONTACT: [**Name (NI) **] (son and HCP) [**0-0-**] Medications on Admission: Insulin SC sliding scale MetronidAZOLE Topical 1 % Gel Miconazole 2% Cream Acetaminophen [**Telephone/Fax (1) 1999**] mg PO Q6H:PRN Oxycodone-Acetaminophen 1 TAB PO Q6H:PRN pain Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob Pantoprazole 40 mg IV Q12H Artificial Tears 1-2 DROP BOTH EYES PRN Ferrous Sulfate 325 mg PO DAILY FoLIC Acid 1 mg PO DAILY Gabapentin 100 mg PO HS Discharge Medications: 1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Metronidazole 1 % Gel Sig: One (1) Appl Topical DAILY (Daily) as needed for acne. Disp:*1 tube* Refills:*0* 5. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed. 7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed. Disp:*30 Tablet(s)* Refills:*2* 11. Midodrine 10 mg Tablet Sig: Two (2) Tablet PO three times a day. Disp:*180 Tablet(s)* Refills:*2* 12. Gabapentin 100 mg Tablet Sig: Two (2) Capsule PO HS (at bedtime). Disp:*60 Capsule(s)* Refills:*2* 13. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 14. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation every four (4) hours as needed for shortness of breath or wheezing. Disp:*1 inhaler* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary Diagnoses: Patent Foramen Ovale with shunting Right sided Congestive Heart Failure Atrial fibrillation Acute renal failure Discharge Condition: The patient was hemodynamically stable prior to discharge. Discharge Instructions: You were admitted to the hospital for weakness and shortness of breath. You were found to have low blood pressure and low oxygen levels. You were admitted to the ICU. After you were stablized you were transferred to the floor. There you underwent cardiac catheterization and a series of imaging to [**Hospital 4656**] causes of your heart failure. You were treated with medications to reduce the pressure in your heart and to help your breathing. . Please weigh yourself daily and report weight gain of more than 3 pounds per day or more than 6 pounds per 3 days to Dr. [**First Name (STitle) 437**]. . Please restrict your sodium intake to 2gm per day. . The following changes were made to you home medications: . 1) STOP Toprol 125mg 2) STOP Mesalamine (Asacol) 3) STOP Torsemide 4) Decrease Spironolactone to 25mg daily 5) STOP Colchicine and Codeine 6) START Aspirin 325 mg by mouth daily 7) START Midodrine 20mg three times a day for your blood pressure 8) START Metoprolol 12.5mg twice a day 9) START Metronidazole 1 % Gel Appl Topical DAILY as needed for acne 10) START Trazodone 25 mg at bedtime as needed 11) START Gabapentin 200 mg at bedtime 12) START Albuterol 90 mcg/Actuation Aerosol Two puffs Inhalation every four hours as needed for shortness of breath or wheezing. . Please notify your physician or return to the hospital if you experience if you experience increased shortness of breath, chest pain, loss of consciousness, fever, chills, or any other symptom that is concerning to you. Followup Instructions: Please keep all of your previously scheduled appointments as listed below: 1)Provider [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2108-3-26**] 1:30pm 2)Provider [**First Name11 (Name Pattern1) 3688**] [**Last Name (NamePattern4) 10476**], MD Phone:[**Telephone/Fax (1) 8645**] Date/Time:[**2108-3-15**] 11:00 3)Provider [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13472**], MD Phone:[**Telephone/Fax (1) 13473**] Date/Time:[**2108-3-16**] 10:30 Completed by:[**2108-4-14**] ICD9 Codes: 5845, 2761, 2851, 5990, 2762, 4280, 4168
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7175 }
Medical Text: Admission Date: [**2176-2-16**] Discharge Date: [**2176-2-22**] Service: MEDICINE Allergies: Nsaids Attending:[**First Name3 (LF) 613**] Chief Complaint: found down, SAH Major Surgical or Invasive Procedure: None History of Present Illness: Ms. [**Known lastname **] is a [**Age over 90 **]yo woman with poorly controlled HTN (baseline 160s per PCP), h/o paroxysmal atrial tach, hypothyroidism, moderate dementia who was found down at NH today in her own urine. Pt does not recall falling, does not recall any symptoms prior to fall. Does not recall whether she hit her head. She was brought to the ER where she was found to be hypertensive with BP 222/111, to have no bruises or stigmata of fall. According to her brother she was only mildly off her baseline mental status in the ER. . Head CT done due to fall showed small parietal SAH. She was seen by neurosurgery and neurology who recommended BP control, no antiepileptics given small size of SAH, and repeat head CT in the AM. She was started on a nitroglycerin drip with goal SBP <165. She was given one dose of hydralazine and aspirin x 1. EKG showed prominent T waves but when repeated several times over several hours showed no evolution. She denied chest pain, shortness of breath but did contain of some dizziness and unsteady gait. She also reported a feeling like something was in her throat and she had to clear her throat although no itching, no difficulty breathing. She was seen putting her finger in her mouth and possibly touching near her uvula. . She was admitted to the ICU for blood pressure control and monitoring. On arrival to the ICU she was found to be disoriented, attempting to crawl out of bed, refusing to cooperate or to answer questions. She repeatedly clears her thorat and says she feels like something is "cack there." She denies all other complaints and does not let me complete ROS as she no longer wishes to cooperate. . Paperwork from her home facility states that her blood pressure medications are typically taken at 8am, although we do not have dispense records to confirm that she received these today. Notes that her BP at 9:30am was 160/80, however she then fell and after the fall it was 190/90. . Past Medical History: Dementia HTN - baseline sbp 160s per pcp paroxysmal atrial tachycardia Hypothyroidism s/p resection of funcitoning goiter s/p R hip replacement L hip ORIF Social History: Lives at Nursing Home. uanble to elicit further history. Family History: unable to elicit Physical Exam: T 98.7 HR 76, BP 165/64, 94% on RA Gen: attempting to climb out of bed, refusing to answer questions, insisting on going home, does not know where she is, refuses to tell me her name, repeatedly clearing her throat HEENT: surgical pupils, MM moist, uvula notably injected and edematous although not obstructing airway Cor: RRR, s1s2, no murmur Pulm: CTAB, limited cooperation Abd: distended, soft, NT, +BS Ext: no edema, w/w/p Neuro: pt not following commands at present however by report in ER she had 5/5 strength throughout and was intact to light touch. Pertinent Results: remarkable for WBC 15.9, 6% bands, 86% polys; CK 1182->1250, MB 18->14; trop 0.08->0.03, MB index 1.5->1.1. creatinine 1.2 (at last check 1.6). . Studies: EKG: NSR at 60, nl axis, nl intervals, tall T waves, persistent on repeat EKG. no ST changes, no Q waves, no TWI. CXR: No radiographic evidence of traumatic injury. . CT head: A tiny amount of subarachnoid blood is seen within a single right parietal focus. No additional intra- or extra-axial hemorrhage is seen. There is no mass effect or shift of normally midline structures. Small lacunar infarcts are noted within the left coronal radiata and bilateral external capsules. The [**Doctor Last Name 352**]-white matter differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are clear. No fractures are identified. The bones of the skull are diffusely demineralized. IMPRESSION: Small right parietal subarachnoid hemorrhage. Brief Hospital Course: [**Age over 90 **]yo woman with paroxysmal atrial tachycardia, hypothyroidism poorly controlled HTN wtih baseline sbp 160s presented s/p unwitnessed fall found in urine with new small SAH on head CT and BP 222/111 on arrival to ER. . # Subarachnoid hemorrhage. The patient was admitted after a fall and was found on CT head to have a small SAH. It is not clear if this was due to hypertension (on admission approximately 200/100) or fall (NO stigmata of head trauma). The patient was seen by neurosurgery and neurology in the ED. She was managed medically with bp control. Without mass effect or ongoing bleeding, the patient was not given seizure prophylaxis. The patient had a repeat CT scan the following morning after overnight ICU monitoring that revealed no change in the SAH. The patient requires ongoing blood pressure control with target 130-160/70-80. The patient should avoid blood thinning medications such as aspirin and heparin products until her SAH resolves. . # HTN. The patient presented with marked hypertensive urgency. She initially was placed on a labetolol drip. After confirmation of her home meds, these were re-instituted. She continued to have periods of elevated blood pressure (up to 190 systolic) for which she received intermittent hydralazine. Her amlodipine was upregulated with much improved control over the 24 hours prior to discharge. . # Mechanical fall vs. syncope. The patient was a poor historian and her fall was unwitnessed, though she was found in her own urine. The patient was maintained on tele without event. She had no EKG changes. She had a cardiac enzyme elevation on admission though these trended downwards. Echo revealed mild AS and no other mechanical explanation for her fall. Carotid ultrasound showed some bilateral plaque without hemodynamically significant stenosis on preliminary read. The patient had an EEG with some signs of frontal cortical irritability likely secondary to the SAH though no signs of seizure activity. Repeat EEG showed slowing at the right parietal lobe again consistent with SAH and no other concerning activity. . # Altered mental status. The patient is known to have baseline 'moderate' dementia. The patinet's brother and son described her baseline mental status as poorly oriented to place and time. The patient had waxing and [**Doctor Last Name 688**] consciousness/orientation consistent with sundowning. She had no signs of infection, a post-ictal state to explain her symptoms. Her TSH was in normal limits. This almost certainly represents baseline dementia exacerbated by sundowning in an elderly woman in a new environment with loss of orienting cues. The patient intermittently required haldol and disintegrating olanzapine tabs at times of agitation. . # Hypothyroidism. TSH normal. Continued on home synthroid. . # Code status: DNR/DNI . # Communication: [**Name (NI) **] [**Name (NI) **], brother and HCP (c) [**Telephone/Fax (1) 107869**], (h) [**Telephone/Fax (1) 107870**] (w) [**Telephone/Fax (1) 107871**]. PCP [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 140**] [**Last Name (NamePattern1) 141**] [**Telephone/Fax (1) **]. . Medications on Admission: Levoxyl 75mcg po qday Dyazide (hydrochlorothiazide/triamterene) 1 cap po qday ECAsa 81mg po qday Atenolol 25mg po qday Avapro (irbesartan) 150mg po qday Lipitor 10mg po qday Ca + Vit D (citracal) 2 tabs qday folgard 2.2mg po qday Discharge Medications: 1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Atorvastatin 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 4. Citracal + D 250-200 mg-unit Tablet Sig: Two (2) Tablet PO once a day. 5. Irbesartan 150 mg Tablet Sig: One (1) Tablet PO qday (). 6. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO BID (2 times a day) as needed for Agitation. 8. Triamterene-Hydrochlorothiazid 37.5-25 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital1 599**] of [**Location (un) 55**] Discharge Diagnosis: Fall Stable subarachnoid hemorrhage Hypertensive urgency . Hypothyroidism Dementia Discharge Condition: Stable. Discharge Instructions: You were admitted because of a fall. Work-up was negative for a cardiac or neurologic explanation for your fall. It is likely that you had a mechanical fall. . You were found to have a small, stable bleed around your brain. This may be due to extremely high blood pressure or from your fall. You do not have any signs of ongoing bleeding. Please take all of your blood pressure medications. Your target blood pressure is systolic 130-160, diastolic 70-80. . You had episodes of confusion, agitation and disorientation while in the hospital. This is in part due to baseline dementia. Your dementia was exacerbated by new surroundings and loss of orienting cues. . Follow-up with Dr. [**Last Name (STitle) 141**]. . Take all medications as prescribed. . Call your doctor or return to the hospital for any new or worsening dizziness, lightheadedness, blurred vision, nausea, vomiting, severe headache, falls, chest pain or other concerning symptoms. Followup Instructions: Dr. [**Last Name (STitle) 141**] [**2176-3-31**] 09:45AM [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**] ICD9 Codes: 2761, 5849, 5859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7176 }
Medical Text: Admission Date: [**2152-2-9**] Discharge Date: [**2152-2-23**] Date of Birth: [**2074-4-3**] Sex: F Service: MEDICINE Allergies: Atorvastatin / Zestril / Cephalosporins / Penicillins Attending:[**First Name3 (LF) 9240**] Chief Complaint: unresponsive, hypoxia Major Surgical or Invasive Procedure: Endotracheal Intubation History of Present Illness: 77 yo female who lives at [**Hospital3 1186**] (baseline, oriented to person and place) had a fall at [**Hospital3 1186**]. 4 hrs later found unresponsive. Intubated at scene. CXR with RLL collapse/infiltrate; bronch/endotracheal specmen grew MSSA. Also with COPD exacerbation, on prednisone and vancomycin (given unknown PCN/ceph allergy). Extubated last week, failed (believed [**1-7**] COPD) and re-intubated. Extubated again on [**2152-2-18**] and now stable on 2L. Post-second extubation, made DNR/DNI. _______________ MICU summary by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]: HPI: 78f, h/o DM, HTN, found unresponsive 4 hrs after she was put into bed after a fall, intubated on scene, now more responsive - intubated/sedated. According to notes, she fell out of bed around 2am (denied trauma to head); assessment revealed normal vitals and patient was apparently mentating appropriately. She was put back in bed. About 3 hours later, she was found by staff to be unresponsive (she had been complaining of SOB--85% RA, improved with O2). VS were otherwise stable, BG was 97. EMS was called, and she was intubated on the seen and brought to the ED. In the ED, she was hypertensive (220/palp), afebrile, was responsive to commands when off sedation. Initial gas showed severe acidosis (7.11/111/141), potassium was increased to 6 with a creatinine of 1.8. One set of CEs that were negative. EKG showed sinus brady with no obvious ST/T changes. She was given 3 L IVF (was transiently hypotensive to 90s while on propofol -- this resolved off propofol and with IVF). She was found to have a positive UA and was given a dose of levofloxacin. She was given kayexalate for hyperkalemia (improvement of K to 5.3). FAST scan was negative, and she had CT neck/head. CT neck was significant for ?right RP soft tissue prominence (no fracture or dislocation), and CT head was negative for acute event. She was transferred to the [**Hospital Unit Name 153**] for further management. __________________________________________ MICU course -- per [**Hospital Unit Name 153**] notes: [**2-10**]: Bronch without mucous plug. BAL with 1+GPC pairs. Vanc and prednisone started. Echo with preserved EF, sm-mod pericard effusion. [**2-11**]: Failed PS trial due to tachypnea/tachycardia. Restarted lasix and increased lopressor. Added back home clonidine. Changed TFs started. Proteus returned [**Last Name (un) 36**] to cephalosporins/zosyn, so switched cipro to ceftriaxone [**2-12**]: Cleared c-spine clinically. On PS for several hours. UOP very low, gave repeated fluid boluses. Lasix d/c'd for rising Creatinine. [**2-13**]: Extubated, but retained C02/somnolent and required re-intubation. Lantus restarted at 1/2 home dose. [**2-14**]: RUE US - for DVT. Spoke with brother RE: trach, he's thinking about it but likely will pursue. Increased BP meds (clonidine). Diuresed with lasix X 2. [**2-15**]: Brother re: trach: no. Prednisone tapered to 40. Lantus increased to 30. [**2-16**]: DNR/DNI per family. Plan thoracentesis tomorrow, extubation Fri. [**2-17**]: Further discussion with family. No plan for trach. [**Female First Name (un) **] planned but not a large enough effusion. D/c'd antibiotics. [**2-18**]: Extubated. Tolerating at time of writing. Officially DNR/DNI: No re-intubation planned if she worsens. Past Medical History: 1. Status post right total knee replacement 2. DM II, c/b neuropathy and nephropathy. 3. Osteoarthritis. 4. Hypertension. 5. Asthma. 6. Hypercholesterolemia. 7. Parkinson's. 8. Obesity. 9. GERD. 10. Bipolar/paranoia. 11. History of falls. Social History: Shx: lives in an [**Hospital3 **] facility. No known h/o tobacco or alcohol use. Family History: NC Physical Exam: temp 96.5 BP 171/74 HR 58 RR 18 sats 99% on 2 liter oxygen nasal canula gen: very awake, very alert, pleasant, no acute distress, cooperative patient examined sitting up in a chair HEENT: anicteric sclera chest: good inspiratory air movement; a bit ronchorous on expiration throughtout heart: RRR; I could not notice a murmur abd: has PEG. very soft. BS+. not tender at all. is mildly distended tympanitic - notably upper [**12-7**] of abdomen (she is sitting in chair) ext: trace pitting edema LE bilaterally pulses: 2+ DP pulse bilaterally neuro: knows her full name. knows president is "[**Doctor Last Name **]." Identifies all 4 family members in the room correctly. eyebrows up symmetrically tongue is midline biceps is 4+/5 bilaterally handgrip is [**3-9**] bilaterally quads is [**4-8**] bilaterally plantarflexion feet is [**4-8**] bilaterally dorsiflexion feet is [**4-8**] bilaterally sensation to light touch is intact on her face/arms/legs (she correctly identifies the body part I touched) Pertinent Results: [**2152-2-9**] 07:29PM TYPE-ART TEMP-38.0 RATES-20/ TIDAL VOL-400 PEEP-10 O2-60 PO2-88 PCO2-51* PH-7.37 TOTAL CO2-31* BASE XS-2 -ASSIST/CON INTUBATED-INTUBATED [**2152-2-9**] 04:53PM TYPE-ART TEMP-36.6 PO2-241* PCO2-48* PH-7.35 TOTAL CO2-28 BASE XS-0 INTUBATED-INTUBATED [**2152-2-9**] 04:53PM LACTATE-0.7 [**2152-2-9**] 02:59PM GLUCOSE-88 UREA N-36* CREAT-1.4* SODIUM-147* POTASSIUM-4.1 CHLORIDE-111* TOTAL CO2-25 ANION GAP-15 [**2152-2-9**] 02:59PM CK(CPK)-44 [**2152-2-9**] 02:59PM CK-MB-4 cTropnT-0.03* [**2152-2-9**] 02:59PM CALCIUM-9.3 PHOSPHATE-3.0# MAGNESIUM-2.6 [**2152-2-9**] 02:59PM TSH-1.2 [**2152-2-9**] 02:59PM WBC-9.4 RBC-3.76* HGB-11.2* HCT-34.4* MCV-92 MCH-29.9 MCHC-32.7 RDW-16.7* [**2152-2-9**] 02:59PM PT-12.6 PTT-20.3* INR(PT)-1.1 [**2152-2-9**] 02:59PM PLT COUNT-305 [**2152-2-9**] 01:00PM PO2-205* PCO2-33* PH-7.46* TOTAL CO2-24 BASE XS-1 COMMENTS-GREEN TOP, [**2152-2-9**] 01:00PM K+-5.3 [**2152-2-9**] 08:15AM URINE COLOR-Yellow APPEAR-SlHazy SP [**Last Name (un) 155**]-1.025 [**2152-2-9**] 08:15AM URINE BLOOD-NEG NITRITE-POS PROTEIN->300 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-0.2 PH-8.0 LEUK-MOD [**2152-2-9**] 08:15AM URINE RBC-0-2 WBC->50 BACTERIA-MANY YEAST-NONE EPI-0 [**2152-2-9**] 08:15AM URINE HYALINE-0-2 [**2152-2-9**] 08:15AM URINE 3PHOSPHAT-FEW [**2152-2-9**] 07:56AM TYPE-ART TIDAL VOL-280 PO2-231* PCO2-87* PH-7.16* TOTAL CO2-33* BASE XS-0 INTUBATED-INTUBATED VENT-CONTROLLED [**2152-2-9**] 06:49AM RATES-/16 PEEP-5 PO2-141* PCO2-111* PH-7.10* TOTAL CO2-36* BASE XS-1 INTUBATED-INTUBATED COMMENTS-GREEN TOP [**2152-2-9**] 06:49AM K+-5.8* [**2152-2-9**] 06:45AM GLUCOSE-125* UREA N-42* CREAT-1.8* SODIUM-143 POTASSIUM-6.0* CHLORIDE-107 TOTAL CO2-28 ANION GAP-14 [**2152-2-9**] 06:45AM estGFR-Using this [**2152-2-9**] 06:45AM ALT(SGPT)-15 AST(SGOT)-17 LD(LDH)-251* CK(CPK)-60 ALK PHOS-106 AMYLASE-25 TOT BILI-0.2 [**2152-2-9**] 06:45AM LIPASE-26 [**2152-2-9**] 06:45AM CK-MB-NotDone cTropnT-0.02* [**2152-2-9**] 06:45AM ALBUMIN-4.2 CALCIUM-10.0 PHOSPHATE-5.8* MAGNESIUM-2.9* [**2152-2-9**] 06:45AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2152-2-9**] 06:45AM WBC-9.3 RBC-3.87* HGB-11.8* HCT-37.5 MCV-97 MCH-30.5 MCHC-31.5 RDW-16.6* [**2152-2-9**] 06:45AM PT-12.5 PTT-22.6 INR(PT)-1.1 [**2152-2-9**] 06:45AM PLT COUNT-334 . CTA chest: 1. No pulmonary embolism or acute aortic pathology. 2. Right lower lobe collapse, left lower lobe partial collapse and patchy atelectasis of the aerated portions of lung. 3. Small bilateral pleural effusions. 4. Endotracheal tube terminates in low position 1-2 cm above the carina. 4. Multiple enlarged mediastinal lymph nodes up to 12 mm are nonspecific. 5. Moderate pericardial effusion. 6. Emphysema. 7. 3 cm predominantly low attenuation lesion of the left hepatic lobe is incompletely characterized, but has features suggestive of a hemangioma. This could be confirmed with ultrasound. . CT C spine: 1. No evidence of acute fracture or dislocation. 2. Soft tissue prominence mostly within the right retropharyngeal space and extending anterior and medial to the right carotid space. This likely represents a hematoma, possibly related to patient's traumatic injury or traumatic intubation. 3. Prominent interseptal thickening within the apices, may be related to underlying failure/volume overload as suggested on chest radiograph done on same day. 4. Multilevel spondylytic changes. . head CT: No intracranial hemorrhage or mass identified. . abd U/S: 2.9-cm lesion of the left hepatic lobe could represent an atypical hemangioma but is not definitively characterized by ultrasound. It does not have particularly worrisome features. If clinically indicated, it could be further characterized with MR after the patient's acute medical problems have resolved. . TTE: The left atrium is normal in size. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Transmitral Doppler and tissue velocity imaging are consistent with Grade I (mild) LV diastolic dysfunction. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Physiologic mitral regurgitation is seen (within normal limits). The left ventricular inflow pattern suggests impaired relaxation. There is a small to moderate sized pericardial effusion. There are no echocardiographic signs of tamponade. Brief Hospital Course: ## PULM - Respiratory failure that was thought to be multifactorial (PNA, COPD, RLL collapse, tracheomalacia, diastolic heart failure) has resolved and pt now on 2 Liters of oxygen by nasal canula with sats of 99%. She is completing a 2 weeks course of vancomcycin for MSSA PNA. ## CARDS - hx of HTN and is on MANY medications for control and still has elevated BP. Has diastolic CHF. Initially BP meds held given instability, but then restarted. On [**2-22**] she triggered on the floor for flash pulmonary edema with elevated BP. After giving IV lasix and better BP control her CHF improved. She may need continued diuresis at NH. Will need daily weights, 1500 cc fluid restriction. ## GI - has hx of PEG and I am not sure why. Tolerates po, apparently. Of note, imaging studies found a possible hemangioma on liver. Will need f/u abdominal MRI per PCP as an outpatient. ## GU - Cr back to normal, follow up with PCP after diuresis. ## ID s/p treatment for proteus UTI and also proteus PNA (sputum + currently finishing abx for MSSA PNA. Pt on vanco bc of concerns of allergies to PCN. Last day will be [**2-25**] of vanco. # ENDO. Pt has DM with HgAIC in [**2149**] of 10. Pt with multiple cardiac risk factors so would hope to get better glucose control. Currently on ss insulin. Restarted pt's home lantus dose. code status: DNR/DNI decision maker is her brother [**Name (NI) **] [**Name (NI) 3234**] [**Telephone/Fax (1) 19567**] Medications on Admission: 1. Novolin R sliding scale 2. Toprol XL 100mg po bid 3. Tylenol 500mg, one tab qid po 4. Alprazolam 0.5 mg tablet po qhs 5. Fleets enema 1 rectally daily prn constipation (2 hr after docolax supp if no BM) 6. Bisocodyl 10 mg supp rectally daily prn constipation (give 24 hrs after MOM of no BM) 7. MOM 30 ml via g-tube daily prn constipation (give on 3rd day without BM) 8. Alprazolam 1 mg tablet po bid prn anxiety/agitation 9. Combivent inhaler 2 puffs by mouth qid prn wheezing 10. Tylenol 650 mg via g-tube q 4 hr prn pain/temp >100 11. Duonieb neb 0.02% qid prn congestion/SOB 12. Lantus 35 units sc q evening 13. Neurontin 50 mg po qhs 14. Isosorbide 60 mg po daily 15. Norvasc 10 mg po daily 16. Prilosec 20 mg po daily 17. Seroquel 100 mg po daily at 4pm 18. Quinine sulfate 260 mg po daily at 8pm 19. Clonidine HCl 0.1 mg po q 12 hr 20. Depakote 250 mg po bid 21. Furosemide 40 mg po daily 22. Senna 2 tablets po bid Discharge Medications: 1. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed. 4. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Zinc Sulfate 220 (50) mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 6. Divalproex 125 mg Capsule, Sprinkle Sig: Two (2) Capsule, Sprinkle PO BID (2 times a day). 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 9. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO BID (2 times a day). 10. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 11. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 12. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO BID (2 times a day). 13. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 14. Insulin Glargine 100 unit/mL Solution Sig: Thirty Five (35) units Subcutaneous at bedtime. 15. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: sliding scale sliding scale Subcutaneous four times a day. 16. Quetiapine 100 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 17. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 18. Prednisone 10 mg Tablet Sig: taper as directed Tablet PO once a day: Take 3 tabs daily for 3 days, then 2 tabs daily for 3 days, then 1 tab daily for 3 days, then stop. Disp:*18 Tablet(s)* Refills:*0* 19. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q4H (every 4 hours). 20. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q2H (every 2 hours) as needed. 21. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours). 22. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Two (2) ML Intravenous DAILY (Daily) as needed. 23. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) g Intravenous Q 24H (Every 24 Hours) for 3 days. Disp:*3 g* Refills:*0* 24. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital3 1186**] - [**Location (un) 538**] Discharge Diagnosis: Diastolic Congestive Heart Failure Staph Pneumonia Respiratory Failure COPD Discharge Condition: stable Discharge Instructions: Continue your medications as listed. Please continue a 1500 cc fluid restiction, and a low salt diet. Please make sure to weigh yourself daily and call your doctor if you gain more than 3lbs. Please make sure you follow up with your PCP [**Last Name (NamePattern4) **] [**12-7**] weeks. Followup Instructions: 1. Please follow up with Dr. [**Last Name (STitle) **] in [**12-7**] weeks. Please discuss having a follow up abdominal MRI with him to evalaute the liver mass seen on ultrasound. ICD9 Codes: 2762, 5849, 2767, 5990, 3572
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7177 }
Medical Text: Admission Date: [**2200-7-28**] Discharge Date: [**2200-8-16**] Date of Birth: [**2126-1-30**] Sex: M Service: CARDIOTHORACIC Allergies: Morphine Attending:[**First Name3 (LF) 1505**] Chief Complaint: Scheduled cardiac catherterization for further assessment of aortic stenosis Major Surgical or Invasive Procedure: [**2200-7-31**] - 1. Aortic valve replacement with a 21 mm [**Last Name (un) 3843**] [**Doctor Last Name **] magna pericardial valve. 2. Left atrial exploration and ligation of left atrial appendage. History of Present Illness: Pt is a 74 yo man with h/o stroke in [**2186**] on warfarin, recent TIA in [**5-1**], a. fib, HTN, and dyslipidemia who presents for scheduled cardiac catheterization for further assessment of aortic stenosis. Pt reports he was recently diagnosed by echocardiogram in [**7-1**]. He planning for a AVR with Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] R. . Pt reports he is in his usual state of health. He denied any chest discomfort or palpitations at rest or with exertion. He does become DOE after 1 flight of stairs. This has been progressively worse over the last few months, esp. after his TIA (presented with general weakness and diplopia x 2-3 hours in [**5-1**]) after which he had been "taking it easy." He had no recent syncopal events. He does have a remote history of syncope during a humid day after standing up too quickly. . Pt denied paroxysmal nocturnal dyspnea, orthopnea, ankle edema. He also denied HA, cough, hemoptysis, N/V/D, abdominal pain, melena, or BRBPR, and recent fevers or chills. He denies exertional buttock or calf pain. Past Medical History: 1. Aortic stenosis 2. A. fib 3. HTN 4. Hypercholesterolemia 5. h/o TIA (generalized weakness, diplopia, dysarthria) in [**5-1**] 6. h/o stroke (R-sided paresthesias) in [**2186**] 7. h/o intermittent vertigo after L ear infection 7. h/o hernia repair 8. h/o L shoulder surgery Social History: Social history is significant for the 15 pack years, quit 37 years ago. He has 1 beer/day. He denies recreational drug use. Family History: Father died of stroke in his 40s. Brother has HTN and MS. Pt is unaware of h/o MI, SCD. Physical Exam: VS - P76, BP165/68, R18, 97% RA Gen: older 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. Neck: Supple without JVD. No carotid bruits noted. CV: PMI located in 5th intercostal space, midclavicular line. Irreg. irreg, normal S1, S2. Grade II/VI high-pitched crescendo-decrescendo murmur best heard at RUSB radiating to apex. 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: warm, no edema. Skin: No stasis dermatitis, ulcers, scars. . Pulses: Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+ Pertinent Results: [**2200-7-28**] 05:17PM PT-15.2* PTT-30.0 INR(PT)-1.4* [**2200-7-28**] 05:17PM PLT COUNT-147* [**2200-7-28**] 05:17PM WBC-8.3 RBC-5.16 HGB-14.7 HCT-42.5 MCV-82 MCH-28.5 MCHC-34.7 RDW-16.2* [**2200-7-28**] 05:17PM GLUCOSE-92 UREA N-14 CREAT-1.3* SODIUM-140 POTASSIUM-3.9 CHLORIDE-100 TOTAL CO2-31 ANION GAP-13 [**2200-7-29**] Cardiac Cath 1. Coronary angiography of this right dominant system revealed moderate two vessel coronary artery disease with slow perfusion consistent with microvascular dysfunction. The LMCA had ostial 20% and distal 40% stenoses. The proximal LAD had a 40-50% stenosis at S1. The distal LAD wrapped well around the apex. The D1-D4 vessels (D2 being the largest) were patent. The LCx had a 50% stenosis in a small distal AV groove just after takeoff of the major OM2. The RCA had a 30% stenosis at the origin, and mild diffuse disease was noted throughout. There was a large RPL. 2. Resting hemodynamics revealed elevated left sided filling pressures with LVEDP of 21-23 mmHg. There was moderate pulmonary hypertension with PASP of 46-47 mmHg. The cardiac index was depressed at 1.1 L/min/m2 with modest augmentation of cardiac output with dobutamine to 15 mcg/kg/min (with minimal change in heart rate and only mild increase in systemic systolic arterial pressure), based on a measured oxygen consumption post-sedation. The SVR and PVR were elevated at 3994 and 222 dynes-sec/cm5. 3. The mean aortic valve gradient was 42 mm Hg at rest with a calculated aortic valve area of 0.5 cm2 WIth dobutamine infusion at 15 mcg/kg/min, the gradient rose to 56 mm Hg, with calculated valve area of 0.5 cm2. The calculated valve area will UNDERESTIMATE the true valve area in the setting of his known aortic regurgitation. 4. Left ventriculography showed a moderate-severely calcified aortic valve, mild (1+) non-ectopic mitral regurgitation, and normal wall motion with estimated ejection fraction of 60%. [**2200-7-30**] Carotid Study There is a less than 40% right ICA stenosis and less than 40% left ICA stenosis with antegrade flow in both vertebral arteries. [**2200-8-6**] Ultrasound 1. Limited study. 2. Gallstone, without evidence of cholecystitis. 3. Slightly echogenic liver, likely steatotic, however, other forms of liver disease such as significant hepatic fibrosis or cirrhosis cannot be totally excluded. 4. Bilateral pleural effusions. [**2200-8-10**] CT Scan 1. Stranding seen adjacent to the pancreas tail, consistent with mild uncomplicated pancreatitis. No evidence of pseudocyst formation or other sequelae of pancreatitis. 2. Peripherally-enhancing relatively low attenuation lesion seen within the spleen, most likely representing a hemangioma, or possibly other vascular lesion. 3. Cholelithiasis. 4. Bilateral pleural effusions with associated atelectasis. [**2200-8-14**] CXR Left lower lobe atelectasis and pleural effusions have improved and nearly resolved. No pneumothorax is identified. The left subclavian line remains in the mid SVC. Brief Hospital Course: Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2200-7-28**] for surgical management of his aortic stenosis. As his coumadin had been stopped 4 days prior to admission, heparin was started for anticoagulation given his chronic atrial fibrillation. He underwent a cardiac catheterization in preparation for surgery which showed mild two vessel coronary artery disease, severe aortic stenosis, mild pulmonary hypertension and a normal left ventricular function. Given his past history of stroke, a neurology consult was obtained. A head CT scan showed a moderate degree of small vessel ischemic changes and scattered lacunes. His risk of perioperative stroke was thus estimated to be around 4.8-8.8% and he was cleared for surgery. On [**2200-7-31**], Mr. [**Known lastname **] was taken to the operating room where he underwent an aortic vakve replacement using a 21mm pericardial valve and a left atrial appendage ligation. Postoperatively he was taken to the intensive care unit for monitoring. On postoperative day one, Mr. [**Known lastname **] was found to not be appropriately following commands but moved all extremities and remained intubated. He developed rapid atrial fibrillation and cardioversion was attempted unsuccessfully. Amiodarone was thus started for rate control. On postoperative day three, Mr. [**Known lastname **] was extubated. He was slow to improve neurologically however was making steady progress. He was transfused with packed red blood cells for postoperative anemia. Ceftriaxone was started for possible aspiration pneumonia however his chest x-rays remained normal. His ceftriaxone thus discontinued. Mr. [**Known lastname **] continued with high nasogastric tube output and he was held NPO for a suspected ileus. His output eventually decreased and his NG tube was removed on postoperative day 6. Mr. [**Known lastname **] soon developed emesis and his NG tube was replaced. Laboratory studies were consistent with pancreatitis and TPN was started for nutrition. The genral surgery service was consulted for assistance with his pancreatitis. A CT scan was performed which showed stranding seen adjacent to the pancreas tail which was consistent with mild uncomplicated pancreatitis however no evidence of pseudocyst formation or other sequelae of pancreatitis was identified. Mr. [**Known lastname 50840**] nasogastric tube (NGT) output slowly decreased. On [**2200-8-7**], he transferred to the step down unit for further recovery. TPN continued for nutrition. The physical therapy service was consulted for assistance with his postoperative strength and mobility. Coumadin was continued for anticoagulation for atrial fibrillation. He continued to be gently diuresed towards his preoperative weight. Slowly Mr. [**Known lastname 50840**] lipase and amylase trended back towards normal. An oral diet was started and slowly advanced as tolerated. Stopped [**8-15**]. Pt stable for DC Medications on Admission: Metoprolol 175 mg po daily lipitor 20 mg po daily furosemide 20 mg po daily quinopril 20 mg po daily coumadin as directed 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 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 3. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Enalapril Maleate 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once): follow INR goal is [**12-28**] (afib). 7. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 8. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). 9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 10. Quinapril 20 mg Tablet Sig: One (1) Tablet PO once a day. 11. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. 12. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: AS s/p AVR Hyperlipidemia HTN AF Sick Sinus Syndrome Cholilithiasis Stroke [**2186**]/ [**5-1**] Postoperative pancreatitis 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) Call with any questions or concerns. Followup Instructions: Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**] Follow-up with cardiologist/pcp [**Last Name (NamePattern4) **]. [**Last Name (STitle) 10543**] in [**11-26**] weeks. [**Telephone/Fax (1) 4475**] Please have thyroid studies done in 1 month. Newly started on levothyroxine, a medication for hypothyroidism. Completed by:[**2200-8-16**] ICD9 Codes: 4241, 2930, 4019, 2449, 2724
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Medical Text: Admission Date: [**2126-8-5**] Discharge Date: [**2126-8-16**] Date of Birth: [**2080-5-8**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1162**] Chief Complaint: transfer for sepsis, DKA Major Surgical or Invasive Procedure: triple lumen catheter placement intubation History of Present Illness: HPI: 46 yo M with IDDM presented to an OSH after being found unresponsive in bed by parents at 10am. Per parents, FS "too high", no h/o trauma, no empty bottles or suicide attempt. Pt reported to be nauseated in the past 2-3 days. OSH Course: Initial VS: 95.6 BP 83/34 HR 118 RR 12 Shallow breaths 93% on NRB. Initial glucose 2150, AG 33, Cr 4.3. ABG: 7.05/22/211/6.03 on 100%O2-Ambu bag. Pt received Ceftriaxone 2gm, Vanco 1gm x1, acyclovir 500mg x1, narcan 2mg, insulin 14U IV x1, 16 U IV, 20IV, + Insulin gtt 7 units/hr-->10units/hr, NaHCO3 2amps x1. At time of transfer AG 26, gluc 1645, BUN/Cr 74/3.8, Calcium 7.3, K 3.4. Head CT negative but + for sinusitis, LP done and treated for possible bacterial/viral meningitis, and PNA. Pt transferred to [**Hospital1 18**] for further management of severe DKA, ARF, MS changes, septic shock on levophed and dopamine gtt prior to transfer. Past Medical History: -IDDM -Medullary sponge kidney -Nephrolithiasis -nueropathy -chronic back pain Social History: -Divorced, lives at home with parents, 2 children. -Tob 1/2ppd, No ETOH use, no other drug use or IVDU Family History: M: Leukemia, currently undergoing chemotherapy F: CAD, HTN Physical Exam: VS: 97.5 BP 90/66 HR 96 RR 27 95% AC 600X12 FiO2 1.00 PEEP 10 GEN: Intubated, shivering off sedation HEENT: ETT in place, PERRL 3-2mm, anicteric sclera RESP: coarse BS throughout, no wheezing CV: Reg Nml S1, S2, no M/R/G ABD: Soft, Distended, +tenderness noted with grimacing, diminished BS EXT: Non pitting peripheral edema, warm, 1+ DP pulses NEURO: not following commands, hyporeflexic (sedated) Pertinent Results: [**2126-8-5**] 10:25PM GLUCOSE-668* UREA N-47* CREAT-2.1*# SODIUM-152* POTASSIUM-3.4 CHLORIDE-133* TOTAL CO2-11* ANION GAP-11 [**2126-8-5**] 10:25PM ALT(SGPT)-12 AST(SGOT)-20 LD(LDH)-158 CK(CPK)-232* ALK PHOS-80 AMYLASE-140* TOT BILI-0.1 [**2126-8-5**] 10:25PM LIPASE-24 [**2126-8-5**] 10:25PM ALBUMIN-2.7* CALCIUM-5.5* PHOSPHATE-1.9* MAGNESIUM-1.9 [**2126-8-5**] 10:25PM TSH-0.37 [**2126-8-5**] 10:25PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2126-8-5**] 10:25PM WBC-12.9* RBC-3.28* HGB-9.9* HCT-31.4* MCV-96 MCH-30.1 MCHC-31.4 RDW-13.7 [**2126-8-5**] 10:25PM NEUTS-56 BANDS-10* LYMPHS-31 MONOS-0 EOS-0 BASOS-0 ATYPS-0 METAS-1* MYELOS-2* [**2126-8-5**] 10:25PM HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-1+ MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-OCCASIONAL OVALOCYT-1+ [**2126-8-5**] 10:25PM PLT COUNT-298 [**2126-8-5**] 10:25PM PT-14.7* PTT-29.3 INR(PT)-1.3* Brief Hospital Course: AP: 46 yo M with hx of IDDM with DKA & sepsis, initially intubted on pressors and admitted to the ICU for further care and management. 1. Respiratory failure/MRSA pneumonia: Patient was initially placed on broad spectrum antibiotics with vancomycin, ceftriaxone, and flagyl for hypotension in the setting of DKA. A sputum culture was obtained that grew out MRSA. He was continued on vanc for a total 10 day course. All blood cultures taken at our hospital were negative. He was sucessfully weaned off of mechanical ventilation and then diuresed with resulting return to baseline function and no oxygen requirement. At the time of discharge the patient had resolved leukocytosis and was afebrile with a markedly improved CXR. 2. DKA: Patient was initially placed on an insulin gtt per protocol and was followed with serial chem 10s and ABGs until his anion gap closed. He was then transitioned to Lantus and a humalog sliding scale. Patient initially had early morning hypoglycemia on a dose of Lantus 20 units daily and this was decreased to 16 units. However the patient's BG then was consistently in the mid 200s. In consultation with [**Last Name (un) **] DM management team who have been following the pt during this hospitalization it was decided to increase the lantus dose to 18 units daily and titrate the humalog scale. He has follow up appointments with [**Last Name (un) **] on [**8-19**]. 3. Thrombocytopenia: Patient had transient thrombocytopenia while in the ICU that resolved prior to transfer to the floor. A HIT-Ab was sent which was negative. He had no evidence of petechiae or easy bruising. 4. Skin lesions: S/p fluid overload & edema with blisters. He was followed by the wound consult nurse and had dressing changes daily. There were no signs of ceullulitis at these sites. He will have VNA follow up at home for continued dressing changes. . 5. ARF: Patient experienced ARF on admission most likely secondary to profound volume depletion. He was aggressively hydrated with IVF and his serum cr returned to baseline upon arrival to the general floor. 6. Depression--Pt was placed back on his prior dose of Celexa. Discharge Medications: 1. Fentanyl 75 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr Transdermal Q72H (every 72 hours). 2. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). Disp:*11 * Refills:*2* 3. Escitalopram 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Insulin Glargine 100 unit/mL Solution Sig: One (1) 18 Subcutaneous at bedtime. Disp:*1 18* Refills:*2* 5. humalog sliding scale For breakfast, lunch and dinner: BG 0-50 1 glass of OJ 51-100 0 units 101-150 7 units Humalog SC 151-200 10 units Humalog SC 201-250 12 units Humalog Sc 251-300 14 units Humalog SC 301-350 16 units Humalog SC 351-400 18 units Humalog SC For Bedtime, if BG is >200 201-250 2 units Humalog SC 251-300 3 units Humalog SC 301-350 4 units Humalog SC 351-400 5 units Humalog SC >400 call your PCP 6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed. Disp:*20 Tablet(s)* Refills:*0* 7. Dulcolax 5 mg Tablet, Delayed Release (E.C.) Sig: [**1-22**] Tablet, Delayed Release (E.C.)s PO daily PRN as needed for constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1* Discharge Disposition: Home With Service Facility: [**Location (un) **] Nursing Services Discharge Diagnosis: DKA sepsis MRSA PNA bilateral UE blisters Discharge Condition: good Discharge Instructions: Patient will have VNA nursing to help with dressing changes. He will follow up with the [**Last Name (un) **] center for further DM. He should return to the ER or call his PCP if he develops fevers, chills, nausea or vomiting. He should monitor his BG 4 times daily and call his PCP if he has a BG >375. Followup Instructions: [**8-19**] with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**], NP - 10 am [**Hospital **] Clinic [**8-20**] with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], RN - 8:30 am. He should follow up with his PCP [**Last Name (NamePattern4) **] [**1-22**] weeks. ICD9 Codes: 2762, 5849, 3572, 3051
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Medical Text: Admission Date: [**2176-1-10**] Discharge Date: [**2176-1-16**] Date of Birth: [**2116-12-12**] Sex: M Service: SURGERY Allergies: Tylenol / Potassium Attending:[**First Name3 (LF) 4748**] Chief Complaint: progressively increased swelling of his graft site since surgery Major Surgical or Invasive Procedure: [**2176-1-11**] Ultrasound-guided access for vascular imaging, aortic catheterization with abdominal aortogram and pelvic runoff, right common iliac artery stent, right external iliac artery stent, right to left femoral to femoral bypass, removal of axillary to femoral bypass graft. History of Present Illness: 59M Hispanic male s/p left axillofemoral bypass on [**2175-4-3**] with PTF Propaten graft. He has a long history of severe symptomatic left aorto-iliac disease thigh and calf claudication with ambuation, L>R. He has had significant improvement in his claudication symptoms since his surgery, however he has had progressively increased swelling of his graft site since surgery. He was recently discharged for increased swelling of the graft site for concern of graft site infection v. seroma v. allergic reaction, and was on IV anti-biotics. Since then, he has continued to have further expansion of the graft site with tightness. Past Medical History: -Coronary artery disease -myocardial infarction in [**2166**], status post percutaneous coronary intervention, vessel intervene unknown. -systolic congestive heart failure recurrent with ejection fraction of 20%. - diabetes,controlled. - hypertension, controlled - bilateral renal artery stenosis status post renal artery stenting bilaterally. - hypercholesteremia - subarachnoid hemorrhage secondary to cerebral aneurysm s/p aneurysm clipping in [**2163**]. Social History: Non contributory Family History: Non contributory Physical Exam: VS T 99.9 P3 BP 142/72 RR 20 O2 sat 97% on RA Gen: AAOx3, NAD Heart: RRR, no murmur Lungs: clear by auscuktatiob bilaterally Abd: soft, non-tender, non-distended Skin: incision dry and intact Ext: well perfused no edema Pulses: Fem [**Doctor Last Name **] DP PT [**Name (NI) 167**] palp dop palp palp Left palp dop palp palp Pertinent Results: [**2176-1-15**] 04:41AM BLOOD WBC-9.4 RBC-3.02* Hgb-9.9* Hct-27.5* MCV-91 MCH-33.0* MCHC-36.2* RDW-14.2 Plt Ct-188 [**2176-1-15**] 04:41AM BLOOD Plt Ct-188 [**2176-1-15**] 04:41AM BLOOD Glucose-116* UreaN-24* Creat-2.1* Na-136 K-4.4 Cl-106 HCO3-25 AnGap-9 [**2176-1-14**] 07:11PM BLOOD CK(CPK)-106 [**2176-1-14**] 07:11PM BLOOD CK-MB-2 cTropnT-<0.01 [**2176-1-15**] 04:41AM BLOOD Calcium-7.7* Phos-2.6* Mg-2.5 [**2176-1-12**] 10:54AM BLOOD Glucose-94 [**2176-1-11**] 08:41PM BLOOD Glucose-83 Lactate-1.2 Na-137 K-3.5 Cl-110 calHCO3-21 Cardiology Report ECG Study Date of [**2176-1-10**] 9:16:54 PM Sinus rhythm with ventricular premature beats. Left ventricular hypertrophy with ST-T wave changes. Compared to the previous tracing of [**2175-9-19**] the ventricular premature beat is new and the ventricular rate is slightly faster. TTE (Complete) Done [**2176-1-11**] at 8:46:47 AM Conclusions The left atrium is dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe global left ventricular hypokinesis with akinesis of the inferior and inferolateral walls. (LVEF = 20-25 %). A left ventricular mass/thrombus cannot be excluded. [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 and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPERSSION: Severe global hypokinesis with akinesis of the inferior and inferolateral walls. Diastolic dysfunction. At least moderate mitral regurgitation with an eccentric jet due to tethering of the posterior mitral valve leaflet by the infarcted infero-lateral wall. ECG Study Date of [**2176-1-11**] 4:15:34 PM Sinus rhythm. Baseline artifact. T wave inversions in the lateral leads. Early R wave transition. Possible right ventricular hypertrophy. Possible left ventricular hypertrophy. The ST-T wave changes may be related to left ventricular hypertrophy. Compared to the previous tracing of [**2176-1-10**] there is no significant change. ECG Study Date of [**2176-1-12**] 12:50:16 PM Sinus rhythm with premature atrial contractions. Possible biventricular hypertrophy with extensive ST-T wave changes secondary to left ventricular hypertrophy. Compared to the previous tracing of [**2176-1-11**] there is no significant change. Radiology Report CHEST (PRE-OP PA & LAT) Study Date of [**2176-1-10**] 8:28 PM Final Report COMPARISON: [**2175-9-19**]. FINDINGS: There is a tortuous thoracic aorta. Heart size is within normal limits. No radiographic evidence of pneumonia present. Pulmonary vascularity appears within normal limits. No effusion or pneumothorax. IMPRESSION: No acute cardiopulmonary process identified. CHEST (PORTABLE AP) Study Date of [**2176-1-12**] 9:07 AM Final Report REASON FOR EXAMINATION: Evaluation of Swan-Ganz position. Portable AP chest radiograph was compared to [**2176-1-11**]. The patient was extubated. The Swan-Ganz catheter tip is at the right main pulmonary artery. The cardiomediastinal silhouette is unchanged. Bibasilar atelectasis are unchanged. No edema or pneumothorax is present. Brief Hospital Course: [**2176-1-10**] Patient admitted for increased swelling of Axillary to femoral bypass graft, seroma versus infection, claudication. Routine nursing, labs, NPO post MN and IVF and Bicarb drip start at MN. Pre-op EKG-Sinus rhythm with ventricular premature beats. Left ventricular hypertrophy with ST-T wave changes. Compared to the previous tracing of [**2175-9-19**] the ventricular premature beat is new and the ventricular rate is slightly faster. Pre-op CXR-No acute cardiopulmonary process identified. Pre-op and consented for abdominal aortogram and pelvic runoff, right common iliac artery stent, right external iliac artery stent, right to left femoral to femoral bypass and removal of axillary to femoral bypass graft. [**2176-1-11**] TTE ECHO-that showed severe global hypokinesis with akinesis of the inferior and inferolateral walls. Diastolic dysfunction. At least moderate mitral regurgitation with an eccentric jet due to tethering of the posterior mitral valve leaflet by the infarcted infero-lateral wall. Taken to OR and underwent Ultrasound-guided access for vascular imaging,aortic catheterization with abdominal aortogram and pelvic runoff, right common iliac artery stent, right external iliac artery stent, right to left femoral to femoral bypass,removal of axillary to femoral bypass graft. A-line, PA line, foley catheter and JP drains were placed intra-op. Cultures sent in OR. Patient tolerated procedure. Transferred to CVICU post-op for recovery and further monitoring. Patient was hypotensive post-op, placed on pressors, transfused with 1 unit PRBC, sedate and intubated. Started ABX vanco/Cipro and Flagyl. Pulses stable pulse signals. DVT prophylaxis. Pain control. [**2176-1-12**] Patient was extubated in CVICU, remains on ABX Vanco/Cipro/Flagyl. T maxed 101.7. Pulse status stable. Pressors weaned off, vitals stable. Started diet. Tranferred to VICU [**Hospital Ward Name 121**] 5 w/ telemetry for further monitoring. Pain managed w/ prn. [**2176-1-13**] Patient remains febrile T maxed 101.4 pan cultured, the rest of his vitals stable. PA line changed to tripple lumen line-placement confirmed by CXR- also showed no evidence of pulmonary vascular congestion and no signs of new parenchymal infiltrates. JP remain in place. Pulse status stable. Physical therapy consult- started out of bed to chair activity. Cultures from the OR came back negative. [**2176-1-14**] Patient c/o vertigo- became intermittent, remains febrile T maxed 101.2. Remains on ABX (Vanco/Cipro/Flagyl). Patient c/o chest pressure with a 9 beat run for V-tach, EKG done and cardiac enzymes sent. All came back negative and R/O for MI. Electrolytes repleted. No further episodes of V-tach. Cultures from [**2176-1-11**] came back negative. A-line d/c'd. [**2176-1-15**] Patient's fever is now coming down, T maxed 99.9. Remains to have intermittent dizziness, w/ VSS. Made floor status w/ telemetry. Foley d/c'd and voiding. Remains on ABX. Cultures from [**1-13**] remain pending. Rehab screening. [**2176-1-16**] Vitals stable overnight, patient is feeling better he wants to go home instead of rehab. All cultures came back preliminary negative. Patient discharged to home in good condition, tolerating diet, ambulating, and voiding adequately, will FU with Dr. [**Last Name (STitle) 1391**] in 2 weeks. Medications on Admission: plavix 75 mg po qd ASA 81 mg po qd carvedilol 12.5 mg [**Hospital1 **] felodipine 5 mg po qd lisinopril 20 mg po qd digoxin 0.25 mg po qd lasix 40 mg po qd zocor 40 mg po qd Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Felodipine 2.5 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily). 7. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed. 10. 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* 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 12. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for temperature. 13. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 14. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 15. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Axillary to femoral bypass graft seroma vs infection, claudication. history of Coronary artery disease, s/p MI [**2166**], status post PCI vessel intervention unknown history of chronic systolic congestive failure with ejection fraction of 20% compensated history of type 2 diabetes controlled with diet history of hypertension history of bilateral renal artery stenosis status post renal artery stenting bilaterally history of hypercholesteremia on statin history of subarachnoid hemorrhage secondary to cerebral aneurysm with aneurysm clipping and second aneurysm embolization in [**2163**]. Discharge Condition: Good Discharge Instructions: walk essential distances only until FU ace wrap left lower extremity from foot to knee when walking elevate lower extremities when sitting no driving till seen in FU with Dr. [**Last Name (STitle) 1391**] may shower, no tub baths continue stool softener while on pain medications continue current medications as directed keep FU appointments call Dr.[**Name (NI) 1392**] office for FU appointment ([**Telephone/Fax (1) 4852**] call if you have a fever of more than 101.5, pain swelling, and draining of your incisions Followup Instructions: Call Dr. [**Last Name (STitle) 1391**] for FU appointment in 2 weeks Phone: ([**Telephone/Fax (1) 29063**] Completed by:[**2176-1-16**] ICD9 Codes: 5845, 4271, 2762, 4280, 412, 2720, 5859
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Medical Text: Unit No: [**Numeric Identifier 70859**] Admission Date: [**2105-1-31**] Discharge Date: [**2105-2-8**] Date of Birth: [**2105-1-29**] Sex: F Service: NB HISTORY: Baby girl [**First Name8 (NamePattern2) **] [**Known lastname **]-[**Known lastname 50359**] delivered at 39 and 6/7 weeks gestation with a birth weight of 3045 grams, and was admitted to the newborn intensive care unit from the newborn nursery at 2 days of life for fever and ill appearance. Mother is a 30-year-old gravida 1, para 0 (now 1) mother with an uncomplicated pregnancy. Prenatal screens included blood type A+, antibody screen negative, rubella immune, hepatitis B surface antigen negative, RPR nonreactive, and group B strep negative. The intrapartum course was unremarkable, with rupture of membranes of clear fluid about an hour prior to delivery. No maternal fever. No maternal antibiotics. The infant emerged vigorous by spontaneous vaginal delivery. Apgar scores were 9 at one minute and 9 and five minutes. In the newborn nursery, the infant initially did well; was breast feeding well with stable vital signs. The second day of life, the infant became jittery, irritable, was feeding poorly, spitting up, and was pale. The temperature went up to 100.7 axillary, was 100.8 rectally; prompting transfer to the newborn intensive care unit. The mother and father had not been ill. There was no history of oral herpetic sores. No recent lesions, and no history of genital herpes. PHYSICAL EXAMINATION ON ADMISSION: Weight 2840 grams, down 7% from birth weight. VITAL SIGNS: Temperature of 99.5 axillary, heart rate 120s to 140s, blood pressure 90s/50s, oxygen saturations 97% on room air. Oxygen saturations noted to drift to high 80s while sleeping or sucking on pacifier. GENERAL: A well-developed infant, jittery and irritable with a high-pitched cry. Skin pale, warm, with cool extremities. HEENT: Head with fontanelle soft and flat. Ears and nares normal. Mildly asymmetric facies within intact facial movements. Intact suck. Eyes equally reactive to light. NECK: Supple. No lesions. CHEST: Well aerated, clear breath sounds. No grunting, flaring or retracting. CARDIAC: Regular rate and rhythm without murmur. Femoral pulses 2+. ABDOMEN: Soft, no hepatosplenomegaly, no masses, bowel sounds present. GU: Normal female. Anus patent. EXTREMITIES: Hips and back normal. No lesions. Somewhat cool distal extremities. NEURO: Increased tone, jittery, without clonus. SUMMARY OF HOSPITAL COURSE BY SYSTEM: 1. RESPIRATORY: Had several episodes of apnea on admission. Subsequently had some desaturations at rest and with sucking on a pacifier, with the last episode on [**2-3**], [**2105**]. Has completed 5 consecutive days without any apnea, bradycardia or desaturations prior to discharge. 2. CARDIOVASCULAR: Received a normal saline bolus on admission for a sodium of 147. Had normal blood pressures and heart rates. Recent blood pressure 80/45 with a mean of 56. 3. FLUIDS, ELECTROLYTES, NUTRITION: Due to spitting up and no interest in feeding, received IV fluids after admission for about 12 hours until was interested in feeding again. Blood glucoses were always in the normal range. Electrolytes on admission; sodium 147, potassium 4, chloride 105, CO2 of 26, calcium 10.5. Discharge weight 3180. 4. GI: Spitting resolved within 24 hours of admission. Abdominal exam has always been normal. Bilirubin on day of life #2 was a total of 2.4, direct 0.2. Has not been jaundiced. AST and ALT were done on admission as part of sepsis eval. The ALT was 12, AST 42. 5. INFECTIOUS DISEASE: A CBC, blood culture, lumbar puncture and urine culture were all done on admission. The CBC showed a white count of 14.1; with 49 poly's; 2 bands; platelets 294,000; hematocrit 49.6%. The urine culture was negative. The blood culture was negative. The LP showed 5 WBCs, 38 RBCs, with 40% poly's. The culture was negative. The Gram stain was negative. The infant received 7 days of ampicillin and gentamicin for presumed sepsis with a gentamicin level of trough 0.6, peak 8.8. 6. NEUROLOGY: On admission was jittery with increased tone, which resolved by 24 hours of life when the infant's exam was normal for age. A head ultrasound was done as part of the workup and was normal. 7. SENSORY: Hearing screening was performed with automated auditory brain stem response, passed both ears. CONDITION ON DISCHARGE: Stable term infant. DISCHARGE DISPOSITION: Discharged home with parents. NAME OF PRIMARY PEDIATRICIAN: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Hospital1 47763**] [**Location (un) **], [**University/College 70860**], [**Location (un) 86**], [**Numeric Identifier 70861**]; telephone number ([**Telephone/Fax (1) 56620**]. CARE AND RECOMMENDATIONS: 1. Feeds: Ad lib breast feeding. 2. Medications: Ferrous sulfate 0.3 mL p.o. once a day using a diluted solution that is 25 mg/mL, which equals 2 to 3 mg/kg/day. Was placed on Tri-Vi-[**Male First Name (un) **], but spit after receiving it, so is no longer receiving Tri-Vi-[**Male First Name (un) **]. 3. State newborn screen was drawn on [**2105-1-31**]. Received hepatitis B immunization on [**2105-1-31**]. DISCHARGE DIAGNOSES: 1. Appropriate for gestational age term female. 2. Presumed sepsis. 3. Apnea and desaturations, resolved. [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern1) **], [**MD Number(1) 54604**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2105-2-6**] 16:03:38 T: [**2105-2-6**] 16:46:59 Job#: [**Job Number 70862**] ICD9 Codes: V053
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Medical Text: Admission Date: [**2156-9-22**] Discharge Date: [**2156-9-25**] Date of Birth: [**2156-9-22**] Sex: F Service: NB HISTORY: Baby girl [**Known lastname 68249**] [**Known lastname 68250**] is a 2700 gram 35 amd [**2-10**] weeker, admitted to the newborn intensive care nursery for management of prematurity. The mother is a 21-year-old gravida 3, para 2, now 3 woman. Prenatal screens included blood type A positive, antibody screen negative, RPR nonreactive, rubella immune, hepatitis B surface antigen negative, and group B strep positive. Maternal history notable for insulin dependent diabetes mellitus, anemia, and a heart murmur of unknown etiology. The pregnancy was complicated by preterm labor requiring hospitalization twice during the pregnancy. She received one course of betamethasone. A fetal echo was done secondary to maternal insulin dependent diabetes mellitus and was normal. She presented in preterm labor and progressed to spontaneous vaginal delivery under epidural anesthesia on [**2156-9-22**]. Interpartum antibiotics were given about 3 hours prior to delivery for GBS colonization. Membranes ruptured about 4.5 hours prior to delivery. There was no maternal fever. [**Known lastname 68249**] emerged with spontaneous respiratory effort and good tone. She received some free flow oxygen. Her Apgar scores were 8 and 9 at 1 and 5 minutes respectively. PHYSICAL EXAMINATION: Weight 2700 grams (50 to 75th percentile), length 45.5 cm (25th to 50th percentile), head circumference 32 cm (25th to 50th percentile). Anterior fontanel was soft and flat, cutis aplasia with an 8 cm long affected area along sagittal suture from the anterior fontanel to the posterior fontanel around a 6 cm linear region with 2 cm long x 1.5 cm wide defect with visible dura in the mid scalp. Slightly depressed nasal bridge, normally set ears, intact palate, clear breath sounds, no murmurs, soft abdomen, three-vessel cord, no hepatosplenomegaly. Normal female external genitalia. Patent anus. No sacral dimple. Normal tone in all extremities equally. Asymmetric face when she cries with decreased movement on the right. Warm extremities. Good perfusion. Ruddy active. SUMMARY OF HOSPITAL COURSE BY SYSTEM: RESPIRATORY: No issues. Breathes comfortably in the 30 to 50s' CARDIOVASCULAR: An echocardiogram was done per recommendation of genetics given that a number of cutis aplasia syndromes are associated with structural heart disease. The echocardiogram showed a patent foramen ovale versus a small atrioseptal defect and a patent ductus arteriosus with bidirectional flow. The heart was structurally normal. Her heart rate ranges in the 130's to 150's. Recent blood pressure 84/53 with a mean of 64. FLUIDS, ELECTROLYTES AND NUTRITION: Started on ad lib feeds on admission to the NICU with Similac 20 with iron. Initial bedside blood glucose was 36 which increased to 63 after feeding, and thereafter with feeding she has maintained her blood glucoses in the 70's to 80's. At discharge she was ad lib feeding with [**Doctor Last Name **]-20 or breast feeding if available. Her discharge weight is 2625 grams. GASTROINTESTINAL: A bilirubin done on [**9-24**] (day of life 2) showed a total of 3.9, direct 0.3. Bilirubin was repeated prior to discharge on [**2156-9-25**] and is pending. HEMATOLOGY: Hematocrit on admission 53.6%, INFECTIOUS DISEASE: CBC and blood culture were drawn on admission and she received 48 hours of ampicillin and gentamycin secondary to preterm labor, prematurity, maternal colonization, group B strep with less than 4 hours of interpartum peripheral access. The CBC was benign. The blood culture was negative. NEUROLOGY: Head ultrasound was done and was normal. Examination is age appropriate. SENSORY: Hearing screening was performed with automated auditory brain stem responses. Results pending. GENETICS: Genetic consult was done secondary to the cutis aplasia. Geneticist on examination found the cutis aplasia - minimal eyebrows, prominent lips, mildly protuberant tongue, hypertelorism but not otherwise grossly dysmorphic. The level of suspicion for trisomy-13 and [**Doctor Last Name 79**]-[**Doctor Last Name 9279**] was low but recommended karyotype be done which was drawn prior to discharge on [**2156-9-25**], and is pending. PLASTIC SURGERY: Plastic surgery found the cutis aplasia of the scalp to be a linear stripe of hairless scar tissue from anterior fontanel to posterior fontanel 8 cm long just posterior to the posterior fontanel, an area of 1.5 x 0.5 cm open wound that appeared not to be full thickness. It was recommended to treat the baby with bacitracin ointment to the lesion about 5 times a day and the mother may shampoo the baby's hair with follow up with Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) 5385**] in 10 days. PSYCHOSOCIAL: [**Hospital1 18**] social worker is involved with the family. The contact social worker is [**Name (NI) 553**] [**Name (NI) **]. She can be reached at [**Telephone/Fax (1) 8717**]. CONDITION ON DISCHARGE: Stable term infant. DISCHARGE DISPOSITION: Discharged home. NAME OF PRIMARY PEDIATRICIAN: Dr. [**First Name8 (NamePattern2) 3504**] [**Last Name (NamePattern1) **], [**Apartment Address(1) 68251**], [**Hospital1 189**], [**Numeric Identifier 23661**]. Telephone No.: [**Telephone/Fax (1) 68252**]. Fax: [**Telephone/Fax (1) 68253**]. CARE RECOMMENDATIONS: 1. Feeds: Ad lib feels with [**Doctor Last Name **]-20 with iron or breast feeding. 2. Medications: Bacitracin to scalp 5 times a day. 3. Car seat position screening test was performed. 4. State newborn screen was drawn on [**9-24**] and is pending. 5. Immunizations received: She received Hepatitis B immunization on [**2156-9-24**]. FOLLOW UP APPOINTMENTS SCHEDULED/ RECOMMENDED: 1. An appointment with pediatrician within 2 days of discharge. 2. Follow up with genetics clinic at [**Hospital3 **] in 6 to 8 weeks. After discharge the parents will call for appointment. 3. Appointment with Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) 5385**], from plastic surgery [**59**] days after discharge. Parents to call for appointment. Phone No. [**0-0-**]. 4. [**First Name (Titles) **] [**Last Name (Titles) 28085**] made to VNA of Greater [**Hospital1 189**]: Tel No. [**Telephone/Fax (1) 68254**]. DISCHARGE DIAGNOSES: 1. Appropriate for gestational age, preterm female. 2. Cutis aplasia. 3. Physiologic jaundice. 4. Rule out sepsis. 5. Infant of diabetic mother. [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern1) **], [**MD Number(1) 54604**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2156-9-24**] 23:37:49 T: [**2156-9-25**] 03:03:56 Job#: [**Job Number 68255**] ICD9 Codes: 7742, V290
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Medical Text: Admission Date: [**2195-1-22**] Discharge Date: [**2195-1-23**] Date of Birth: [**2133-4-13**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 618**] Chief Complaint: intracerebral hemorrhage Major Surgical or Invasive Procedure: none History of Present Illness: Mr. [**Known lastname 61596**] is a 61 year old male presenting as transfer from and outside hospital with large ICH. He was found in his garage unresponsive this evening with a bag of cocaine next to him. He was last seen well ~6 hours prior. BP at the scene was 220's/110's. He was taken to an OSH where his temperature was noted to be 88 degrees, head CT revealed a large Left basal ganglia hemorrhage with extensive intraventricular spread to lateral, 3, 4th, communicating hydrocephalus and dissection down into the brainstem. His examination was notable mid position and equal pupils unreactive to light, intact gag, no purposeful withdrawal of extremities. He was intubated at the OSH and transferred to [**Hospital1 18**] for further care. Neurosurgery was consulted and based on poor examination and CT findings was not felt to be a candidate for decompression or drainage. Past Medical History: Hep C on interferon GERD HTN Social History: Lives with his wife, children in the area. No illicit drug use. Family History: Not elicited Physical Exam: Vitals: T 97 (on bear hugger), BP 160/96, HR 62, R 14, 100% CMV Gen- critically ill, unresponsive to noxious stimulation HEENT- NCAT, MMM, Anicteric sclera Neck- C-collar CV- RRR, no MRG Pulm- scattered crackles. Abd- soft, nd, bs+ Extrem- no CCE NEUROLOGIC EXAM: MS- no response to deep noxious stimulation. CN- pupils equal at 4mm and unreactive to light, gaze midposition, absent dolls, absent corneal reflex, intact gag. no response to nasal tickle. Motor/Sensory- no spontaneous movements. internally rotates towards noxious stimulus in bilateral UE's. Triple flexion to noxious in bilateral LE's. DTR's- brisk, symmetric throughout. plantar response upgoing bilaterally. Pertinent Results: [**2195-1-22**] 10:30PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-POS amphetmn-NEG mthdone-NEG Head CT- There is a large parenchymal hemorrhage in the left cerebral hemisphere, measuring approximately 8.5 x 4.7 in greatest dimension, with surrounding edema. Blood products are present in both lateral ventricles, third as well as the fourth ventricle. There is mass effect on the ipsilateral lateral ventricle body as well as contralateral ventricular dilatation. There is 7-mm shift of the septum pellucidum as well as rightward subfalcine herniation. There is global sulcal effacement, highly concerning for cerebral edema. There is obliteration of the suprasellar cistern, as well as contralateral temporal [**Doctor Last Name 534**] enlargement. Evaluation of the posterior fossa is limited by an artifact, however there is high attenuation in the pons and possibly mid brain, concerning for additional foci of hemorrhage. Brief Hospital Course: Mr. [**Known lastname 61596**] is a 61 year old male found unresponsive with massive intracerebral hemorrhage. Etiology based on location is likely hypertensive hemorrhage in the setting of cocaine use. His condition upon arrival was consistent with severe neurologic injury without chance of meaningful neurologic recovery. The patient's condition was discussed at length with his wife and family. He was admitted to the ICU and later extubated for comfort measures only. The patient expired promptly following extubation with his family at the bedside. Medications on Admission: Interferon Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: large L basal ganglia Discharge Condition: expired Discharge Instructions: NA Followup Instructions: NA [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**] ICD9 Codes: 431, 4019
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Medical Text: Admission Date: [**2164-12-12**] Discharge Date: [**2164-12-24**] Date of Birth: [**2105-9-12**] Sex: M Service: MEDICINE Allergies: Penicillins / Codeine Attending:[**First Name3 (LF) 1145**] Chief Complaint: xfer from OSH s/p cardiac arrest Major Surgical or Invasive Procedure: Cardiac catheterization ICD Placement History of Present Illness: HPI: Patient is a 59 year-old man with hx of aortic valve replacement (congenital bicuspid valve [**2149**] with aortic insufficiency, redo [**8-/2164**] secondary to [**3-9**]+ AI and perivalvular leak at [**Hospital1 18**]), DDD pacer for complete heart block [**2159**], Thalassemia, HTN who was transferred from an OSH after suffering cardiac arrest yesterday evening. . Reportedly, patient was in USOH, compliant with medications day of admission to OSH. Was getting oil change, then suddenly found down. EMS arrived at sceen 10 minutes later, patient in Vfib, defibrillated x 2, and again 5 times by EMS on way to hospital, with eventual restoration of AV paced rhythm. Amiodarone gtt instituted. Patient intubated. [**Location (un) 2611**] coma scale 3 on arrival. CT Head showed subgleal hematoma but no intracranial bleeding. Pacemaker interrogation performed, no pacemaker dysfunction. ECHO at OSH showed LV systolic function of 25-30% with abnormal septal motion and severe anterior hypokinesis with distal septal and apical dyskinesis. Neurology saw patient, repeated CT scan which was negative for acute bleed. EEG done, results pending. INR on day of transfer was 3.1. . Day after, patient becoming more responsive, intermittently responding appropriately to commands. Patient of [**Last Name (un) **] Papageorgious, xferred here for further management. [**Last Name (un) 1291**] [**2151**] (bicuspid aortic valve), re-do Aortic Valve Repair [**8-/2164**] Past Medical History: 1. St. [**Male First Name (un) 923**] Mechanical [**Male First Name (un) 1291**] (Primary [**2151**], re-do [**8-/2164**]) 2. Pacer [**2159**] DDD for Complete Heart Block 3. Thallasemia 4. Hypertension Social History: smokes cigars occ. drinks 2 beers a day lives with wife and 3 kids runs own company Family History: non-contrib. Physical Exam: VS: Afebrile, HR 70, BP 113/70, 100% O2Sat GEN: sedated, intubated, arousable HEENT: MMM. ET tube in place. No JVD. CV: S1 Metallic S2. II/VI SEM preceding metallic valve sound LUNGS: CTA Anteriorly. ABD: soft, NT/ND. +BS EXT: 2+ DPs. No C/C/E Pertinent Results: ECHO [**2164-12-13**]: The left atrium is moderately dilated. The right atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is moderately dilated. Overall left ventricular systolic function is mildly-to-moderately depressed (ejection fraction 40 percent) secondary to severe hypokinesis of the anterior free wall and apex. No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. A bileaflet aortic valve prosthesis is present. The transaortic gradient is higher than expected for this type of prosthesis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. Compared with the findings of the prior report (images unavailable for review) of [**2164-2-23**], the aortic regurgitation is reduced. . CARDIAC CATH [**2164-12-14**] 1. Selective coronary angiography in this right dominant patient revealed no angiographically apparent coronary artery disease. The LMCA, LAD, LCX, RCA and their branches were without flow limiting disease. The LCx was a small vessel and the lateral wall was supplied via RCA. 2. Limited resting hemodynamics revealed systemic pressures of 130/67/88 FINAL DIAGNOSIS: 1. Coronary arteries are normal . CT HEAD [**2164-12-14**] 1. No intracranial hematoma. Subcutaneous/subgaleal hematoma at the right frontal region, without underlying skull fracture. 2. No CT features of acute cerebral infarcts. If clinically indicated, MRI is a more sensitive study to exclude acute cerebral ischemia. . EEG IMPRESSION: This is an abnormal EEG due to the presence of a diffusely slow background rhythm with bursts of generalized slowing consistent with a mild to moderate encephalopathy of toxic, metabolic, or anoxic etiology. No evidence of ongoing or potential seizure activity was seen during this tracing. . CXR PA and LAT INDICATION: Newly placed dual chamber ICD. Check position. FINDINGS: PA and lateral chest views have been obtained with the patient in upright position. There is status post sternotomy, and in the aortic valve area, the semitranslucent structures of a butterfly type (St. [**Male First Name (un) 923**]) aortic valve prosthesis can be identified. The heart size is now within normal limits and clearly smaller than on a previous PA and lateral chest examination of [**2164-8-30**]. A permanent pacer is present in left anterior axillary position connected to a dual intracavitary pacing system with termination points in the right atrial appendage and apical portion of right ventricle correspondingly. In addition to these wires already present on examination [**8-30**], there are now two electrodes approach from the right subclavian route also terminating in right atrial and right ventricular position as demonstrated on both frontal and lateral view. The right ventricular wire with two local electrode enforcements (ICD) traverses from the right axilla over to the left side where it is connected with the permanent pacer capsule. The thin right-sided right atrial wire terminates blindly in the right axilla. The pulmonary vasculature is normal without evidence of congestive pattern. No acute infiltrates are seen, and the lateral and posterior pleural sinuses are free. No evidence of pneumothorax on either side. Comparison with a most recent AP single view examination of [**2164-12-19**] demonstrates unchanged findings. IMPRESSION: Uncomplicated placement of additional pacer electrodes for unusual connection, see description. Remarkable reduction and normalization of heart size since [**8-30**]. . Brief Hospital Course: Patient is a 59 year-old gentleman s/p [**Month (only) 1291**] with re-do in [**8-/2164**] who presented to an OSH with VFib arrest, tranferred here for further management. The following issues were addressed during his hospital stay: . # VFIB ARREST/ICD PLACEMENT/HEMATOMA Exact etiology remains unclear. Laboratory values from OSH not consistent with acute ischemic event, though ECHO suggested some new anterior wall motion dysfunction. Patient underwent coronary catheterization at [**Hospital1 18**] which revealed normal coronaries. Patient reportedly compliant with medications, pacemaker interrogation successful at OSH. No significant electrolyte abnormalities or QT interval prolongation noted, blood cultures negative from OSH. Patient was evaluated by the Electrophysiology service and ICD was ultimately placed in left arm with slight difficulty in positioning leads. Course complicated by hematoma at pacer entry sites (L and R arm), controlled with pressure dressings. Patient transfused 1 unit PRBCs given blood loss secondary to hematomas. Given ECHO findings suggestive of possible ischemic event, patient was started on Lipitor 10mg PO qd and Toprol XL 100. . # RESPIRATORY (INTUBATION) Patient had been intubated for airway protection at OSH during arrest episode. Patient successfully extubated at [**Hospital1 18**] the following day after CXR was unremarkable for pulmonary pathology. Patient had some stridor post-extubation which was treated with racemic epinpehrine. No further respiratory issues were experienced. . # NEUROLOGIC (HEAD HEMATOMA/CONFUSION/MEMORY LOSS) Patient had 2 Head CT scans on day of admission at OSH which showed sub-galeal hematoma but no intracranial bleeding. Given amnesia, confusion, and lethargy, patient received repeat Head CT at [**Hospital1 18**] which was negative for acute bleed, intracranial mass, or other concerning pathology. Symptoms improved over time. Patient was evaluated by the neurology service and anoxic brain injury specialist. No extensive cortical damage, patient diagnosed with executive dysfunction; some improvement in function expected over the next 6 months, but prognosis for returning to work and/or living independently are poor. Patient received an EEG which showed slowing consistent with anoxic/toxic injury; no seizure activity was noted. Patient will follow-up with behavioral neuro service as outpatient. Patient was discharged to rehab facility under brain injury division for targeted care. Patient started on Seroquel 25mg PO BID given agitation/unrest and low dose Trazadone 25mg PO qd for sleep at night. . # PROSTHETIC AORTIC VALVE Patient had therapeutic INR on presentation to OSH. Patient's Coumadin was held in preparation for cardiac cath and ICD placement, and was maintained on heparin gtt in interim. Coumadin re-started once ICD placed, and patient kept on heparin gtt until INR therapeutic. Goal INR 2.5-3.5. . # L ARM CELLULITIS Patient developed L arm cellulitis from IV site, treated with PO Keflex and warm compresses. Patient was afebrile and without leukocytosis. . # HEMATURIA/INCONTINENCE Patient experienced hematuria while under heparin gtt after foley was discontinued, likely due to irritation and trauma. PTT was in therapeutic range, and drip was necessary due to prosthetic valve. Hematuria improved when transiently off heparin gtt, and will likely cease once patient off heparin. Patient also incontinent of urine when nursing staff not accessible. Patient otherwise able to void normally when accompanied to the bathroom by nursing. We do not suspect underlying urinary pathology anf attribute incontinence to mental status. Medications on Admission: MEDS: 1. Coumadin 5mg PO qd alternating with 7.5 mg PO qd 2. Folic Acid 1mg PO qd 3. Norvasc 5mg PO qd 4. Omeprazole 20mg PO qd Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 7. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 2 days. Capsule(s) 8. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for Sleep/sedation. 9. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. Warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): Please have your INR checked and dose adjusted accordingly. Goal INR 2.5-3.5. Discharge Disposition: Extended Care Facility: [**Hospital6 979**] - [**Location (un) 246**] Discharge Diagnosis: Primary 1. VFib Arrest s/p ICD placement 2. Anoxic Brain Injury Secondary 1. HTN 2. Thalassemia Minor Discharge Condition: hemodynamically stable Discharge Instructions: 1. Please take all medications as prescribed 2. Please make all follow-up appointments 3. If you develop chest pain, shortness of breath, palpitations, or other concerning signs/symptoms, please contact your PCP or report to the nearest Emergency facility. Followup Instructions: 1. Device clinic in 1 week: Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2165-1-1**] 10:00. [**Location (un) 436**], [**Hospital Ward Name 23**] Clinical Center, [**Hospital Ward Name 516**] of [**Hospital1 1170**] 2. Please follow-up with Dr. [**Last Name (STitle) 1911**] in [**1-8**] months 3. Please make an appointment to see your PCP [**Last Name (NamePattern4) **] [**10-19**] days: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 16963**]. Please keep all previously scheduled appointments: Provider: [**Name10 (NameIs) 1918**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 902**] Date/Time:[**2165-5-30**] 10:30 Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2165-5-30**] 10:00 Completed by:[**2164-12-24**] ICD9 Codes: 4275, 2851, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7184 }
Medical Text: Admission Date: [**2111-12-31**] Discharge Date: [**2112-1-3**] Date of Birth: [**2045-6-26**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3984**] Chief Complaint: altered mental status Major Surgical or Invasive Procedure: none History of Present Illness: Pt is a 66 yo man with pmhx MCA stroke [**7-7**] and [**12-7**], hyperlipidemia, HTN, DM who presents from [**Hospital 38**] rehab with altered mental status for the last three days. His wife reported that he was barely responsive on the day of admission and he was sent to the ED. Of note, he has also been having very loose stools for the last three days and was c dif positive on tuesday and started on flagyl. He spiked fever on monday and had low grade temps at rehab since then. He was on IVF at rehab per his wife. Past Medical History: R M1 segment MCA stroke [**7-/2111**] with residual left facial droop, left hand weakness/stiffness, mild dysarthria hyperlipidemia hypertension diabetes, diagnosed [**8-/2111**], initially diet controlled w/ FS 100s, last A1C 6.8, started on metformin h/o tobacco use, quit after stroke [**7-/2111**] s/p tonsillectomy Social History: tob 2.5ppd x 50yrs, h/o heavy EtOH use, "in recovery" 21yrs, no drug use, married Family History: mother died age 66, had HTN, stroke; father died age 87 Physical Exam: VS: T 97 HR 127 Bp 102/51, RR 27, SaO2 92% on 100% NRB Genl: tacchypneic, not responsive to questions or sternal rub, withdrew to painful stimuli HEENT: NCAT, Pupils 2 mm and slugishly reactive, MM dry Neck: supple, no bruits CV: irreg and tacchy, nl S1, S2, difficult to appreciate murmur over loud chest sounds Chest: anterior exam was diffusely rhoncherous Abd: soft, NTND, BS+ Ext: warm and dry Pertinent Results: ADMISSION LABS [**2111-12-31**] 08:10PM BLOOD WBC-5.5 RBC-4.19* Hgb-12.7* Hct-37.9* MCV-91 MCH-30.4 MCHC-33.6 RDW-14.1 Plt Ct-192 [**2111-12-31**] 08:10PM BLOOD Neuts-79* Bands-5 Lymphs-5* Monos-6 Eos-0 Baso-0 Atyps-5* Metas-0 Myelos-0 [**2111-12-31**] 08:10PM BLOOD Plt Ct-192 [**2112-1-1**] 12:17AM BLOOD Fibrino-649* [**2112-1-2**] 04:17AM BLOOD Fibrino-806*# D-Dimer-1592* [**2112-1-1**] 12:17AM BLOOD Ret Aut-0.6* [**2111-12-31**] 08:10PM BLOOD Glucose-144* UreaN-93* Creat-3.6*# Na-149* K-3.9 Cl-109* HCO3-25 AnGap-19 [**2112-1-1**] 12:17AM BLOOD ALT-46* AST-105* LD(LDH)-318* AlkPhos-41 TotBili-0.2 [**2111-12-31**] 08:10PM BLOOD Calcium-8.4 Phos-4.0 Mg-2.4 [**2112-1-1**] 12:17AM BLOOD Hapto-305* [**2112-1-1**] 12:17AM BLOOD TSH-0.36 [**2112-1-1**] 06:23AM BLOOD Phenyto-4.8* [**2112-1-2**] 04:17AM BLOOD Phenyto-8.4* [**2111-12-31**] 11:39PM BLOOD Type-ART Temp-36.1 pO2-52* pCO2-48* pH-7.25* calTCO2-22 Base XS--6 . LACTATES: [**2111-12-31**] 08:18PM BLOOD Lactate-2.6* [**2111-12-31**] 11:39PM BLOOD Lactate-1.3 [**2112-1-1**] 06:55AM BLOOD Lactate-1.2 [**2112-1-2**] 03:03PM BLOOD Lactate-2.3* . IMAGING ---------------- [**12-31**] head CT Evolution of right MCA territory infarction with cortical laminar necrosis. . [**1-1**] chest X ray Airspace process of both lower lungs consistent with aspiration or pneumonia. . [**1-2**]/ EEG evidence of encephalomalacia, no epileptiform focus (prelim read) Brief Hospital Course: Mr. [**Known lastname 23203**] is a 66 yo man with pmhx HTN, DM2, hyperlipidemia, R MCA CVA who presented with altered mental status, fever, c diff, seizure and was found to have pna and uti. . In the ED, initial vs were: T 98.4 HR 103 BP 120/60 R 26 O2 sat 90 % on RA. He was given 1 g vanco, 1 g ceftriaxone, 500 mg IV flagyl, 975 mg rectal tylenol, 3 liters IVF for presumed UTI and pna. He had a seizure in ED characterized by tonic clonic movements witnessed and he was given 2 mg ativan. CT head done in ED showed evolution of R MCA infarction. While in the ED, he went into afib with rvr to the 140s which was new for the patient. He was bolused with fluids but not given beta blockers because of borderline low blood pressure. Patient was also noted to be hypoxic to 80s on room air and cxr showed b/l infiltrates. He was put on NRB and sats went up to mid 90s. Patient's family confirmed DNR/DNI and did not want central line placed either. . On admission to the ICU, patient was tachy to 120-140s, SBP low 100s, afebrile, RR 20-30s and satting 88-90% on 100% NRB. . #. MS [**Name13 (STitle) 52034**] had multiple reasons for ms changes. Most likely reason is infection given fever, newly diagnosed pna and uti and recently diagnosed c diff infection. Patient had normal ms after his cva and was alert and oriented x 3 before the past few days when he began to spike fevers. He is somnolent now after seizure in ED follwed by ativan and morphine. His stoke may also be contributing although head CT showed evolution of cva not a new stroke or bleeding into the stroke already present. He was initially treated with vanc, zosyn and flagyl He was given a dilantin load and then continued on q 8 hour dilantin at 100 mg. EEG was done although seizure occured in setting of fever of 104 which is likely culprit although he does have known stroke focus. He was not communicative, but did move right side, respond to painful stimuli and eye flutter to voice. Neurology consulted but not following. MS changes likely multifactorial, infection (PNA, UTI, Cdiff), stroke, hypoxia, w/ some residual deficits from old stroke. His mental status did not recover after 2 days and after conversation with his wife, his status was changed to [**Name (NI) 3225**]. #. Hypoxia- Patient had a large Aa gradient. This is likely due to pna. He is unlikely to have PE given supratherapeutic INR of 6.1 and his cxr shows b/l infiltrates c/w pna. This could be aspiration pna given ms changes and recent stroke. Pt may also have a component of fluid overload from IVF given in ED. He was treated with vanc and zosyn for broad coverage of nursing home/hosp acquired pna and aspiration. Non-invasive ventilation was started but he became uncomfortable, NC was used, then discontinued after he became [**Name (NI) 3225**]. . #. Hypotension- Fever, bandemia, consolidations on cxr, dirty ua, recent c dif dx point towards sepsis as likely cause. Patient also in afib with rvr which is contributing. Attempted to slow hr down with 5 mg IV lopressor and pressure dropped to 70s systolic. He was given IVF to keep MAP > 65. No central access or a-line was placed as per his wife. . # cdif- He was continued on IV flagyl as he could not take po due to mental status changes. . #. UTI- UA positive for leuks, bacteria and nitrites. He was treated with vanc and zosyn as he was covered for PNA was well. Antibiotics were discontinued when the patients status was changed to [**Name (NI) 3225**] . #. PNA- Patient could have nursing home associated pna and he has recently been hospitalized. He had bands on diff, consolidation on cxr and fever. Treated initially with vanc/zosyn, then discontinued. . #. ARF- likely pre-renal given low bp and afib with rvr, sepsis. Bolused w/ IVF and renally dosed meds. Held lisinopril. . #. Stroke- Patient has known MCA infarct and on CT head here he has evolution of infarct but no new stroke or bleed. Dilantin loaded and maitenance doses given, INR was supratherapeutic, held coumadin continued asa pr. . #. Seizure- patient had seizure in ED likely related to high grade fever or known cva. Given ativan in ED. Dilantin as above and eeg with results as reported. . #. hyperlipidemia- held statin as npo . #. HTN-held anti-hypertensives as pt was hypotensive . #. Afib- patient already supratherapeutic on coumadin, rate under better control after 5 mg IV lopressor . #. DM- RISS, finger sticks qachs . #. FEN- IVF bolus to keep MAP > 65, replete lytes prn, npo . #. PPx- IV protonix, no need for subq heparin as last INR was 6 . #. Access: 2 PIV, family does not want central access . #. Communication: with wife: [**Name (NI) 2048**] [**Name (NI) 23203**], p# is (c) [**Telephone/Fax (1) 52033**], (h) [**Telephone/Fax (1) 52032**] . #. Code: DNR/DNI confirmed with wife . #. Dispo: ICU level of care for now . #. MICU INTERN PROGRESS NOTE UPDATED [**2112-1-2**] A/P: Pt is a 66 yo man with pmhx HTN, DM2, hyperlipidemia, R MCA CVA [**12-7**] and [**7-7**] who presents from rehab w/ 1 week of diarrhea, cdiff confirmed at rehab, did not improve on IV flagyl at rehab, presenting with Acute MS changes, seizure, Afib w/ RVR, found to have PNA, UTI, hypoxia with supratherapeutic INR. . #. MS changes- Unlikely Non-convulsive status epilepticus, but needs to be ruled out still. - EEG today to rule out epileptic focus and NCSE - Cont infection rx as below. - Monitor for clinica sz activity if worsens give ativan, otherwise avoid ativan. - If aggitated use haldol rather than ativan. . #. Hypoxia- Patient has large Aa gradient. This is likely due to pna. He is unlikely to have PE given supratherapeutic INR of 6.1 and his cxr shows b/l infiltrates c/w pna. Possible Asp PNA given stroke hx. -Cont Rx with Vanc and zosyn for PNA covergage given NH/rehab/hosp exposure. -discuss non-invasive vent w/ family. -DNI . #FEVER to 101.1 [**1-2**] -cont ABX -po liquid tylenol -pan culture . #. [**Name (NI) **] Resolved, Pt had SIRS like picture on admission. -Leukocytosis and bandemia -IVF to keep MAP > 65, UOp >25cc/hr -no central access or a-line per wife - IF respiratory status declines, could consider brief peripheral pressors to avoid fluid overload. . # cdif- Send repeat Cdiff eia. -Pt spiked through IV flagyl at rehab, -added PO Vanc starting [**1-2**] . #. UTI- UA positive for leuks, bacteria and nitrites. -[**12-31**] Ucx grew GNR -F/u sensi. -Cont Zosyn, narrow coverage as sensitivities return. . #. PNA- Patient could have nursing home associated pna and he has recently been hospitalized. Has bands on diff, consolidation on cxr and fever. -treat w/ vanc and zosyn -check sputum cx -urine legionella ag pending . #. [**Name (NI) 10271**] Pt has ATN like picture. FENA of 3.6% on [**1-1**]. -Cr improving from 3.2 to 2.5 -cont to follow urine lytes. -dose meds renally -hold lisinopril. . #. Stroke- Patient has known MCA [**12-7**] and [**7-7**] infarct and on CT head here he has evolution of infarct but no new stroke or bleed. -dilantin load and maitenance doses -check level in am -INR supratherapeutic, will hold coumadin -cont asa pr . #. Seizure- patient had seizure in ED likely related to high grade fever -cont dilantin 100mg TID, check daily levels -eeg today r/o NCSE -ativan for breaking any clinical seizures. . #. hyperlipidemia- hold statin as npo . #. HTN-hold anti-hypertensives as pt is hypotensive at this time . #. Afib w/ RVR. Difficult to control likely related to infection. Did not respond to lopressor. -Better response to dilt, -cont Dilt drip . #. Hypernatremia: -continue D5W and free water boluses. . #. Coagulopathy: INR 7.5, PTT 78 not on heparin, -5mg Vitamin K SQ -cont to monitor . #. DM- RISS, finger sticks qachs . #. FEN- IVF bolus to keep MAP > 65, replete lytes prn, Place dopoff, nutrition consult. . #. PPx- IV protonix, no need for subq heparin as last INR was 6 . #. Access: 2 PIV, family does not want central access . #. Communication: with wife: [**Name (NI) 2048**] [**Name (NI) 23203**], p# is (c) [**Telephone/Fax (1) 52033**], (h) [**Telephone/Fax (1) 52032**] . #. Code: DNR/DNI confirmed with wife . #. Dispo: ICU level of care for now . Medications on Admission: senna zocor 80 mg qd coumadin dulcolax daily zofran 4 mg prn oxycodone 5 mg q4 prn sorbitol 30 cc qd cardizem 30 mg q6 colace 100 mg [**Hospital1 **] pepcid 20 mg [**Hospital1 **] neurontin 300 mg tid sliding scale insulin lisinopril 5 mg qd combivent q4 prn tylenol prn asa 325 mg daily Discharge Medications: pt expired Discharge Disposition: Expired Discharge Diagnosis: pt expired Discharge Condition: pt expired Discharge Instructions: non-applicable Followup Instructions: non-applicable [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**] Completed by:[**2112-5-12**] ICD9 Codes: 0389, 486, 5990, 5849, 2724, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7185 }
Medical Text: Admission Date: [**2151-1-2**] Discharge Date: [**2151-1-9**] Date of Birth: [**2094-1-5**] Sex: F Service: MEDICINE Allergies: Penicillins / Codeine / Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 7202**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: cardiac catheterization with stent placement angiography of mesenteric and renal arteries esophagogastroduodenoscopy History of Present Illness: 54 yo F with CAD s/p 4 stents, +smoker, DM2, HTN, PVD, hypercholesterolemia, family history of premature CAD now with chest pain. She states she was sitting in her living room around 8 p.m. when she started to feel SOB. Went upstairs and sat on a stool and states began to have CP. CP described as stabbing in the middle to L chest, radiating to L arm and jaw. States she was feeling hot but no diaphoresis, n/v. +SOB. Took 3 NTG each 15 mins apart with no relief so called EMS. States the pain was similar to that she had when she had her previous MI's. EMS found her tachycardic and gave 6 Adenocard, 25mg cardizem, 1" nitropaste, and ASA. . At [**Hospital3 **] she arrived with a HR of 140 in Afib. BP was 195/106. Was given 25mg Cardizem. HR was still 140 and a diltiazem drip was started. She converted to NSR with HR in the 60's and the diltiazem drip was stopped. Nitropaste was removed. Trop was was 0.16 and ECG was concerning for ST elevations and pt was sent in helicopter to [**Hospital1 18**] for possible cath. . On arrival to [**Hospital1 18**] pt stated she was having some CP and was started on nitro gtt. CP went away, but nitro was titrated up to 90 mcg for high systolic BP's in the 180's-190's. HR in the 60's. She was given 25mg metoprolol po and 12.5mg captopril po. Stated she still had a small tingling sensation in her L jaw, and c/o headache, but otherwise was CP free. . She states she has been having CP with SOB at least 1-2 times per week for the last few weeks. States it comes on both at rest and when she is walking or doing other activities. States exerting herself does not bring on the CP. It usually resolves with 2 NTG's and is accompanied by SOB. States lately the episodes have been coming more often and seem to last longer. Past Medical History: -CAD s/p 4 stents at [**Hospital1 112**] --Cath [**2147-12-27**] at [**Hospital1 18**] showed LAD with diffuse disease, 70% focal stenosis mid segment. Stent placed to mid RCA. LVEF 45% with global hypokinesis. -HTN -DM2 -h/o renal artery stenosis s/p B stents -h/o PVD s/p stents in bilateral LE's -hypercholesterolemia -s/p partial hysterectomy -s/p cholecystectomy -Fatty liver -h/o ETOH abuse -obesity -cerebral aneurysm clipping [**8-22**] Social History: Lives with husband. [**Name (NI) **] 2 sons and one daughter. Is disabled s/p aneurysm clipping. Smokes 1 ppd. Drinks a beer "once in awhile", no h/o withdrawal sx's. Son is coming home from [**Country 2451**] today. Family History: Mother had DM and died of MI at age 59. Father died of throat and lung cancer age 61. Physical Exam: PE: 98.6 HR 72, BP 187/80, RR 16, O2sat 100% on 2L NC Gen: in nad. HEENT: PERRLA, EOMI, OP clear and moist. CV: RRR, +[**12-28**] HSM at LUSB. Lungs: CTAB Abd: +ttp of RUQ. +bs. No rebound or guarding. Ext: no c/c/e. Pulses: no palpable pulse R groin, L femoral very faint. PT 2+ bilaterlly, DP: 2+ L, 1+ R. Pertinent Results: [**2151-1-2**] 02:05AM WBC-13.2* RBC-4.27 HGB-12.6 HCT-36.0 MCV-84 MCH-29.5 MCHC-34.9 RDW-15.3 [**2151-1-2**] 02:05AM PLT COUNT-286 [**2151-1-2**] 02:05AM PT-12.0 PTT-22.7 INR(PT)-1.0 [**2151-1-2**] 02:05AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2151-1-2**] 02:05AM CK-MB-13* MB INDX-12.3* cTropnT-0.16* [**2151-1-2**] 02:05AM LIPASE-48 [**2151-1-2**] 02:05AM ALT(SGPT)-21 AST(SGOT)-33 CK(CPK)-106 AMYLASE-72 TOT BILI-0.2 [**2151-1-2**] 09:30AM CK-MB-48* MB INDX-15.6* cTropnT-0.60* [**2151-1-2**] 09:30AM CK(CPK)-308* [**2151-1-2**] 09:30AM GLUCOSE-178* UREA N-14 CREAT-1.3* SODIUM-137 POTASSIUM-4.4 CHLORIDE-105 TOTAL CO2-21* ANION GAP-15 . ECGs: at OSH: NSR at 66 nl axis, nl intervals, poor R wave progression. Q in III. 2mm ST elevation in III comp to prior. 1mm ST elevation V2-V3 present on old ECG. -at [**Hospital1 18**] 01:23 - NSR at 73, nl axis, nl intervals. TWI V6 old comp to prior. 1mm ST elevations V1-V3 old comp to prior from [**2147**]. Brief Hospital Course: . # CAD: She was diagnosed with a non-ST elevation MI and was started on IV heparin and loaded with clopidogrel. As she was asymptomatic at the time, the plan was made to stabilize her with antiplatelet agents and plan for catheterization on [**1-4**]. She had recurrent chest pain the next day and was started on integrilin, after which time she was chest pain-free. Her peak CK was 347, MB 49, and troponin T 1.68. She underwent cardiac catheterization on [**1-4**], with PCI to the an 80% stenotic lesion of the ostial RCA. She was continued on ASA 325, Plavix, lipitor 80, and beta blocker. She had no further chest pain. She was discharged to PCP follow up with establishment of Cardiology follow up. . # CHF: TTE on [**1-5**] with EF 50%, mild LVH, mildly dilated ascending aorta with no AI. She was volume overloaded on exam after her procedure and was diuresed with IV Lasix. She was maintained on a beta blocker, ACE-inhibitor, and oral Lasix. She was euvolemic on discharge. . # Atrial fibrillation: She has a history of paroxysmal atrial fibrillation with RVR at the outside hospital that converted with diltiazem. She had an episode of RVR in CCU, that was treated with diltiazem gtt, after which she converted to NSR. She was maintained on a beta blocker and was in sinus rhythm on discharge. She was not started on anticoagulation due to her recent GI bleed. . # HTN: She is not adherent to her medication regimen as an outpatient. Her hypertension was thought to be a likely trigger for her AF w/ RVR. She was severely hypertensive in the CCU to the 230s/100s. Her blood pressure was controlled in the CCU with labetalol and nifedipine gtt. She was hypertensive off the drips on the floor. Her severe renal artery stenosis was thought to be the main cause for her refractory hypertension. She was discharged on carvedilol, lisinopril, and furosemide. She was discharged to follow up with her PCP for further titration of her medications. . # GI bleed: She had melenic stools in the cath holding area on [**1-4**] while on aspirin, clopidogrel, IV heparin, and integrilin. She had patent celiac and mesenteric arteries on angiography, so ischemic bowel was thought to be unlikely. GI was consulted and performed an EGD that showed gastric erosions and duodenitis as the only sources of upper GI bleed. She was started on IV pantoprazole and carafate with close monitoring of her hematocrit. She required a total of 8U PRBC. Her hematocrit stabilized and her diet was advanced. She had no further episodes of melena during her stay. She was encouraged to have a colonoscopy as an outpatient as she has never had one before. . # RP bleed: She had severe hypertension during the [**1-4**] cardiac catheterization requiring nitroprusside. Her renal arteries were engaged during the cath, and she was found to have severe in-stent restenosis of her right renal artery, but attempts at intervention were unsuccessful. In the cath holding area, she became hypotensive and had a large melenic stool. She was taken back to the cath lab where she was found to have patent celiac and superior mesenteric arteries, but had bleeding from the right kidney which was stopped with balloon tamponade. No further chest pain. A CT abdomen was performed that showed a large perinephric hematoma extending into the retroperitoneum. Transplant Surgery was following. Surgical intervention was not indicated as she was hemodynamically stable. Repeat CT showed stable hematoma and her hematocrit stabilized. . # ARF: She has known RAS s/p stenting, and was thought to likely have some hypertensive nephropathy as well. Her baseline creatinine was unknown. Her creatinine was 1.5 on the day of cath, and her FENa was 0.9%, indicating a prerenal state. Angiography showed right renal artery in-stent restenosis. She likely had some hypoperfusion to the R kidney in setting of bleed. She also received a large dye load for aniography of coronaries, mesenterics, renals, and iliacs. Her left kidney appeared atrophic on imaging. Her creatinine increased to 1.6 and was then stable for several days. She was discharged on an ACE-inhibitor, with PCP follow up for further management. . # Glucose intolerance: She was hyperglycemic throughout her stay. She has no known diagnosis of diabetes. Her HgA1C was 6.7. She was maintained on an insulin sliding scale. . # Code status: FULL . Medications on Admission: Aspirin 325 daily States she last saw her PCP 2 months ago who recommends she take many other meds but she has not been able to afford them. Discharge Medications: 1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 7. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: Gentiva Discharge Diagnosis: Primary: Non-ST elevation MI Congestive heart failure, systolic GI bleed, source unknown Hypertension Renal artery stent restenosis Renal failure, likely acute on chronic Secondary: Peripheral vascular disease Primary: Non-ST elevation MI Congestive heart failure, systolic GI bleed, source unknown Hypertension Renal artery stent restenosis Renal failure, likely acute on chronic Secondary: Peripheral vascular disease Discharge Condition: good, hematocrit stable, chest pain free, BP fairly well-controlled, creatinine stable Discharge Instructions: It is very important that you take all of your medications as prescribed. . If you experience chest pain, shortness of breath, dizziness, bloody or black stools, or other concerning symptoms, please call your doctor or go to the ER. Followup Instructions: 1) Please call your PCP, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 24354**], to schedule a follow up appointment within the next week. You should have your hematocrit and renal function labs checked. Please discuss colonoscopy with Dr. [**First Name (STitle) **]. Completed by:[**2151-4-1**] ICD9 Codes: 5849
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Medical Text: Admission Date: [**2106-5-14**] Discharge Date: [**2106-5-18**] Date of Birth: [**2059-12-15**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1561**] Chief Complaint: several years of DOE and progressive SOB-treated for asthma. CT scan showed TBM- Y stent placed but had persistant cough. Major Surgical or Invasive Procedure: bronchoscopy tracheoplasty History of Present Illness: The patient is a delightful athletic young man who has a several year history of progressive dyspnea on exertion who has been found to have severe tracheobronchomalacia. He underwent extensive evaluation in the tracheobronchomalacia protocol, including respiratory questionnaires, 6-minute walk test, functional bronchoscopy, dynamic airway CT scan, pulmonary function tests and a stenting trial. He did well from the stenting trial with an excellent response. His flexible bronchoscopy and dynamic airway CT scan demonstrated severe tracheobronchomalacia. His pulmonary function tests demonstrated good lung capacity based on DLCO. We felt that he was, therefore, an excellent candidate for tracheobronchoplasty with mesh. Therefore, he was taken to the operating room for the following operation. Past Medical History: HTN, HA, GERD, bilateral inguinal hernia, bilateral carpal tunnel, appy, left foot neuroma Social History: lives w/ wife in [**Name (NI) 29586**] Family History: non-contributory Physical Exam: general: well appearing robust man w/ cc shortness of breath, cough. HEENT: unremarkable Chest: wheezes on expir R>L Cor: RRR S1, S2 Abd: round, soft, NT, ND, +BS Extrem: no C/C/E Neuro: A+OX3. No focal deficits. Pertinent Results: [**2106-5-14**] 04:27PM TYPE-ART PO2-102 PCO2-67* PH-7.24* TOTAL CO2-30 BASE XS-0 Brief Hospital Course: pt was admitted and taken to the OR [**5-14**]/for a tracheobroncheoplasty. OR course was uneventful. An epidural was placed for pain control. Extubated post op and tranferred to the CSRU for pulmonary/airway maintainance and monitoring. Pleural and subcutaneous chest tubes to sxn w/ serosang drainage. maintained on prophylactic vancomycin to protect mesh. POD#1 Bronchoscopy done for minimal secretions. POD#2 transferred out of ICU. [**Doctor Last Name 406**] drains placed to bulb sxn w/ minimal serosang drainage. POD#3 doing well. Epidural for pain control. [**Last Name (un) 1815**] reg diet. ambulating well on room air w/ sats >94%. POD#4 epidural d/c'd-[**Last Name (un) 1815**] po pain med. pleural [**Doctor Last Name **] d/c'd and subcutaneous [**First Name8 (NamePattern2) **] [**Doctor Last Name **] remained in place to bulb sxn. Pt taught how to empty [**Doctor Last Name **] drain and will call the office w/ drainage amounts. Pt d/c'd to nearby hotel on po levoflox x 2 weeks. He will return on wednesday [**5-26**] for a flex bronch and his drain will be d/c'd at that time. Medications on Admission: lisinopril 5, HCTZ 25, Lexapro 40, P.O. dilaudid . Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q2H (every 2 hours) as needed. Disp:*60 Tablet(s)* Refills:*0* 4. Escitalopram 10 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). Disp:*120 Tablet(s)* Refills:*2* 5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day for 2 weeks. Disp:*14 Tablet(s)* Refills:*0* 6. drain care please empty and record your bulb drainage and bring to your follow up appointment. Please call the office daily to report the drainage from the bulb [**Telephone/Fax (1) 170**] 7. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 8. medication change do not take your lisinopril while you are taking lopressor. Discharge Disposition: Home Discharge Diagnosis: TBM-tracheoplasty Discharge Condition: good Discharge Instructions: Call Dr.[**Name (NI) 1816**] office [**Telephone/Fax (1) 170**] if you develop fever, chills, chest pain shortness of breath or problems with the drain. DO NOT shower, swim or tub bath until your drain is removed. Followup Instructions: You have a follow up appointment on [**2106-5-26**] 9am for a bronchoscopy in interventional pulmonology [**Telephone/Fax (1) 3020**] with Dr. [**Last Name (STitle) 952**]. DO NOT EAT OR DRINK anything after midnight on tuesday [**2106-5-25**]. Completed by:[**2106-5-19**] ICD9 Codes: 4019
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Medical Text: Admission Date: [**2196-12-8**] Discharge Date: [**2196-12-14**] Service: MEDICINE Allergies: Codeine Attending:[**First Name3 (LF) 1711**] Chief Complaint: cardiac catherization complicated by femoral artery bleed Major Surgical or Invasive Procedure: cardiac catherization History of Present Illness: 89 yo female with history of severe CAD including CABG (SVG->OM, SVG->RCA, LIMA->LAD) followed by artherectomy for SVG total occlusion and recent cath ([**2196-11-21**]) for accelerating anigina resulting in stent to 95% ostial LMCA lesion who as transferred to [**Hospital1 18**] from [**Hospital **] hospital for recurrent chest burning times 2 days without ECG changes or +CE's. Decison made for repeat diagnostic catherization to assess patency of LMCA stent; wich showed patent stent however procedure complicated by commonn femoral artery aneursym and brisk retroperitoneal bleed. Pt was able to be succesfully [**Hospital 79818**] tamponade just proximal to the aneurysm. During which Pt recieved two units PRBC and started on dopamine gtt. Upon arrival to the CCU, Pt c/o left abd pain and nausea. Denies any chest discomfort or anginal equivalent. Past Medical History: 1) coronary artery disease 2) hypertension 3) dyslipidemia 4) hypothyroidism 5) dejenerative joint disease 6) h/o spinal stenosis - treated with epidural injections 7) COPD 8) hiatal hernia 9) s/p cholecystectomy [**02**]) chronic renal insufficiency (crn. baseline 1.8) Social History: Quit smoking 30yrs ago. No alcohol. Lives alone in senior houing. Ambulates with cane. Family History: mother - ca father - MI at age 60 Physical Exam: VS: 95.2, 69, 130/60 (MAP 80) on dopa 10 PE: Lying in bed, comfortable Anicteric, MMM, OP wnl supple, JVP not appreciable RRR, nl S1/S2, [**2-9**] SM anteriorly CTA-B obese, significant LLQ tendernes, ND, no rebound/guarding, Hypoactive BS stable left groin hematoma, FEM 2+ Ext without edema, warm and perfused, DP 1+ with R>L A&O Pertinent Results: [**2196-12-9**] 12:33AM BLOOD Hct-37.3 Plt Ct-219 [**2196-12-9**] 04:09AM BLOOD WBC-16.1*# RBC-3.62* Hgb-11.5* Hct-34.3* MCV-95 MCH-31.9 MCHC-33.7 RDW-14.2 Plt Ct-188 [**2196-12-9**] 09:30AM BLOOD Hct-26.2* [**2196-12-9**] 09:29PM BLOOD Hct-28.9* [**2196-12-10**] 06:00AM BLOOD WBC-7.5# RBC-3.17* Hgb-10.1* Hct-28.9* MCV-91 MCH-31.9 MCHC-34.9 RDW-15.5 Plt Ct-133* [**2196-12-10**] 12:48PM BLOOD Hct-34.0* [**2196-12-10**] 05:29PM BLOOD Hct-34.7* [**2196-12-11**] 05:30PM BLOOD WBC-8.3 RBC-3.59* Hgb-11.3* Hct-33.6* MCV-94 MCH-31.5 MCHC-33.6 RDW-14.8 Plt Ct-129* [**2196-12-9**] 12:33AM BLOOD Plt Ct-219 [**2196-12-10**] 06:00AM BLOOD Plt Ct-133* [**2196-12-11**] 06:50AM BLOOD Plt Ct-113* [**2196-12-11**] 05:30PM BLOOD Plt Ct-129* [**2196-12-9**] 04:09AM BLOOD Glucose-170* UreaN-29* Creat-1.2* Na-142 K-4.3 Cl-112* HCO3-24 AnGap-10 [**2196-12-10**] 06:00AM BLOOD Glucose-76 UreaN-26* Creat-1.2* Na-144 K-3.9 Cl-112* HCO3-25 AnGap-11 [**2196-12-11**] 06:50AM BLOOD Glucose-79 UreaN-23* Creat-1.1 Na-141 K-3.9 Cl-111* HCO3-26 AnGap-8 [**2196-12-9**] 04:09AM BLOOD CK(CPK)-190* [**2196-12-10**] 11:11PM BLOOD CK(CPK)-158* [**2196-12-9**] 04:09AM BLOOD CK-MB-4 cTropnT-<0.01 [**2196-12-10**] 11:11PM BLOOD CK-MB-2 cTropnT-<0.01 [**2196-12-9**] 04:09AM BLOOD Calcium-7.4* Phos-3.2 Mg-1.8 [**2196-12-10**] 06:00AM BLOOD Calcium-7.5* Phos-2.7 Mg-1.8 [**2196-12-11**] 06:50AM BLOOD Calcium-7.6* Phos-2.5* Mg-1.9 ECHO Conclusions: 1. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). Regional left ventricular wall motion is normal. 2. The aortic valve leaflets (3) are mildly thickened. 3. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 4. There is mild pulmonary artery systolic hypertension CCath Brief Hospital Course: 89 yo female with extensive CAD s/p CABG and TO SVG and recent 95% LM lesion stented. Pt with recurrent angina like symptoms, resulting in repeat diagnostic cath c/b FA bleed and aneurysm requiring multiple blood transfusions and pressors. 1) CAD: Pt with extensive CAD s/p CABG and recent LMCA stent who presented for repeat diagnostic catherization that showed patent stent but complicated by common femoral artery bleed. Given Pt's HD instability post-procedure, Pt was only continued on [**Last Name (LF) **], [**First Name3 (LF) **] and Plavix; while holding BB. After stabilization Pt was restarted on a BB. Pt will continue to be managed medically. [**Hospital **] medical regimen consisting of atenolol 12.5 mg qd (to be titrated up as outpatient as tolerated), [**Hospital **] 325 qd, Plavix 75 mg qd times 9 months, Simvastatin 10 mg qd. On transfer Pt recieving Cozaar 50 mg qd, which was held during hospital stay due to HD instability; it should be added back on as an outpatient when seen next week by PCP if Pt continues to be stable. 2) Vascular: As above, Pt's catherization complicated by CFA aneurysm and bleed. Initial external pressure unsuccesful in stopping the bleed. Attempt to asses artery from the other femoral artery unsuccessful given extensive artherosclerosis. However, with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 79818**] [**Last Name (un) **] from a the same FA was able to be advanced to the aneursym with succesful tamponade. CT confirmed significant retroperitoneal bleed. Pt did require 2 emergent units of PRBC and the initiation of dopamine gtt given hypotension. Pt aggresively hydrated overnight, with serial Hcts being stable. Hct then began to trend down requiring an additional 4 units of PRBC the following day. Hemodynamically Pt improved and was weaned off dopamine. Vascular surgery followed throughout and was integral in her management. Hct stabilized once again; not requiring further transfusions or exploratory surgery. 3) Pump: A p-MIBI earlier in the year with evidence of EF 72%. Pt without history of CHF or LV dysfunction. Pt hypovelemic secondary to RP bleed and was aggresively hydrated during initial hospital days. [**Last Name (un) **] held due to this instability and BB started at a lower dose. Out Pt cardiac regimen as above and weill be titrated to maximum effect as outpatient given Pt's ability to tolerate. 4) CRI: Pt with known CRI with a reported baseline Cr 1.8 prior to admission. Initial Cr 2.1 however remaining Cr ranged from 1.2 - 1.1. Pt managed with mucomyst prior to and proceeding catherization as well as receiving D5 with NaBicarb. No evidence of renal failure or insufficiency during hospital stay. Pt to be followed up as outpatient. Medications on Admission: [**Last Name (un) **] 81 Plavix 75 Cozaar 50 Indur 30 Zocor 30 Levoxyl 0.25 Iron Protonix 40 Procrit times one Discharge Medications: 1. Levothyroxine Sodium 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*6* 2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 9 months. Disp:*30 Tablet(s)* Refills:*6* 3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*6* 4. 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:*3* 5. Simvastatin 10 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). Disp:*90 Tablet(s)* Refills:*6* 6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*3* 7. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 9. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation Q12H (every 12 hours). 10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 11. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 12. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig: Thirty (30) ML PO QID (4 times a day) as needed for indigestion. 13. Simethicone 80 mg Tablet, Chewable Sig: 0.5-1 Tablet, Chewable PO QID (4 times a day) as needed for abdominal discomfort. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: CAD with patent LMA stent common femeral artery bleed Discharge Condition: good Discharge Instructions: please attend all follow up appointments as scheduled below. If you are unable to, please call and reschedule as soon as possible. call your PCP or return to ED if persistent fever greater than 101.4, chest discomfort typical of your angina, abrupt shortness of breath, persistent nausea and vomitting, inability to tolerate food or liquid, severe weight gain, severe leg or abdominal pain. Followup Instructions: please follow up with PCP, [**Name10 (NameIs) **] [**First Name8 (NamePattern2) 2048**] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 133**]) Friday [**2196-12-23**] at 3:00, if unable to make please call and rechedule. Please make a follow up appointment to be seen by a cardiologist of either Dr[**Initials (NamePattern4) 15012**] [**Last Name (NamePattern4) 7027**] or with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] who can be reached at [**Telephone/Fax (1) 5003**]. ICD9 Codes: 5849, 2765, 496, 2449, 4019
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Medical Text: Admission Date: [**2114-5-24**] Discharge Date: [**2114-6-6**] Date of Birth: [**2050-7-20**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 668**] Chief Complaint: hepatocellular carcinoma and two pulmonary nodules found on PET scan (FDG avidity in the right upper lobe nodule) To undergo resection with Dr [**First Name (STitle) **] and Dr [**Last Name (STitle) 77624**] Major Surgical or Invasive Procedure: [**2114-5-24**] Exploratory laparotomy, resection segment 4B, Flexible bronchoscopy, VATS right upper lobectomy, mediastinal lymph node dissection. [**2114-5-28**] cardiac catheterization with stenting of RCA History of Present Illness: Mr. [**Known lastname 77625**] was involved in a motor vehicle accident [**2-20**] and on a CT scan an incidental 3-cm lesion involving the left lobe of the segment 4B was found. He had further workup including a chest CT which demonstrated 2 small lung nodules. He was seen by thoracic surgery and underwent a flexible bronchoscopy with biopsy and cervical mediastinoscopy which was unremarkable. A PET scan showed + right upper lobe nodule. It was decided to proceed with right upper lung lobectomy and liver resection for removal of the lesion. Past Medical History: type 2 diabetes mellitus, history of alcohol abuse, duodenal ulcer Social History: 50-pack-year tobacco use, history of alcohol abuse. He works as a floor sander. Family History: Mother had myocardial infarction in her 70s. Father had myocardial infarction in his 70s and had an unknown type of cancer. Physical Exam: VS: 98.3, 105, 89/45, 8, 100% Gen: A+O, MAE Card: Reg rhythm, tachy Resp: CTA bilaterally Abd: Soft, non-tender, non-distended, + BS Extr: No edema Dressings C/D/I Pertinent Results: [**2114-5-24**] 06:34PM BLOOD WBC-19.0* RBC-3.17*# Hgb-9.8*# Hct-29.1*# MCV-92 MCH-31.1 MCHC-33.8 RDW-13.7 Plt Ct-348 [**2114-5-24**] 06:34PM BLOOD PT-14.4* PTT-34.6 INR(PT)-1.3* [**2114-5-24**] 06:34PM BLOOD Glucose-173* UreaN-29* Creat-0.9 Na-141 K-5.2* Cl-112* HCO3-21* AnGap-13 [**2114-5-24**] 06:34PM BLOOD ALT-67* AST-96* LD(LDH)-185 AlkPhos-61 Amylase-116* TotBili-0.6 [**2114-5-24**] 06:34PM BLOOD Albumin-3.2* Calcium-8.8 Phos-4.1 Mg-1.1* [**2114-5-27**] 10:05PM BLOOD CK-MB-8 cTropnT-0.16* [**2114-5-28**] 02:27AM BLOOD CK-MB-9 cTropnT-0.39* [**2114-5-28**] 10:05AM BLOOD CK-MB-33* MB Indx-10.0* cTropnT-1.12* [**2114-5-28**] 03:41PM BLOOD CK-MB-29* MB Indx-10.3* cTropnT-1.07* [**2114-5-28**] 09:47PM BLOOD CK-MB-14* MB Indx-7.9* cTropnT-1.01* [**2114-5-29**] 04:12AM BLOOD CK-MB-10 MB Indx-7.8* [**2114-5-29**] 04:12AM BLOOD cTropnT-0.93* Pathology: [**2114-5-24**] Lung, right upper lobe, lobectomy (G-P): a. Moderately differentiated adenocarcinoma; see synoptic report #1. b. Immunostains of the tumor cells are positive for cytokeratin 7 and TTF-1, and negative for cytokeratin 20 and HepPar1, with satisfactory controls. This immunophenotype supports a pulmonary origin. Gallbladder, cholecystectomy (Q): a. Mild chronic cholecystitis. b. No calculi present. Liver, segment 4A, resection (R-U): a. Hepatocellular carcinoma, well-differentiated; see synoptic report #2. b. Immunostains of the tumor cells are diffusely and strongly positive for HepPar1, with satisfactory controls, supporting the diagnosis Imaging: [**2114-5-24**] echo: The left atrium is normal in size. Overall left ventricular systolic function is normal (LVEF>55%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. There are complex (>4mm) atheroma in the descending thoracic aorta. The aortic valve leaflets appear structurally normal with good leaflet excursion. Trace aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. [**2114-5-28**] Cardiac cath: Selective coronary angiogrpahy in this right dominant system revealed one vessel coronary disease. The LMCA was free of angiographically apparent CAD. The LAD had minimal luminal irregularities. The LCX had a 30% proximal lesion. The RCA had a 99% mid vessel stenosis and an aneuysm of the ostium which was present at baseline. 2. Resting hemodynamics revealed nromal systemic blood pressure. 3. Successful stenting of a a heavily calcified mid RCA lesion with a 2.5 X 8 mm Driver and a 2.5 X 12 mm Vision bare metal stents (see PTCA comments for detail). [**2114-5-28**] echo: The left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses and cavity size are normal. There is mild to moderate regional left ventricular systolic dysfunction with basal to mid inferior akinesis and inferoseptal and inferolateral hypokinesis. Overall EF 40-45%. The estimated cardiac index is normal (>=2.5L/min/m2). The right ventricular cavity is mildly dilated There is abnormal systolic septal motion/position consistent with right ventricular pressure overload. 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. The estimated pulmonary artery systolic pressure is mildly elevated. There is no pericardial effusion. There is an anterior space which most likely represents a fat pad. IMPRESSION: Mild to moderate focal left ventricular dysfunction consistent with CAD. Mild right ventricular dilation with preservation of apical motion (base less well seen), mild pulmonary hypertension, and septal flattening. Cannot rule out pulmonary embolism. Compared with the prior study (images reviewed) of [**2114-4-4**], the focal wall motion abnormalities and right ventricular findings are new. \ Brief Hospital Course: Mr. [**Known lastname 77625**] was admitted to the hepatobiliary surgery service and was followed closely by the thoracic surgery service after his surgeries on [**5-24**]. For details of the surgeries, please refer to the operative notes. He was kept in the PACU for close monitoring post op. He had an epidural in place which was held due hypotension. He had 2 chest tubes in place as well as an abdominal JP drain. On POD 1 ([**5-25**]) his chest tubes were placed to water seal, the epidural was continued and he was stable for transfer to the floor. On POD 2 ([**5-26**]), he was doing well and his pain was well controlled with the epidural/PCA and chest tube #1 was removed and the 2nd chest tube was placed to bulb suction. On POD 3 ([**5-27**]) he was started on clear liquid diet. Overnight he had acute mental status changes with increased O2 requirements and respiratory distress. EKG showed new Afib and Lopressor was given with no change. ABG showed decreased PaO2. CXR demonstrated increased left lung opacity. He was transferred to the SICU for further management. He was intubated and diltiazem IV drip for afib was started. Cardiac enzymes revealed increased troponins with new ischemia on EKG. A Heparin drip and pressors were started. IV antibiotics were started for possible sepsis. Cardiology was consulted and he was taken emergently to the cath lab for a PTCA and stenting (bare metal)of RCA on the morning of POD 4 ([**5-28**]). He was started on aspirin, plavix and was maintained on integrelin x 18 hours post procedure. Lower extremity US which were negative for DVT and a bronchoscopy which was clear. He remained intubated on POD 5 ([**5-29**]). The epidural was d/c'd on POD 6 ([**5-30**]). Overnight he had a acute change in neurological exam where he was only moving his LUE to sternal rub and not moving his RUE and had R pupil > L pupil. Sedation (versed & propofol)was turned off. A stat head CT was done which showed no evidence of acute intracranial pathology. Two units of PRBC were transfused for a hct of 25.8. Neuro exam improved. He was slowly weaned off of pressors and given lasix for volume overload. CXR showed Asymmetrical interstitial edema affecting the left lung to a greater degree than the right. Nebs were given. A low dose propofol drip was used for agitation. He was weaned off the vent on [**6-2**]. On [**6-2**], he was transferred out of the SICU to the [**Hospital Ward Name 121**] 10 (med-[**Doctor First Name **] unit) where he continued to improve. The CT was d/c'd without incident. CXR on [**6-3**] showed persistent right-sided moderate-to-large pneumothorax, unchanged and left-sided effusion and left basilar atelectasis persisted. Breath sounds were diminished on the left. O2 was weaned off. He was assisted OOB. The foley was removed and diet was advanced. Vicodin was used for pain with break thru dilaudid. It was noted that he had periods of forgetfulness. PT declared him safe for discharge home as he was ambulatory and able to do stairs. On [**6-6**], the JP drain was removed. Vital signs and labs were stable. He was ambulatory and tolerating a regular diet. Follow up appointments with Drs. [**First Name (STitle) **] and [**Name5 (PTitle) 5795**] were made as well as with Dr. [**Last Name (STitle) **] (Oncology). A follow up appointment with Cardiology was to be made. Medications on Admission: metformin 1000mg [**Hospital1 **] Discharge Medications: 1. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*0* 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Aspirin, Buffered 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 5. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4-6H () as needed. Disp:*40 Tablet(s)* Refills:*0* 6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 7. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 8. Outpatient Physical Therapy Cardiac rehab post MI (STEMI) Discharge Disposition: Home Discharge Diagnosis: Hepatoma Right upper lobe carcinoma s/p STEMI with RCA stent placement [**2114-5-28**] Discharge Condition: Stable/good Discharge Instructions: Please call Dr[**Name (NI) 670**] office at [**Telephone/Fax (1) 673**] if you have fevers > 101, chills, nausea, vomiting, diarrhea, yellowing of skin or eyes, shortness of breath, chest pain,inability to eat or take medications. Monitor incision for redness, drainage or bleeding No heavy lifting. No driving or alcohol while taking pain medication Followup Instructions: -Follow up with Oncology, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]/Dr. [**Last Name (STitle) **] on Tuesday, [**6-12**] at 3pm, [**Hospital Ward Name 23**] building, [**Location (un) **], phone [**Telephone/Fax (1) 77626**]. -CXR at [**Hospital1 18**] [**Hospital Ward Name 23**] Building [**Location (un) **] [**2114-6-21**] at 3:30 then go to -[**Location (un) **] for follow up with Dr. [**Last Name (STitle) 11482**] [**Name (STitle) 77627**] (Thoracic)at 4pm 5/8([**Telephone/Fax (1) 1504**] Follow up with Cardiology Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] . Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2114-6-14**] 1:10 Completed by:[**2114-6-6**] ICD9 Codes: 9971
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Medical Text: Admission Date: [**2193-10-17**] Discharge Date: [**2193-10-21**] Date of Birth: [**2117-4-27**] Sex: M Service: MEDICINE Allergies: Heparin Agents Attending:[**First Name3 (LF) 2167**] Chief Complaint: GI Bleed, Syncope Major Surgical or Invasive Procedure: Push Enteroscopy ([**2193-10-18**]) Impression: - Mucosa suggestive of Barrett's esophagus - Clotted blood in the stomach body - Erythema and congestion in antrum suggestive of mild gastritis - 1.5cm cratered ulcer in duodenal bulb with visible vessel. 5cc of 1:10,000 epinephrine, heater probe and one endoclip applied with successful hemostasis. History of Present Illness: This is a 76 year-old male with a history of metastatic small cell lung cancer, ESRD on PD who is being transferred to [**Hospital1 18**] for push enteroscopy after presenting to [**Hospital6 **] with black stool, syncope, and hypotension. . He reports that on [**10-12**], he had his first episode of large dark black loose bowel movement. He had had a normal brown BM the day prior and denies any h/o BRBPR or GIB previously. He had no abdominal pain nor nausea/vomiting prior to the event. Shortly thereafter, he experienced LOC although the events surrounding this are not entirely clear. He is not sure exactly what he was doing and does not recall fall from what distance. He denies hitting his head, but did scrape his right anterior calf. He presented at that time to [**Hospital6 **] where he underwent EGD which reportedly showed candidal esophagitis and a nonbleeding duodenal ulcer. He received 2U prbcs and hct stabilized thereafter. He was discharged home on [**10-14**] on protonix and fluconazole and nystatin. . He is unsure if his BMs upon discharge revealed any blood or black expect for he again noted a large black loose BM on [**10-16**]. He again had a syncopal event upon rising thereafter and presented again to [**Hospital6 33**]. There he was found to be tachy to low 100s with SBPs in the 70s-80s. He was reportedly fluid resuscitated with crystalloid and received a total of 3 units prbcs with resolution of his tachycardia and improvement in BPs. Repeat EGD demonstrated duodenitis but again no clear evidence of active bleed. He was prepped for colonoscopy at [**Hospital3 **] (clear output [**Name8 (MD) **] RN signout). He is now being transferred to [**Hospital1 18**] for push enteroscopy and colonoscopy. Hct was 27 on presentation (was 34 on most recent discharge) and prior to transfer was 28.7 after 3U prbcs. Past Medical History: -Metastatic small cell lung cancer s/p chemotherapy (no rx since [**11-8**]) -ESRD on PD since [**6-9**] -DVT and PE [**11-8**] s/p IVC filter (never on coumadin) -"Suspected HIT in past" per [**Hospital3 **] d/c summary (unclear hx) -BPH -s/p ventral hernia repair -Anemia -Chronic LE edema Social History: Widowed. Lives alone at home. Has two sons both of whom live locally and are involved in his life and health care. Son [**Name (NI) **] is HCP. 60+ packyear history of smoking cigarettes prior to diagnosis of lung cancer. Occasional EtOH, perhaps [**2-3**] drinks/week. Family History: Noncontributory Physical Exam: GEN: Elderly gentleman in NAD. HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, dry MM. NECK: No JVD, carotid pulses brisk, no cervical lymphadenopathy, trachea midline COR: RRR, soft systolic murmur heard best at apex. PULM: course BS bilaterally and diffusely rhonchorus, no wheezing. CHEST: Right sided tunnelled HD line site CDI. ABD: PD site right lower abdomen CDI. Distended, but soft, +BS. NTTP. EXT: 3+ b/l LE pitting edema (L very sl. greater than right) NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Strength and sensation to soft touch grossly intact. SKIN: No jaundice, cyanosis, or gross dermatitis. Confluent ecchymoses bilateral forearms. Pertinent Results: [**2193-10-17**] 07:21PM BLOOD WBC-9.0 RBC-2.91* Hgb-9.4* Hct-25.8* MCV-88 MCH-32.4* MCHC-36.7* RDW-16.8* Plt Ct-88* [**2193-10-17**] 07:21PM BLOOD PT-11.5 PTT-22.0 INR(PT)-1.0 [**2193-10-17**] 07:21PM BLOOD Glucose-131* UreaN-42* Creat-1.6* Na-146* K-3.0* Cl-110* HCO3-27 AnGap-12 [**2193-10-17**] 07:21PM BLOOD Albumin-3.0* Calcium-8.0* Phos-1.7* Mg-1.8 . Push enteroscopy A single acute cratered 1.5cm ulcer was found in the first part of the duodenum. A visible vessel suggested recent bleeding. 5 cc.epinephrine 1/[**Numeric Identifier 961**] was injected into the ulcer base and heater probe applied for hemostasis with success to the ulcer in the duodenal bulb.One endoclip was successfully applied to the duodenal bulb ulcer for the purpose of hemostasis. Impression: Mucosa suggestive of Barrett's esophagus Clotted blood in the stomach body Erythema and congestion in antrum suggestive of mild gastritis 1.5cm cratered ulcer in duodenal bulb with visible vessel. 5cc of 1:10,000 epinephrine, heater probe and one endoclip applied with successful hemostasis. Recommendations: Continue IV PPI drip Follow serial Hct, Continue NPO Check H. pylori serology and treat if positive Brief Hospital Course: 76 year-old male with a history of metastatic small cell lung cancer who presented to OSH with syncope and black stool x 2 without clear source of bleed on EGD at the OSH. # Upper GI bleed from bleeding duodenal ulcer: Initial EGD at an OSH showed a nonbleeding duodenal ulcer with repeat scope showing duodenitis without evidence of ulceration. GI bleed considered likely to be from small bowel AVM vs. ulceration distal to segments scoped. Right sided colonic source was also considered a possibility. Thus, patient was transferred to [**Hospital1 18**] for push enteroscopy and colonoscopy for further work up. Push enteroscopy revealed a 1.5cm cratered ulcer in duodenal bulb with visible vessel. 5cc of 1:10,000 epinephrine, heater probe and one endoclip applied with successful hemostasis. H/H has been stable, along with sx. He was continued on IV protonix for completion of 72h and then switched to po pantoprazole. His H. pylori serologies were pending at time of discharge, but are now negative. He will not need treatment. His hematocrit remained stable. His diet was advanced to regular and he tolerated this well. . # Anemia, Chronic anemia from chronic disease, and acute anemia due to acute blood loss. Patient required 2 units of PRBC during his [**Date range (1) **] admission and then an additional 3 units since [**10-16**] (recieved at OSH prior to tx here). On admission, HCT=25.8 which increased to 30.4 after the endoscopy. This remained stable for the duration of his hospital stay. . # Candidal esophagitis: Reportedly, the initial EGD at [**Hospital **] indicated candidal esophagitis, with initiation of fluconazole and nystatin. Repeat EGD a few days later did not state presence of candidal esophagitis. Enteroscopy performed at [**Hospital1 18**] also did see this finding. Fluconazole and nystatin were discontinued after 4 days of treatment. Patient has denied dysphagia or odynophagia. . # ESRD on PD: Per records - seems pt with bx [**6-9**] - chronic AIN with signs ATN - overall more consistant with possible FSGS - Patient continues to recieve PD per home regimen here. Phosphate was low on admission with daily increase to near normal levels. He was continued on peritoneal dialysis. . # Lower extremity edema. He was given one dose of Lasix for his lower extremity edema with some improvement in his symptoms, but with rise in creatinine. He was given a prescription for Lasix but should discuss use of this medication with his PCP and nephrologist. This was communicated to the patient. . # Small cell lung cancer: Metastatic and not currently undergoing any therapy. Followed by Dr. [**Last Name (STitle) 58562**]. Plan to f/u as outpt. . # BPH: Patient is oliguric, taking flomax, which was held initially for concerns of hypotension. This medication was restarted. His Foley was removed, and he voided without problems. . # h/o DVT/PE/thrombocytopenia: s/p IVC filter. With history of HIT and GI bleed, prophylaxis with pneumoboots. . He remained DNR/DNI throughout his hospital stay. He was discharged to home with services. Medications on Admission: PhosLo Flomax Renagel Colace Dialyvite Protonix Fluconazole Nystatin suspension Ambien CR prn Discharge Medications: 1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 2. Protonix 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* 3. Ambien CR 12.5 mg Tablet, Multiphasic Release Sig: One (1) Tablet, Multiphasic Release PO at bedtime as needed for insomnia. 4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. 5. Renagel Oral 6. PhosLo 667 mg Capsule Sig: One (1) Capsule PO three times a day. 7. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day: Please discuss use of Lasix with your nephrologist before starting this medication. . Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: 1. Upper GI bleed from duodenal ulceration 2. Acute blood loss anemia 3. ESRD on peritoneal dialysis 4. DVT s/p IVC filter placement 5. Peripheral edema. Discharge Condition: Stable Discharge Instructions: You were admitted with GI bleeding. Your blood count was stable after leaving the ICU. If you develop fevers, chills, nausea, vomiting, or shortnes of breath, please call your primary care doctor or go to the emergency room. Followup Instructions: Please follow up with your primary care doctor in [**1-2**] weeks. Your H. pylori serology is still pending, and your PCP will be [**Name (NI) 653**] with the result when it returns. An appointment was made for you with Dr. [**Last Name (STitle) **]. The appointment is on Friday [**11-1**] at 11:30am in the [**Location (un) 8072**] office. ICD9 Codes: 5856, 2851
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Medical Text: Admission Date: [**2168-7-19**] Discharge Date: [**2168-7-21**] Date of Birth: [**2110-10-9**] Sex: F Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 7333**] Chief Complaint: Syncope. Major Surgical or Invasive Procedure: Cardiac catheterization ICD placement ([**Hospital3 **]) History of Present Illness: Patient is a 57 y/o Mandarin only woman with no significant PMHx who presents as a transfer from [**Hospital3 **] Hospital for ventricular tachycardia with prolonged QT after presenting there originally for syncope. The patient was in her usual state of health until yesterday morning when she woke up and a general sensation of malaise, before getting on a bus tour from [**Location (un) 7349**] to [**Hospital3 **] that left yesterday morning. After exiting the bus in [**Hospital3 **], she walked to her hotel and had a witnessed syncopal event where she fell forward and hit her head on a glass door. She was incontinent of urine, and regained conciousness after 2-3 minutes per the husband. There were no tonic-clonic movements witnessed. She does describe some palpitations and light-headedness prior to syncopizing. She denies recent chest pain, shortness of breath, fevers, chills, N/V/D, illnesses. She denies any past history of syncope. At [**Hospital3 **] Hospital, she ws found to have brief runs of NSVT, then had a run of 15 seconds that broke spontaneously. An EKG there revealed AV conduction delay, RBBB, inferior Q waves and a prolonged QT (~750msec). She was loaded with amiodarone 150mg IV, then started on a drip at 1mg/min gtt. She also got magnesium 2gm IV. Labs were notable for a K of 4.3, Mg 2.4, CK 281, MB 1.7, Trop neg, and negative Head CT She was transferred to [**Hospital1 18**] for further management. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema. Past Medical History: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: possible myocarditis at 6 or 7 years old 3. OTHER PAST MEDICAL HISTORY: Osteoarthritis of left knee Unknown thyroid surgery approximately 20 years ago Social History: Lives in [**Location 7349**] with husband, originally from [**Name (NI) 651**] and works in nail salon -Tobacco history: denies -ETOH: denies -Illicit drugs: denies Family History: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Father passed at age 84 from old age. Mother died at 80 from emphysema. No family history of sudden death, syncope. Physical Exam: GENERAL: WDWN female in NAD. Responds appropriately to questions. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Horizontal scar anterior neck at cricoid cartilage. NECK: Supple with JVP of 2 cm. No carotid bruits, no LAD. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. 2/6 systolic murmur heard best at lower sternal border. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, on anterior exam ABDOMEN: Soft, NTND. No HSM or tenderness. + bowel sounds EXTREMITIES: No c/c/e. No femoral bruits. 2+ DP/PT pulses. Right groin site c/d/i, no tenderness, no hematoma/bruising. Pertinent Results: Labs: [**2168-7-19**] 06:25PM GLUCOSE-148* UREA N-10 CREAT-0.8 SODIUM-138 POTASSIUM-4.4 CHLORIDE-104 TOTAL CO2-26 ANION GAP-12 [**2168-7-19**] 06:25PM ALT(SGPT)-70* AST(SGOT)-48* LD(LDH)-224 ALK PHOS-63 TOT BILI-0.7 [**2168-7-19**] 06:25PM ALBUMIN-4.4 CALCIUM-8.4 PHOSPHATE-3.8 MAGNESIUM-2.8* [**2168-7-19**] 06:25PM TSH-0.82 [**2168-7-19**] 06:25PM T4-6.1 [**2168-7-19**] 06:25PM WBC-11.2* RBC-4.53 HGB-13.3 HCT-38.6 MCV-85 MCH-29.3 MCHC-34.4 RDW-13.9 [**2168-7-19**] 06:25PM PLT COUNT-213 [**2168-7-19**] 06:25PM PT-12.3 PTT-24.6 INR(PT)-1.0 . TTE: The left atrium is elongated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Doppler parameters are most consistent with Grade I (mild) left ventricular diastolic dysfunction. There is no left ventricular outflow obstruction at rest or with Valsalva. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: No structural cardiac cause of syncope identified. Preserved global and regional biventricular systolic function. No significant valvular abnormality seen. No resting or inducible outflow tract obstruction. . Cardiac Cath: 1. Selective coronary angiography in this right dominant system demonstrated no angiographically apparent flow-limiting disease. The LMCA was patent. The LAD had 25% proximal stenosis and luminal irregularities to 20% in the mid-segment. There was a large D1 and the distal LAD wrapped around the apex. In the LAD there was slow flow consistent with microvascular dysfunction. The LCx had a proximal 20% stenosis. It supplied a modest very high OM1 and a larger OM2, as well as a large OM3/LPL and an OM4/LPL2. The was slightly slow pulsatile flow consistent with microvascular dysfunction. The RCA had minimal luminal irregularities to 15% Ther were multiple RPDAs and the mid-distal septum was supplied by a large AM. Again, there was slightly slow pulsatile flow consistent with microvascular dysfunction. 2. Limited resting hemodynamics revealed mild-moderate left ventricular diastolic dysfunction was an LVEDP of 19 mmHg. There was moderate systemic systolic arterial hypertension with an SBP of 162 mmHg. 3. Left ventriculography revealed a calculated LVED of 55-65% with mild global hypokinesis, worse in the anterobasal segment. There was 2+ mitral regurgitation. FINAL DIAGNOSIS: 1. No angiographically apparent flow-limiting coronary artery disease; however, there was atherosclerosis and diffuse slow flow consistent with microvascular dysfunction. 2. Mild to moderate left ventricular diastolic dysfunction. 3. Moderate systemic systolic arterial hypertension. 4. Mild global hypokinesis with calculated LVEF of 55-65% Brief Hospital Course: 57 year old female with no sig PMHx who presents as transfer from [**Hospital3 **] Hospital with syncope found to have ventricular tachycardia. s/p Cardiac cath at [**Hospital1 18**]. . # RHYTHM: Patient with no PMHx who had sudden LOC with rapid spontaneous return of conciousness with no intervention. Has long QT on EKG (750 ms) as well as sinus bradycardia. At OSH had sinus bradycardia, then PVC and started with Torsades De Pointes (TDT). She received magnesium and 150 mg IV amiodarone. The Diff dx considered included ischemic CAD, structural disease, electrical abnormalities with long QT sydromes, hypothyroidism. Had cath with patent coronary arteries. She was on no medications. Her thyroid function test were within normal range. Her echo did not show structural abnormalities. Amiodarone was stopped initially was started on metoprolol 25 mg TID (to decrease chances of PVCs on TW and Torsades). She also was started on spironolactone to raise her potassium. She had no more episodes on telemetry and underwent PPM/ICD Placement without complications ([**Hospital3 **]). She was discharged home with PCP and cardiology follow up in [**Location (un) 7349**]. . # CORONARIES: s/p cardiac cath today with clean coronaries as per the report in the previous section on Pertinent Results. Has Q waves in II, III, aVF, V4-V6 cannot rule out prior inferior/lateral MI. Her CE were negative. . # PUMP: No known history of heart failure. Clinically not in heart failure, no crackles, no lower extremity edema, no elevated JVD. Normal echocardiogram. . # Elevated liver enzymes - Patient had elevated liver enzymes at OSH. Had hepatitis panel drawn and were pending last time we checked. Will need to follow up Hepatitis panel from [**Hospital3 **] Hospital - [**Telephone/Fax (1) 29170**]. Her AST 70, ALT 48, AP 63, TB 0.7. . # Thyroid Surgery - Unknown what surgery was for. Patient not on thyriod replacement. Euthyroid. Medications on Admission: unknown painkiller for her osteoarthritis - has not taken for greater than 1 week Denies OTC, herbal, prescription meds Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain for 5 days. Disp:*20 Tablet(s)* Refills:*0* 2. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* 4. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 2 days. Disp:*8 Capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Ventricular tachycardia Syncope Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Ms. [**Known lastname 86964**], It was a pleasure to take care of you at [**Hospital1 **] Hospital in [**Location (un) 86**]. You were admitted to [**Hospital3 **] Hospital after fainting and found to have an irregular heart beat and given medication to help your heart return to normal rhythm. You were transferred to [**Hospital1 18**] for further management of this [**Last Name **] problem. At [**Hospital1 18**] you underwent a study to evaluate the vessels of your heart called a cardiac catheterization procedure. It showed that you did not have a recent heart attack and that your blood vessels on your heart are not the reason for your fainting spell. You were taken for placement of an ICD device which will prevent your heart from entering that arrhythmia that caused you to faint. This will need to be followed by a cardiologist in NY where you live. The wound will need to be evaluated by your PCP/Dr. [**First Name (STitle) **] next week at your appointment scheduled below. . The following changes have been made to your medications: * You were started on a medication called spironolactone to increase your potassium and keep it in the high side to prevent your arrhytmia. You will need to take one tab (25 mg ) twice a day. * You will need to take a beta-blocker to prevent your arrhythmia. It is called Toprol-XL 50 mg daily. * We will give you a medication for pain control. Your pain should imrpove within a few days ([**4-1**]) * Given your recent procedure you will need antibiotics for 2 days: Cephalexin 500 mg Capsule You cannot lift anything heavier than 10 pounds or lift your arm above your shoulder given yoru recent ICD placement. Followup Instructions: Dr. [**First Name8 (NamePattern2) 803**] [**Last Name (NamePattern1) **] [**2168-7-27**] Wednesday at 3:00pm for wound check. You will also need a cardiologist and/or electrophysiologist. Completed by:[**2168-7-21**] ICD9 Codes: 4271, 2449
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Medical Text: Admission Date: [**2192-11-3**] Discharge Date: [**2192-11-12**] Date of Birth: [**2115-3-20**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1406**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2192-11-5**] Coronary Artery Bypass Graft x 5 History of Present Illness: This 77 year old man was transferred from [**Hospital3 417**] for management of three vessel disease requiring CT Surgery evaluation. He presented there with recurrent chest pain starting at 22:00 on the date of admission while lying in bed, lasting 1 hour before calling EMS. + SOB. He had transient chest pain the night prior. He denies any DOE, PND, orthopnea, palpitations, ankle edema, dizziness that he recalls. He feels like he may fatigue more easily with exertion lately. En route, the monitor showed ST elevations in inferior wall with reciprocal changes in lateral leads. He was given ASA, sl Nitro x2, with positive EKG changes and resolution of CP. In the ED, vitals were 98.2F, H76, R16, 138/78, 98%Patient taken emergently to cath lab. He received ASA, 600mg Plavix load, 80mg lipitor and a 4000 U IV Heparin bolus. An intra aortic balloon was placed and he was painfree. Past Medical History: Hypertension Benign prostatic hypertrophy Social History: lives with his wife. Is generally very active. Feels like he can walk 1 mile and no trouble with flight of stairs at home. -Tobacco history: 50 year smoking hx, up to 2 packs per day -ETOH: ~6 beers a day -Illicit drugs: none Family History: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death. Mother had cancer. Physical Exam: PHYSICAL EXAMINATION on Admission: VS: T=afebrile BP= 152/73 HR=70 RR= - O2 sat=100% GENERAL: NAD, denies chest pain. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. Left eye was 3.5 mm and R eye was 2mm (could not fully eval b/c of light brightness), EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. No carotid bruits noted NECK: Supple with JVP at jaw when lying flat. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, sound of balloon pump, otherwise no m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. Exam limited to anterior b/c pt need to lie flat given balloon pump ABDOMEN: Soft, NTND. No HSM or tenderness. Can hear pumping of IABP. EXTREMITIES: No LE edema, pulses present but feet cool. No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: CN II-XII grossly intact. Oriented A&O x3, able to relate history PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ Pertinent Results: Pre-op labs: [**2192-11-3**] 03:03AM BLOOD WBC-5.9 RBC-4.31* Hgb-13.6* Hct-39.7* MCV-92 MCH-31.7 MCHC-34.4 RDW-13.4 Plt Ct-217 [**2192-11-3**] 03:03AM BLOOD Glucose-103* UreaN-15 Creat-0.7 Na-137 K-4.1 Cl-101 HCO3-26 AnGap-14 [**2192-11-3**] 03:03AM BLOOD ALT-22 AST-26 LD(LDH)-166 CK(CPK)-222 AlkPhos-55 TotBili-0.3 [**2192-11-3**] 02:03PM BLOOD CK-MB-2 cTropnT-0.05* [**2192-11-3**] 03:03AM BLOOD %HbA1c-5.5 eAG-111 [**2192-11-3**] 03:03AM PT-12.5 PTT-31.8 INR(PT)-1.1 [**2192-11-3**] 11:03AM CK-MB-3 cTropnT-0.04* [**2192-11-3**] 02:02PM URINE RBC->50 WBC-0-2 BACTERIA-OCC YEAST-NONE EPI-0-2 [**2192-11-3**] 02:02PM URINE BLOOD-LG NITRITE-NEG PROTEIN->300 GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-6.0 LEUK-NEG Post-op labs: [**2192-11-12**] 04:50AM BLOOD WBC-9.5 RBC-2.80* Hgb-8.4* Hct-24.8* MCV-89 MCH-29.9 MCHC-33.7 RDW-14.2 Plt Ct-486* [**2192-11-12**] 04:50AM BLOOD Plt Ct-486* [**2192-11-5**] 01:59PM BLOOD PT-13.7* PTT-27.0 INR(PT)-1.2* [**2192-11-12**] 04:50AM BLOOD Glucose-104* UreaN-11 Creat-0.7 Na-133 K-3.7 Cl-99 HCO3-27 AnGap-11 [**2192-11-12**] 04:50AM BLOOD ALT-31 AST-23 AlkPhos-49 Amylase-165* TotBili-0.5 [**2192-11-11**] 07:30AM BLOOD ALT-34 AST-32 AlkPhos-48 Amylase-200* TotBili-0.5 [**2192-11-12**] 04:50AM BLOOD Lipase-269* [**2192-11-11**] 07:30AM BLOOD Lipase-339* [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: 3.8 cm <= 4.0 cm Left Atrium - Four Chamber Length: 4.0 cm <= 5.2 cm Right Atrium - Four Chamber Length: 3.8 cm <= 5.0 cm Left Ventricle - Septal Wall Thickness: 1.1 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: 1.1 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 5.6 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 50% to 55% >= 55% Left Ventricle - Stroke Volume: 91 ml/beat Left Ventricle - Cardiac Output: 7.21 L/min Left Ventricle - Cardiac Index: 3.66 >= 2.0 L/min/M2 Left Ventricle - Lateral Peak E': 0.12 m/s > 0.08 m/s Left Ventricle - Septal Peak E': *0.07 m/s > 0.08 m/s Left Ventricle - Ratio E/E': 7 < 15 Aorta - Sinus Level: *3.7 cm <= 3.6 cm Aorta - Ascending: 2.6 cm <= 3.4 cm Aorta - Arch: 2.6 cm <= 3.0 cm Aortic Valve - Peak Velocity: 1.2 m/sec <= 2.0 m/sec Aortic Valve - LVOT VTI: 24 Aortic Valve - LVOT diam: 2.2 cm Mitral Valve - E Wave: 0.7 m/sec Mitral Valve - A Wave: 1.1 m/sec Mitral Valve - E/A ratio: 0.64 Mitral Valve - E Wave deceleration time: 202 ms 140-250 ms TR Gradient (+ RA = PASP): 18 to 21 mm Hg <= 25 mm Hg Findings LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Normal LV wall thickness and cavity size. Mild regional LV systolic dysfunction. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Mildly dilated aortic sinus. Normal ascending aorta diameter. Normal aortic arch diameter. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. Trace AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. Mild thickening of mitral valve chordae. Calcified tips of papillary muscles. Trivial MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. Normal PA systolic pressure. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized. No PS. Physiologic PR. PERICARDIUM: No pericardial effusion. REGIONAL LEFT VENTRICULAR WALL MOTION: Conclusions The left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. There is mild regional left ventricular systolic dysfunction with basal inferior hypokinesis. The remaining segments contract normally (LVEF = 50-55%). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. 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. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: Mild regional left ventricular systolic dysfunction, c/w CAD. No surgically-significant valvular or proximal aortic disease. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2192-11-3**] 12:10 Radiology Report CHEST (PA & LAT) Study Date of [**2192-11-11**] 4:14 PM CHEST (PA & LAT) Clip # [**Clip Number (Radiology) 87668**] Reason: evaluate effusions/atx Final Report Two views of the chest demonstrate marked cardiomegaly. Status post CABG. Left lower lobe atelectasis, small left pleural effusion. Essentially no change since prior study. Upper lung zones are clear. DR. [**First Name11 (Name Pattern1) 3993**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3994**] [**Hospital 93**] MEDICAL CONDITION: 77 yo man with ileus and dilated cecum REASON FOR THIS EXAMINATION: change air fluid levels and cecum diameter. Final Report: Two views of the abdomen demonstrate multiple radiopaque densities in the mid abdomen likely representing pills. Since the prior study, there has been interval decompression of the cecum. On the prior study, it measured 12 cm. Currently it measures approximately 8.1 cm. There are multiple dilated small bowel segments and air is seen throughout the transverse colon and in the rectum. These findings likely represent the sequela of postoperative ileus. DR. [**First Name11 (Name Pattern1) 3993**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3994**] = = = = = = = = = = = = = = = = = = = = =======================================================Radiology Report ABDOMEN (SUPINE & ERECT) [**2192-11-8**] 10:11 PM Clip # [**Clip Number (Radiology) 87669**] Reason: s/p CABG w/abdominal distention r/o ileus/obstruction Final Report ABDOMINAL RADIOGRAPH, SUPINE UPRIGHT VIEWS: There are multiple loops of dilated large and small bowel seen overlying the mid abdomen. A single loop of small bowel in the left lower quadrant measures 3.5 cm which is above the normal limit. There is diffuse dilatation of the cecum which measures approximately 11 cm. No free air is seen in upright film to suggest perforation. These findings are concerning for postoperative ileus. Sternotomy wires are visualized overlying the midline thoracic vertebral bodies and degenerative changes of the lumbar spine are evident. IMPRESSION: Diffusely dilated loops of small bowel and colon. Significantly dilated cecum measuring approximately 11 cm in largest diameter. No free air to suggest perforation. These findings are concerning for postoperative ileus. The study and the report were reviewed by the staff radiologist. DR. [**First Name8 (NamePattern2) **] [**Name (STitle) **] SENAPATI Brief Hospital Course: On transfer to [**Hospital1 18**] he was stable with an intra-aortic balloon pump in place. Cardiothoracic surgery was consulted and saw him for evaluation for revascularization. He had received a Plavix loading dose of 300mg during catheterization so surgery was delayed until Monday [**2192-11-5**] while Plavix washed out. While awaiting surgery overnight on [**9-19**] he had a moderate hematoma and bleeding from the balloon pump site but the hematocrit remained stable at 36. He also had hematuria with Foley insertion which was likely related to minor trauma with placement given his known prostatic hypertrophy. Urojet lidocaine was used to improve his comfort level. Urology follow-up is recommended after pt is discharged. He went to the Operating Room on [**11-5**] where revascularization was performed, please see operativer ereport for details in summary he had: coronary artery bypass grafting x5 with the left internal mammary artery to the left anterior descending artery and reverse saphenous vein grafts to the posterior descending artery, the obtuse marginal artery, and saphenous vein Y-graft to the ramus intermedius artery and the diagonal artery. His bypass time was 104 minutes, with a CROSSCLAMP TIME of 83 minutes. He tolerated the operation well, weaned from bypass on Propofol and Neo Synephrine. He remained stable and the balloon pump was removed after the operation in the CVICU. He was weaned from the ventilator and and pressors. He was begun on beta blockers and diuresed towards his preoperative weight. The chest tubes and pacing wires were removed per cardiac surgery protocols. Physical Therapy was consulted for strength and mobility. He experienced atrial fibrillation which converted to sinus rhythm after treatment with amiodarone and lopressor. His oral lopressor was increased. He did develop a post-operative ileus. General surgery was consulted. NG tube was inserted and the patient remained NPO. Ileus eventually resolved, and bowel function returned. Diet was advanced as tolerated. The remainder of his post-op course was uneventful. By post-operative day 7 he was ready for discharge to home. All follow-up appointments were advised. Medications on Admission: Proscar Flomax 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 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. 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* 5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day: Please take 400mg once a day until [**11-20**] then decrease to 200 mg daily until follow up with cardiologist . Disp:*40 Tablet(s)* Refills:*0* 6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 7. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 7 days. Disp:*28 Capsule(s)* Refills:*0* 8. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*15 Tablet(s)* Refills:*0* 9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 10. 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* 11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 12. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 13. Zaroxolyn 2.5 mg Tablet Sig: One (1) Tablet PO once a day for 2 weeks: with lasix. Disp:*14 Tablet(s)* Refills:*0* 14. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 2 weeks. Disp:*14 Tablet(s)* Refills:*0* 15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: Two (2) Tab Sust.Rel. Particle/Crystal PO once a day for 2 weeks. Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Grafts x 5 Myocardial Infarction Hypertension Benign prostatic hypertrophy 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 Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments Wound check [**Hospital Ward Name 121**] 6 with NP/PA [**11-19**] at 1100 am [**Telephone/Fax (1) 170**] Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) on [**12-5**] at 1pm Cardiologist: Dr. [**First Name (STitle) **] [**Name (STitle) **] on [**12-17**] at 10:30am at [**Street Address(2) **], Suite 205W, [**Hospital1 1474**], [**Numeric Identifier 8728**]. The location is in parking lot near the ER entrance at [**Hospital3 417**] hospital. Please call to schedule appointments with your Primary Care Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 10381**]) in [**5-21**] weeks You will need a colonscopy in the next few weeks - Dr [**Last Name (STitle) **] office is contacting Dr [**Name (NI) **] office to set up - they should be contacting you **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:[**2192-11-12**] ICD9 Codes: 9971, 2761, 4240, 4019, 2859
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Medical Text: Admission Date: [**2175-8-16**] Discharge Date: [**2175-8-21**] Service: MEDICINE Allergies: Ace Inhibitors Attending:[**First Name3 (LF) 3705**] Chief Complaint: Hypotension Major Surgical or Invasive Procedure: None History of Present Illness: [**Age over 90 **]F AF on warfarin (goal INR 3 as previous atrial emboli), s/p MVR with tissue valve, history of DVT, PE (DVT [**11-19**], PE '[**57**]), CHF/cardiomyopathy EF 15-20 %, HTN, previous strokes presenting from rehabilitation where she is for a recent mechanical fall complicated by lower back pain, recurrent UTI, A. fib on Coumadin presenting with hypotension and leukocytosis from rehab in the context of a long term indwelling foley. EMS was called for asymptomatic hypotension at rehab (76/54) with initial EMS VS BP 81/46 with repeat 82/49 and HR in 60s. The impression of the rehab per note was no constitutional symptoms such as fever, chills, or major change in clinical appearance. She was not started empirically on antibiotics. It was favored to be an UTI in setting of indwelling foley for urinary retention. Her WBC on [**8-11**] was 8.4 with WBC 18.4 on [**2175-8-16**] with 91.5 % neutrophils. Of note, she was recently hospitalized from [**2175-8-5**] to [**2175-8-10**] with trouble coordinating her left arm and dysarthria in setting of a fall at rehab. An extensive neurological work-up revealed evidence of subacute infarction in right anterior parietal lobe favored to be embolic. She was discharged to rehab. . In the ED, initial vs were: 10 96.6 62 73/50 1 98% RA. Exam with no focal findings except for cloudy urine in Foley catheter. Labs significant for WBC 17, stable Hct although MCV 81, Diff N 85.1 L 9.8, lactate 2.2, Na 132, Cl 94, BUN 41, Cr 1.8 (baseline 1.3 - 1.6), Glc 108. UA significant for large LE, Bld, RBC 13, WBC 35, Few Bacteria, CastHy 9. She was given linezolid 600 mg IV x 1. CXR performed showing LLL opacification consistent with atelectasis vs. early pneumonia cannot be excluded. Blood and urine cultures were drawn. EKG showing atrial fibrillation, LBBB similar compared to prior. She received 1 L of NS. She was admitted for hypotension and presumed urosepsis. Sepsis pathway not utilized secondary to improved blood pressure with IVF resuscitation in setting of low EF. Admission VS: 108/68, 62, 14, 100% RA; Access: 2x20G Past Medical History: Afib on coumadin (goal INR 3) hx of DVT, PE (DVT [**11-19**], PE '[**57**]) CHF/cardiomyopathy EF 20-25%, last echo [**3-23**] Moderate Tricuspid Regurgitation s/p MVR w/porcine tissue '[**61**] HTN (SBP 120's at baseline) hypothyroidism atrial emboli- INR should be 3 DJD h/o CVA p/w slurred speech and facial droop CKD baseline Cr 1.4-1.6 Social History: Pt normally lives alone when not in rehab, does some of cooking, has cleaning and shopping aid, has three daughters who are very supportive. Walks very short distances, slowly, with walker but primarily in wheel chair. Denies EtOH, tobacco and illicits. Family History: SSA trait No hx of stroke, DM, HTN or heart disease Physical Exam: Admission: General Appearance: Well nourished, No acute distress, No(t) Overweight / Obese, No(t) Anxious, No(t) Diaphoretic Eyes / Conjunctiva: No(t) Pupils dilated, No(t) Conjunctiva pale, No(t) Sclera edema Head, Ears, Nose, Throat: Normocephalic, No(t) Poor dentition, No(t) Endotracheal tube, No(t) NG tube, No(t) OG tube Lymphatic: Cervical WNL, Supraclavicular WNL, No(t) Cervical adenopathy Cardiovascular: (PMI Normal), (S1: Normal, No(t) Absent), (S2: Normal), No(t) S3, No(t) S4, No(t) Rub, (Murmur: No(t) Systolic, No(t) Diastolic) Peripheral Vascular: (Right radial pulse: Diminished), (Left radial pulse: Diminished), (Right DP pulse: Diminished), (Left DP pulse: Diminished) Respiratory / Chest: (Expansion: Symmetric, No(t) Paradoxical), (Breath Sounds: Clear : , Crackles : fine at right lung base, No(t) Wheezes : ) Abdominal: Soft, Non-tender, No(t) Bowel sounds present, No(t) Distended, No(t) Tender: , No suprapubic tenderness Extremities: Right lower extremity edema: Absent, Left lower extremity edema: Absent, No(t) Cyanosis, No(t) Clubbing, distal extremities cool to touch bilateral UE and LE Musculoskeletal: Muscle wasting, Unable to stand Skin: Not assessed, No(t) Rash: , No(t) Jaundice Neurologic: Attentive, Follows simple commands, Responds to: Verbal stimuli, Oriented (to): , Movement: Purposeful, No(t) Sedated, No(t) Paralyzed, Tone: Not assessed Discharge: Vitals: 96.3-98.3, 101-130/60-79, 56-73, 18-20, 94-100% RA General: NAD, AOx3; able to roll herself over in bed. HEENT: OP clear, MMM, sclera anicteric. Neck: L-side bandage removed; JVP flat; no LAD, no carotid bruits Cardiac: RRR, no m/r/g appreciated Lungs: CTAB Abdomen: positive bowel sounds, soft, non-tender, non-distended Ext: no C/C/E; 2 radial pulses, DP pulses b/l Skin: no rashes, jaundice or eccymoses noted Neuro: AOx3, CN2-12 intact; no decreased sensation to touch throughout; proprioception in both large toes b/l. L hand weakness persists. Pertinent Results: [**2175-8-16**] 07:15PM WBC-17.0* RBC-4.59 HGB-13.2 HCT-37.1 MCV-81* MCH-28.8 MCHC-35.6* RDW-17.9* [**2175-8-16**] 07:15PM NEUTS-85.1* LYMPHS-9.8* MONOS-3.4 EOS-1.3 BASOS-0.3 [**2175-8-16**] 07:15PM PLT COUNT-412 [**2175-8-16**] 06:42PM LACTATE-2.2* [**2175-8-16**] 06:25PM GLUCOSE-108* UREA N-41* CREAT-1.8* SODIUM-132* POTASSIUM-4.0 CHLORIDE-94* TOTAL CO2-29 ANION GAP-13 [**2175-8-16**] 03:45PM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-LG [**2175-8-18**] 08:35AM BLOOD TSH-4.2 [**2175-8-18**] 08:35AM BLOOD Cortsol-17.2 [**2175-8-21**] 05:35AM BLOOD WBC-5.7 RBC-4.66 Hgb-13.0 Hct-39.2 MCV-84 MCH-27.9 MCHC-33.1 RDW-18.0* Plt Ct-334 [**2175-8-21**] 05:35AM BLOOD Glucose-89 UreaN-16 Creat-1.1 Na-133 K-5.2* Cl-102 HCO3-24 AnGap-12 [**2175-8-21**] 05:35AM BLOOD Calcium-8.6 Phos-2.8 Mg-2.6 [**2175-8-20**] 07:45AM BLOOD PT-37.7* PTT-40.6* INR(PT)-3.8* URINE CULTURE (Final [**2175-8-19**]): 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 Blood Cultures X2 Pending: XXXXXXX CXR [**2175-8-16**]: IMPRESSION: Left lower lobe opacification, likely atelectasis, though early pneumonia is not excluded. EKG [**2175-8-16**]: Atrial fibrillation with controlled ventricular response. Left bundle-branch block with secondary ST-T wave abnormalities. Compared to the previous tracing of [**2175-8-6**] no diagnostic change. INR Pending from [**2175-8-21**]: XXXXX Blood cultures from [**2175-8-16**] Pending Brief Hospital Course: [**Age over 90 **]-year-old woman with a past medical history of atrial fibrillation with previous stroke, CHF with EF 15-20%, HTN, and previous MVR and a chronic indwelling foley found to be hypotensive, a result of UTI and medications. # Complicated Enterococcus UTI. Urinary tract infection is complicated given chronic foley placed and WBC 17 in setting of hypotension. Given her history of [**Age over 90 **] UTI, she was started empirically on linezolid ([**2175-8-16**]), as well as piperacillin/tazobactam for possible pneumonia. Her white count fell by the following morning and her lactate normalized and piperacillin/tazobactam was stopped. Patient was then transitioned to linezolid and cefepime. When sensitivities of the infection returned as enterococcus, patient was transitioned to ampicillin. Her white count decreased and she was afebrile. Her foley was removed and patient was able to void without difficulty into diapers which were changed appropriately. Patient is to finish PO course of PO ampicillin on [**8-27**]. # Hypotension. Differential diagnosis for hypotension is quite broad and includes cardiac versus metabolic versus medication-related including large dose of home torsemide (30mg TID), oxycodone which the patient is on secondary to hip pain. Initial hypotension was responsive to 500cc NS, and patient was hemodynamically stable throughout admission without fluid or pressor support. We had the patient discharged on a reduced dose of her torsemide and losartan, with the possibility to increase as an outpatient. # Atrial fibrillation. Patient has history of atrial fibrillation and tissue MVR with goal 2.5 to 3.5 due to previous atrial emboli. INR was elevated and warfarin was held, with discharge INR at 2.5 and most recent dose of coumadin 5mg daily started with follow up on Friday with PCP. # Back pain/ pain along right thigh. Likely sciatica given positive straight leg raise test versus piriformis syndrome. Patient was initially treated with oxycodone, however was altered during the course of the hospitalization briefly, which resolved when oxycodone was stopped and tramadol was started. Patient was intermittently given tramadol with good control of her pain. By time of discharge, patient was able to get out of bed with assist to chair and without pain. # Chronic systolic heart failure. Patient with EF 15-20% on ECHO in [**2-24**] with significant dyssynchrony but normally functioning mitral prosthesis and moderate TR. Patient's CHF was not active during this hospitalization. # CKD. Baseline Cr 1.4-1.7 with admission Cr 1.8. This is likely prerenal given the patient's apparent hypovolemia, and her creatinine fell to 1.6 the following morning. At discharge, patient's creatinine was at 1.1. # Mild hyponatremia. Likely volume depleted given low urine Na and Cl. TSH and cortisol normal. Resolved during hospitalization. # Hypothyroidism. She was continued on her home synthroid with a normal TSH. # Transitional issues: -Please check INR, goal 2.5 to 3.5. Warfarin was held throughout hospitalization. was 2.5 upon discharge, with resumption of most recent warfarin dose. -Please check blood pressure Medications on Admission: - acetaminophen 975 mg PO TID - ASA 81 mg PO qD - calcium carbonate 650 mg PO BID - cholecalciferol 1000 unit PO qD - levothyroxine 88 mcg PO qD - lidocaine patch PO qD - losartan 25 mg PO qD - metoprolol succinate 12.5 mg PO qD - torsemide 30 mg PO TID - warfarin 5 mg PO qPM - oxycodone 5 mg PO BID - oxycodone IR 5 mg PO q 4 hr prn pain 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. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical Daily PRN as needed for body pain . 4. torsemide 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). Disp:*0 Tablet(s)* Refills:*0* 5. losartan 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*0 Tablet(s)* Refills:*0* 6. ampicillin 250 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours) as needed for UTI for 8 days: [**Date range (1) 100323**]. Disp:*0 Capsule(s)* Refills:*0* 7. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: 0.5 Tablet Extended Release 24 hr PO DAILY (Daily). 8. docusate sodium 100 mg Tablet Sig: 1-2 Tablets PO twice a day as needed for constipation. Disp:*0 Tablet(s)* Refills:*0* 9. tramadol 50 mg Tablet Sig: One (1) Tablet PO twice a day as needed for pain. Disp:*0 Tablet(s)* Refills:*0* 10. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO three times a day. 11. calcium carbonate 650 mg calcium (1,625 mg) Tablet Sig: One (1) Tablet PO twice a day. 12. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital **] rehab Discharge Diagnosis: Primary Diagnosis: Complicated Enterococcal Urinary Tract Infection, Systolic heart failure, Hypertension, Acute kidney injury, Back pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Ms. [**Known lastname **], It was our pleasure to take care of you at [**Hospital1 18**]. You were admitted for low blood pressure likely related to an infection in your bladder and from taking too much torsemide. We found that the infection was due to a bacteria called enterococcus which is sensitive to ampicillin, which we are being treated with. For follow up, please continue rehabilitation at your current rehabilitation center and keep the following appointments below. We have made the following changes in your medications: START Ampicillin until [**2175-8-29**] START Tramadol for pain START Colace as needed for constipation STOP Oxycodone as it caused you to be confused DECREASE Torsemide to 30mg DAILY as this may have also contributed to your low blood pressures. DECREASE Losartan to 12.5mg DAILY as this may have also contributed to your low blood pressures. Please continue taking all your other home medications. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Please attend the following appointments: Department: [**Hospital3 249**] When: FRIDAY [**2175-8-25**] at 10:40 AM With: [**Doctor First Name **] FERN, RNC [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: NEUROLOGY When: FRIDAY [**2175-9-22**] at 10:30 AM With: [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**], MD [**Telephone/Fax (1) 2574**] Building: [**Hospital6 29**] [**Location (un) 858**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: CARDIAC SERVICES When: WEDNESDAY [**2175-10-25**] at 11:00 AM With: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], NP [**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: 5849, 4254, 2761, 2930, 4280, 5990, 5859, 2449
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Medical Text: Admission Date: [**2149-1-13**] Discharge Date: [**2149-1-21**] Date of Birth: [**2098-10-28**] Sex: F Service: ACOVE MEDICINE HISTORY OF THE PRESENT ILLNESS: The patient is a 50-year-old female with multiple medical problems status post recent admission to Medicine for hyponatremia and seizures who presented with generalized weakness and inability to transfer herself at home with a swollen knee. In the ED, she was noted to have focal seizures and left facial twitching. She denied generalization. Treated with Ativan 2 mg IV. A left subclavian line was placed for IV access. Swollen left knee prompted a tap of the knee times three with no fluid obtained. Left lower extremity negative with no DVT. The patient was given vancomycin times one dose prophylactically after knee tap. U/A revealed positive UTI. The patient was given Levaquin in the ED. Positive urinary incontinence without dysuria, without back pain, but has knee pain. PAST MEDICAL HISTORY: 1. Complex partial seizure with a right temporal occipital lobectomy, VP shunt in [**2137**]. 2. OCD. 3. Depression. 4. Chronic left lower extremity edema. 5. History of bilateral hip arthroplasty. 6. History of MRSA infection in the left hip. 7. Left hip osteoporosis. 8. Anorexia. 9. B12 deficiency. 10. Anemia. 11. Incontinence. 12. PVD. 13. SIADH secondary to Tegretol. ADMISSION MEDICATIONS: 1. Tiagabine 4 mg q.h.s. 2. Amoxapine 50 mg twice a day. 3. Oxybutynin 10 twice a day. 4. Protonix 40 once a day. 5. Risperidone 1 twice a day. 6. Loxapine 60 once a day. 7. Phenobarbital 30 three times a day. 8. Baclofen 10 four times a day. 9. Hydrazine 25 p.m. 10. Sodium chloride 4 grams three times a day. 11. Lactulose 30 three times a day p.r.n. 12. Colace 100 twice a day. 13. Calcium. 14. Vitamin D. 15. Senna one twice a day. 16. Tegretol XL 200 a.m., 200 afternoon, 300 p.m. 17. Hydrocortisone cream p.r.n. 18. Ibuprofen 600 p.r.n. 19. Oxycodone sustained release 10 twice a day. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Blood pressure 110/70, pulse 100, respiratory rate 20, temperature 99.3, saturating 100% on 2 liters. General: The patient was frail and ill appearing. HEENT: The extraocular movements were intact. The oropharynx was clear. Neck: Supple. Chest: Clear to auscultation bilaterally. Cardiovascular: Regular rate and rhythm, normal S1, S2, negative murmur, rubs, or gallops. Abdomen: Soft, nontender, nondistended. Back: She has a stage I sacral decubitus. Extremities: Left foot erythematous, 4+ edema to the knee. Pain over the left knee without appreciable effusions, without warmth. Upper extremity revealed bilateral hand erythema, [**12-5**]+ edema. Neurological: The patient was alert and oriented times three. LABORATORY DATA UPON ADMISSION: White count 6.0, hematocrit 28.9, platelets 440,000. Sodium 134, potassium 4.4, chloride 84, bicarbonate 27, BUN 11, creatinine 0.2, glucose 86. The U/A revealed greater than 50 white cells, moderate leukocytes, positive nitrates. The urine culture is pending. LENI negative for DVT. Knee film revealed osteopenia. HOSPITAL COURSE: The patient is a 50-year-old female well known to the team who presented with a potential seizure, SIADH, although not with obvious hyponatremia and UTI. 1. INFECTIOUS DISEASE: The patient's UTI was treated with Cipro. The patient also had likely cellulitis of the hands. The patient was started on a 14 day course of vancomycin. The patient had a PICC line placed for vancomycin prior to discharge. 2. NEUROLOGIC: The patient was continued on medications without seizures. The patient has very small seizures. The patient was also found to be unresponsive one morning. The patient was transferred to the SICU which is likely urosepsis. The patient responded with fluids and antibiotics. The patient was discharged back to the floor the next day without incident. 3. FLUIDS, ELECTROLYTES, AND NUTRITION: The patient had a sodium of 134, retested the patient's sodium was 120, 134 was likely an error in the laboratory. The patient's sodium came up appropriately with fluid restriction and salt tabs. 4. KNEE PAIN: No workup was really done. This patient is well known to Dr. [**Last Name (STitle) 7111**] and is to have outpatient workup of pain. 5. PSYCHIATRY: The patient's medicines were continued. 6. GASTROINTESTINAL: The patient was put on a bowel regimen. Protonix was continued. 7. ENDOCRINE: The patient was continued on calcium, vitamin E. 8. PAIN: MS04 and Oxycodone were held as the patient was found to be unresponsive. The patient was changed to Percocet. 9. FLUIDS, ELECTROLYTES, AND NUTRITION: The patient was given a regular diet with Boost. 10. LINES: The patient's left subclavian was changed to a PICC. DISCHARGE CONDITION: Fair. DISCHARGE DIAGNOSIS: Unable to care for self. DISCHARGE MEDICATIONS: 1. Tiagabine 4 q.h.s. 2. Amoxapine 50 b.i.d. 3. Oxybutynin 10 b.i.d. 4. Pantoprazole 40 once a day. 5. Risperidone one twice a day. 6. Loxapine 60 once a day. 7. Phenobarbital 30 three times a day. 8. Baclofen 10 four times a day. 9. Hydroxyzine 25 p.r.n. 10. Sodium chloride 4 grams t.i.d. 11. Colace 100 twice a day. 12. Calcium 500 three times a day. 13. Vitamin D 400 once a day. 14. Senna one twice a day. 15. Carbamazepine 200 in the a.m., 200 in the p.m., 300 in the evening. 16. Ibuprofen for pain. 17. Acetaminophen for pain. 18. Ciprofloxacin 500 b.i.d. 19. Vancomycin 750 b.i.d. 20. Lactulose 30 three times a day. [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D. [**MD Number(1) 3475**] Dictated By:[**Name8 (MD) 23023**] MEDQUIST36 D: [**2149-1-17**] 04:35 T: [**2149-1-17**] 23:13 JOB#: [**Job Number **] ICD9 Codes: 5990, 311
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Medical Text: Admission Date: [**2151-5-4**] Discharge Date: [**2151-5-10**] Date of Birth: [**2090-12-5**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 165**] Chief Complaint: coronary artery disease Major Surgical or Invasive Procedure: coronary artery bypass x 3(LIMA-LAD, SVG-Diag, SVG-PDA) [**2151-5-6**] History of Present Illness: This 60 year old white male presented at [**Hospital3 1280**] with known coronary disease but worsening dyspnea with exertion and fatigue. A stress est was positive with LV dilatation on stressing, and catheterization revealed triple vessel disease. He was transferred for surgery. Past Medical History: hypercholesterolemia R eye does not fully close resulting in dry eyes s/p Left hip replacement s/p multiple knee surgeries s/p repair of torn/ruptured achillies tendon-bilat Social History: Lives with:wife and son Occupation:owns own real estate management company Tobacco:denies ETOH:occasional Family History: noncontributory Physical Exam: admission: Pulse:61Resp: 16 O2 sat: 96 on RA B/P Right:126/62 Left: Height: Weight: 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] Extremities: Warm [x], well-perfused [x] Edema 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: none Left:none Pertinent Results: [**2151-5-10**] 04:30AM BLOOD WBC-9.8 RBC-4.46* Hgb-13.4* Hct-39.3* MCV-88 MCH-30.1 MCHC-34.2 RDW-13.3 Plt Ct-216 [**2151-5-8**] 06:00AM BLOOD WBC-12.8* RBC-4.58* Hgb-13.9* Hct-41.0 MCV-89 MCH-30.3 MCHC-33.9 RDW-13.4 Plt Ct-147* [**2151-5-6**] 04:27PM BLOOD PT-13.8* PTT-25.8 INR(PT)-1.2* [**2151-5-9**] 04:15AM BLOOD Glucose-106* UreaN-17 Creat-1.1 Na-137 K-4.0 Cl-98 HCO3-27 AnGap-16 [**2151-5-8**] 06:00AM BLOOD Glucose-111* UreaN-18 Creat-1.4* Na-137 K-4.4 Cl-100 HCO3-30 AnGap-11 [**2151-5-9**] 04:15AM BLOOD Mg-2.2 Intra-op TEE PREBYPASS No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Physiologic mitral regurgitation is seen (within normal limits). POSTBYPASS Biventricular systolic function is preserved. The study is otherwise unchanged from prebypass. Brief Hospital Course: The patient was admitted to the hospital and brought to the operating room on [**2151-5-6**] where the patient underwent CABG x 3. Overall the patient tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. Vancomycin was used for surgical antibiotic prophylaxis given the preoperative stay of greater than 24 hours. POD 1 found the patient extubated, alert and oriented and breathing comfortably. The patient was neurologically intact and hemodynamically stable on no inotropic or vasopressor support. Beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. The patient was transferred to the telemetry floor for further recovery. Chest tubes and pacing wires were discontinued without complication. 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 25' simvastatin 40' ibuprofen 800' thera tears eye gtts aspirin 325' Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain/fever. 6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. 7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 8. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 9. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). Disp:*90 Tablet(s)* Refills:*2* 10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for 1 weeks. Disp:*7 Tablet(s)* Refills:*0* 11. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 1 weeks. Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 932**] Area VNA Discharge Diagnosis: coronary artery disease s/p coronary artery bypass grafts hyperlipidemia s/p left total knee replacement s/p knee surgeries chronic dry eye- right benign prostatic hypertrophy Discharge Condition: Alert and oriented x3, nonfocal. Ambulating with steady gait. Incisional pain managed with ultram Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema: Discharge Instructions: 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. 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**]). Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge of sternal wound. **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 [**6-7**] at 1:30 Please call to schedule appointments with: Primary Care/Card.: Dr. [**Last Name (STitle) **],AUROBINDO [**Telephone/Fax (1) 8058**] in [**12-12**] weeks **Please call cardiac surgery office with any questions or concerns ([**Telephone/Fax (1) 170**]). Answering service will contact on call person during off hours.** [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2151-5-10**] ICD9 Codes: 4111, 2720, 4019
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Medical Text: Admission Date: [**2156-4-1**] Discharge Date: [**2156-4-2**] Date of Birth: [**2091-4-15**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1167**] Chief Complaint: Admitted for right heart catheterization and evaluation for weaning off milrinone therapy Major Surgical or Invasive Procedure: cardiac catheterization and Swan Ganz catheter placement History of Present Illness: Patient is a 64 year old man with a history of end stage ischemic cardiomyopathy s/p CABG in [**2135**] now with improved EF to 35-40% on Milrinone at 0.6mcg/kg/min since [**2151**]. At that time, he was not a heart transplant candidate due to irreversible pulmonary hypertension. Over the years he has been doing extremely well without significant heart failure. He has not been on diuretics in years. Last echo from [**2154**]: LVEF 35-40%. He was admitted for RHC and hemodynamics on and off milrinone to assess for possible weaning off of milrinone. Right heart catheterization was performed, and he tolerated the procedure well. PA pressures 35/15, PCWP 22, CO 3.47 and CI 1.97 on milrinone .6 mcg.kg/min. . Patient reports he has been feeling quite well. Denies any increasing SOB, CP, palpitations, dizziness, lightheadedness, fevers. He does report a dry cough that is occasionally productive of small amounts of white sputum. He has been taking sugar free robitussin as home. Two of his daughters at home currently have colds. He has had the flu shot. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . Past Medical History: 1) Ischemic Cardiomyopathy (EF15-20% at worst and started on milrinone in [**2151**], last echo in [**2154**] with EF35-40%) s/p [**Hospital1 **]-V Pacer/ICD ([**11-12**]) 2) CAD/CABG [**2135**] (SVG-LAD-s/p stent in [**2148**], SVG-LCX(known occlusion), LIMA to diag, SVG to RCA-known occlusion, stent to LM into LCX) 3) DMII 4) CRI (Cr 1.3-1.8) 5) Anemia of Chronic Disease 6) HTN 7) Lichen Simplex Chronicus 8) h/o left subclavian vein occlusion 9) Hernia repair [**2151**] . Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension . Cardiac History: CABG, in [**2145**] anatomy as above . Percutaneous coronary intervention, as above . Pacemaker/ICD placed in [**2151**] . Social History: Lives with wife and daughters. [**Name (NI) **] five children and two grandchildren. Born in [**Country 9819**] - has lived in USA for ten years. Previous leather goods importer/exporter. Never smoked cigs, drank ETOH or used recreational drugs. . Family History: Brother had MI at 48. Mother had DM, CHF and MI and unknown age. Father had CAD, but no MI. . Physical Exam: VS: T 97.3, BP 116/76 , HR 75 , RR 17 , O2 100% on RA Gen: Eldery male in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple could not assess JVP as lying flat after cetherter placement. CV: RR, normal S1, S2. II/VI SEM at LLSB Chest: Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi anteriorly. Abd: soft, NTND, No HSM or tenderness. No abdominial bruits. Well-healed midline scar Ext: No c/c/e. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; 2+ DP, PA catheter in place without ooze Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP . Pertinent Results: MEDICAL DECISION MAKING . EKG demonstrated V pacing, rate 72 . 2D-ECHOCARDIOGRAM performed on [**9-15**] demonstrated: The left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated with mild-moderate global hypokinesis (EF 35-40%) and septal near akinesis. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is a minimally increased gradient consistent with minimal aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. . HEMODYNAMICS: RA 8, RV 40/4, PCWP 22, PA 35/15 . LABORATORY DATA: [**2156-4-1**] 01:11PM WBC-3.9* RBC-4.08* HGB-12.6* HCT-36.8* MCV-90# MCH-31.0 MCHC-34.4 RDW-14.4 [**2156-4-1**] 01:11PM PLT COUNT-161 [**2156-4-1**] 01:11PM PT-12.5 PTT-48.3* INR(PT)-1.1 [**2156-4-1**] 01:11PM GLUCOSE-73 UREA N-22* CREAT-1.2 SODIUM-144 POTASSIUM-4.0 CHLORIDE-111* TOTAL CO2-25 ANION GAP-12 [**2156-4-1**] 01:11PM CALCIUM-9.2 PHOSPHATE-3.1 MAGNESIUM-2.2 . . . . . Cardiac catheterization ([**2156-4-1**]) - 1. Resting hemodynamics revealed high-normal right-sided filling pressures with RVEDP 9 mmHg. Mild elevation of pulmonary arterial systolic pressures with PASP 35 mmHg. Elevated mean wedge of 22 mmHg. Depressed cardiac output with CI 2.0 L/min/m2. FINAL DIAGNOSIS: 1. Mild elevation of filling pressures on chronic milrinone. 2. Transfer to CCU for milrinone wean with swan in place. . . Trans-Thoracic Echocardiogram ([**2156-4-1**]) - The left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. LV systolic function appears moderately-to-severely depressed (ejection fraction 30 percent) secondary to akinesis of the septum and hypokinesis of the rest of the left ventricle. Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. There are focal calcifications in the aortic arch. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the findings of the prior study (images reviewed) of [**2154-9-24**], the left ventricular ejection fraction is somewhat reduced. . . Trans-Thoracic Echocardiogram ([**2156-4-2**]) - Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. There is moderate to severe global left ventricular hypokinesis (LVEF = 30 %). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. The supporting structures of the tricuspid valve are thickened/fibrotic. Moderate [2+] tricuspid regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the findings of the prior study (images reviewed) of [**2156-4-1**], the findings are similar. . . Brief Hospital Course: ASSESSMENT AND PLAN, TO BE REVIEWED AND DISCUSSED IN MULTIDISCIPLINARY ROUNDS: #. Ischemic cardiomyopathy - The patient has a known history of ischemic cardiomyopathy with an EF of 15-20% in [**2151**] and has been on milrinone since then. Repeat TTE in [**9-/2154**] revealed improvement in his EF to 35-40%. He had not been requiring standing diuretics, and has been doing quite well at home. He underwent cardiac catheterization that showed mildly elevated filling pressures, and Swan-Ganz catheter placement in the cath lab showed a Cardiac Index of 1.97 on milrinone. He had a TTE that showed moderately-to-severely depressed LV systolic function (EF 30%) secondary to akinesis of the septum and hypokinesis of the rest of the left ventricle. He was weaned off the milrinone with a stable Cardiac Index of 1.94 off milrinone. Repeat TTE after weaning off milrinone was similar to that done while he was on milrinone. He was able to be discharged home off of milrinone. He was otherwise continued on his home medications, and discharged on these without any changes. . Medications on Admission: milrinone via a continuous infusion at 0.6 mcg/kg/minute Aspirin 325 mg daily Lipitor 20 mg daily, Bumex 0.5 mg only as needed - has not taken in 3 months Coreg 12.5 mg twice a day Plavix 75 mg daily digoxin 0.125 mg a half a tablet daily Imdur 30 mg a half a tablet at bedtime lisinopril 5 mg daily multivitamin daily Glipizide 4 mg QAM and 2 mg QPM . Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Digoxin 125 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr Sig: 0.5 Tablet Sustained Release 24 hr PO QHS (once a day (at bedtime)). 7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 9. Amaryl 2 mg Tablet Sig: Two (2) Tablet PO qam. 10. Amaryl 2 mg Tablet Sig: One (1) Tablet PO qpm. 11. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Two (2) mL Intravenous once a day: 2 mL of 100 Units/mL heparin (200 units heparin) each lumen Daily. Inspect site every shift. Disp:*120 ml* Refills:*2* Discharge Disposition: Home With Service Facility: physicians' home care-[**Hospital1 **] Discharge Diagnosis: Primary: 1. acute on chronic systolic heart failure Secondary: 1. coronary artery disease 2. diabetes mellitus 3. chronic renal insufficiency 4. hypertension 5. hyperlipidemia Discharge Condition: Ambulatory. O2 sats in 90s on room air. BP and HR stable. Discharge Instructions: You were admitted to the hospital for evaluation of your heart failure. Your medication milrinone was stopped. increases by > 3 lbs. Please adhere to a 2 gm sodium diet. Please restrict fluid intake to 2 liters per day. Avoid heavy lifting (>10 lbs) for the next week to rest your groin after the catheterization. Please follow up with Dr. [**Last Name (STitle) 1968**] and Dr. [**First Name (STitle) 437**] as below. Please call your doctor or return to the hospital if you experience worsening shortness of breath, chest pain, lightheadedness, palpitations, or any other concerns. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2156-4-7**] 9:50 Provider: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D. Phone: [**Telephone/Fax (1) 3512**] Date/Time: [**2156-4-19**] 1:00 Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2156-6-1**] 1:30 Provider: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 3512**] Date/Time:[**2156-6-1**] 2:00 ICD9 Codes: 4280, 5859
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Medical Text: Admission Date: [**2105-4-4**] Discharge Date: [**2105-4-10**] Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Doctor First Name 3298**] Chief Complaint: Dysphagia Major Surgical or Invasive Procedure: Intubation Endoscopy History of Present Illness: 88 year old female with hx of a. fib and right brachial artery embolism on dabigatran, CAD, diastolic CHF, HTN, hypothyroidism presenting with dysphagia. Pt was recently admitted [**Date range (1) 22336**] for DOE and melenotic stools; Hct was found to be 22 from baseline 40. She underwent extensive GI workup including EGD, colonoscopy and capsule endoscopy that was largely unrevealing for source of bleed. She was started on omeprazole for gastritis. She received total of 4 units PRBCs during admission with Hct in low 30s on discharge. She was discharged on lower dose of dabigatran and lower dose of atenolol. She was discharged to rehab where she had difficulties with constipation and intermittent dysphagia. She was discharged home approximately one week ago and has complained of intermittent dysphagia. On day of admission, she had difficulties even swallowing water. Reports vomiting twice. In the ED, initial VS were: 96.6 50 167/69 16 94% RA. She was evaluated by GI who plan to perform EGD tonight. Anesthesia was called for intubation for MAC anesthesia. CXR was unremarkable. CT chest showed fluid distention of the stomach and fluid layering up to mid esophagus. Past Medical History: CAD s/p DES to LAD and OM1, [**2098**] Mild biventricular systolic/diastolic CHF (compensated) Reactive Airway Disease Hypothyroidism Hypertension Hyperlipidemia Osteoporosis Previous pneumonia Atrial Fibrillation, not anticoagulated [**1-8**] falls Bilateral rotator cuff repair Status post right hip repair [**2096**]. Social History: quit smoking 9 years ago, glass wine per day. Family History: sister - deceased from CVA Physical Exam: ADMISSION PHYSICAL EXAM 96.6 50 167/69 16 94% RA. General: Alert, oriented x 3, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Irregularly irregular rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: bibasilar crackles, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis; trace b/l edema Neuro: CNII-XII intact, following commands, moving all extremities Discharge PE: T97.8, HR 77, BP 133/60, RR 18, 94% RA General: Alert, oriented x 3, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Irregularly irregular rhythm, normal S1 + S2, 2/6 systolic murmur heard at R and L sternal border Lungs: minimal bibasilar crackles, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis; trace b/l edema at ankle Neuro: CNII-XII intact, following commands, moving all extremities Pertinent Results: ADMISSION LABS [**2105-4-4**] 04:35PM BLOOD WBC-5.5# RBC-4.39# Hgb-10.5* Hct-35.5* MCV-81* MCH-24.0*# MCHC-29.7* RDW-17.2* Plt Ct-123* [**2105-4-4**] 04:35PM BLOOD Neuts-83.4* Lymphs-8.9* Monos-6.7 Eos-0.7 Baso-0.3 [**2105-4-4**] 04:35PM BLOOD PT-14.9* PTT-50.3* INR(PT)-1.4* [**2105-4-4**] 04:35PM BLOOD Glucose-102* UreaN-23* Creat-1.0 Na-133 K-6.4* Cl-92* HCO3-28 AnGap-19 [**2105-4-4**] 04:35PM BLOOD Calcium-8.3* Phos-4.0 Mg-2.3 [**2105-4-4**] 04:35PM BLOOD TSH-2.1 [**2105-4-4**] 04:35PM BLOOD Digoxin-0.7* Discharge labs [**2105-4-10**] 07:00AM BLOOD WBC-3.3* RBC-3.89* Hgb-9.1* Hct-31.1* MCV-80* MCH-23.4* MCHC-29.3* RDW-17.3* Plt Ct-108* [**2105-4-10**] 07:00AM BLOOD Glucose-101* UreaN-22* Creat-1.0 Na-137 K-3.9 Cl-99 HCO3-32 AnGap-10 IMAGING CXR [**2105-4-4**] FINDINGS: PA and lateral views of the chest were obtained. Cardiomegaly is again noted with diffuse ground-glass opacity concerning for pulmonary edema. Bilateral pleural effusions are present, left greater than right with bibasilar consolidation, likely representing compressive atelectasis. No pneumothorax is seen. Aortic calcifications again noted. Bony structures are demineralized. IMPRESSION: Pulmonary edema, bilateral effusions and bibasilar atelectasis, stable cardiomegaly. CT CHEST [**4-4**] 1. Fluid distension of the esophagus suggesting dysmotility. 2. Left adrenal nodule is incompletely assessed. Elective evaluation with dedicated adrenal protocol CT may be performed as an outpatient. EGD [**2105-4-4**]: Impression: Food in the whole Esophagus Erythema and friability in the lower third of the esophagus compatible with esophagitis Retained fluids in stomach Normal mucosa in the duodenum Otherwise normal EGD to third part of the duodenum Recommendations: Trial clears with close monitoring. Continue PPI to allow esophagitis to heal. F/u TSH. Barium swallow and esophageal manometry should be done to evaluate motility within the esophagus. Can consider further motility evaluation if it becomes clear that the stomach as well as colon are involved as well and if the above is unrevealing. Barium Swallow [**2105-4-5**] FINDINGS: The patient has mild esophageal dysmotility. The primary stripping wave breaks in the mid to distal esophagus. There is a moderate amount of residual contrast in the esophagus after swallowing, even in the upright position. There is no abnormal dilation, stricture, or evidence of achalasia. The esophagus distends normally. The 13-mm tablet passes easily into the stomach. IMPRESSION: Mild esophageal dysmotility. No evidence of achalasia. Manometry [**2105-4-8**]: no signs of achalasia, final read pending Brief Hospital Course: Patient is a 88 year old female with hx of a. fib and right brachial artery embolism on dabigatran, CAD, diastolic CHF, HTN, hypothyroidism who presented with dysphagia and was found to have esophagitis and food particles throughout the esophagus without evidence of stricture on barium swallow. Manometry showed no signs of achalasia. Dysphagia: Patient presented with intermittent dysphagia. She had a CT of the chest which showed large amounts of food in the esophagus with air fluid levels. She was intubated for her EGD given food seen on CT scan and concern for aspiration. Her EGD showed large amounts of food in the esophagus as well as esophagitis without evidence of strictures or malignancies. Food was removed and she was extubated without incident. Barium swallow showed no stricture. Manometry showed no signs of achalasia. She was advanced to clear liquids then full liquids and finally to a pureed diet which she tolerated. She was given pantoprazole IV initially and then started on po omeprazole 40 mg po BID. She was discharged on pureed diet after the nutrition specialist gave her diet education. Etiology of dysphagia remains unclear. Gastroenterology thinks esophagitis likely is contributing to esophageal dysmotility, though there is concern for dysmotility elsewhere in the GI tract including in the colon given constipation and the stomach as this was full of food. No clear metabolic cause for this has been discovered, however. Patient will be closely followed by GI to discuss further work up as indicated. Diastolic CHF: Torsemide dosing recently increased from 20mg to 40mg for worsening LE edema. She initially appeared euvolemic on exam and torsemide was initially held. It was restarted when she developed an O2 requirement on [**2105-4-6**]. She then was oxygenating well on room air and had minimal LE edema. Her torsemide dose was subsequently decreased from 40 mg to 20 mg prior to discharge as she developed a contraction alkalosis and appeared euvolemic to slightly dry. She was instructed to weigh or if she developed lower extremity edema. Intubation: Pt electively intubated with fentanyl/versed for MAC anesthesia/EGD. She was extubated following the procedure without complications. Atrial fibrillation: Rate controlled on atenolol and digoxin. On dabigatran on off-label dosing for afib and right brachial artery embolism. Hypothyroidism: TSH within normal limits. She was continued on her home levothyroxine. Anemia: Recent extensive workup for source of anemia was unrevealing (pt is s/p EGD, colonoscopy, capsule endoscopy). Hct remained at her baseline in low 30s. She will need a repeat colonoscopy in 6 months as outpatient Thrombocytopenia: Has long-standing thrombocytopenia. Platelet count remained in her baseline range. She had no evidence of active bleeding # Transition issues: 1. Patient needs to be followed up on her dysphagia as outpatient, and further work up should be discussed with GI 2. Patient needs to monitor her daily weight for appropriate volume status 3. Patient needs a repeat colonoscopy in 6 months as outpatient 4. Patient needs to be followed up for thrombocytopenia and leukopenia as outpatient with consideration of hematology follow up if this fails to resolve 5. Patient complained of difficulty hearing, and found to have bilateral ear wax impaction. Attempt to remove ear wax but unsuccessful. She was given prescription for Carbamide Peroxide to use as outpatient. 6. Left adrenal nodule found incidentally on CT chest, should have adrenal protocol CT as outpatient to further assess # Communication: [**Name (NI) **] [**Name (NI) 575**] (son, [**Name (NI) 382**] [**Telephone/Fax (1) 22335**]; [**Telephone/Fax (1) 22334**] # Code: Full (confirmed with HCP) Medications on Admission: 1. digoxin 125 mcg Tablet Sig: 0.5 Tablet PO once a day. 2. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (1-2 times a day). 4. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. torsemide 40 mg Tablet daily(recently doubled) 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for c. 8. dabigatran etexilate 75 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 9. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 10. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Medications: 1. Dabigatran Etexilate 75 mg PO TID 2. Atenolol 25 mg PO DAILY hold for sbp < 100 or hr < 60 3. Torsemide 20 mg PO DAILY 4. Carbamide Peroxide 6.5% 5-10 DROP AD [**Hospital1 **] Duration: 4 Days RX *carbamide peroxide 6.5 % twice a day Disp #*1 Bottle Refills:*0 5. Digoxin 0.0625 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH [**Hospital1 **] 8. Levothyroxine Sodium 100 mcg PO DAILY 9. Omeprazole 40 mg PO BID RX *omeprazole 40 mg twice a day Disp #*60 Capsule Refills:*0 10. Senna 1 TAB PO BID:PRN constipation 11. Simvastatin 40 mg PO DAILY Discharge Disposition: Home With Service Facility: Greater [**Location (un) 1468**] VNA Discharge Diagnosis: Primary: Dysphagia Secondary: diastolic heart failure, hypertension, atrial fibrillation 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 trouble and pain with swallowing. You had an endoscopy to look at your esophagus and food was found within your esophagus as well as irritation of your esophagus called esophagitis. We also performed a barium swallow study which did not show any strictures. A study called esophageal manometry was performed and showed no evidence of achalasia. You can further discuss the final result with your GI doctor. Please weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than [**1-9**] lbs. Followup Instructions: Please keep the following appointments: Department: [**Hospital3 249**] When: MONDAY [**2105-4-20**] at 12:00 PM With: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**Telephone/Fax (1) 2010**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: DIV. OF GASTROENTEROLOGY When: WEDNESDAY [**2105-5-6**] at 2:30 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 22337**], MD [**Telephone/Fax (1) 463**] Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **] Campus: EAST Best Parking: Main Garage ICD9 Codes: 4280, 4019, 2449, 2724, 2859, 2875
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Medical Text: Admission Date: [**2113-3-29**] Discharge Date: [**2113-4-5**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1973**] Chief Complaint: Hypoxic respiratory distress Major Surgical or Invasive Procedure: none History of Present Illness: The patient is a [**Age over 90 **]F with hx of Rheumatoid Arthritis, osteroarthritis, malnutrition, recently admitted to [**Hospital1 18**] with diffuse esophageal spasm with subsequent recent admission to [**Hospital1 112**] with GIB, who recent finshed a course of abx for UTI, and is currently undergoing treatement for Clostridium difficile infection. She is brought to the ED today by her family, as she's had a 7 day course of progressive lethargy, anorexia, cough productive for clear sputum, & pleuritic chest pain. There are no reported fevers or chills, nausea, vomiting, aspiration events, recent travel, or smoking. The family does report that she's had increasing erythema at the sacrum and worsening of her lower extremity skin tears. They also report that she's had dependent edema without changes in her urinary habits. ED Course: She was found to be slighly unresponsive and in no apparent distress, and vital signs were remarkable for an oxygen saturation in the mid-80's. She had a CXR done that revealed infiltrates vs effusions bilaterally, and her labs were notable for a WBC count of 17 with 92% PMNs. She was subsequently given IV CTX/Flagyl/Azithromycin. Given her clinical findings and ongoing hypoxia she was admitted to the [**Hospital Unit Name 153**] for observation. Past Medical History: 1. Rheumatoid arthritis for 2. Osteoporosis. 3. Hiatal hernia. 4. Intermittent cognative impariment of unclear cause, 5. Failure to thrive 6. Urinary incontinence. 7. Intermittent leg edema Social History: Patient resided at the [**Hospital 599**] Nursing Home in past; however, daughter and granddaughter took the patient home after discharge on [**3-2**]. Her daughter [**Name (NI) 1258**] is very involved with her care. On last admission, the did not want to send her to rehab. EtOH: none. Tobacco: none. Illicits: None. Family History: noncontributory Physical Exam: Tmax: 36.2 ??????C (97.2 ??????F) Tcurrent: 36.2 ??????C (97.2 ??????F) BP: 143/119(125) {133/68(85) - 143/119(125)} mmHg RR: 20 (20 - 30) insp/min Heart rhythm: SR (Sinus Rhythm) Peripheral Vascular: (Right radial pulse: 1+), (Left radial pulse: 1+ (Right DP pulse: Not assessed), (Left DP pulse: Not assessed) Skin: sacral skin breakdown with surrounding erythema, dressed bilateral skin tears Neurologic: Responds to: voice, Movement: MAEW, Tone: increased upper extremity tone HEENT: AT/NC, patient did not open eyes, dry MM, poor dentition, no JVD CARDIAC: irregular rhythm, S1/S2, [**1-4**] holosystolic murmur @ RUSG LUNG: decreased air movement bilaterally, without wheezes, rales, or rhonci ABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding M/S: moving all extremities well, no cyanosis, clubbing o Pertinent Results: CXR [**3-31**] PORTABLE AP SEMI-UPRIGHT CHEST RADIOGRAPH: The cardiomediastinal silloutte is stable, however partially obscured by large bilateral pleural effusions that are unchanged. There is no pulmonary edema or evidence of pneumonia CXR [**3-30**] IMPRESSION: Pulmonary edema with enlarging bilateral pleural effusions significantly worse since [**3-3**]. KUB [**3-31**] IMPRESSION: Paucity of bowel gas component, which could be seen with obstruction. If clinically indicated, either a repeat study or a CT may be obtained for better characterization TTE [**3-30**] The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is unusually small. Left ventricular systolic function is hyperdynamic (EF 70-80%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The tricuspid valve leaflets are mildly thickened. The supporting structures of the tricuspid valve are thickened/fibrotic. Moderate to severe [3+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. IMPRESSION: hypertrophic, hyperdynamic left ventricle with very small cavity size; at least moderate mitral regurgitation and moderate-to-severe tricuspid regurgitation Brief Hospital Course: 1. Aspiration Pneumonia - Patient was maintained on Vancomycin and Zosyn - Aspiration Precautions were continued - Family declined PEG - Geriatrics were consulted 2. C. Difficile Colitis - Patient was maintained on Flagyl - Plan was for 2 weeks post cessation of vanco/zosyn - Serial toxin assay 3. Severe Malnutrition - No NGT or PEG per family - Continous Aspiration 4. Sacral Decubitus - Vascular Consultation - Wound Care Consult - Wound Care 5. Coagulopathy - Nutritional # GOALS OF CARE: patient was extensively consulted on by palliative care and geriatrics. Lengthy discussions with the family. Patient was CMO/DNR/DNI with plans to discharge to hospice on [**2113-4-6**], however she expired prior to discharge Medications on Admission: Docusate 100mg PO BID Lidocaine patch 5% on 12 hrs, off 12 hrs daily Megestrol 40mg qhs Miconazole 2% topical daily Mirtazapine 15mg qhs Omeprazole 40mg daily Sucralfate 1gm q6h Boutreaux butt past daily Oxycodone prn (rarely takes) Senna 2 tabs daily prn Discharge Disposition: Expired Discharge Diagnosis: Aspiration Pneumonia C. Diff Colitis Septicemia Pressure Ulcers Severe Malnutrition Coagulopathy Discharge Condition: Expired Discharge Instructions: You are going home with hospice services. They will be your primary contact for symptom management. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 719**] Date/Time:[**2113-4-11**] 1:00 Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2113-4-13**] 12:00 ICD9 Codes: 5070, 0389, 5849, 2760, 2762, 4275
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Medical Text: Admission Date: [**2135-5-13**] Discharge Date: [**2135-5-18**] Date of Birth: [**2078-12-5**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2009**] Chief Complaint: Hyperglycemia, abdominal pain, n/v Major Surgical or Invasive Procedure: none History of Present Illness: This patient is a 56 year old female with hx of DMI (x5 years), b/l dropped feet, [**Doctor Last Name **] disease with frequent admissions for diabetic Ketoacidosis presenting with DKA and gastroparesis flare. . The patient reports that she has had abdominal pain for the past 2-3 days, which is consistent with her gastroparesis. Nausea and vomitting has increased in intensity over the past 3 days. She was unable to tolerated a diet all day yesterday, so her daughter called EMS. The patient reports that she continued to vomit overnight. The patient reports fevers to 102-103. She reports [**10-30**] abdominal pain. She has not had emesis since last night. She reports no chills. some cough, nonproductive. no dysurea. no diarrhea, but reports being chronically constipated, has not had BM in 3 days. The patient was confused in the ER, but on the floor she is A&Ox3. Patient also reports that FS have been increaseing . In the ER, intial vitals were, T 97.7, BP 133/58, HR 110, RR 16, O2sat 100%. Her access was very difficult to obtain in the ER, an eventually a femoral cvl was obtained. After this, she recieved 2L NS, insulin IV bolus of 7units, then drip at 7units/hour. She had a foley placed. Her anion gap was 33. . Review of sytems: (+) Per HPI (-) Denies ,chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied shortness of breath. Denied chest pain or tightness, palpitations. Denied diarrhea. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Past Medical History: # DM Type 1: Years w/ DM: 5 Age of Diag: 48 Year Diag: [**2127**]. Several episodes of DKA, managed on 28U Lantus [**Hospital1 **] plus HISS - Frequent episodes of DKA - DKA has been complicated by CVA, 3 episodes suspected (including [**2135-5-14**] episode) # Diabetic polyneuropathy and gastroparesis # Hypertension # Grave's disease s/p RAI [**2129**] # Reactive airway disease # Seronegative arthritis, followed in rheumatology # Hepatitis C, genotype 1A, biopsy with grade 1 inflammation, never been on antiviral therapy, acquired via blood transfusion during surgery in [**2110**] # GERD # Migraines # Bilateral knee arthroscopy in [**5-24**] # s/p TAH and pelvic floor surgery with bladder lift # Depression # Bone spurs in feet # Bilateral foot drop requiring wheelchair use Social History: Patient lives in a multi apartment building in the same apartment with a daughter, grandaughter, and grandson. She has a son, daughter and another brother who live on another floor. She is a never smoker and does not use alcohol or drugs. She has not worked for many years. She uses a wheelchair at baseline. Family History: Her mother died of colon cancer. There are multiple family members with DM Physical Exam: Admission: Vitals: T: 96.4 BP: 161/71 P: 120 R: 23 O2: 100% on 2L General: Alert, oriented, no acute distress [**Date Range 4459**]: Sclera anicteric, mucous membranes dry, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: +BS, tender to palpation throughout, no rebound, no acute abdomen GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. Patient has b/l drop foot. . On discharge: Vitals: T: 98.1 BP: 124/86 P: 77 R: 16 O2: 97% on 2L General: Alert, oriented, no acute distress [**Date Range 4459**]: Sclera anicteric, mucous membranes moist, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: +BS, tender to palpation throughout, no rebound, no acute abdomen GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. Patient has b/l drop foot. Right fourth toe with ulcer on the medial aspect, minimal swelling. Pertinent Results: CBC: [**2135-5-13**] 12:30PM BLOOD WBC-14.8*# RBC-4.07*# Hgb-11.3*# Hct-38.0# MCV-93 MCH-27.8 MCHC-29.8* RDW-15.6* Plt Ct-323 [**2135-5-13**] 05:48PM BLOOD WBC-15.7* RBC-3.51* Hgb-9.9* Hct-32.0* MCV-91 MCH-28.2 MCHC-31.0 RDW-15.1 Plt Ct-288 [**2135-5-17**] 06:30AM BLOOD WBC-4.2 RBC-3.30* Hgb-9.6* Hct-29.1* MCV-88 MCH-29.0 MCHC-32.9 RDW-15.6* Plt Ct-194 Chem Panels: [**2135-5-13**] 12:30PM BLOOD Glucose-733* UreaN-33* Creat-1.7* Na-130* K-5.6* Cl-90* HCO3-7* AnGap-39* [**2135-5-13**] 02:50PM BLOOD Glucose-733* UreaN-34* Creat-1.6* Na-135 K-4.2 Cl-98 HCO3-LESS THAN [**2135-5-17**] 06:30AM BLOOD Glucose-144* UreaN-4* Creat-0.7 Na-140 K-3.4 Cl-105 HCO3-28 AnGap-10 [**2135-5-13**] 10:53PM BLOOD Calcium-7.4* Phos-1.3*# Mg-1.7 [**2135-5-14**] 04:24AM BLOOD Calcium-7.1* Phos-2.6* Mg-3.0* [**2135-5-17**] 06:30AM BLOOD Calcium-8.6 Phos-1.8* Mg-1.6 TFTs: [**2135-5-14**] 02:49PM BLOOD TSH-1.4 [**2135-5-14**] 02:49PM BLOOD Free T4-0.93 U/A: [**2135-5-16**] 04:14PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.005 [**2135-5-16**] 04:14PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-TR Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-SM [**2135-5-16**] 04:14PM URINE RBC-1 WBC-4 Bacteri-FEW Yeast-NONE Epi-1 Micro: [**2135-5-16**] Blood Culture, Routine-PENDING INPATIENT [**2135-5-16**] Blood Culture, Routine-PENDING INPATIENT [**2135-5-16**] URINE CULTURE-Negative [**2135-5-13**] MRSA SCREEN-Negative Radiology: CT HEAD W/O CONTRAST 1. Questionable early cytotoxic edema in the right MCA distribution, concerning for acute infarction. Based on clinical symptoms, MR head already been ordered. 2. No evidence of acute hemorrhage. MR HEAD W/O CONTRAST; MRA BRAIN W/O CONTRAST; MRV HEAD W/O CONTRAST; MRA NECK W&W/O CONTRAST IMPRESSION: 1. No evidence of an acute infarction or other acute intracranial abnormalities. 2. Technically limited head MRV. 3. Slightly limited head MRA without evidence of significant stenosis or aneurysm larger than 3 mm. 4. Normal neck MRA. CHEST (PA & LAT) IMPRESSION: No acute cardiopulmonary findings. . Discharge labs: [**2135-5-18**] 06:40AM BLOOD WBC-5.5 RBC-3.24* Hgb-9.7* Hct-28.7* MCV-89 MCH-30.0 MCHC-33.7 RDW-15.5 Plt Ct-218 [**2135-5-18**] 06:40AM BLOOD Glucose-175* UreaN-9 Creat-0.8 Na-137 K-3.5 Cl-104 HCO3-30 AnGap-7* Brief Hospital Course: This patient is a 56 y/o F with history of DMI with frequent admissions for DKA, [**Doctor Last Name 933**], who presents with DKA and gastroparesis flare. . Diabetic Ketoacidosis: Patient with numerous admissions for DKA. Infectious workup was negative. It appears that patient developed DKA in the setting of a flare of her gastroparesis. She was started on Insulin gtt in the ER 7unit bolus then 7units/hour. She was initially admitted to the ICU. Her gap closed quickly on the insulin drip and she was started on her home dose of lantus 32 units twice daily. She was hypovolemic and was given fluid boluses with potasium. After her anion gap closed she was called out to the floor for ongoing care. Her electrolytes continued to improve, and her bicarb gradually returned to [**Location 213**]. [**Last Name (un) **] was consulted, and assisted with insulin titration. Her lantus dose was changed to [**Hospital1 **] dosing, briefly at 20 units [**Hospital1 **], however she developed recurrent hypoglycemia and her lantus was titrated down to 15 units [**Hospital1 **], with a sliding scale. This can be titrated back up as necessary. . Acute Renal Failure: Patient had acute renal failure on admission due to dehydration in setting of DKA. Creatinine was 1.7 on admission (baseline is 0.8). This resolved over the course of the admission with IV fluids/hydration. . Nausea/[**Hospital1 **]/Gastroparesis: The patient stated that she had a flare of her gastroparesis prior to developing this episode of DKA, with 10/10 abdominal pain and no bowel movement x3 days. Her gastroparesis improved and she was able to tolerate a regular diabetic diet without difficulty. There was no evidence of obstruction. She was continued on her home medications for her gastroparesis. . Right arm weakness: After MICU callout, patient complained of R arm paresthesias, weakness, and loss of coordination. Evaluating MD had concern for possible CNS ischemic event, and thus an urgent Neuro consult was obtained. A repeat head CT was performed, as well as extensive MRI imaging of the head/neck (MRI, MRA, MRV, see results). There was initially concern of a "cortical hand" (cortical CVA) from the Neuro team, and patient was placed on Q2hr neuro checks, the patient was layed flat to promote CNS perfusion, and her antihypertensives were held. However, imaging and further evaluation by the Neurology attending was not consistent with a CNS event. At this time, patient is NOT thought to have had a CVA. Her symptoms gradually improved. Patient did have some R arm edema, due to IV access and aggressive hydration, which may have caused some altered sensation. Note that at the time of initial identification of the neurologic complaints, her calcium level was noted to be low, however this corrected to 8.3 once an albumin level was obtained, and thus not likely to contribute to her symptoms. . Hypertension: Patient was initially somewhat hypertensive, but this improved with continuation of her home blood pressure medications. . [**Doctor Last Name 933**] Disease: - continued Methimazole 10 mg three times a day . Reactive airway disease: currently stable - continued Albuterol inhaler as needed - continued Advair 250/50 twice daily - continued Montelukast 10 mg daily . Diabetic Neuropathy with diabetic ulcer: Patient with known bilateral foot drop. Pt was noted to have a small wound on her left second toe from injury several weeks ago which appeared to be healing well, without any evidence of infection. She was [**Doctor Last Name 1988**] to see podiatry as an outpatient. Pt's Gabapentin was initially decreased to 300 twice daily given her acute renal failure, but this was increased back to her home dose of 900 mg three times daily once her renal function improved back to baseline. . Migraines: none currently - Her Amitriptyline 25 mg Tablet Nightly was initially held given her altered mental status on admission. This medication was later resumed. . Hepatitis C: stable currently. . Pending labs: Blood cx [**5-16**] still pending at discharge. . Key follow up: 1. Podiatry for ulcer evaluation on [**5-31**]. 2. Diabetes management with titration up of lantus. Medications on Admission: Albuterol inhaler as needed Advair 250/50 twice daily Aspirin 81 mg Tablet Daily Amitriptyline 25 mg Tablet Nightly Methimazole 10 mg three times a day Metoclopramide 10 mg Tablet QIDACHS Montelukast 10 mg daily Pantoprazole 40 mg Tablet daily Simvastatin 10 mg Tablet daily Sulfasalazine 500 mg twice daily Hyoscyamine Sulfate 0.125, 3 tabs three times daily Losartan 50 mg daily Docusate Sodium 100 mg twice a day. Humalog sliding scale Toprol 25mg daily Percocet 7.5-500 mg every 6 hours as needed pain Diazepam 5 mg Tablet twice a day. Hxdroxyzine 25mg every 6 hours PRN itching Vitamin D 50,000 weekly Zomig 2.5 mg Tablet daily as needed nausea Gabapentin 900 mg Capsule 3 times a day Insulin Lantus 32 units Sc twice a day Miralax 17gm daily PRN. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette 1-2 drops PRN Prednisolone Acetate 1 % 1 drop twice daily 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 90 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) puff Inhalation [**Hospital1 **] (2 times a day). 4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. Amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 6. Methimazole 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 7. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). 8. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 10. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Sulfasalazine 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Hyoscyamine Sulfate 0.375 mg Capsule, Sust. Release 12 hr Sig: One (1) Capsule, Sust. Release 12 hr PO Q 8H (Every 8 Hours). 13. Losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 15. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 16. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 17. Zolmitriptan 2.5 mg Tablet Sig: One (1) Tablet PO once a day as needed for nausea. 18. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO TID (3 times a day). 19. Insulin Glargine 100 unit/mL Solution Sig: Fifteen (15) units Subcutaneous twice a day: Give 1/2 dose if NPO. 20. Polyethylene Glycol 3350 17 gram/dose Powder Sig: Seventeen (17) mg PO DAILY (Daily) as needed for constipation. 21. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for itching. 22. Diazepam 2 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) as needed for anxiety. 23. Humalog 100 unit/mL Solution Sig: Sliding Scale Subcutaneous QAC and QHS. Discharge Disposition: Extended Care Facility: [**First Name8 (NamePattern2) 1495**] [**Hospital 11042**] Rehab Discharge Diagnosis: # Diabetic ketoacidosis # Type I Diabetes # Acute renal failure # Gastroparesis flare # Right hand weaknes # Acute encephalopathy # Diabetic foot ulcer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted with an episode of your DKA, likely triggered by a flare of your gastroparesis. Please monitor your glucose closely, and follow up with your [**Last Name (un) **] providers. . You have an ulcer on your right fourth toe which does not appear infected. You will see a podiatrist in 2 weeks to evaluate it. Please contact them earlier if it worsens. . You also had right arm weakness and pain. The neurologists recommended an EMG if your symptoms persist. Followup Instructions: Name: [**Last Name (LF) **],[**First Name3 (LF) **] H. Appointment: [**Last Name (LF) 766**], [**5-23**], 2pm Location: UPHAMS CORNER HEALTH CENTER Address: [**University/College 17629**], [**Location (un) **],[**Numeric Identifier 58270**] Phone: [**Telephone/Fax (1) 7538**] Department: PODIATRY When: TUESDAY [**2135-5-31**] at 2:45 PM 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 Contact Dr. [**Last Name (STitle) 557**], Neurology, ([**Telephone/Fax (1) 13172**] if you continue to have weakness in your right hand for an EMG test. ICD9 Codes: 5849, 3572, 4019, 311
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Medical Text: Admission Date: [**2138-6-19**] Discharge Date: [**2138-6-30**] Date of Birth: [**2071-5-23**] Sex: F Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3223**] Chief Complaint: Complex pelvic mass. Major Surgical or Invasive Procedure: Total abdominal hysterectomy, bilateral salpingo-oophorectomy, extensive pelvic adhesiolysis, pelvic and periaortic lymphadenectomy, omentectomy. History of Present Illness: This patient, a 67 year old female, with a past medical history significant for multiple small bowel obsructions and ventral hernia and known left ovarian mass for 10 year was admitted to [**Hospital3 8834**] [**2138-1-10**] for a small bowel obstruction. Her symptoms resolved with consrevative therapy, however a MR enterography performed. An As an incidental finding, a complex left adnexal mass was seen. This imaging was then followed by a dedicated pelvic MR. This was read here at [**Hospital1 69**] by Dr. [**First Name4 (NamePattern1) 2092**] [**Last Name (NamePattern1) **]. The uterus and right adnexa were unremarkable. In the expected location of the left adnexa, a 4 x 6 x 4 cm complex lesion was noted with an avidly enhancing 2 cm component. The MRI impression included in the differential diagnosis was an epithelial neoplasm of the ovary, versus an endometrioma with an associated malignancy. A recent CA-125 was 11 on a scale of 0-35. The MR enterography showed a 6 cm lower abdomen wide neck ventral hernia containing multiple loops of small bowel. She was asymptomatic. The patient was seen in consultation concurrently by Dr. [**First Name4 (NamePattern1) 518**] [**Last Name (NamePattern1) 519**], who planned abdominal exploration with abdominal wall reconstruction and also by GYN Oncology. Surigcal excision TAH-BSO and frozen section were recommended. The patient presented to [**Hospital1 18**] for surgical intervention. Past Medical History: PMH: Breast CA, Morbid Obesity, Pre-DM, Dizzy Spells, HTN, Hiatal Hernia, GERD, Mild Anemia, Arthritis/Gout, Glaucoma, Bowel Obstructions. Social History: Ex-smoker, but having quit over 40 years ago. Drinks socially. Denies substance abuse. Lives with her husband, [**Name (NI) 122**]. Family History: Family history is negative for breast, colon, uterine, or ovarian cancer. Physical Exam: PHYSICAL EXAMINATION Inpatient Vitals: T: 96.9 degrees Farenheit, BP: 98/46 mmHg supine, HR 80 bpm, RR 18 bpm, O2: 100% on 2L NC. Gen: Mildly lethargic, arousable, NAD HEENT: No conjunctival pallor. MMM. OP clear. NECK: Supple, No LAD. JVP low. Normal carotid upstroke CV: PMI in 5th intercostal space, mid clavicular line. RRR. nl S1, S2. II/VI <> sys murmur. + S4. LUNGS: CTAB. No wheezes, rales, or rhonchi. ABD: NABS. Surgical dressing in place. Soft, NT, ND. No HSM. EXT: WWP. 2+ LE edema. Full distal pulses bilaterally. SKIN: Scattered ecchymoses NEURO: A&Ox3. CN 2-12 grossly intact. Moving all extremities At Discharge: General: Patient appears well, NAD, VSS, Tolerating a regular diet. Cardiac: RRR Pulm: No issues, CTA Abd: Obese abd, no nausea, no vomiting, Surgical wound intact, Left JP drain removed on day of discharge, Right JP drain draining 95cc overnight and to remain in place until follow-up. Lower Extremities: Obese, no significant edema noted. Pertinent Results: [**2138-6-28**] 05:35AM BLOOD WBC-7.4 RBC-2.82* Hgb-8.8* Hct-26.5* MCV-94 MCH-31.3 MCHC-33.4 RDW-14.1 Plt Ct-383 [**2138-6-27**] 08:55PM BLOOD Hct-26.9* [**2138-6-27**] 08:30AM BLOOD WBC-7.1 RBC-2.44* Hgb-7.5* Hct-23.2* MCV-95 MCH-30.9 MCHC-32.5 RDW-12.8 Plt Ct-386 [**2138-6-26**] 12:45PM BLOOD WBC-7.5 RBC-2.44* Hgb-7.8* Hct-23.4* MCV-96 MCH-32.0 MCHC-33.4 RDW-12.8 Plt Ct-349# [**2138-6-22**] 06:55AM BLOOD WBC-7.3 RBC-2.52* Hgb-8.3* Hct-24.2* MCV-96 MCH-32.9* MCHC-34.2 RDW-12.2 Plt Ct-183 [**2138-6-21**] 09:57AM BLOOD WBC-7.2 RBC-2.62* Hgb-8.8* Hct-24.9* MCV-95 MCH-33.6* MCHC-35.3* RDW-12.2 Plt Ct-195 [**2138-6-30**] 09:16AM BLOOD PT-25.4* PTT-27.2 INR(PT)-2.4* [**2138-6-29**] 02:45AM BLOOD PT-22.6* PTT-69.2* INR(PT)-2.1* [**2138-6-28**] 09:50AM BLOOD PTT-82.4* [**2138-6-28**] 05:35AM BLOOD Plt Ct-383 [**2138-6-28**] 05:35AM BLOOD PT-19.7* PTT-150* INR(PT)-1.8* [**2138-6-27**] 10:55PM BLOOD PTT-62.9* [**2138-6-27**] 08:30AM BLOOD PT-13.7* PTT-64.9* INR(PT)-1.2* [**2138-6-26**] 12:45PM BLOOD PT-12.2 PTT-23.5 INR(PT)-1.0 [**2138-6-20**] 06:29PM BLOOD PT-11.9 PTT-24.3 INR(PT)-1.0 [**2138-6-20**] 01:06AM BLOOD PT-12.8 PTT-23.8 INR(PT)-1.1 [**2138-6-30**] 07:35AM BLOOD Glucose-125* UreaN-13 Creat-0.6 Na-142 K-4.4 Cl-103 HCO3-31 AnGap-12 [**2138-6-29**] 02:11AM BLOOD Na-143 K-3.4 Cl-103 [**2138-6-28**] 05:35AM BLOOD Glucose-122* UreaN-9 Creat-0.7 Na-145 K-3.6 Cl-105 HCO3-30 AnGap-14 [**2138-6-27**] 08:30AM BLOOD Glucose-154* UreaN-11 Creat-0.7 Na-135 K-4.0 Cl-99 HCO3-25 AnGap-15 [**2138-6-23**] 03:10PM BLOOD CK(CPK)-177 [**2138-6-22**] 11:21PM BLOOD CK(CPK)-234* [**2138-6-23**] 03:10PM BLOOD CK-MB-2 cTropnT-0.04* [**2138-6-23**] 01:52PM BLOOD cTropnT-0.04* [**2138-6-23**] 05:50AM BLOOD cTropnT-0.04* [**2138-6-22**] 11:21PM BLOOD CK-MB-3 cTropnT-0.06* [**2138-6-30**] 07:35AM BLOOD Calcium-8.9 Phos-3.1 Mg-1.8 [**2138-6-29**] 02:11AM BLOOD Mg-1.6 [**2138-6-28**] 05:35AM BLOOD Calcium-8.5 Phos-4.0 Mg-1.4* [**2138-6-27**] 08:30AM BLOOD Calcium-8.5 Phos-3.6 Mg-1.6 [**2138-6-24**] 06:10AM BLOOD Calcium-8.4 Phos-3.5 Mg-1.9 [**2138-6-23**] 01:52PM BLOOD Calcium-8.2* Phos-2.6* Mg-2.4 Pathology [**2138-6-19**]: 1. Uterus and cervix, right tube and ovary (A-D): - Uterus with atrophic endometrium and adenomyosis. - Unremarkable cervix. - Ovary with benign simple cyst. - Unremarkable fallopian tube. 2. Left tube and ovary (E-J): Clear cell carcinoma, see synoptic report. 3. Pannus (K): Skin and fibroadipose tissue with focal fibrosis. 4. Abdominal wall (L): Dense fibroconnective tissue with foreign body giant cell reaction and scar. 5. Left pelvic lymph node (M-S): Seven lymph nodes, no malignancy identified (0/7). 6. Left peri-aortic lymph node (T): One lymph node, no malignancy identified (0/1). 7. Omentum (U): Unremarkable fibroadipose tissue. ECG [**2138-6-22**]: Regular SVT @ ~ 160 bpm. No obvious PWs.- Per Cardiology ECG1 [**2138-6-23**]: atrial fibrillation at 58. -Per Cardiology ECG2 [**6-23**]: sinus @ 80. Nl A/I. Low voltage. Compared to prior, now in sinus, otherwise findings similar. - Per Cardiology CTA Chest [**2138-6-26**] IMPRESSION: 1.Bilateral pulmonary emboli with new linear atelectasis in the lower lobes. 2.Small dependent fluid postoperative collection surrounding the spleen. The findings of the pulmonary emboli were conveyed to Dr. [**Last Name (STitle) 28528**] at the time of reporting. Brief Hospital Course: The patient was admitted to the [**Hospital Ward Name 332**] Intensive Care Unit after total abdominal hysterectomy, bilateral salpingo-oophorectomy, extensive pelvic adhesiolysis, pelvic and periaortic lymphadenectomy omentectomy intubated for observation on [**2138-6-19**]. All tissues from the case were sent to pathology for evaluation. The patient was In the ICU the patient received boluses of intravenous fluids for low urine output with good affect. The patient was extubated and started on a PCA for post-operative pain control, and transferred to the inpatient floor where she was placed on telemetry. She was followed closely by General Surgery as well as GYN Oncology. On the inpatient [**Hospital1 **] the patient developed atrial fibrillation with a heart rate up to 150s. She noted nausea and diaphoresis with the episode but was otherwise asymptomatic and the episode was hemodynamically tolerated. She received Lopressor 5 mg IV x 3 with decrease in her HRs to <100. However, rates returned to the 150s and she was given diltiazem 10 mg IV which reportedly dropped her HRs to the 30s and SBPs to 60s. However, this was transient and resolved without intervention. She again had ventricular rates into the 150s and she received an additional 5 mg of IV Lopressor with HR drop to <100. This am, she spontaneously converted to sinus rhythm. Cardiology was consulted for further management which recommended continuing Lisinopril 20mg daily, initiating Lopressor 25mg three times daily, Aspirin 325mg daily, Echocardiogram which showed LVEF >55%, no aortic regurgitation, mitral mildly thickened mitral valve leaflets. Mild (1+) mitral regurgitation, mild pulmonary artery systolic hypertension, and no pericardial effusion, control of surgical pain, hold Dyazide diuretic, continue statin, and check TSH which was normal at 2.5mg. The patient recovered well from surgery, increased her activity as tolerated, progressed her diet, and remained in normal sinus rhythm. On [**2138-6-26**], the GYN oncology surgical team became concerned that the patient may have had atrial fibrillation related to pulmonary emboli given her prolonged operative case, new diagnosis of cancer, and obesity. The patient was not short of breath, expressing complaints of chest pain, hypoxic, or tachycardic at this time. A CTA was obtained [**2138-6-26**] which showed Bilateral pulmonary emboli with new linear atelectasis in the lower lobes and small dependent fluid postoperative collection surrounding the spleen. The patient was a started on intravenous Heparin and Warfarin therapy was initiated with the INR goal of [**2-12**]. The Heparin gtt was monitored closely with every six hour PTT values. The patient remained on telemetry on the inpatient floor without issue on intravenous Heparin and Warfarin PO until [**2138-6-27**] when, after missing approximately two doses of Lopressor by mouth developed short bursts of sinus tachycardia which resolved with Lopressor by mouth. The patient was monitored with daily INR values and dosed with 5 mg of Warfarin. On discharge the patient's INR was 2.4 and she was discharged on 4mg of Warfarin daily with follow up with her primary care provider on Thursday [**2138-7-3**] for INR check and dose adjustment. The patient's bowel function returned appropriately post-operatively and she was tolerating a regular diet on discharge. On discharge, the left [**Location (un) 1661**]-[**Location (un) 1662**] drain was discontinued however, the Right drain remained in place with the intention of the drain being discontinued at follow-up. The surgical incision was closed and remained stable. The patient was discharged home with appropriate medical instruction and follow-up. Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 410**], the patient's primary care provider, [**Name10 (NameIs) **] [**Name (NI) 653**] and aware of the [**Hospital 228**] hospital coarse and discharge. Medications on Admission: Arimidex 1 mg daily Azopt 1% 1gtt OD twice daily Keflex prior to dental work Lisinopril 20 mg daily Meclizine 25 mg TID prn Simvastatin 20 mg daily Timolol eyedrops 0.5% OU [**Hospital1 **] Triamteren-Hydrochlorothizide 37.5/25 Vitamin C 1000 mg daily Aspirin 81 mg daily Vitamin D 1000 iu Biotin 2500 mg calcium with D Multivitamins Omega fish oils Discharge Medications: 1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO every eight (8) hours as needed for pain: Do not take more than 4000mg of Tylenol daily. 5. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for pain for 5 days: Please do not drink alcohol or drive a car while taking this medication. Take as prescribed. Disp:*40 Tablet(s)* Refills:*0* 6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 7. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3 times a day). 8. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 10. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 11. Anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily () as needed for Br CA hx. 12. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO once a day: Please take daily at 400pm. Please follow-up with your primary care who will be managing this medication. . Disp:*60 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Complex pelvic mass, malignant ovarian neoplasm on frozen section. 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 for surgical managment of the complex mass located in your pelvis. You had quite an extensive surgery as listed below. Pathology reports indicated that the left ovary showed cancerous tissue. You were admitted to the intensive care unit overnight after your surgery for monitoring and then your were transfered to the inpatient floor. You have a very low abdominal incision which is closed with staples. This may be left open to air, you may apply a dry sterile gauze if the skin becomes irritated. Monitor for signs of infection including; white/green drainage, incresing warmth or redness of the skin, increased pain, or if you develop a fever. Call the office if you develop these symptoms or report the emergency room if severe. You had 2 [**Location (un) 1661**]/[**Location (un) 1662**] drains in your incision, one of them was removed prior to your discharge. The other remains in place. Please follow the instructions given to you by the nurses. If you have [**Last Name (un) 57199**] than 100 cc of drainage in the blub of the drain in one day please call the office, if the drain begins to ooze outside on the dressing incertion site onto the gauze dressing please call the office. The dressing should remain intact and do not shower until after you see Dr. [**Last Name (STitle) 519**]. This drain will be removed at the same time as your staples at your first follow-up visit. Watch for similar signs of infection at the JP drain site. No heavy lifting for [**4-15**] lbs unless instructed otherwise by Dr. [**Last Name (STitle) 519**]. On the floor you had a rapid heart rate in an irregular rythm called atrial fibrillation. The surgical team consulted the cardiology team who recommended we start you on the medication lopressor. This fast heart rate was controlled with this medication. It is important that you follow-up with your primary care provider for blood pressure monitoring as this is a new medication. You may want to consider purchasing a blood pressure cuff which you can monitor your blood pressure at home with. Normal blood pressure is 120/80, if the top number is ever higher than 160 or lower than [**Age over 90 **] you should call the doctor. If your top number is very low wait to consult the primary care office's nurse prior to taking this medication. The cause of this atrial fibrillation was determined to be multiple small blood clots in your lungs called pulmonary emboli. These can happen when peaople are immobile or have conditions that make them more likely to develop a blood clot. Cancer can do this. You were started on a heparin drip to thin the blood to prevent the clot from growing and transitioned to Coumadin a medication you will take by mouth for 6months-1 year. You will take 4mg of this medication by mouth daily preferably, in the afternoon around 4pm, however this will be up to you. It is good to take it at this time if you will go ot have your blood drawn in the monring. You will require frequent blood laboratory value monitoring which will be preformed by your primary care provider. [**Name10 (NameIs) **] is very important that you take this medication as presecribed and report to the office to have your laboratory values checked because you will be at increased risk to bleed. Your primary care provider will be managing the dose of your coumadin, it is important that you follow their recommendations exactly. You are at increased risk for bleeding, please follow the coumadin and food teaching sheets and monitor yourself for brusing, bloody stools, fast heart rate, or low blood pressure. You have an appointment with your primary care provider as listed below and it is important that you see her. Please keep this appointment. Monitor your bowel function and eat small frequent meals.Stay well hydrated. If you become nauseated, constipted, vomit, or your abdomen becomes distended call your doctor. If severe come to the emergency room. You will see GYN Oncology as written below. Your oncologist is planning on adressing the plan for further care at this visit. You have not been taking your Dyazide (water pill) during this admission. Please discuss this with your primary care physician. [**Name10 (NameIs) 357**] hold of on restarting your other vitamins besides the iron and folic acid you were taking here and discuss with your primary care. Take care! Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6887**], MD Phone:[**Telephone/Fax (1) 1144**] Date/Time:[**2138-7-3**] 12:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. Phone:[**Telephone/Fax (1) 6554**] Date/Time:[**2138-7-7**] 10:30 Provider: [**Name10 (NameIs) 35354**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 5777**] Date/Time:[**2138-7-7**] 9:30 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**] Completed by:[**2138-6-30**] ICD9 Codes: 5180, 2859